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Transcript of Schizophrenia
Etiology and Diagnostics
Genetics and Biological
By How Lee, RN, MN
Faculty of Nursing
University of Alberta
Age of Onset
Hospitalization and Co-morbidities
52% percent of hospitalizations for schizophrenia in general hospitals are among adults 25-44 years of age
Percentage that attempt suicide: 40 to 60% with about 10% who will die from suicide
May require certification under the Mental Health Act
Interdisciplinary care is needed in all phases of treatment
Stabilization in hospital may require several months to find the right medications and manage symptoms
The patient needs to establish positive coping strategies for maintenance and recovery
Management of side effects and ensuring medication compliance is important
Prognosis and Outcome
Happily Ever After?
So is the answer?
Social support networks
Interaction with others
Family support to reduce caregiver burden
With rapid treatment and stabilization and continued support in the community, patient's with schizophrenia can lead healthy, productive lives
Males - Onset during the late teens to early adulthood, ranges from 15 to 25
Females - Onset most often during late 20s, ranges from 25 to 35
Research shows that there is a chemical imbalance of neurotransmitters in the brain primarily with dopamine (known as the dopamine hypothesis).
Health Promotion and Disease Prevention
Antipsychotic medication that blocks dopamine in the brain: 1st generation (typical) and 2nd generation (atypical)
Anxiolytics: benzodiazepines are common
Affects about 1% of the Canadian population
Cost to Canadian Economy: $2.35 billion per year in direct cost including health care and social assistance
Stigma of Schizophrenia
So what have you heard and what do you think about schizophrenia?
Insight and medication compliance is one of best predictors of a good outcome
Initial treatment may involves stabilization in hospital and symptom management
Factors Affecting Prognosis
So what does the word psychotic mean to you?
Types of Schizophrenia
A group of mental disorders characterized by a breakdown in the relation between thought, emotion, and behavior, in which people interpret reality abnormally.
Immediate Family - both parents: 50% chance
Twins - fraternal and identical: 10 to 15% chance
MRI, CT Scan, PET Scan
Frontal Lobe Changes
Well twin - left Twin with Schizophrenia - right
Income and social status
Personal health and coping practices
Social support networks
Interview the patient
Observe the behavior
Assess: mental status, spiritual, cultural, biological, psychological, social, environment
Difficulties with decision making
Self concept changes
Reduced stress response
Depression is the biggest co-morbidity associated with schizophrenia
People with schizophrenia are violent and dangerous
Common Myths of Schizophrenia
People with schizophrenia can't live productive lives
Schizophrenia develops quickly
Schizophrenia is purely genetic
People with schizophrenia should remain in hospital
Remember that mental health is on a continuum
Perhaps you may have experienced symptoms of psychosis.
So if schizophrenia and other mental illnesses are difficult to diagnose until their onset, then what can we do for prevention?
Symptoms that persist for a significant portion of 1 month and continuous signs of disturbance persisting for at least 6 months.
Criteria are based on the DSM-V
Nursing Interventions and Communication
Validation and empathy
Reinforce safety and care
Provide distraction from hallucinations and delusional thoughts
Support and encourage interaction and activity during stabilization, maintenance and recovery
Stabilization and Maintenance
Schizophrenia is the same as multiple (dissociative) personality disorder
Remember that mental illness is something that is culturally related
So is it still a mental illness if in the culture you come from, hallucinations and delusions are a regular part of your life?
Think about how scary it could be for someone from another culture with schizophrenia in our Western health care system
Once stabilized and on medication that is working, the goal is to move the patient into
40 to 60% of people with substance issues have a mental illness
Antipsychotic Side Effects
Drowsiness, dizziness, blurred vision
Atypical - weight gain, metabolic changes
Typical - extrapyramidal side effects (EPS) like rigidity, muscle spasms, tremors, restlessness
35 to 50% of homeless have a mental illness
50 to 80%
of homeless abuse substances
25% completely recover
25% much improved and are relatively independent
25% Improved but require extensive social support
15% hospitalized and unimproved
10% dead (mostly by suicide)
After 10 years, people diagnosed with schizophrenia
How can you tell if your friend who strongly encourages you to come to their church is delusional?
A patient with schizophrenia may have delusional thoughts revolving around spirituality.
Spirituality is a normal part of everyday life.
Atypical Anitpsychotics Are Preferred
Treat both positive and negative symptoms better
Fewer EPS side effects
Delusional thought content
Grandiose and persecutory thoughts that also affect his daily functioning
Note his facial expression (affect), it would be considered "flat" or "blunted" as he does not express much emotion
He is also having positive symptoms of visual and auditory hallucinations
Your career goal as a might not be in mental health
But remember that mental health is all around us...
In all types of health care settings
In patients, families, colleagues, and in you
Hallucinations are still present, but a full recovery has been made
He has insight
Mental Status Examination
Affect and mood
Cognition - Thought Content and Thought Process
Other Things Included: General Appearance, Memory, Orientation, Judgment, Somatic Function
So what is your role?
There are a combination of factors that lead to the development of schizophrenia.
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Canadian Mental Health Association (2013). Schizophrenia.http://www.cmha.ca/mental-health/understanding-mental-illness/schizophrenia/
Government of Canada. (2006). The Human Face of Mental Health and Mental Illness in Canada 2006.
Kneisl & Trigoboff. (2009). Contemporary Psychiatric-Mental Health Nursing. (2nd ed). Pearson-Prentice Hall.
Mood Disorders Society of Canada. (2009). Quick Facts: Mental Illness and Addictions in Canada (3rd. ed).
Public Health Agency of Canada. (2002). A Report on Mental Illness in Canada. http://www.phac-aspc.gc.ca/publicat/miic-mmac/index-eng.php
Trypuc, B. & Robinson, J. (2009). Charity Intelligence Canada -Homeless in Canada
Schizophrenia Society of Canada. (2009). Schizophrenia in Canada: A National Report.
Schizophrenia Society of Canada. (2009). Quality of Life As Defined by People Living with Schizophrenia and Their Families
World Health Organization. (2004). Prevention of Mental Disorders.
World Health Organization. (2005). Promoting Mental Health.