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NRSG 331 > Ch. 15: Schizophrenia & Psychotic Disorders > Flashcards

Ch. 15: Schizophrenia & Psychotic Disorders Flashcards

1
Q

Intro: schizophrenia is probably caused by a combination of factors, including:

A
  • Genetic predisposition
  • Biochemical dysfunction
  • Physiological factors
  • Psychosocial stress
  • We still don’t know the exact cause. More predisposed for it if you have a parent with it. Definitely dysfunctional neurotransmitters. Early onset of drug use can cause more mental illness.
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2
Q

treatment for schizophrenia needs to be…

A
  • comprehensive and presented in a multidisciplinary effort
  • There is a sense of loss for people who have schizophrenia. We need to treat with de-stigmatization
  • 1/3 of people with schizophrenia die from suicide
  • High ongoing SI is common
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3
Q

Of all mental illnesses, schizophrenia probably causes more…

A
  • Lengthy hospitalizations
  • Chaos in family life
  • Exorbitant costs to people and governments
  • Fears
  • Majority of people dx w/ it will be dx by age 25
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4
Q

Nature of schizophrenia. It can cause disturbances in:

A
  • Thought processes
  • Perception (often paranoid delusions)
  • Affect (often blunted)
  • there is a severe deterioration of social and occupational functioning
  • In the U.S. the lifetime prevalence of schizophrenia is about 1%
  • Psychosis: a break from reality
  • Sometimes a loss of abstract thinking
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5
Q

4 phases of schizophrenia: phase 1

A
  • Premorbid phase
  • Could be seen as a normal part of puberty or middle school
  • Social maladjustment, antagonistic thoughts and behavior, shy and withdrawn
  • poor peer relationships
  • Doing poorly in school
  • Antisocial behavior
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6
Q

4 phases of schizophrenia: Phase 2

A
  • Prodromal phase
  • A distinct change
  • lasts from a few weeks to a few years
  • Deterioration in role functioning and social withdrawal
  • substancial functional impairment
  • Sleep disturbance, anxiety, irritability
  • Depressed mood, poor concentration, fatigue
  • Perceptual abnormalities, ideas of reference, and suspiciousness herald onset of psychosis
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7
Q

4 phases of schizophrenia: Phase 3

A
  • Schizophrenia
  • Acute psychosis. many have hallucinations.
  • If one gets tx on first break, then prognosis is better overall
  • In the active phase of the disorder, psychotic symptoms are prominent –>
  • Delusions
  • Hallucinations
  • Impairment in work, social relations, and self-care
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8
Q

4 phases of schizophrenia: Phase 4

A
  • Residual phase
  • symptoms similar to those of the prodromal phase
  • Flat affect and impairment in role functioning are prominent
  • One becomes more impaired with the more episodes of psychosis they have
  • Meds and other tx’s help
  • Talk dismissal to voices can help
  • Pts often go off meds
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9
Q

Prognosis of schizophrenia

A
  • A return to full premorbid functioning is not common
  • Better is later onset
  • More positive prognosis if there is no family history
  • And if they are female
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10
Q

Biological Predisposing factors for schizophrenia

A
  • Biological influences: genetics play an important role in dev. of schizophrenia.
  • Biochemical influences: one theory suggests that schizophrenia may be caused by an excess of dopamine activity in the brain. Abnormalities in other neurotransmitters have also been suggested.
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11
Q

Other bio Predisposing factors for schizophrenia

A
  • Factors that have been implicated:
  • Viral infection
  • Anatomical abnormalities
  • Electrophysiology
  • Epilepsy
  • Huntingtons disease
  • Birth trauma, head injury in adulthood, alc. abuse, cerebral tumor, cerebrovascular accident, Lupus
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12
Q

Psyc. Predisposing factors for schizophrenia

A
  • These theories no longer hold credibility. Researchers now focus their studies of schizophrenia as a brain disorder.
  • Psychosocial theories probably developed early on out of a lack of info related to a bio connection
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13
Q

