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Psych > 22. Schizophrenia/Psychotic Disorders > Flashcards

22. Schizophrenia/Psychotic Disorders Flashcards

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1
Q

named the disorder schizophrenia and identified a group of schizophrenias

A

Eugen Bleuler

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2
Q

differentiated behaviors of schizophrenia and categories them into ranks

A

Kurt Schneider

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3
Q

risk factors of schizophrenia

A

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
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4
Q

age of onset of schizophrenia

A

usually late adolescence or early adulthood

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5
Q

gender differences in schizophrenia

A

earlier diagnosis and poorer prognosis in men

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6
Q

neuroanatomic findings w/ schizophrenia

A
  • larger lateral and third ventricles

- smaller total brain volume

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7
Q

comorbidities associated w/ schizophrenia

A
  • substance abuse and depression
  • DM and obesity
  • disturbed water balance (polydipsia and disturbed electrolyte imbalances)
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8
Q

Why is it necessary to assess for depression in patients w/ schizophrenia

A
  • 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)
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9
Q

risk factors for suicide among pts w/ schizophrenia

A
  • untreated psychosis
  • under 28 y/o
  • Hx of suicide attempts
  • severity of depression and substance abuse
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10
Q

social stressors that contribute to changes in brain function

A
  • social stigma
  • absence of good, affordable, and supportive housing
  • fragmented mental health care delivery system
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11
Q

clinical course of schizophrenia

A
  • prodromal period
  • acute illness (schizophrenia)
  • stabilization (residual phase)
  • maintenance and recovery
  • relapse
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12
Q

T/F: a person’s prognosis w/ schizophrenia is worse if their first episode of psychosis occurs at an earlier age

A

True

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13
Q

factors associated w/ having a good prognosis

A
  • having a good premorbid period (sxs not severe)
  • later onset in life
  • good healthy coping skills
  • psychotic outbreak brief
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14
Q

phase w/ decline in overal function; pt is withdrawn, irritable, may have physical complaints; newfound interest in religion

A

prodromal period

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15
Q

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

A

acute illness (schizophrenia)

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16
Q

phase where person is on medication that should help; sxs become less acute but still lingering; negative sxs hardest to treat

A

stabilization (residual phase)

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17
Q

phase where you make sure pt is compliant w/ meds and removing stress from life; assess their support system and protective factors

A

maintenance and recovery

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18
Q

phase can occur at any time and for any reason; pt may stop taking their meds (main cause)

A

relapse

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19
Q

symptoms that are added to or not present in healthy individuals

A

positive sxs

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20
Q

examples of positive sxs

A
  • hallucinations
  • delusions
  • excessive or distorted thoughts and perceptions
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21
Q

emotions and behaviors that should be present but are diminished; more severe sxs

A

negative sxs

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22
Q

examples of negative sxs

A
  • 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)
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23
Q

sxs involving memory, vigilance, verbal fluency, and executive function

A

neurocognitive impairment

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24
Q

most common type of hallucination (positive sx) and how you know someone is experiencing them

A
  • 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
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25
Q

interventions for someone experiencing auditory hallucinations

A
  • avoid touching the pt without warning
  • be accepting of what they are experiencing
  • encourage development of healthy coping skills (music or art therapy)
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26
Q

auditory hallucination that tells pt to harm themselves or someone else

A

command hallucination

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27
Q

hallucination where pt sees things that aren’t present

A

visual hallucination

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28
Q

hallucination where pt feels something that isn’t there

A

tactile hallucination

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29
Q

hallucination where pt tastes something that is often strange or unpleasant

A

gustatory hallucination

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30
Q

hallucination where pt smells some type of odor or scent

A

olfactory hallucinations

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31
Q

fixed false belief where the pt may misinterpret environment or experiences (believes fireworks are gunshots)

A

delusions

32
Q

pt repeats what someone else says (like a parrot)

A

echolalia

33
Q

pt provides unecessary detail when discussing a topic or asked a question

A

circumstantiality

34
Q

pt’s thoughts are not connected to each other

A

loose associations

35
Q

pt never answers your question or story never gets to the point (goes on a tangent)

A

tangentiality

36
Q

pt’s thoughts change very quickly or the topic of conversation changes very quickly

A

flight of ideas

37
Q

pt uses a bunch of words in a sentence that have no meaning; jumbled words that aren’t connected

