Schizophrenia

Psychosis, Altered cognition, Altered perception, Impaired ability to determine what is or is not real

True.

15-25 (18-20 most commonly)

Very rare

1%

Delusions (+), Hallucinations(+), Disorganzied speech (+), Gross disorganzation or catatonia, Negative symptoms (diminished emotional expression or avolition), Functional impairment of some kind, Continuous disturbance for at least 6 months, Ruled out: substances or other disorders

False thoughts or beliefs that have last 1 month or longer, Delusions include: grandiose, persecutory, somatic and referential themes, The delusions are not severe enough to impair functioning

Sudden onset of at least 1 of: delusions, hallucinations, disorganized speech, and disorganized or catatonic behavior, Lasts long than 1 day but not longer than 1 month with expectation of return to normal functioning., Find underlying cause! i.e. electrolyte imbalance or trauma etc.

Person fits criteria for major depression, manic, or mixed episode (bipolar) concurrent with symptoms that meet criteria for schizophrenia, Not caused by any substance use or general medical condition

Substance-induced psychotic disorder

Psychotic disorder due to another medical condition

True

True

Hallucinations, Delusions, Disorganized speech

Be unable to function, Neglect basic needs i.e. don’t brush teeth, take showers etc., Usually will need assistance

Very rare, Diagnosed before 12 years old, Poor prognosis, 1 in 40,000 children

Prodromal symptoms: social withdrawal, irritability, depression, conduct problems, suspiciousness, May be tied to immune system activation (autoimmune)

True

Substance abuse disorders (nicotine dependence 60%, cannabis), Anxiety, depression, and suicide, suicide 8.5x greater than general population 20% attempt, Physcial health or illness: die 28 yrs prematurely, Polydipsia: 20%, hyponatremia (seizures)

Biologial factors: genetics, Nuerobiological: glutamate, dopamine, serotonin, acetylcholine, Brain structure abnormalities, Prenatal stressors, Environmental factors

50%

Increases

That specific changes occur within the immune system around 18-19 that cause the brain to attack itself.

Yes

Enlarged asymmetrical ventricles, reduced brain volum, increased size of sulci, lower cerebral blood flow and glucose.

Prenatal stressors that include:, Poor maternal nutrition, hypoxia, Viral infections, Father older than 35 at child’s conception, Born in late winter early spring., Psychological stressors increasing cortisol, Envirnmental and toxins i.e. poverty, lead

Socially awkward, lonely, Depressed, vague/odd/eccentrice expressions, Intrusive thoughts, Decreased functioning, Mystical/symbolic meanings, Can’t read other peoples facial expressions

Majority of pts somewhat controlled by medications and psychosocial interventions, Less positive: earlier onset, insidious onset, delay of first treatment, negative sx, poor premorbid functioning, Each relapse progresses the disease

Prodromal: onset, mild changes, Acute: exacerbation of symptoms, Stabilization: symptoms diminishing, movement toward previous level of functioning, Maintenance or residual: new baseline is established

Early detection and treatment

Positive symptoms, Negative symptoms, Cogntive symptoms, Affective symptoms, Alterations in reality testing

Appear early in the illness, Usually responds to antipsychotics, Presence of something not there, Hallucinations, delusions, disorganized speech, bizarre behaviors

Devleop slowly, interfere with coping, Absence of something that should be there, Blunted/flat affect, alogia (poverty of thought), avolition (no motivation), anhedonia (unable to experience pleasure/joy)

Inattention, Impaired memory, Poor problem solving, Poor decision making, Illogical thinking, Impaired judgement

Dysphoria, Sucidality, Hoplessness

Fixed false beliefs that cannot be changed by logic, 75% of schizophrenics have delusions, Relegiosity, Is alterations in reality testing, Delusions tend to be persecutory, grandiose, somatic, ideas of reference

Pereceiveing sensory experience when there is no external stimuli, Is an alteration in pereception, Command hallucinations: telling the person to do something are a psychiatric emergency, “What are there saying?”, “That must be scary I’ll stay with you” or divert attention