Environment Predisposing factors for schizophrenia

A
  • Sociocultural factors: poverty has been linked with the development of schizophrenia
  • Downward drift hypothesis: Poor social conditions seen as consequence of, rather than a cause of, schizophrenia
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14
Q

more environment Predisposing factors for schizophrenia

A
  • Stressful life events may be associated with exacerbation of schizophrenic symptoms and increased rates of relapse
  • Studies of genetic vulnerability for schizophrenia have linked certain genes to increased risk for psychosis and particularly for adolescents who use cannabinoids
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15
Q

Theoretical integration for schizophrenia

A
  • It is likely a biologically based disease, the onset of which is influenced by factors in the internal or external environment
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16
Q

Side note: complication of clozapine

A

can cause agranulocytosis which one can die from. Rare. A very very effective drug otherwise that can save peoples lives.

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17
Q

Schizophrenia and marijuana use

A

marijuana can cause schizophrenia in 1/10 people who are predisposed to it. Can be after one use, or chronic use.

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18
Q

Types of schizophrenia: Delusional disorder

A
  • Must be at least one month of 1 of the following (remember this criteria)
  • The existence of prominent, nonbizarre delusions
  • Erotomanic type (someone like a celebrity is in love with them)
  • grandiose type, Jealous, persecutory
  • Somatic type or mixed type
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19
Q

Types of psychotic disorders: Brief psychotic disorder

A
  • Sudden onset of symptoms
  • May or may not be preceded by a severe psychosocial stressor
  • Lasts less than 1 month
  • Return to full premorbid level of functioning
20
Q

Substance induced psychotic disorder

A
  • The presence of prominent hallucinations and delusions that are judged to be directly attributable to substance intoxication or withdrawal.
  • can also occur with prescription meds
21
Q

Psychotic disorder associated with another medical condition

A
  • Prominent hallucinations and delusions are directly attributable to a general medical condition
22
Q

Catatonic disorder

A
  • Catatonic features may be associated with other psychotic disorders, such as brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, and substance-induced psychotic disorder
  • Symptoms of catatonic disorder include: Stupor and muscle rigidity or excessive, purposeless motor activity
  • Also waxy flexibility, negativism, echolalia, echopraxia
23
Q

Catatonic disorder associated with another medical condition

A

When we know the general medical condition is causing the catatonic symptoms

24
Q

Schizophreniform disorder

A
  • Same symptoms as schizophrenia with the exception that the duration of the disorder has been at least 1 month but less than 6 months
    1 - 6 months
25
Q

Schizoaffective disorder

A
  • Schizophrenic symptoms accompanied by a strong element of symptomatology associated with the mood disorders either mania or depression
  • Not always worse
  • usually Mood stabilizers are added
26
Q

Assessment: Positive symptoms

A
  • They are what is “added” in schizophrenia, not what is necessarily good.
  • Content of thought !
  • Delusions: false personal beliefs
  • Religiosity: Excessive demonstration of obsession with religious ideas and behavior
  • Paranoia: Extreme suspiciousness of others
  • Magical thinking: Ideas that one’s thoughts or behaviors have control over specific situations
27
Q

Assessment: More examples of positive symptoms

A
  • Form of thought:
  • Associative looseness: shift of ideas from one unrelated topic to another
  • Neologisms: made up words that have meaning only to the person who invents them
  • Concrete thinking: Literal interpretations of the environment
  • Clang associations: choice of words is governed by sound (often rhyming)
28
Q

Assessment: More examples of positive symptoms …. More form of thought

A
  • More form of thought:
  • Word salad: Group of words put together in a random fashion
  • Circumstantiality: Delay in reaching the point of a communication because of unnecessary and tedious details
  • Tangentiality: Inability to get to the point of communication due to introduction of many new topics
  • Mutism: inability or refusal to speak
  • Perseveration: persistent repetition of the same word or idea in response to different questions
29
Q

Assessment: More examples of positive symptoms … perceptions …

A
  • Perception: interpretation of stimuli through the senses
  • Hallucinations: false sensory perceptions not associated with real external stimuli (auditory, visual, tactile, gustatory, olfactory)
  • Illusions/delusions: misperceptions of real external stimuli
30
Q

