a negative symptom; is especially common; characterized by the person’s face appearing immobile and unresponsive with poor eye contact and reduced body language. Client may smile and warm up occasionally, but his/her range of emotional expressiveness is clearly diminished most of the time; voice is usually monotonous.

absence of energy.

unable to come to the point of the conversation. Conversation is filled with minute details.

the rapid succession of ideas that are not necessarily related  to each other (common in patients with bipolar, manic or schizo-affective diagnoses)

a false sensory perception unrelated to external stimuli (i.e. seeing things that are not there (visual hallucination); hearing voices (auditory hallucination). Clinet may also have gustatory (taste), olfactory (smell) and tactile (feeling through the skin) hallucinations. The term, RIS (responding to internal stimuli) may also be seen on patients’ records, meaning auditory/visual hallucinations.

the belief that some events have special meaning (i.e. people are laughing near the client are perceived to be laughing at him; people are talking are talking about the client).

thinking characterized by speech in which ideas shift from one subject to another that is unrelated.

Mutism

repetitively stating the same thought or word

persistent repetition of senseless acts or words

the flow of thought is directed toward an incidental aspect of the conversation and the content of the statement is avoided.

believes thoughts are being forced into one’s mind from the outside.

the person feels that his thoughts are escaping from his mind and being heard by others.

• Neurobiochemical
• Neuroanatomical
• Genetic
• Nongenetic risk factors

What are Eugen Bleuler's 4 A's of Schizophrenia?

• Affect: Flat, blunted, inappropriate, bizarre
• Associative looseness: fine thread between thoughts.
• Autism: Internal fantasy world, not really based
• Ambivalence: opposing ideas (Love+Hate)

• Ability to work
• Self-care
• Social functioning
• Interpersonal relationshiop
• Quality of life.

• Ideas of Reference
• Persecution
• Grandiosity
• Somatic sensation
• Jealousy
• Control
• Thought broadcasting
• Thought insertion
• Thought withdrawal
• delusions
• Religious
• Hallucinations

• Flat affect
• Anhedonia
• Alogia
• Thought blocking
• Depressed mood
• Lack of goal
• poor grooming
• Apathy
• Motor retardation

• Inattention, easily distracted
• Impaired memory
• Poor problem-solving skills
• Poor decision making skills
• Illogical thinking
• impaired judgment
• impaired insight into illness
• Inability to manage one's health, relationships, jobs

• Regression
• Projection: seen with paranoid schizophrenics
• Withdrawal
• denial

Withdrawal from others

Depressed

Anxious

Phobias

Obsession and compulsion

Difficulty concentrating

preoccupation with religion

preoccupation with self.

• substance abuse
• depression - suicide
• Nicotine dependence
• Anxiety disorders
• Psychosis-induced polydipsia

• Acute phase
• Maintenance phase
• Stabilization phase

• Safety of clients and others
• medical history and medical workup
• Positive, negative, cognitive and mood symptoms
• Current medications and compliance to treatment
• Family response/support

Nursing interventions

• Maintain comfortable distance
• Allow clients to make some choices
• provide help with ADL's
• Use restraints when necessary

• traditional or conventional
• Atypical or novel

Traditional Antipsychotics

• dopamine antagonist
• Targets POSITIVE symptoms
• Advantage: less expensive than atypical
• disadvantage: does not treat negative symptoms, Extrapyramidal side effects, tardive dyskenesia, Anticholergenic effects, Lower seizure threshold

• Serotonin-dopamine antagonist
• Advantages: Diminishes positive and negative symptoms, Lessens suicide behavior
• disadvantage: weight gain, metabolic abnormalities

• Clozapine (clozaril)
• Quetiapine (Seroquel)
• Respiridone ( Risperdal)
• Ziprasidone (Geodon)
• Olanzapine ( Zyprexia)
• Apriprazole ( Abilify)

• Dry mouth
• Constipation
• Urinary retention
• Blurred vision
• Photosensitivity
• Inability to ejaculate with men.

• Psuedoparkinsonism
• Acute dystonic reaction
• Akathisia
• Tardive dyskinesia
• Trunk

• Paranoid
• Catatonic
• Disorganized
• Undifferentiated
• Residual