A group of disorders characterized by psychosis that usually begin between the ages of 15-30 years old. Diagnosis is higher in men than women

Etiology

It is thought that there are both biological and immunological components to the development:

  • genetic link
  • dopamine/ serotonin hyperactivity
  • viral exposure during pregnancy/ trauma from birth
  • drug use
  • severe stress

 

Types

Paranoid: There are delusions of persecutory or grandiosity, or both. The delusional themes often include jealousy, religiosity, and somatization (mental illness manifesting in physical afflictions- psychosomatic). Extreme anger and emotional disconnect may occur in this type.

Disorganized: disorganised speech and behaviour. Exhibits flat or inappropriate behaviour that is aimless and not constructive. Also disturbed emotional responses. The main difference is that in disorganized schizophrenia, there is a lot of strange, aimless behavior and often speech that does not make sense.

Catatonic: Marked by psychomotor disturbance that can include motor immobility. mutism, echolalia (repeatedly copying words) and echopraxia (repeatedly copying movements. What differentiates this type is that it predominantly affects movement and can lead to catatonic stupor.

Undifferentiated: when a person demonstrates delusions, hallucinations, disorganized behaviour but does not exhibit behaviour associated with any other type

Residual: there is continuing display of negative symptoms but do not display any positive signs.

 

Behavioural/Clinical findings

Positive: delusions, hallucinations, thought disorders, disorganised speech, bizarre behaviour and inappropriate affect

Negative: anhedonia, attention deficit, blunted affect, disturbance in association and activity

Cognitive dysfunction: memory disturbance, abstract thinking, impaired decision-making

Work/social dysfunction and alterations in mood will be present; suicide ideation, hopelessness lasting at least 6 months.

 

Nursing process

Assessing: 

  • history of onset, work and social functioning
  • ascertain presence of delusions/hallucinations
  • explore feelings of suspicions or paranoia
  • current stressors/drug/alcohol use

Analysing:

  • Risk for self harm/violence
  • Self care deficit
  • ineffective coping due to inability to met role expectations
  • impaired communication/interactions due to delusions/hallucinations
  • and confusion related to changes in functioning
  • disturbed sleep patterns

Planning/implementing

  • maintain safety
  • administer antipsychotics
  • monitor for adverse drug reactions
  • organise planned activity and drug dosing regime
  • set limits on unacceptable behaviours
  • accept the reality of the clients delusions but point out reality
  • encourage and facilitate social relationships

Evaluation/outcomes

  • minimise adverse drug effects
  • adherance to medication
  • ability to differentiate from delusions and reality
  • remains free from injury
  • continued therapy after discharge

 

Pharmacology interventions

Antipsychotics for positive symptoms

Typical: first generation drugs with more severe extrapyramidal effects

Atypical: less likely to cause pyramidal effects and more likely to disturb metabolism: diabetes, weight gain

Mechanism of action: dopamine antagonists in dopamine pathways. May also block, serotonin, histamine, muscarinic receptors causing adverse effects.

Adverse effects

Chlorpromazine: rash, sedation, photosensitivity, weight gain, anticholonergic (dry mouth, blurred vision, constipation, urinary retention)

Droperidol: extra pyramidal, sedation

Haloperidol: extra pyramidal, insomnia, rashes, breast enlargement, weight gain, hyperprolactinemia

Aripiprazole: insomnia, weight gain, trouble swallowing, anxiety

Clozapine: anticholonergic, weight gain, tachycardia, hypotension, sedation, agranulocytosis(leukopenia-infection risk)

Olanzapine: Weight gain, extrapyramidal, anticholonergic

Quetiapine: hyperprolactinaemia, GI upsets, + appetite, weight gain, drowsiness

Risperidone: extrapyramidal effects, dizziness, fatigue, dry mouth, + appetite, weight gain

 

Extrapyramidal effects

Akathisia: motor restlessness, need to move

Dystonia: muscle spasm of face and neck, hyperextension

Parkinsonism: tremours, drooling, slowed movements

Tradive Dyskineesia: involuntary movement of mouth, face arms and legs (can be irreversible)

 

 

Resources

Practice quiz: https://nurseslabs.com/nclex-exam-psychiatric-nursing-schizophrenic-disorders-15-items/

A helpful video: https://www.youtube.com/watch?v=H1blxu9S94s

Quiz related to the video: http://empowern.com/2015/07/schizophrenia/

For more info:  http://www.sparknotes.com/psychology/psych101/disorders/section8.rhtml

 

 

 

Reference

Bryant, B., & Knights, K. (2015). Pharamacology for health professionals (4th ed). Sydney, Australia: Mosby Elsevier. 

Saxton, D., Nugent, P., & Pelikan, P. (2003). Mosby’s comprehensive review for nursing for NCLEX-RN. StLouis, MO: Mosby.

University of Maryland Medical Centre. (2017). Schizoprenia. Retrieved February 16, 2017, from http://umm.edu/health/medical/ency/articles/schizophrenia-disorganized-type

 

 

 

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