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Lecture 5

NURS 3524 Lecture Notes - Lecture 5: Mood Disorder, Mental Disorder, Schizophrenia

Course Code
NURS 3524
Mavoy Bertram

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 5
HH/NUR 3524 6.0
Psychiatric & Mental Health Nursing For Canadian Practice
Mental Health, Psychotic Disorders, Schizophrenia, Substance Use, Concurrent Disorders
Chapter 20, 21, 26, 33
Schizophrenia and Substance Use
What is Schizophrenia?
Complex biochemical brain disorder affects a person’s ability to determine what is reality and what is
Treatable brain illness
Affects thinking, mood, behaviour
Can impact all aspects of life…work, school, family, social
1996 total direct cost ~ $2.35 billion
Symptoms of Schizophrenia
affected by delusions
o fixed false beliefs that can be terrifying to the person experiencing them
o sensory experiences, such as hearing voices talking about them when there is no one there
social withdrawal and disturbed thinking
Schizophrenia is
Psychosis is the defining feature, but a universal definition of ‘psychosis’ does not exist
A narrow definition “is restricted to delusions or prominent hallucinations, with the hallucinations
occurring in the absence of insight into their pathological nature” (DSM-V, 2013)
Diagnostic Criteria for Schizophrenia
Criterion A presence of two of the following for at least one month
o Delusions
o Hallucinations
o Disorganized speech
o Grossly disorganized behaviour
o Negative symptoms
Criterion B- social or occupational impairment
Criterion C- six-month duration of disturbance
Criterion D & E- exclusion of diagnosis
o Not due to a mood disorder
o Not due to substance use
o Not due to a medical condition
Who is Affected? Not on the test
1 person in 100
Men usually develop illness earlier than women
Onset late teens or early 20’s, most often in the 16 to 30 year age group

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 5
HH/NUR 3524 6.0
Childhood Schizophrenia
Early onset grave for the life course of the child
Symptoms include: Seeing or hearing things that don't exist (hallucinations), especially voices, having
beliefs not based on reality (delusions), lack of emotion, emotions inappropriate for the situation, social
withdrawal, poor school performance, decreased ability to practice self-care, strange eating rituals,
incoherent speech, illogical thinking, agitation
Treatment hard to find
NOT Autism or Asperger’s syndromes
Affects 2 in 1000 children
Risk factors:
o Genetic characteristics; Gestational and birth difficulties
Believed to be the result of altered development of the central nervous system
can result in severe emotional, behavioral, health, and even legal and financial problems
Causes of Schizophrenia
No one knows for certain
Stress-vulnerability model
strong evidence of important inherited factors
Physiologic Diagnosis of Schizophrenia
part of the brain that governs thought and higher mental
functions behaves abnormally in persons with schizophrenia
MRI show the same area in the brain of some people with
schizophrenia appears either to have deteriorated or not to
have developed normally
CAT scans show that the fluid-filled spaces within the brains
of people with schizophrenia tend to be larger than those in
people without the illness
Substance Use and Schizophrenia
People with schizophrenia often use alcohol or other drugs
80% of people with schizophrenia will abuse substances at some point in their lives
Nicotine dependence most common form of substance use
People with schizophrenia smoke about 3X the rate of the general population
Substance use can reduce the effectiveness of antipsychotic medication
Symptoms of schizophrenia may worsen when amphetamines, cocaine, PCP or marijuana is used
Phases of Schizophrenia
Prodromal (Beginning)
o loss of interests
o withdrawal

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 5
HH/NUR 3524 6.0
o easily confused
o preoccupied
o troubles concentrating
o preoccupied with religion or philosophy
o can last weeks or months
o delusions
o hallucinations
o distortions in thinking
o disturbances in behaviour and feelings
o Can appear suddenly
o Similar to prodome phase
o Trouble concentrating, withdrawn
o residual symptoms may increase, while ability to function normally may decrease, after each
active phase
Tend to occur in sequence and appear in cycles throughout
Symptoms of Schizophrenia
Positive symptoms (“positive” doesn’t mean good)
o Additions to or exaggerations of normal functioning
o Occur during active phase
Negative symptoms
o Loss or diminishing of functioning
o Can be more persistent
Positive Symptoms
delusions fixed, false beliefs
hallucinations disturbances in perception
o hearing, seeing, smelling, touching, tasting
disorganized thoughts
disorganized behaviour
Negative Symptoms
physical symptoms
reduced motivation
social withdrawal
change in habits and ability to function
low energy (anergia)
diminished pleasure in activities (anhedonia)
blunted affect
Associated Symptoms
disturbances of feelings/mood
cognitive difficulties
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