Schizophrenia Spectrum Disorders
Tuesday, January 26, 2021 10:37 AM
• Schizophrenia Spectrum Disorders
○ Varcarolis’ Chapter 12
• Class Objectives:
○ Define psychosis & schizophrenia spectrum
disorders
§ Diagnostic criteria
§ Clinical manifestations
□ Compare & Contrast positive vs
negative symptoms
§ Risk factors
§ Treatment strategies –
□ Typical vs Atypical antipsychotics
□ Side Effects / EPS
○ Discuss nursing interventions when interacting with
a psychotic client
○ Discuss client / family educational needs & support
• What schizophrenia isn’t
○ Split personality - has nothing to do with
personality - more like split mind, disruption of the
brains/mind
○ A major source of violence , or danger to others
○ Something to be feared (“schizophobia”)
• Schizophrenia
○ Psychotic disorder
○ Prototypical - what people think when they hear
“mental illness”
○ Disturbs:
§ Thought processes
§ Perception
§ Affect
○ Onset:
§ Late adolescence or early adulthood 15 – 25
, yrs
§ Before 15 = Childhood Onset
§ After 40 = Late Onset
□ Pattern of development for late onset
has 4 phases
□ Milder symptoms – months or years
before full onset
® Prodromal Phase
○ Effects behavior, walking, sitting, posture, facial
expression, thinking, concentration, making
decisions
○ Will mute your experience of feelings, environment,
reality
• Psychosis
○ Altered Cognition
§ Some medical disorders that will cause
psychosis and features of schizophrenia, and
delirium
○ Altered Perception
§ Toxic situations, drugs that have been abused
or prescribed can alter perception, or meds
that can cause hallucinations (digoxin)
○ Impaired ability to tell real / not real
§ Loss of contact with or distortion of reality
§ Possible hallucinations & delusional thinking
○ Disorganization of personality
○ Deterioration in social functioning
○ Prototypical disorder - what people assume when
they hear mental illness
○ Effects behavior, walking, sitting, concentration,
priorities
• Prodromal Phase of Schizophrenia
§ Stage that Proceeds the full blown illness
§ Sooner tx is started the better the long term
prognosis
□ Why it is so important to catch early on
○ Lasts few weeks - few years
○ Deterioration role functioning & social withdrawal
, ○ Substantial functional impairment
○ Sleep disturbance, anxiety, irritability, Depressed
mood, poor concentration, fatigue
○ Late = Perceptual abnormalities:
§ Ideas of reference, suspiciousness
§ Imminent onset of psychosis
• Maintenance or Residual Phase of Schizophrenia
○ Symptoms of acute phase – absent
○ Pt will experience fewer or lesser symptoms of
those that are in the active stage
○ Typically don’t experience positive symptoms in this
stage (hallucinations or delusions)
○ Symptoms of prodromal phase – present – the new
baseline
§ Residual phase is similar to the prodromal
stage
○ Flat affect & impairment in role functioning
(Negative)
○ Residual impairment increases between episodes
○ Active stage/acute
§ Most alarming - causes symptoms of
psychosis - a delusions, hallucinations,
jumbled speech and thoughts
□ Sometimes this stage appears suddenly
without a prodromal stage
• Prognosis – Worse If:
○ Slow onset (2-3 yrs)
○ Younger age of onset
○ Longer duration of first symptoms to first treatment
○ Long untreated periods
○ More negative symptoms
§ Positive symptoms tend to lessen with age
while negative will worsen
• Prognosis – Better If:
○ Good adjustment
○ Later age at onset
○ Female - men typically have more severe symptoms
initially but lessen as they age while women don’t
Tuesday, January 26, 2021 10:37 AM
• Schizophrenia Spectrum Disorders
○ Varcarolis’ Chapter 12
• Class Objectives:
○ Define psychosis & schizophrenia spectrum
disorders
§ Diagnostic criteria
§ Clinical manifestations
□ Compare & Contrast positive vs
negative symptoms
§ Risk factors
§ Treatment strategies –
□ Typical vs Atypical antipsychotics
□ Side Effects / EPS
○ Discuss nursing interventions when interacting with
a psychotic client
○ Discuss client / family educational needs & support
• What schizophrenia isn’t
○ Split personality - has nothing to do with
personality - more like split mind, disruption of the
brains/mind
○ A major source of violence , or danger to others
○ Something to be feared (“schizophobia”)
• Schizophrenia
○ Psychotic disorder
○ Prototypical - what people think when they hear
“mental illness”
○ Disturbs:
§ Thought processes
§ Perception
§ Affect
○ Onset:
§ Late adolescence or early adulthood 15 – 25
, yrs
§ Before 15 = Childhood Onset
§ After 40 = Late Onset
□ Pattern of development for late onset
has 4 phases
□ Milder symptoms – months or years
before full onset
® Prodromal Phase
○ Effects behavior, walking, sitting, posture, facial
expression, thinking, concentration, making
decisions
○ Will mute your experience of feelings, environment,
reality
• Psychosis
○ Altered Cognition
§ Some medical disorders that will cause
psychosis and features of schizophrenia, and
delirium
○ Altered Perception
§ Toxic situations, drugs that have been abused
or prescribed can alter perception, or meds
that can cause hallucinations (digoxin)
○ Impaired ability to tell real / not real
§ Loss of contact with or distortion of reality
§ Possible hallucinations & delusional thinking
○ Disorganization of personality
○ Deterioration in social functioning
○ Prototypical disorder - what people assume when
they hear mental illness
○ Effects behavior, walking, sitting, concentration,
priorities
• Prodromal Phase of Schizophrenia
§ Stage that Proceeds the full blown illness
§ Sooner tx is started the better the long term
prognosis
□ Why it is so important to catch early on
○ Lasts few weeks - few years
○ Deterioration role functioning & social withdrawal
, ○ Substantial functional impairment
○ Sleep disturbance, anxiety, irritability, Depressed
mood, poor concentration, fatigue
○ Late = Perceptual abnormalities:
§ Ideas of reference, suspiciousness
§ Imminent onset of psychosis
• Maintenance or Residual Phase of Schizophrenia
○ Symptoms of acute phase – absent
○ Pt will experience fewer or lesser symptoms of
those that are in the active stage
○ Typically don’t experience positive symptoms in this
stage (hallucinations or delusions)
○ Symptoms of prodromal phase – present – the new
baseline
§ Residual phase is similar to the prodromal
stage
○ Flat affect & impairment in role functioning
(Negative)
○ Residual impairment increases between episodes
○ Active stage/acute
§ Most alarming - causes symptoms of
psychosis - a delusions, hallucinations,
jumbled speech and thoughts
□ Sometimes this stage appears suddenly
without a prodromal stage
• Prognosis – Worse If:
○ Slow onset (2-3 yrs)
○ Younger age of onset
○ Longer duration of first symptoms to first treatment
○ Long untreated periods
○ More negative symptoms
§ Positive symptoms tend to lessen with age
while negative will worsen
• Prognosis – Better If:
○ Good adjustment
○ Later age at onset
○ Female - men typically have more severe symptoms
initially but lessen as they age while women don’t
