22. Schizophrenia/Psychotic Disorders Flashcards
named the disorder schizophrenia and identified a group of schizophrenias
Eugen Bleuler
differentiated behaviors of schizophrenia and categories them into ranks
Kurt Schneider
risk factors of schizophrenia
genetics and environment
- first-degree biologic relatives w/ greater risk (parents/siblings)
- unstable family/chaotic household
- homeless/poverty
- extreme stress
- maternal/prenatal factors
- early life cannabis use
age of onset of schizophrenia
usually late adolescence or early adulthood
gender differences in schizophrenia
earlier diagnosis and poorer prognosis in men
neuroanatomic findings w/ schizophrenia
- larger lateral and third ventricles
- smaller total brain volume
comorbidities associated w/ schizophrenia
- substance abuse and depression
- DM and obesity
- disturbed water balance (polydipsia and disturbed electrolyte imbalances)
Why is it necessary to assess for depression in patients w/ schizophrenia
- may suggest a mood disorder diagnosis is more appropriate
- common in chronic stages of schizophrenia and deserves attention
- suicide rate among people w/ schizophrenia is higher than general population (want voices to stop or may have voices telling them to do it)
risk factors for suicide among pts w/ schizophrenia
- untreated psychosis
- under 28 y/o
- Hx of suicide attempts
- severity of depression and substance abuse
social stressors that contribute to changes in brain function
- social stigma
- absence of good, affordable, and supportive housing
- fragmented mental health care delivery system
clinical course of schizophrenia
- prodromal period
- acute illness (schizophrenia)
- stabilization (residual phase)
- maintenance and recovery
- relapse
T/F: a person’s prognosis w/ schizophrenia is worse if their first episode of psychosis occurs at an earlier age
True
factors associated w/ having a good prognosis
- having a good premorbid period (sxs not severe)
- later onset in life
- good healthy coping skills
- psychotic outbreak brief
phase w/ decline in overal function; pt is withdrawn, irritable, may have physical complaints; newfound interest in religion
prodromal period
phase w/ prominent positive and negative sxs; person unable to work, social relationships deteriorate, and hygiene is severely neglected; unable to care for basic needs; common to engage in substance use during this phase
acute illness (schizophrenia)
phase where person is on medication that should help; sxs become less acute but still lingering; negative sxs hardest to treat
stabilization (residual phase)
phase where you make sure pt is compliant w/ meds and removing stress from life; assess their support system and protective factors
maintenance and recovery
phase can occur at any time and for any reason; pt may stop taking their meds (main cause)
relapse
symptoms that are added to or not present in healthy individuals
positive sxs
examples of positive sxs
- hallucinations
- delusions
- excessive or distorted thoughts and perceptions
emotions and behaviors that should be present but are diminished; more severe sxs
negative sxs
examples of negative sxs
- alogia (pt doesn’t talk much)
- anhedonia (pt loses interest in activities they use to enjoy)
- avolition (lack of motivation to do tasks; include ADLs)
- flat affect and facial expression
- apathy
- ambivalence (pt can’t make decisions)
sxs involving memory, vigilance, verbal fluency, and executive function
neurocognitive impairment
most common type of hallucination (positive sx) and how you know someone is experiencing them
- auditory hallucination: pt is hearing voices
- pt’s head is tilted to side like they are listening to someone
- pt is conversing with themselves while sitting alone
interventions for someone experiencing auditory hallucinations
- avoid touching the pt without warning
- be accepting of what they are experiencing
- encourage development of healthy coping skills (music or art therapy)
auditory hallucination that tells pt to harm themselves or someone else
command hallucination
hallucination where pt sees things that aren’t present
visual hallucination
hallucination where pt feels something that isn’t there
tactile hallucination
hallucination where pt tastes something that is often strange or unpleasant
gustatory hallucination
hallucination where pt smells some type of odor or scent
olfactory hallucinations
fixed false belief where the pt may misinterpret environment or experiences (believes fireworks are gunshots)
delusions
pt repeats what someone else says (like a parrot)
echolalia
pt provides unecessary detail when discussing a topic or asked a question
circumstantiality
pt’s thoughts are not connected to each other
loose associations
pt never answers your question or story never gets to the point (goes on a tangent)
tangentiality
pt’s thoughts change very quickly or the topic of conversation changes very quickly
flight of ideas
pt uses a bunch of words in a sentence that have no meaning; jumbled words that aren’t connected
word salad
pt makes up words that can’t be found in a dictionary
neologisms
pt is suspicious of others and believes someone is out to get them
paranoia
