{"id":4671,"date":"2019-01-09T18:14:14","date_gmt":"2019-01-09T23:14:14","guid":{"rendered":"https:\/\/www.amyork.ca\/academic\/zz\/?p=4671"},"modified":"2019-01-09T19:56:22","modified_gmt":"2019-01-10T00:56:22","slug":"schizophrenia-psychotic-spectrum","status":"publish","type":"post","link":"https:\/\/www.amyork.ca\/academic\/zz\/mental-health-nursing\/schizophrenia-psychotic-spectrum\/","title":{"rendered":"Schizophrenia &#038; Psychotic Spectrum\u00a0"},"content":{"rendered":"<h2>Psychosis-<\/h2>\n<p>\u2212 People who have changes in their:<\/p>\n<ul>\n<li><strong>Perception<\/strong>&#8211; see or hear things that others may not<\/li>\n<li><strong>Thinking<\/strong>&#8211; disordered; inability to think logically\/rationally<\/li>\n<li><strong>Behaviour<\/strong>&#8211; withdrawal, irritability<\/li>\n<li><strong>Emotional responses-<\/strong> blunted affect; incongruence of mood &amp; affect<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h2>Schizophrenia &amp; Psychotic Spectrum<\/h2>\n<p>Causes are multifactorial<\/p>\n<p>\u2212 <strong>Genetics <\/strong>\u2013 family history <strong>\u00a0<\/strong><\/p>\n<p>\u2212 <strong>Brain chemicals \u2013 <\/strong>Neurotransmitters e.g ^ in dopamine <strong>\u00a0<\/strong><\/p>\n<p>\u2212 <strong>Neurodevelopment (birth complications)- <\/strong>foetal brain injury, obstetric complications, low birth weight <strong>\u00a0<\/strong><\/p>\n<p>\u2212 <strong>Environmental \u2013 <\/strong>high expressed emotion, adverse life events (trauma), socioeconomic deprivation<\/p>\n<p>\u2212 <strong>Drug induced (Cannabis) <\/strong>\u2013 gene interaction <strong>\u00a0<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<h2>Schizophrenia<\/h2>\n<p>\u2212 <strong>\u00a0<\/strong>A mental illness that affects the way a person thinks <strong>\u00a0<\/strong>\u2212 Can be noticed as: <strong>\u00a0<\/strong><\/p>\n<ul>\n<li>Prodromal phase (early stage)<\/li>\n<li>Acute<\/li>\n<li>Chronic (continuous symptoms)<\/li>\n<\/ul>\n<p>\u2212 Can be stigmatising\/discriminating<\/p>\n<p>\u2212 Often the reason for people to withdraw from the community<\/p>\n<p>\u2212 Can cause distress<\/p>\n<p>&nbsp;<\/p>\n<p>\u2212 <strong>Onset<\/strong> usually early adulthood (early stage is called prodromal phase)<\/p>\n<p>\u2212 Can be rapid or develop over months or years<\/p>\n<p>&nbsp;<\/p>\n<p><strong>FACTS- <\/strong><\/p>\n<p>\u2212 Sufferers are more likely to be victims of crime<\/p>\n<p>\u2212 IQ rates are similar to general population &amp; is NOT a characteristic of the illness<\/p>\n<p>\u2212 Major advancements in psychopharmacology to increase lives of sufferers<\/p>\n<p>\u2212 Treatment encourages for holistic, community-based treatment<\/p>\n<p>\u2212 Individuals have a 20% decrease in life span due to CVD<\/p>\n<p>\u2212 Whilst people with the illness don\u2019t have high rates of cancers, they\u2019re more likely to present with metastases at diagnosis<\/p>\n<p>\u2212 <u>Increased risk of:<\/u> Metabolic syndrome, smoking, poverty, poor nutrition, reduced access to medical care<\/p>\n<p>\u2212 History of cannabis misuse is more common in schizophrenia<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Prodromal- The Warning <\/strong><\/p>\n<p>\u2212 Differs from frank psychotic features in intensity, frequency &amp; duration<\/p>\n<p>\u2212 Pre-hallucinatory perceptual abnormalities<\/p>\n<ul>\n<li>Brief subtle changes (hearing or seeing things others cant)<\/li>\n<li>Usually once or twice\/month, lasting only a few minutes<\/li>\n<\/ul>\n<p>\u2212 Subtle changes in behaviour (deterioration of school work\/work performance)\u00a0 \u2212 Social withdrawal<\/p>\n<p>\u2212 Pre-delusional unusual thoughts (emergence of strange beliefs)<\/p>\n<p>\u2212 Non-specific symptoms such as depression\/anxiety<\/p>\n<p>\u2212 Motor disturbance<\/p>\n<p>\u2212 Impaired tolerance to