schizophrenia - Introduction—~Demographies l S chiz...

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Unformatted text preview: Introduction—~Demographies l S chiz Ophl‘ enia; Care Of Clients 7 a occurs In about1% of the population __ WW. “Hf/@Nm. W W W, - 3 million people in the US. With Though \‘ d Perceptual 0 costs about $73 billion annually ”QQQHLQ—l‘fim - no difference between industrialized and developing countries Introduction—:pemo graphics = Introduction-J)emographics i . High prevalence rates: a First episode 0 Yugoslavia, Sweden, Ireland, Canadian Catholics, Tamils in 0 late adolescence or early adulthood inéia, African Americans o Men—£14 years on average ' LOW prevaience rates: ‘ I: 0 Women——26.8years on average E 0 American Old Order Amish, Aboriginal tribes in Taiwan, : a More favorable course for women E r' ‘ ,h . . . ”1 “mm C am a Late onset schizophrenia beginsbctwcen ages 45 and i 50 J _ . a Most peOple with Schizophrenia are in the lower i - Prior to this century, treated with fear and ignorance class ' o ls this getting better? 0 downward drift - woos—described and categorized o something causative about poverty (1’) o Kraeplin . Homelessness o Bieuler o 1120:}: of sevei'eiy mentally ili estimated to be homeless C Schneider 0 1/3 ofthe homeless estimated to be mentally ill [M l g l g l i - dementia praecox - schizophrenia described as a syndrome 0 wide variety of impaired behaviors 0 chronic course 0 began early in life (teens) o generaily poor outcome a First rank symptoms 0 bizarre psychotic delusions and hallucinations I - Second rank symptoms 0 all other experiences- and behaviors - delusions - aggression l i Em - hallucinations i i - altered thought processes and disorganizedthinkjng i Bleuler (Q . ‘Group of Sch170phrenias o splitting or fragmentation of thought - 4A5: ambivalence, autism, affective bluntingloose g associations E - PlusAs: avolitions,auditory hailucinations, attentional impairments some aw 2m - DSM IV - Positive and Negative Symptoms Negative fSym ptoms o affective bianting ' . impoverished nonfiaent speech 0 loss of drive - anhedonia (inabilityto experience pleasure) - inability to experience emotional attachment . impaired attention “r" WWWW’ mgw mm Symptoms——\ddeo o behavior - cognition/thought content c emotions - perceptions 0 social functioning of these categories? r' ‘\ . In the case study, what symptoms are evident in each 3 - reflect the feelings - use exaggeration: “Evegone is after you?” - Belief modification - Do not argue Hallucinations - What to do? a How do you establish a trusting relationship with someone hailueinating? . What are the behavioral cuesof hallucinations? o What needs or feelings might be the underlying source of hallucinations? Delusions - fixed false beliefs - no basis in a consensuallyvalidated cultural belief - some basis in fact stimuli - can be experienced in all sensory modalities a primarily audition- v staging: comforting, condemning, controlling, conguermg Eti ological Theories - Genetic - InfectiOUSMAutoimmune - Biochemical l - Brain Structure / o lst degree biological} reiaiiees~A10 times more likely to be schizophrenic o Monozygotictwine-concordance for the diagnosis of schizophrenia ranges from 35% to 69% - no direct evidence 0 prenatai exposure to viral infection during 2nd 5 trimester . more schizophrenic patient borniate winter or early spring . wzmu m ‘l‘ -, LHu m m a. we: wamm mum: rm: W .- wmraeamu W WM mp mm . Rn Immnpaifiywzy WW.» unmeann CNS an,“ mm“. , mew-mm Hairy ESIW _ _ Biochemical Q - depamine I acetylcholine ° serotonin - nerepinephzine We? wastes - antipsychotic dmgs “ a dopamine enhancing drugs create psychotic symptoms 0 amphetamines o cocaine ”1.5.