pt feels something they read or heard is a special message for them (ex. billboard, book passage, song lyric)
referential thinking (delusion of reference)
pt’s thinking is restricted to where they are living in their own world and making up their own rules
autistic thinking
pt is unable to understand abstract concepts (metaphors or punch lines)
concrete thinking
disorganized thinking that is a repetition of words or phrases
verbigeration
pt uses certain words to refer to a particular object (ex. “I feel like a sword” when they feel angry)
metonymic speech
pt states similar sounding words in a sentence
clang association
pt uses very formal language (like old English)
stilted language
pt is forcing out or pushing out their words
pressured speech
pt displays anger and violence
aggression
pt is unable to sit still and is irritable
agitation
pt experiences period of motionless
catatonia
periods of extreme restlessness and excessive and apparently purposeless motor activity
catatonic excitement
involuntary imitation of another person’s movement or gestures
echopraxia
pt regresses back to childhood behaviors (ex. thumb sucking or bed wetting)
regressed behavior
pt engages in constant repetition of words or movement (ex. body rocking); also seen in autism
stereotypy
pt’s senses are heightened and they are expecting something to happen; on high alert
hypervigilance
when posture is held in an odd or unusual fixed position for extended periods of time
waxy flexibility
describe a brief psychotic disorder
- duration between 1 day and 1 month (need to know how long pt has been experiencing sxs)
- hallucination, delusions, disorganized speech, disorganized catatonic behavior
describe shared psychotic disorder (Folie a deux)
- dominant person experiences paranoia or psychotic behavior that gets passed to a less dominant person
- if separated, the less dominant person will go back to normal behavior
4 types of other psychotic disorders
- brief psychotic disorder
- shared psychotic disorder
- psychotic disorder due to medical condition
- substance induced psychotic disorder
schizophrenic sxs accompanied by sxs associated w/ mood disorders (either manic or depressive); at great risk for suicide
schizoaffective disorder
what is included in schizoaffective disorder
2 or more of the following
- delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behavior
- negative sxs
psychotic illness w/ sxs similar to schizophrenia but lasts for less than 6 months; at least 2 sxs must be present
schizophreniform disorder
pt feels very paranoid that someone is out to get them or trying to trick them
delusions of prosecution
pt feels they have special powers (ex. pt will say they can make it rain or can read your mind)
delusion of grandeur
pt feels that people are controlling them
delusion of control/influence
pt is preoccupied with their appearance or body (ex. think they have a tumor, 2 heads, snakes in their body, or a foreign substance in their body)
somatic delusion
pt feels they are not connected to their body or they don’t exist
nihilistic delusion
pt feels they are in love with a prominent figure
erotomanic delusion (plausible)
pt feels their significant other is being unfaithful to them
jealous type delustion (plausible)
biologic-physical assessment for schizophrenia
- current and past health status and physical exam
- physical functioning
- nutritional assessment (some psych meds only work when they bind to food)
- pharmacologic assessment
physical interventions for schizophrenia
- promotion of self-care activities
- activity/exercise
- nutrition
- thermoregulation
- promotion of normal fluid balance and prevention of water intoxication
- pharmacologic interventions (antipsychotics and anticholinergics)
psychological assessment for schizophrenia
- response to mental health problems
- coping skills
- general appearance
- speech, mood, and affect
- thought processes
- hallucinations and delusions
- disorganized communication
- cognitive impairment
- memory and orientation
- insight and judgment
- self-concept
- social network
- risk assessment
social assessment for schizophrenia
- functional status
- social systems
- quality of life
- family assessment
psychological interventions for schizophrenia
- development of nurse-pt relationship, trust, acceptance, and hope
- management of disturbed thoughts and sensory processes
- education about sxs
- enhancement of cognitive functioning
- use of behavioral interventions
- teaching and coping w/ stress
- pt education
- family education
T/F: laughing or whispering and then looking towards the pt can set them off
True
social interventions for schizophrenia
- promote safety
- monitor for aggression
- administer meds as ordered
- reduce environmental stimulation
- use individualized approach
- convening support groups
- implementing milieu therapy (pt’s social environnent is controlled or manipulated with a view to preventing self-destructive behavior)
- developing recovery-oriented rehabilitation strategies
- implement family interventions
priority care issues for schizophrenia
- suicide assessment
- aggression and safety of pt, staff, and others
- antipsychotic medications
