117 - Schizophrenia

• Ambivalence

  Holding seemingly contradictory beliefs or feelings about the same person, event, or situation
• Associative looseness

  Fragmented or poorly related thoughts and ideas
• Delusions

  Fixed false beliefs that have no basis in reality
• Echopraxia

  Imitation of the movements and gestures of another person whom the client is observing
• Flight of ideas

  Continuous flow of verbalization in which the person jumps rapidly from one topic to another
• Hallucinations

  False sensory perceptions or perceptual experiences that do not exist in reality
• Ideas of reference

  False impressions that external events have special meaning for the person
• Perseveration

  Persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic
• Alogia

  Tendency to speak very little or to convey little substance of meaning (poverty of content)
• Anhedonia

  Feeling no joy or pleasure from life or any activities or relationships
• Apathy

  Feelings of indifference toward people, activities, and events
• Blunted affect

  Restricted range of emotional feeling, tone, or mood
• Catatonia

  Psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless, as if in a trance
• Flat affect

  Absence of any facial expression that would indicate emotions or mood
• Lack of volition

  Absence of will, ambition, or drive to take action or accomplish tasks
• Schizophrenia, paranoid type:

  characterized by persecutory (feeling victimized or spied on) or grandiose delusions, hallucinations, and, occasionally, excessive religiosity (delusional religious focus) or hostile and aggressive behavior
• Schizophrenia, disorganized type:

  characterized by grossly inappropriate or flat affect, incoherence, loose associations, and extremely disorganized behavior
• Schizophrenia, catatonic type:

  characterized by marked psychomotor disturbance, either motionless or excesisive motor activity. Motor immobility may be manifested by catalepsy (waxy flexibility) or stupor.
• Schizophrenia, undifferentiated type:

  characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior
• Schizophrenia, residual type:

  characterized by at least one previous, though not a current, episode; social withdrawal; flat affect; and looseness of associations
• Schizophreniform disorder:

  The client exhibits the symptoms of schizophrenia but for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia. Social or occupational functioning may or may not be impaired.
• Delusional disorder:

  The client has one or more nonbizarre delusions—that is, the focus of the delusion is believable. Psychosocial functioning is not markedly impaired, and behavior is not obviously odd or bizarre.
• Brief psychotic disorder:

  The client experiences the sudden onset of at least one psychotic symptom, such as delusions, hallucinations, or disorganized speech or behavior, which lasts from 1 day to 1 month. The episode may or may not have an identifiable stressor or may follow childbirth.
• Shared psychotic disorder (folie à deux):

  Two people share a similar delusion. The person with this diagnosis develops this delusion in the context of a close relationship with someone who has psychotic delusions.
• In the past, electroconvulsive therapy, insulin shock therapy, and psychosurgery were used, but since the creation of chlorpromazine (Thorazine) in 1952, other treatment modalities have become all but obsolete.
• Antipsychotic medications, also known as neuroleptics, are prescribed primarily for their efficacy in decreasing psychotic symptoms.
• The older, or conventional, antipsychotic medications are dopamine antagonists. The newer, or atypical, antipsychotic medications are both dopamine and serotonin antagonists.
• Two antipsychotics are available in depot injection forms for maintenance therapy: fluphenazine (Prolixin) in decanoate and enanthate preparations and haloperidol (Haldol) in decanoate.
• Conventional Antipsychotics

  1. Chlorpromazine (Thorazine)
  2. Perphenazine (Trilafon)
  3. Fluphenazine (Prolixin)
  4. Thioridazine (Mellaril)
  5. Mesoridazine (Serentil)
  6. Thiothixene (Navane)
  7. Haloperidol (Haldol)
  8. Loxapine (Loxitane)
  9. Molindone (Moban)
  10. Perphenazine (Etrafon)
  11. Trifluoperazine (Stelazine)
• Atypical Antipsychotics

  1. Clozapine (Clozaril)
  2. Risperidone (Risperdal)
  3. Olanzapine (Zyprexa)
  4. Quetiapine (Seroquel)
  5. Ziprasidone (Geodon)
  6. Paliperidone (Invega)
  7. Aripiprazole (Abilify)
• Extrapyramidal Side Effects

  EPS are reversible movement disorders induced by neuroleptic medication. They include dystonic reactions, parkinsonism, and akathisia.
• Dystonic reactions to antipsychotic medications appear early in the course of treatment and are characterized by spasms in discrete muscle groups such as the neck muscles (torticollis) or eye muscles (oculogyric crisis).
• Pseudoparkinsonism

  or neuroleptic-induced parkinsonism, includes a shuffling gait, mask-like facies, muscle stiffness (continuous) or cogwheeling rigidity (ratchet-like movements of joints), drooling, and akinesia (slowness and difficulty initiating movement).
• Akathisia is characterized by restless movement, pacing, inability to remain still, and the client’s report of inner restlessness.
• SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS

  1. Dystonic reactions
  2. Tardive dyskinesia
  3. Neuroleptic malignant syndrome
  4. Akathisia
  5. EPS or neurolyptic-induced parkinsonism
  6. Seizures
  7. Sedation
  8. Photosensitivity
  9. Weight gain
  10. Anticholinergic symptoms - dry mouth, blurred vision, constipation, urinary retention, orthostatic hypotension
• Tardive dyskinesia

  a late-appearing side effect of antipsychotic medications, is characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet.
• Seizures

  are an infrequent side effect associated with antipsychotic medications. The incidence is 1% of people taking antipsychotics. The notable exception is clozapine, which has an incidence of 5%
• Neuroleptic malignant syndrome (NMS)

  It is characterized by muscle rigidity, high fever, increased muscle enzymes (particularly creatine phosphokinase), and leukocytosis (increased leukocytes).
• Agranulocytosis.

  Clozapine has the potentially fatal side effect of agranulocytosis (failure of the bone marrow to produce adequate white blood cells). Agranulocytosis develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia.
• Thought blocking

  clients may suddenly stop talking in the middle of a sentence and remain silent for several seconds to 1 minute