Transcript Schizophrenia and Psychosis

Rebecca Sposato MS, RN
SCHIZOPHRENIA AND
PSYCHOSIS
Brief Psychotic Disorder

Mental disturbance involving one of the following
symptoms
◦ Hallucinations
◦ Delusions
◦ Disorganized speech/mannerisms

Episode lasts over one day but less then one
month

Person returns to premorbid level of function

Substance use and medical conditions did not
cause the episode
Schizophrenia
“Split mind” as in separated from reality
 Symptoms are acutely present for >1
month (if not being treated) and persist in
a lesser form over 6 months

◦ Anecdotal research suggests prodromal
period

Symptoms are severe enough to impair
ability to function
Etiology and Epidemiology
Over expression of dopamine in
cerebrum and a collection of structural
changes
 Stressed conditions as fetus
 Lifetime prevalence of 1%, most cases
start in young adulthood, more male
 Over 80% use nicotine, over 50% have
substance abuse diagnosis
 The earlier the onset the more severe
and chronic the schizophrenic course

Psychomotor changes

Catatonia – changes in rate and amount
of motion, not reactive to environment
◦ Retardation: slow stiff movement
◦ Agitation/excitement: repetitive and
purposeless or pacing motions
 Rule out EPS/TD from meds
◦ Posturing/catalepsy: holding same position for
extended length of time
Positive Symptoms

Represent an excess or distortion of a
normal function
◦ Thought content: delusions, concrete thinking,
◦ Perceptions: hallucinations, derealizations,
depersonalizations, capgras (imposters)
◦ Language: word salad, clang associations,
neologisms

Acute onset and recovery, respond well
to treatment and medications
Negative Symptoms

Represent a loss or lessened form of a
normal function
◦ Emotive: flat, blunt, inappropriate, and
anhedonia
◦ Speech/thought: alogia
◦ Behavior: avolition

Chronic course, greater contributor to
disability and social withdrawal
Subtypes
Paranoid: delusions of persecution or
imminent harm
 Disorganized: purposeless and fragmented
speech, thought and behavior patterns
 Catatonic: diminished or peculiar
movement patterns

◦ Speech: mute or echolalia

Residual: presence of negative symptom
or positive symptom in diminished form
after the acute phase has passed
Schizophreniform

Similar clinical picture to Schizophrenia
except:
◦ Symptoms present less than 6 months
◦ Does not require impairment of social
functioning
Schizoaffective

Period of illness includes both
schizophrenic and depression features
◦ Delusions/hallucination had to be present
over 2 weeks (in the absence of depression)
Delusion Disorder

Presence of non-bizarre delusion for over
1 month despite lack of evidence, without
the other features of psychosis
◦ Erotomanic- another person is in love with
individual
◦ Grandiose- individual has great but
unrecognized talent
◦ Jealous- spouse or lover is unfaithful
◦ Persecutory- others conspire, harass, harm
and malign individual
◦ Somatic- altered body functions
Therapeutic Communication
Do not dissuade or use logic to convince
patient of reality
 Ask patient to explain the experience, but
do not explore or go along with the
hallucinations or delusions
 Address patient’s reaction to psychosis
 Your statements should communicate
what is real, here and now

Treatment – Acute Phase

Patient/other safety
◦ Calm, organized and safe environment
Reduce symptoms and their impact
 Antipsychotic medication: reduce activity
of dopamine and other neurotransmitters

◦ EPS: TD/dystonia, akathisia
Neuroleptic malignant syndrome
A life threatening acute reaction to
antipsychotic medications due to their
blockage of dopamine-2 pathways
 Signs: changes in consciousness, delirium,
hyperthermia, muscle cramps/rigidity,
increased and unstable VS

◦ Elevated CPK, WBC
◦ Rapid course, peaks in 3 days

Cease all suspect medications, support
clinical picture, provide dopamine agonist
Treatment – Maintenance Phase

Provide supportive environment to
prevent relapse and adherence to
treatment
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
Partial hospital program
Crisis centers
Halfway houses/group homes
Day treatment programs
Recreation and vocational programs