1. psychotic
2.  affect:
   • thinking
   • behavior
   • emotions
   • ability to perceive reality

Refers to the presence of:

• Hallucinations
• Delusions
• Disorganized speech, or
• Catatonic Behavior

Type age at onset is late teens and early twenties, but schizophrenia has occurred in young children and may begin in later adulthood.

• Substance Abuse
• Nicotine Dependence
• Depression
• Suicidal ideation
• Anxiety Disorders

• Hallucinations
• Delusions
• Disorganized speech
• Bizarre behavior

• Affect
• Alogia
• Avolition
• Anhedonia
• Anergia

Negative symptoms of Schizophrenia:

Affect

Usually blunted (narrow range of normal expression)

or

Flat (facial expression never change)

Negative symptoms of Schizophrenia:

Alogia

 Poverty of thought or speech.

Ex:  The client may sit with a visitor but may only mumble or respond vaguely to questions.

Negative symptoms of Schizophrenia:

Avolition

  Lack of motivation in activities and hygiene.

Ex:  The client completes an assigned task, such as making his bed, but is unable to start the next common chore without prompting.

Negative symptoms of Schizophrenia:

Anhedonia

Lack of pleasure or joy.   The client is indifferent to things that often make others happy.

Ex:  Such as looking at beautiful scenery

Negative symptoms of Schizophrenia:

Anergia

Lack of energy

• Positive
• Negative
• Cognitive
• Depressive

• Disordered thinking
• Inability to make decisions
• Poor problem-solving ability
• Difficulty concentrating to perform tasks
• Memory deficits
  • Long-term
  • Working memory, such as inability to follow directions to find an address

• Hopelessness
• Suicidal Ideation

1. Paranoid
2. Disorganized
3. Catatonic
4. Residual
5. Undifferentiated

Types of schizophrenia:

Paranoid

and its symptoms.

1. Characterized by suspicion toward others
2. symptoms:
   • Hallucinations, such as hearing threatening voices, and delusions, such as believing onself president of the US.
   • Other-directed violence may occur.

Types of schizophrenia:

Disorganized

and its symptoms.

1. Def:
   • Characterized by withdrawl from society and very inappropriate behaviors, such as poor hygiene or muttering constantly to oneself.
   • Frequently seen in the homeless population
2. symptoms:
   • Loose associations
   • Bizarre mannerisms
   • Incoherent speech
   • Hallucinations and delusions may be present but are much less organized than those seen in the client with parania.

Types of schizophrenia:

Catatonic

and its symptoms.

1. Characterized by abnormal motor movements
2. There are two stages:  withdrawn stage & excited stage
   • Withdrawn stage
     • Psychomotor retardation; the client may apper comatose
     • Waxy flexibility may be present
     • The client often has extreme self-care needs, such as for tube feeding due to an inability to eat.
   • Excited state
     • Constant movement, unusual posturing, incoherent speech.
     • Self-care needs may predominate
     • The client may be a danger to self or others.

Types of schizophrenia:

Residual

and its symptoms.

1. Active symptoms are no longer present, but the client has two or more "residual" symptoms.
2. Symptoms:
   • Anergia, anhedonia, or avolition
   • Withdrawn from social activities
   • Impaired role function
   • Speech problems, such as alogia
   • Odd behaviors, such as walking in a strange way

Types of schizophrenia:

Undifferentiated

and its symptoms.

1. The client has symptoms of schizophrenia but does not meet criteria for any of the other types.
2. Symptom:
   • Any positive or negative symptoms may be present.

1. Acute phase
   • Periods of both positive and negative symptoms
2. Maintenance phase
   • Acute symptoms decrease in severity
3. Stabilization phase
   • Symptoms in remission

Type of Delusion:

Ideas of reference

Misconstrues trivial events and attaches personal significance to them.

EX:  such as believing that others, who are discussing the next meal, are talking about him.