stress<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>SIGNS OF SCHIZOPHRENIA\u00a0 <\/strong><\/p>\n<h3>Positive symptoms<\/h3>\n<p>\u2212 Best described as \u201cexcess\u201d of, or additional symptoms\/experiences<\/p>\n<p>\u2212 Positive doesn\u2019t mean \u2018good\u2019<\/p>\n<p>\u2212 Respond well to unconventional antipsychotics<\/p>\n<p>\u2212 rxamples:<\/p>\n<ul>\n<li>Delusions<\/li>\n<li>Hallucinations<\/li>\n<li>Disorganised speech<\/li>\n<li>Disorganised behaviour<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Negative symptoms<\/h3>\n<p>\u2212 Best described as withdrawal of normal everyday functioning<\/p>\n<p>\u2212 Absence of normal patterns of behaviour (emotional responsiveness, spontaneous speech)\u00a0 \u2212 Respond to poorly to typical antipsychotics<\/p>\n<p>\u2212 rxamples:<\/p>\n<ul>\n<li>Lack of motivation, slow movement<\/li>\n<li>Reduced range of emotions<\/li>\n<li>Significant impact on work, interpersonal relations or self-care<\/li>\n<li>Anhedonia (lack of interest)<\/li>\n<li>Avolition (lack of motivation)<\/li>\n<li>Alogia (poverty of speech)<\/li>\n<li>Asociality (social withdrawal)<\/li>\n<li>Change in sleep patterns<\/li>\n<li>Poor hygiene &amp; grooming<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>*Secondary negative symptoms\u00a0 <\/strong><\/p>\n<p>\u2212 Are a result of the primary condition<\/p>\n<p>\u2212 Caused by unresolved <em>positive symptoms<\/em> that are existing in the illness<\/p>\n<p>&nbsp;<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>HALLUCINATIONS- <\/strong><\/p>\n<p>\u2212 rxperiences that affect your sensory perceptions<\/p>\n<p>\u2212 These experiences feel real for the person, however they\u2019re not to others\u00a0 \u2212 It can affect the following senses:<\/p>\n<ul>\n<li>AUDITORY (sound)<\/li>\n<li>VISUAL (sight) \u00d8 TACTILr\u00a0 (touch) \u00d8 GUSTATORY (taste)<\/li>\n<li>OLFACTORY (smell)<\/li>\n<\/ul>\n<p><strong>DELUSIONS-\u00a0 <\/strong><\/p>\n<p>\u2212 Fixed, false beliefs<\/p>\n<p>\u2212 rxperiences feel real to the person, but aren\u2019t to others<\/p>\n<p>\u2212 The beliefs may be illogical or irrational<\/p>\n<p>\u2212 Can be bizarre<\/p>\n<p>\u2212 Different delusional themes people may experience:<\/p>\n<ul>\n<li>IDrAS OF RrFrRrNCr \u2013 e.g \u201cthe television sends me special messages\u201d<\/li>\n<li>PARANOID \u2013 e.g. \u201cI think my mum is poisoning my food\u201d<\/li>\n<li>PrRSrCUTORY \u2013 e.g \u201cI am going to be harmed by the police\u201d<\/li>\n<li>SOMATIC \u2013 e.g. \u201cI have cancer, I don\u2019t believe the doctors tests\u201d<\/li>\n<li>GRANDIOSr e.g. \u201cI am Donald Trump, I have power\u201d<\/li>\n<li>RrLIGIOUS e.g. \u201cI am God\u201d<\/li>\n<li>rROTOMANIC e.g. when a person believes that a person of a higher stasis is in love with them \u00d8 NIHLISTIC e.g. \u201cI believe the world is coming to an end\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>DISORGANISED THINKING- <\/strong><\/p>\n<p>\u2212 rxpressed through speech<\/p>\n<p>\u2212 rxamples:<\/p>\n<ul>\n<li>Neologism<\/li>\n<li>Word salad<\/li>\n<li>Flight of ideas<\/li>\n<li>Thought broadcasting- (believing other people can read your thoughts)<\/li>\n<li>Thought insertion- (believing someone\u2019s put a thought in your head)<\/li>\n<li>Thought withdrawal- (believing someone\u2019s taken\/removing your thoughts) \u00d8 Obsessional &amp; abnormal thoughts<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>PROGNOSIS <\/strong><\/p>\n<p>Better outcomes are associated with:<\/p>\n<p>\u2212 Female<\/p>\n<p>\u2212 Older age onset<\/p>\n<p>\u2212 Married<\/p>\n<p>\u2212 Living in a developed country<\/p>\n<p>\u2212 Functional premorbid personality (healthy personality pre-illness)<\/p>\n<p>\u2212 No previous psychiatric history<\/p>\n<p>\u2212 Good education &amp; employment history<\/p>\n<p>\u2212 Acute onset (affective symptoms)<\/p>\n<p>\u2212 Medication compliant<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h2>Other spectrum disorders<\/h2>\n<p><strong>Schizoaffective Disorder- <\/strong>\u2022\u00a0 Affects 1 in 200 people<\/p>\n<ul>\n<li>Symptoms of schizophrenia (positive symptoms) and major mood disorder (mania or depression)<\/li>\n<li>Typical onset age is early adulthood<\/li>\n<li>Can be more complicated to diagnosis<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Brief Psychotic Disorder- <\/strong><\/p>\n<ul>\n<li>Characterised by positive symptoms- hallucinations, delusions, disorganised speech &amp; gross thought disorder<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Delusional disorder- <\/strong><\/p>\n<ul>\n<li>People who don\u2019t meet the criteria for schizophrenia<\/li>\n<li>Characterised by one or more delusions lasting longer than one month<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Schizophreniform-\u00a0 <\/strong><\/p>\n<ul>\n<li>\u201cPre- schizophrenia\u201d<\/li>\n<li>Symptoms of schizophrenia<\/li>\n<li>Both positive and negative symptoms<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Catatonia-\u00a0 <\/strong><\/p>\n<ul>\n<li>Associated with other neurodevelopment &amp; psychotic disorders<\/li>\n<li>Characterised by psychomotor disturbance<\/li>\n<li>Unresponsiveness<\/li>\n<li>Severe stupor<\/li>\n<li>Moderate waxy flexibility<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h3>Treatment &amp; Interventions<\/h3>\n<p>\u2212 Strengths &amp; recovery orientated practices<\/p>\n<p>\u2212 Family therapy<\/p>\n<p>\u2212 Cognitive behavioural therapy (CBT)<\/p>\n<p>\u2212 rlectroconvulsive therapy (rCT) \u2212 Antipsychotic medication<\/p>\n<ul>\n<li>Dopamine antagonists<\/li>\n<li>Work by decreasing dopamine activity in the brain<\/li>\n<li>Typical\/1<sup>st<\/sup> generation agents<\/li>\n<li>Atypical\/2<sup>nd<\/sup> generation (novel) agents<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>NURSING ASSESSMENT\u00a0 <\/strong><\/p>\n<ul>\n<li>MSr- to gather baseline on cognitive, behavioural &amp; emotional responses<\/li>\n<li>RISK- to ensure no risk to self, others, or vulnerability<\/li>\n<li>PHYSICAL HrALTH- ensuring individual\u2019s physical health is prioritised (e.g. cardiac function, respiratory etc) RrLATIONSHIPS- family\/friends\/carers<\/li>\n<li>SOCIAL &amp; rNVIRONMrNTAL- housing, finances<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>EFFECTIVE COMMUNICATION <\/strong><\/p>\n<ul>\n<li>Listen carefully<\/li>\n<li>Assist them with their stressors<\/li>\n<li>Keep conversations brief<\/li>\n<li>Give one message at a time<\/li>\n<li>Don\u2019t dismiss what\u2019s being said, despite they\u2019re unusual thoughts<\/li>\n<li>Don\u2019t argue<\/li>\n<li>Gentle reality feedback<\/li>\n<li>Avoid touch<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>RECOVERY &amp; STRENGTH BASED <\/strong><\/p>\n<ul>\n<li>Supporting individuals in shared decision making<\/li>\n<li>Balancing risk (positive risk taking)<\/li>\n<li>Working on wellness plans that supports the person, families and carers to identify early warning signs (helps to reduce relapse)<\/li>\n<li>Helping the person to incorporate their illness into their day to day life \u00a0 Understanding that there may be acute episodes<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>ATYPICAL ANTIPSYCHOTIC MEDICATIONS <\/strong><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>TYPICAL ANTIPSYCHOTIC MEDICATIONS <\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><strong>DEPOT ANTIPSYCHOTIC MEDICATIONS (LAI) <\/strong><\/p>\n<ul>\n<li>Incidence- about 30% of Australian users with schizophrenia are on LAI<\/li>\n<li>Indications for use are for non adherence of oral medications<\/li>\n<li>Oral medication MUST be used before a LAI (due to unknown side