A

word salad

38
Q

pt makes up words that can’t be found in a dictionary

A

neologisms

39
Q

pt is suspicious of others and believes someone is out to get them

A

paranoia

40
Q

pt feels something they read or heard is a special message for them (ex. billboard, book passage, song lyric)

A

referential thinking (delusion of reference)

41
Q

pt’s thinking is restricted to where they are living in their own world and making up their own rules

A

autistic thinking

42
Q

pt is unable to understand abstract concepts (metaphors or punch lines)

A

concrete thinking

43
Q

disorganized thinking that is a repetition of words or phrases

A

verbigeration

44
Q

pt uses certain words to refer to a particular object (ex. “I feel like a sword” when they feel angry)

A

metonymic speech

45
Q

pt states similar sounding words in a sentence

A

clang association

46
Q

pt uses very formal language (like old English)

A

stilted language

47
Q

pt is forcing out or pushing out their words

A

pressured speech

48
Q

pt displays anger and violence

A

aggression

49
Q

pt is unable to sit still and is irritable

A

agitation

50
Q

pt experiences period of motionless

A

catatonia

51
Q

periods of extreme restlessness and excessive and apparently purposeless motor activity

A

catatonic excitement

52
Q

involuntary imitation of another person’s movement or gestures

A

echopraxia

53
Q

pt regresses back to childhood behaviors (ex. thumb sucking or bed wetting)

A

regressed behavior

54
Q

pt engages in constant repetition of words or movement (ex. body rocking); also seen in autism

A

stereotypy

55
Q

pt’s senses are heightened and they are expecting something to happen; on high alert

A

hypervigilance

56
Q

when posture is held in an odd or unusual fixed position for extended periods of time

A

waxy flexibility

57
Q

describe a brief psychotic disorder

A
  • duration between 1 day and 1 month (need to know how long pt has been experiencing sxs)
  • hallucination, delusions, disorganized speech, disorganized catatonic behavior
58
Q

describe shared psychotic disorder (Folie a deux)

A
  • 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
59
Q

4 types of other psychotic disorders

A
  • brief psychotic disorder
  • shared psychotic disorder
  • psychotic disorder due to medical condition
  • substance induced psychotic disorder
60
Q

schizophrenic sxs accompanied by sxs associated w/ mood disorders (either manic or depressive); at great risk for suicide

A

schizoaffective disorder

61
Q

what is included in schizoaffective disorder

A

2 or more of the following

  • delusions
  • hallucinations
  • disorganized speech
  • disorganized or catatonic behavior
  • negative sxs
62
Q

psychotic illness w/ sxs similar to schizophrenia but lasts for less than 6 months; at least 2 sxs must be present

A

schizophreniform disorder

63
Q

pt feels very paranoid that someone is out to get them or trying to trick them

A

delusions of prosecution

64
Q

pt feels they have special powers (ex. pt will say they can make it rain or can read your mind)

A

delusion of grandeur

65
Q

pt feels that people are controlling them

A

delusion of control/influence

66
Q

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)

A

somatic delusion

67
Q

pt feels they are not connected to their body or they don’t exist

A

nihilistic delusion

68
Q

pt feels they are in love with a prominent figure

A

erotomanic delusion (plausible)

69
Q

pt feels their significant other is being unfaithful to them

A

jealous type delustion (plausible)

70
Q

biologic-physical assessment for schizophrenia

A
  • current and past health status and physical exam
  • physical functioning
  • nutritional assessment (some psych meds only work when they bind to food)
  • pharmacologic assessment
71
Q

physical interventions for schizophrenia

A
  • promotion of self-care activities
  • activity/exercise
  • nutrition
  • thermoregulation
  • promotion of normal fluid balance and prevention of water intoxication
  • pharmacologic interventions (antipsychotics and anticholinergics)
72
Q

psychological assessment for schizophrenia

A
  • 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
73
Q

social assessment for schizophrenia

A
  • functional status
  • social systems
  • quality of life
  • family assessment
74
Q

psychological interventions for schizophrenia

A
  • 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
75
Q

T/F: laughing or whispering and then looking towards the pt can set them off

A

True

76
Q

social interventions for schizophrenia

A
  • 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
77
Q

priority care issues for schizophrenia

A
  • suicide assessment
  • aggression and safety of pt, staff, and others
  • antipsychotic medications

Psych (17 decks)

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