Type of Delusion:

Persecution

Feels singled out for harm by others

Ex:  being hunted down by the FBI

Type of Delusion:

Grandeur

Believes that he/she is all powerful and important, like a god.

Type of Delusion:

Somatic delusions

Believes that his body is changing in an unsusual way.

Ex:  such as growing a third arm.

Type of Delusion:

jealousy

May feel that his/her spouse is sexually involved with another individual.

Type of Delusion:

Being controlled

Believes that a force outside his body is controlling him.

Type of Delusion:

Thought broadcasting

Believes that his/her thoughts are heard by others.

Type of Delusion:

Thought insertion

Believes that other's thoughts are being inserted into his mind.

Type of Delusion:

Thought withdrawl

Believes that his/her thoughts have been removed from her mind by an outside agency.

Type of Delusion:

Religiosity

Is obsessed with religious beliefs.

Alterations in speech:

Flight of ideas

• Associative looseness
• The Pt may say sentence after sentence, but each sentence may relate to another topic, and the listener is unable to follow the Pt's thoughts.

Alterations is speech:

Neologisms

• Made up works that only have meaning to the Pt.

Ex:  "I tranged and flittled."

Alterations is speech:

Echolalia

• The Pt repeats the words spoken to him.

Alterations is speech:

Clang association

• Meaningless rhyming of words, often forceful.

Ex:  "Oh fox, box, and lox."

Alterations is speech:

Word Salad

• Words jumbled together with little meaning or significance to listener.

Ex:  "Hip horray, the flip is cast and wide-sprinting in the forest."

• Hallucinations
• Personal boundary difficulties

• Auditory
• Visual
• Ofactory
• Gustatory - tastes
• Tactile

Alterations in perception:

Personal Boundary difficulties

and two types.

• Disenfranchisement with one's own body, identity, and perceptions.
• Two types: 
  • Depersonalization - nonspecific feeling that a person has lost his/her identity; self is defferent or unreal
  • Derealization - perception that environment has changed.

• Extreme agitiation
• Stereotyped behaviors
• Automatic obedience
• Wavy flexibility
• Stupor
• Negativism
• Echopraxia

Alterations in Behavior:

Extreme agitiation

• including pacing and rocking

Alterations in Behavior:

Stereotyped behaviors

• Motor patterns that had meaning to client (sweeping the floor) but now are mechanical and lack purpose

Alterations in Behavior:

Automatic Obedience

• Responding in a robot-like manner

Alterations in Behavior:

Wavy flexibility

• Excessive maintenance of position

Ex:  For instance, if one were to move the arm of someone with waxy flexibility, they would keep their arm where one moved it until it was moved again, as if it were made from wax.

Alterations in Behavior:

Stupor

• Motionless for long periods of time; coma-like

Alterations in Behavior:

Negativism

• Doing the opposite of what is requested

Alterations in Behavior:

Echopraxia

• Purposeful imitation of movements made by others

• Don't lie; argue or agree with client's view
• Ask client directly about hallucinations

• Do not argue, but focus on Pt's feelings and possibly offer reasonable explanations.

• Atypical antipsychotics
  • current medications of choice for psychotic disorders, and they generally treat both positive and negative symptoms
• Typical antipsychotics
  • are used to treat mainly positive psychotic symptoms
• Antidepressants
  • used to treat the depression seen in many clients with schizophrenia
• Axxiolytics/benzodiazepines
  • used to treat the anxiety often found in clients with schizophrenia, as well as some of the positive and negative symptoms of schizophrenia

• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon)
• Aripiprazole (Abilify)
• Clonapine (Clozaril)

• Haloperidol (Haldol)
• Loxapine (Loxitane)
• Chlorpromazine (Thorazine)
• Fluphenazine deconoate (Prolixin)

Antidepressants

SSRI

• Celexa
• Lexapro
• Paxil
• Prozac
• Zoloft

• Lorazepam (Ativan)
• Clonazepam (Klonopin)