(4'VX‘7 a Dopaminerliypothesis ;. “““““ item.._.,.wic,.mWWWv.7,.fir‘Qfi",fimfififiwq,iriiwmw 6 feedback mechanism between mesolimbicand mesocortical tracts - hyperdopaminergicfiinctionnmesolimbic 0 positive symptoms - hypodopaminergicfunction—wmesocortical 0 positive and negative symptoms 3 l l >r§§ffiffil§ ill «r Vulnerability—Stress Model ‘ a constitutional predisposition 0 genetic - activated by environmental stressors o viruses 0 life events . result in biochemical and structuralEJrain changes Relapse—symptoms - anxiety 3 - éepression ‘ v psychosis - problems in interpersonal relationships - seif—meéication with drugs and alcohol v. fififixwfifiéfizf‘ Brain structure ,,,.,,7,,,,, ,.__ ‘._____._..__. ._.__._{®J____ ____.__ ., . i, , - enlarged ventricles ., o lateral and third - enlarged sulci 0 suggest brain atrophy and decreasedbrain mass “l 3 Goals of Treatment e Prevent relapse 0 “having an episode" 0 return of symptoms that require help from a health care professional o assumptions 1 lower skew-symptoms stability I unmoderatedstrese-relapse andpsychosis . Enhance recovery 0 Decrease stigma 0 Encourage hope Stressors a neurological éysfunction . . psychologicaistressors 0 drug and alcohol abuse 0 number of symptoms 0 negative appraisal - - cnvironmental/interpersonal o stressful life events 0 environmental stimulation 0 critical family/residential staff - Symptom regulation skill competencies ‘ - Perceived socialsupport - Antispychotic medications W swearwweaiem 333% giggefsréw’ Interventions 9 Clinical o collaborate with symptoms monitoring skills 0 teach family a provide social support 0 monitor and assess medications Interventions - Family and / or residentialstaff 0 support o modulate environmental stimulation 0 modulate rate of change Peer support 0 social activity without substances 0 sociaisupport o reinforce use of medications o reinforce use of symptom regulation W- - ”for: - assertive outreach ; 0 Rehabilitation ammo»? are" czar-mm . » 5: ‘fiifi‘fiém W grim Enterventions——pscyhosociai structures - consume: and famiiy invoivement o EBPAfamily based services E - legai protections é - treatment ‘ 0 mental iliness I EBP—cognitivebehavioral therapy I EBP—tokeneconomy interventions x EBPwpsycliosocjai interventions for weighrnanagemem 0 drug and alcohol :1 EBPepsychosocial interventions for alcohol and substancobuse if? vagg‘ ‘Ifixfiifi’vfig‘ i“: igfiiwaht' .m..-.-__.._—! I nterventions-—psychosocial structures 0 ESP—Assertive communitytreatment (ACT) integrated case management a EBP~~ACT safe havens housing income support 0 EBvaupported employment 0 EBPeskflls training - Antipsychoticmedications 0 High dose, low potency I Chlorpromazine (Thorazine) w Mesoridafino($eremii) I Thjon'dazine (Meiiex‘ii) 0 Low dose, high potency r HaloperidolU-laldol) I FiupbenazinMPi-olim'n) :Wy xix figs-*4” Medications Medications f""\ _ _ __ /"\ \_// \‘/f . Antipsychotic medications - Antiparkinson medications o Atypical medications . O Artane I Ciozapine (Ciozarii) 0 Cogentin x RispezidoneKRisperdai] ; o Kgmadrin x Dianzapine€Zyprexa) I Quetiapinef'umerate [Seroquel} 1: Ziprasidone HCL€Geodnn) I miyipmzolemhiiify) 5 i i WW W .M ”1“..me WWW a? m N: m WW: .V; _ flimfigfiéflfigfii‘gfigfiwfifigfizi am; 5» “fizw‘éiéfigxfi Medications Q. . Side effects-—antipsychotics o Side effectSMAntipsychotics 0 Enrapy'ramidai 0 Weight gain and Diabetes I Pseudoparkjnsonism g 0 Cardiovascular u Dystonia 3 A1raf3nir:-\ l Tardive dyskinesia o Neuroieptic malignant syndrome 0 Agramiiocytosis gé‘W4“%W «0 fifigfi’é‘agmww waawv . H rdWWWWWWmi“WWWWMW...”‘mm Mediogtions - Side effecmwAntipsychotlcs o Serotonin syndrome - Manta} status changes (confusion orhypornania) I Restiessnessand agitation 1- Myoclonus x Hyperrefiexia x Diaphoresis 1- Shivering I Tremor x Diarrhea, abdominai cramps, nausea :- Ataxia and incoordination I headaches ...
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