effects)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>METABOLIC SYNDROME <\/strong><\/p>\n<ul>\n<li>Impacted by second-generation antipsychotic agents<\/li>\n<li>Screening tests include: \u00d8 BMI testing (every week)\n<ul>\n<li>Fasting glucose test (every 3-6 months)<\/li>\n<li>Fasting lipids test (every 3-6 months)<\/li>\n<li>Measure BP (every week)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h4>Characterised by-<\/h4>\n<ul>\n<li>Abdominal obesity\/BMI\/waist measurements<\/li>\n<li>rlevated triglycerides<\/li>\n<li>High density cholesterol levels<\/li>\n<li>rlevated fasting glucose<\/li>\n<li>Hypertension <u>rxacerbated by-<\/u> \u00a0 Increased sedation<\/li>\n<li>Appetite stimulation<\/li>\n<li>Thirst &amp; hypersalivation<\/li>\n<li>Negative symptoms<\/li>\n<li>Poverty<\/li>\n<li>Access to healthcare<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>SMOKING, CAFFEINE &amp; PSYCHOTROPIC DRUGS\u00a0 <\/strong><\/p>\n<ul>\n<li>Cigarette smoking significantly induces the metabolism of Clozapine &amp; Olanzapine<\/li>\n<li>Results in requiring higher doses of medication to achieve therapeutic effect<\/li>\n<li>rxercise caution in smoking cessation while on Clozapine and Olanzapine<\/li>\n<\/ul>\n<p><strong><u>POTENTIAL SIDE EFFECTS<\/u>\u00a0 <\/strong><\/p>\n<ul>\n<li><strong>Neuroleptic malignant syndrome (NMS) <\/strong>\n<ul>\n<li>Potentially lethal<\/li>\n<li>More common in typical high potent antipsychotics (e.g. Haloperidol)<\/li>\n<li>Usually occurs within one week of treatment<\/li>\n<li><u>Symptoms<\/u>: Hyperthermia (&gt;42<sup>o<\/sup>)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Rigidity<\/p>\n<p>Impaired ventilation<\/p>\n<p>Tremor<\/p>\n<p>Altered consciousness<\/p>\n<p>Tachycardia<\/p>\n<p>Death<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Agranulocytosis <\/strong><\/li>\n<li><strong>Extra pyramidal side effects (EPSE) Akathisia <\/strong>\n<ul>\n<li>Restless legs<\/li>\n<li>\u2018Jittery\u2019 feelings<\/li>\n<li>Nervous energy<\/li>\n<li>Pacing, agitation<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Pseudoparkinsonism <\/strong>\n<ul>\n<li>Blank mask-like presentation<\/li>\n<li>Tremor in limbs<\/li>\n<li>Muscle rigidity<\/li>\n<li>Stiffness<\/li>\n<li>Shuffling gait<\/li>\n<li>Drooling<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Acute dystonia\u2019s <\/strong>\n<ul>\n<li>Oculogyric crisis (persons eyes roll up)<\/li>\n<li>Neuroleptic induced torticollis (neck pain)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Tardive dyskinesia (TD) <\/strong>\n<ul>\n<li>Late occurring movement disorder<\/li>\n<li>Can be irreversible<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>rmbarrassing &amp; troublesome symptoms (tongue writhing, teeth grinding, lip smacking, spasm-like movements)<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Psychosis- \u2212 People who have changes in their: Perception&#8211; see or hear things that others may not Thinking&#8211; disordered; inability to think logically\/rationally Behaviour&#8211; withdrawal, irritability Emotional responses- blunted&hellip; <a class=\"continue\" href=\"https:\/\/www.amyork.ca\/academic\/zz\/mental-health-nursing\/schizophrenia-psychotic-spectrum\/\">Continue Reading<span> Schizophrenia &#038; Psychotic Spectrum\u00a0<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[121],"tags":[],"_links":{"self":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4671"}],"collection":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/comments?post=4671"}],"version-history":[{"count":0,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4671\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/media?parent=4671"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/categories?post=4671"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/tags?post=4671"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}