Hallucinations, Illusions, Depersonalization, Derealization

Illusions

Depersonalization

Derealization

Associative looseness: Word sale-most extreme form; jumble of words meaningless to listener, Clang association: Rhyming, Neologisms: Meaning only to the patient (Atmospharettes), Echolalia: Patholoogical repetition of another’s words

Circumstatiality

Tangentiality

Cognitive retardation

Pressured speech

Flight of ideas

Symbolic speech

Thought blocking, Thought insertion, Thought deletion, Magical thinking, Paranoia

Thought blocking

Thought insertion

Thought deletion

Magical thinking

Paranoia

Catatonia, Motor retardation, Motor agitation, Stereotyped behaviors, Waxy flexibility, Echopraxia, Negativism, Impaired impulse control, Gesturing or posturing, Boundary impairment

Flat, Blunted, Constrcited, Inappropriate, Bizarre

Affect

Flat

Blunted

Constricted

Inappropriate

Bizarre

Attention, Memory, Information processing, Cognitive flexibility, Executive functions

Anhedonia

Avolition

Asociality

Echopraxia

Concrete thinking: impaired ability to think abstractly, interprets things literally, difficulty responding to concepts like love or humor, Impaired memory: impacts short-term memory and ability to learn, Impaired information processing: Delayed responses, misperceptions, difficulty understanding others, may lose ability to screen out insignificant stimuli., Impaired executive functioning: Difficulty with reasoning, setting priorities, playing things in logical groups., Anosognosia: inability to realize one is ill caused by the illness itself

May herald impending relapse, Increases substance abuse, Increases suicide risk, Further impairs functioning

Inability to realize they are ill, Caused by illness itself, May result is resistance or cessation of treatment, Often combined with paranoia so that accepting help is impossible

Medical causes, Substance use or disordered, Mental status, Cogitive assessment (reality testing), Hallucinations, delusions, Suicide risk, Ability to ensure personal safety and health, Perscribed meds, Symptoms impact on functioning, Family knowledge

Disturbed sensory perception, Risk for self-directed or other-directed violence, Impaired verbal communication

Social isolation, Chronic low self-esteem

Patient safety and medical stabilization, Best strategies to provide symptom stabilization

Help patient understand illness and treatment, Stabilize medications, Control or cope with symptoms

Provide patient and family education, Relapse prevention skills are vital, Achieve independence, satisfactory quality of life

Psychiatric medical and neurological evaluation, Pscyopharmacological treatment, Support, psychoeducation, and guidance, Self care (hygiene, grooming, basic needs), Supervision and limit setting the milieu, Monitor fluid intake, Working with aggression

Medication administration/adherence, Relationships with trusted care providers, Community- based therapeutic services, Teamwork and safety, Activities and groups

What they hear/ what the voices are saying, Ability to recognize hallucinations are not real, Ability to resist command, Pt may falsly deny hallucination, Do you recognize the voice? Do you plan to follow the command?

Ask directly about the hallucinations, Watch for cues, Redirect focus, Assess and treat anxiety, Use competing stimuli, Assress underlying issues (fear, low self esteem, guilt), Assess triggers, Offer quiet room, Offer PRN anti anxiety agents and PRN antipsychotics

Assess for paranoid thoughts or factors that may ⬆️violence, Engage regularly with patient to assess concerns and risks, Engender goodwill via support activities and a strong therapeutic relationship, Increase supervision when risk present, Ensure patient is taking ordered medications, Monitor for and promptly de-escalate increasing tension, Take action to help patient feel safe, Promote communication in safe manner, Teach and guide pt through coping skills, Provide constructive diversion and outlets for physical energy, Pateint may need to be relocated, Only when necessary use seclusion/restraints

Matter of fact approach, Assess content of delusions but quickly move to reality-based topics, Focus on feelings underlying the delusion (fear self esteem), Observe triggers that precede delusions or make them worse

Do not touch patient without consent, Sealed food and drink