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Schizophrenia

Incidence & Prevalence of Schizophrenia

The incidence and prevalence is nearly one percent of the world population. The incidence of new cases each year is about 1.5 for every 10,000 individuals. The age of onset of schizophrenia is normally in adolescence to young adulthood (Deng & Dean, 2013).

Pathophysiology- Advanced Practice Perspective

Schizophrenia involves neurotransmitters dopaminergic, glutamatergic, and GABAergic systems that are dysregulated. An imbalance of serotonin, norepinephrine and dopamine also play a role. The diagram below demonstrates how this neurotransmitters interact (Mental Help, 2020).

(Slide Share, 2020).

Assessment

History of Present Illness Questions-

  1. Have you in the past, have ever, or are hearing people talking around you that others do not hear? Or see objects, shadows, people, animals that others to not?
  2. Where are the voices coming from? When do these visualizations occur?
  3. How often do you hear these voices or have those visualizations?
  4. How do you feel when you experience this?
  5. What would I hear or see if I were to hear or see them?
  6. Tell me exactly what they say or what you are seeing.
  7. Do they every make statements that command you to do something?
  8. Do they ever tell you to hurt yourself?
  9. Do you feel as though you want to hurt yourself?
  10. Do you have a plan to hurt yourself?
  11. Do you have the means to carry out this plan?
  12. Have you ever hurt yourself in the past?

Physical Exam-

  1. Test for alertness and orientation.
  2. Observe patient for grooming and hygiene.
  3. Observe for talking to self or unseen others.
  4. Observe body for any areas of self-harm.
  5. Cranial Nerves should be examined.

Diagnosistics

  1. Neuropsychological test performed by a psychotherapist. This will test for processing speed, working memory, attention span, verbal and visual learning memory, reasoning, executive function, verbal comprehension and social cognition.
  2. Prolactin levels should be tested to determine if underlying factors are tumor related or neuropsychological in nature (González-Blanco et. al., 2016).

Evidenced-Based Treatment Plan (Adolescent and Non Pregnant Adults).

Pharmacological Treatment

Non-pharmacological Treatment

Ability (10-15 mg Q day for the first to weeks and may increase up to 30 mg)

Psychotherapy

Clozapine (Initial 12 mg Q day or BID then increase by 25 mg per day up to 250-300mg). Monitor WBC count.

Cognitive Meditation

Seroquel (150 mg- 750 mg Q day)

Cognitive Behavioral Therapy

Zyprexa (5-20 mg days)

Social Cognitive Training

Geodon (20-80mg Q day or up to BID)

Cognitive Remediation Therapy

(Up To Date, 2020).

Chronic- Ability Maintaia (IM Q 28 days), Ivega Trinza (IM 273-819 mg Q 90 days), Risperdal Consta (IM 50mg Q 14 days)/

Episodic- Haldol (IM 5-10 mg IM or PO every 4-6 hours PRN distorted thoughts) and or for (Lorazepam 0.5-2mg PO or IM every 4-6 hours PRN aggression).

(Up To Date, 2020).

Patient Education

Patients should be advised of some side effects of these medications, including extra pyramidal side effects, PRN Cogentin should prescribed 0.5-2mg along with an antipsychotic in order to prevent these effects. Patients should be advised that these medications can cause increased waist circumference that could lead to diabetes mellitus type 2 and dyslipidemia. Patient should be advised to maintain a healthy amount of physical activity and a healthy diet. Patient should be advised not to miss a dose, but not to double a dose when missed. Family members and close friends should be very involved as noncompliance is a very big issue with this population. Encourage patients with schizophrenia to use a combination of pharmacological and nom pharmacological therapies will have the best impact in combating this disease (Galling et. al., 2016).

Evaluation to Assess Efficacy and Outcomes of Evidence-Based Treatment

The clinician will be clearly see the difference between a patient with schizophrenia that is well managed and a patient that is poorly managed or not managed at all. Some importance signs of efficacy of treatment are not going to be seen by lab data or other diagnostics, however by whether patient is well groomed, interacting, and able to maintain a job and social relationships for example. If the client with schizophrenia has more insight as to whether he or she is having auditory and or visual hallucination and or delusional thinking, is a very good sign of efficacy of treatment (Up To Date, 2020).

References

Deng, C., & Dean, B. (2013). Mapping the pathophysiology of schizophrenia:

interactions between multiple cellular pathways. Frontiers in cellular neuroscience, 7, 238.

Galling, B., Roldán, A., Nielsen, R. E., Nielsen, J., Gerhard, T., Carbon, M., … & Kahl,

K. G. (2016). Type 2 diabetes mellitus in youth exposed to antipsychotics: a systematic review and meta-analysis. JAMA psychiatry, 73(3), 247-259.

González-Blanco, L., Greenhalgh, A. M. D., Garcia-Rizo, C., Fernandez-Egea, E.,

Miller, B. J., & Kirkpatrick, B. (2016). Prolactin concentrations in antipsychotic-naive patients with schizophrenia and related disorders: a meta-analysis. Schizophrenia research, 174(1-3), 156-160.

Mental Help. (2020). Schizophrenia symptoms, patterns and statistics and patterns.

Retrieved from https://www.mentalhelp.net/schizophrenia/statistic…

Slide Share. (2020). Role of neurotransmitters in neuropsychiatric disorders. Retrieved

from https://www.slideshare.net/dpadevkota/role-of-neur…

Up To Date. (2020). Pharmacotherapy for schizophrenia: side effects management.

Retrieved from https://www.uptodate.com/contents/pharmacotherapy-…

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