Transcript Schizophrenia In-service

Schizophrenia
Overview
October 2011
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Experience. Education. Excellence.
Harvest is a leading full-service behavioral health
provider, specializing in the delivery of progressive
and innovative consultative behavioral health services
for patients and residents residing in skilled nursing,
rehabilitation, and assisted living facilities. Our
multidisciplinary team of highly skilled professionals
work together to offer a broad menu of services
including but not limited to 24-hour prescriber on-call
services and hospitalization support, comprehensive
cognitive assessments, documentation review, OBRA
compliance support and customized educational
programs designed for the individual needs of your
facility.
Introduction to Harvest
Healthcare
This presentation was developed for the
continuing education of health care
providers.
 At the conclusion of this presentation,
participants will have a basic
understanding of schizophrenia including
symptoms and treatment.
 Mental health professionals should be
consulted in the management of patients
with schizophrenia.
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Objectives
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Chronic mental illness that usually strikes in
late adolescence or early adulthood.
Signs and symptoms vary from individual to
individual but all have one or more of the
following:
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Delusions
Hallucinations
Bizarre behavior
Disorganized speech
Negative symptoms (lack of motivation or interest,
diminished cognitive functioning, decreased
emotional expression, decreased attention to
personal hygiene, little interest in interacting with
others and rarely seem to feel or express strong
emotions)
Schizophrenia
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People with schizophrenia suffer a decline in
their level of functioning
May lose all ability to withstand the pressures
of the working world
They may show a decline in their ability to
attend to household chores or all the
demands of raising their children, and or they
may not be able to have a full social life
anymore.
Some may have constant symptoms and
others may have periods when they are
relatively symptom free.
Schizophrenia
Schizophrenia is a complex illness.
 Mental health experts are not sure what
causes it.
 Genetic factors appear to play a role.
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◦ Certain environmental events may trigger
schizophrenia in people who are genetically at
risk for it.
◦ One is more likely to develop schizophrenia if
you have a family member with the disease.
Causes, incidence, and risk factors
Schizophrenia affects both men and
women equally. Tends to start later for
women.
 Childhood-onset schizophrenia begins
after age 5. It is rare and can be difficult
to differentiate from other childhood
developmental disorders such as autism.
 Older people with schizophrenia are an
often neglected group who are often at
the mercy of the least expensive care
available and sometimes no care at all.
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Causes, incidence, and risk factors
Cognitive decline is often seen in
schizophrenia
 Once a person with schizophrenia
becomes elderly, it can be difficult to sort
out cognitive decline related to
schizophrenia versus dementia.
 Psychosis is chronic and does not subside
if and when dementia develops which
creates an even more complex clinical
situation.
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Cognition
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The outlook for a person with schizophrenia is
difficult to predict.
Most times symptoms improve with medication.
Some may have difficulty functioning and are at
risk for repeated episodes acute symptoms.
Research indicates that the more quickly the
disease is diagnosed and properly managed the
better the long term prognosis.
Symptoms WILL return if the patient is noncompliant with medication.
Most will need supportive housing, job training,
and other community support programs.
Those with the most severe form may not be able
to live alone.
Prognosis
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Two or more of the following, each
present for a significant portion of time
during a one month period (or less if
successfully treated):
• Delusions
• Hallucinations
• Disorganized speech (e.g., frequent derailment
or incoherence)
• Grossly disorganized or catatonic behavior
• Negative Symptoms, i.e., affective flattening,
alogia, or avolition
Characteristic Symptoms
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Paranoid type: preoccupation with one or
more delusions or frequent auditory
hallucinations
Disorganized type: disorganized speech,
disorganized behavior, flat or inappropriate
affect.
Catatonic type: motoric immobility, excess
motor activity, extreme negativism, mutism,
peculiarities of voluntary movement as
evidenced by posturing, stereotyped
movements, prominent mannerisms or
prominent grimacing, echolalia or echopraxia.
Types of Schizophrenia
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There are no medical tests to diagnose
schizophrenia.
The diagnosis is made based on a thorough
interview of the person and family members.
The practitioner will ask questions about:
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How long the symptoms have lasted
How the person's ability to function has changed
Developmental background
Genetic and family history
How well medications have worked
Brain scans (such as CT or MRI) and blood
tests may help to rule out other disorders
that have similar symptoms to schizophrenia.
Diagnosis
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Antipsychotic medications are the most
effective treatment for schizophrenia.
Medications change the balance of chemicals
in the brain and can help control symptoms.
Finding the right medication can be difficult,
and a trial-and-error process may have to
occur. It is also important to learn the
contraindications of certain medications, such
as the effects of alcohol or sunlight on the
effectiveness of the medication.
Treatment: Medication
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Common side effects from antipsychotics
may include:
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Sleepiness
Dizziness
Weight gain
Increased chance of diabetes and high
cholesterol
◦ Feelings of restlessness or “jitters”
◦ Slowed movements
◦ Tremor
Treatment: Medications
Long term use of antipsychotic
medications may increase risk for a
movement disorder called tardive
dyskinesia. This condition causes
repeated movements that cannot be
controlled, especially around the mouth.
 Health care providers are responsible for
assessing for this potential side effect by
using the Abnormal Involuntary
Movement Scale (AIMS) examination.
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Treatment: Medications
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Supportive therapy may be helpful for many
people with schizophrenia. Behavioral
techniques, such as social skills training, can
be used to improve social and work
functioning. Job-training and relationship
building classes are important.
Therapy can help with problems that arise
day to day, as well as setting realistic goals
and defining strategies for reaching those
goals.
Individual, group, and family
therapy
These programs can help the person with
schizophrenia reach his or her highest
potential and greatest level of
independence.
 Staff in these programs become wellacquainted with their clients and can help
find living arrangements, work, and
recreational activities that are well-suited
to each client's needs.
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Residential, day-treatment, and
vocational programs:
Family members should be educated
about the disease and offered support.
 Family members and caregivers are often
encouraged to help people with
schizophrenia stick to their treatment.
 Family should learn how to diminish stress
and conflict, which can sometimes help
spark a relapse.
 It is also important to learn what
resources are available in the community
for treating mental illnesses
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Education
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It is important that the person with
schizophrenia learns how to:
◦ Take medications correctly and how to manage
side effects
◦ Notice the early signs of a relapse and what to
do if symptoms return
◦ Cope with symptoms that occur even while
taking medication. A therapist can help.
◦ Manage money
◦ Use public transportation
Education
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Important to understand the patient in terms of their
diagnosis and history.
Expectations for individuals should be based on
diagnosis.
Healthcare providers need to address their own fear
(likely based in lack of education/understanding)
about particular patients.
Team strategies should be discussed regarding
treatment approach for patients with behavior
problems.
Remember that all psychosis is not problematic. It is
ok to ask the patient about their hallucinations,
delusions, etc.
Talking with the patient about their symptoms can
create ease and open communication.
Care Strategies
What are common symptoms in
Schizophrenia?
 What are the usual treatment
approaches?
 Are people with Schizophrenia dangerous?
 How can you make a referral for a
psychiatric evaluation for a patient with
schizophrenia?
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Thought Provoking Questions