Assessment: More examples of positive symptoms … Sense of self …

A
  • Sense of self: The uniqueness and individuality a person feels
  • Echolalia: repeating words that are heard
  • Echopraxia: Repeating movements that are observed
  • Identification and imitation: taking on the form of behavior one observes in another
  • Depersonalization: feelings of unreality
31
Q

Assessment: Negative symptoms - Affect -

A
  • What they have lost. A loss of normal functions.
  • Affect: The feeling state or emotional tone
  • Inappropriate affect: emotions are incongruent with the circumstances
  • Bland: weak emotional tone
  • Flat: Appears to be void of emotional tone
  • Apathy: disinterest in the environment
32
Q

Assessment: Negative symptoms - Avolition -

A
  • Avolition: impairment in the ability to initiate goal-directed activity
  • Emotional ambivalence: coexistence of opposite emotions toward same object, person, or situation.
  • Deterioration in appearance: impaired personal grooming and self-care activities
33
Q

Assessment: Negative symptoms - Impaired things -

A
  • Impaired interpersonal functioning and relationship to the external world
  • Impaired social interaction: Clinging and intruding on the personal space of others, exhibiting behaviors that are not culturally and socially acceptable
  • Social isolation: A focus inward on the self to the exclusion of the external environment
34
Q

Assessment: Negative symptoms - Lack of insight -

A
  • Anosognosia: Lack of awareness of any illness or disorder
  • Anergia: deficiency of energy
  • Anhedonia: inability to experience pleasure
  • Lack of abstract thinking ability
35
Q

Assessment: Negative symptoms - Xtra ones -

A
  • Waxy flexibility: passive yielding of all movable parts of the body to any effort made at placing them in certain positions
  • Posturing: Voluntary assumption of inappropriate or bizarre postures
  • Pacing and rocking
  • Regression
  • Eye movement abnormalities
36
Q

Nursing outcomes: A few examples

A
  • The client…
  • Demonstrates an ability to relate to others satisfactorily
  • Recognizes distortions of reality
  • Has not harmed self or others
  • Maintains anxiety at a manageable level
37
Q

Intervention for disturbed thought process…

A
  • Do not argue or deny the belief
  • Reinforce and focus on reality
38
Q

Interventions for patients at risk for violence

A
  • Observe client’s behavior
  • Maintain calm attitude
  • Have sufficient staff on hand
39
Q

Educate client and family on:

A
  • Nature of illness and what to expect as illness progresses
  • Symptoms associated with illness
  • Ways for family to respond to behaviors associated with illness
40
Q

Individual psychotherapy

A

Long term therapeutic approach; difficult because of client’s impairment in interpersonal functioning

41
Q

Group therapy

A

some success if occurring over the long-term course of the illness; less successful in acute, short-term treatment

42
Q

The recovery model

A

A concept of healing and transformation enabling a person with mental illness to live a meaningful life in the community while striving to achieve his or her full potential

43
Q

Recovery after an initial schizophrenia episode (RAISE)

A

A program of case management that takes a team approach in providing comprehensive, community based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness

44
Q

Two types of antipsychotics

A
  • Typicals: Dopaminergic blockers with various affinity for cholinergic, a-adrenergic, and histaminic receptors
  • Atypicals: Weak dopamine antagonists; potent 5HT2A antagonists; also exhibit antagonism for cholinergic, histaminic, and adrenergic receptors.
45
Q

EPS symptoms include:

A
  • Pseudoparkinsonism
  • Akinesia
  • Akathisia
  • Dystonia
  • Oculogyric crisis
  • Antiparkinsonian agents may be prescribed to counteract EPS.
  • AIMS examination to screen for Tardive Dyskinesia
46
Q

The client should…

A
  • Not stop taking the drug abruptly
  • Use sunscreen and protective clothing
  • Be aware of possible risks during pregnancy
  • not drink alcohol
  • Not consume other meds without the physician’s knowledge

NRSG 331 (26 decks)

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