Psych- Schizophrenia And Chronic Mental Illness 3(P68-71), 15

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Schizophrenia
def

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- brain disorder that affects a persons thinking, lanuage, emotions, social behavior and ability to perceive realitity accuratly

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Bleuler's 4 A'a of Schizo.

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-Affect
-Assosiative looseness
-autism
-ambivilance

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Citeria for dx
A. characteristic symptoms

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-2 or more over 1 month
--delusions
-hallucinations
-disorganized speech
-grossly disorganzied or catatonic behavior
-negative symptoms
* if delusions or hallucinations ar bizzare or run a commentary on ones behavior OR 2 or more voices are conversing then only one criteria is necessary

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Citeria for dx
B Social/occupational Dys

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- if one or more areas of the pts life are markedly below pre morbid functioning OR
-childhood or adolescence failure to acheive expected level of interpersonal, acedemic or occupational acheviemtn

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Citeria for dx
C. Duration

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-Continues for at least 6 months with at least one month that meets (A) and may include prodomal or residual symptoms

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Schizophrenia Criteria
D.

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-all other mental illness have been ruled out
-all other medical conditions have been ruled out
-if h/o of pervasive developmetal disorders. then prominent hallucinations or delusions for 1 month are needed to make the dx

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Schizophreniform disorder

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- total duration is > 1 month, < 6 months
-impaired social/occupational function may not be apparent
-may develop into schizophrenia

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Breife psychotic disorder

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-sudden onset of psychosis
-last >1 day < 1 month
-usually presipiated by stressors and usally returns to pre morbid functioning

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Schizoaffective disorder

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-majorm depressive, manic or mixed mood episode presenting concurrently with s/s of schizophrenia. Usual due to SA or medical condition

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Delusional Disorder

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- non bizzare delusions present for at leat one month

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Capgras Syndrome

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- involves a delusion about a signifigant other being replaced by an imposter

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Shared Psychotic Disorder(Folie a Deux)

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-shares the delusions of another
-Impairement is usually less than person with the disorder

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Induced or secondary psychosis

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-induced by substances, mediactions, toxins or medical disorders

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Schizophrenia
related co-morbidities

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- Substance Abuse
-Nicotine Dependence
- Anxiety
-Depression
-Suicide
-physical illness
-Polydipsia related probs

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Diathesis stree model of Schizophrenia

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-multiple inherited gene abnormalities combine with non- gentetic factords altering the structures of teh brain and effecting neuro transmitter system

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Phase 2 Stabilization

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-symptoms are diminishing and there is movement towards ones previous level of functioning. Day hospitalization or residential centers may be needed

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phase 3 maintenance

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-the pt is at or nearing baseline
-symptoms are absent or diminshed
-lives in the community

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Neologisms

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-made up words that have meaning to the pt

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echolalia

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-pathological repeatin of others' words and is often seen in catonia

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echopraxia

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imiking of movemens of another. Also seen in catatoina

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claang assosiation

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-choice of words based on their sound rather than there meaning. may also be seen in neurological disorders

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word salad

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-jumble of words that is meaningless to the listener.

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Schizo
Alterations in bahavior

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-catatonia
-motor reardation
-motor agitation
-stereotyped bahviors
-automatic obediance
-waxy flexibility
-negativism
-impaired impulse control

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Schizo
Negative symptoms

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-affective blunting
-anergia
-anhedonia
-avolition
-poverty of content of speech
poverty of speech
-though blocking

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Acute phase
main goal

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-patient saftey and medical stabilization

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Phase 2 stabilizationmain goal

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-adherance to treatment
-stablized on medications
-control/cope with symptoms

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Phase 3-maintenance

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-maintaining acheivment
-preventing relapse
-acheiving independance

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Acute phase 1
planning

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-hospitalization for saftey
-coping skills
-external factors
-

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Phase 2 + 3
planning

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-education/skills training
-relapse prevention skills
-community needs

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Phase 1
implementation

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-depends on pt needs
-hospitalization vs partial
-evaluation
-pharm treatment
-support
-supervision
mileau therepy

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Phase 2+3
implementation

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-medication admin/adherance
-nursing interention/community support
-family psycheducation

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Mileau Managment

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-activities and grpups
-saftey

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Paranoid Schizo
criteria

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-dominet: hallucinations and delusions
-no disorgnized speech, disorganized behavir,catatonia,
-or inappropriate behavior

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disorganized
criteria

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-dominent: disorgnized speechand behavior and inappropirate affect
-delusions and hallusinaions, if present are not prminent or fragmented.
-associated features include grimaing, mannerisma and other oddities of behavior

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cataonic
criteria

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-motor immobility
-excessive purposeless motor activity
-extreme negatvism or mutism
-peculiur voluntary movements
-ecolia or exopraxia

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residual
criteria

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-no longer has active phase symptoms, however persistance of some syptoms are noted

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undifferentiated
criteria

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-has active phase symptoms
-no one clincal presentation prominent