Ch. 24 - Schizophrenia Flashcards
Schizophrenia is caused by an elevation of what neurotransmitter?
Dopamine
Why should you suggest that a schizophrenic person wears white socks?
they have reduced pain sensitivity. If they wear white socks they are more likely to notice if there has been damage to their feet.
T or F: There is increase risk for suicide in patients with schizophrenia
true
Why is it important to monitor a schizophrenic patients blood sugar?
reduced insulin sensitivity
Why do schizophrenic people have morbid obesity, reduced insulin sensitivity, elevated cholesterol and HTN?
increased cortisol (metabolic syndrome)
What is downward drift theory?
person moves to lower socioeconomic class…
example - parent kicks kid out of house because they can’t deal or are scared. Kid has to live on streets
What is RAIN PM? (Hint risk factors for child onset)
Relatives Attention impairment Impaired cognitive Neuromotor difficulty Positive symptoms Memory impairment
Side note: Kids with ADHD may be schizophrenic later in life
What is double blind communication?
damned if I do, damned if I don’t
(you punch your brother who you love or I will punch you)
splitting
hostile
critical
CONTRADICTORY
GOOGLE: A double bind is an emotionally distressing dilemma in communication in which an individual (or group) receives two or more conflicting messages, and one message negates the other.
What are the four stages in the course of illness?
Premorbid
Prodromal
Acute
Residual
What is the premorbid stage?
think PRE adolescent (12-15)
BEFORE diagnosis
Shy, withdrawn, somatic complaints, antisocial, poor peer relationships
What is the prodromal stage?
Adolescent age (15-18)
This is when you see changes in their academia, poor concentration
Even more withdrawn
Aggressive, anxious, irritable, depressed, sleep disturbances
Rituals, magical thinking,
What is the acute stage?
Schizophrenia
18+
Usually schizophrenia is diagnosed at age 18-19.
Here is when we see acute onset of positive and negative symptoms of schizophrenia
- hallucinations
- delusions
- disorganized speech
- alogia
- flat affect
- catatonia
What is the residual stage?
client is in remission. still impaired socially and occupationally. negative signs present but not always psychotic.
What is alogia?
Alogia is the inability to speak because of mental defect, mental confusion, or aphasia. It is a speech disturbance that can be seen in people with dementia. However, it is often associated with the negative symptoms of schizophrenia.
What is catatonia?
cat·a·to·ni·a
ˌkatəˈtōnēə/Submit
nounPSYCHIATRY
abnormality of movement and behavior arising from a disturbed mental state (typically schizophrenia). It may involve repetitive or purposeless overactivity, or catalepsy, resistance to passive movement, and negativism.
disorganized speech
https://www.youtube.com/watch?v=avbfd_OkLoU
Positive symptoms are?
Think Positive (+)
ADDING to a person
-adding things that are not there…hallucinations…illusions
-adding visuals, seeing things that are not there
-add smells, smelling things that are not there etc.
-add thoughts, adding beliefs (delusions, paranoia, magical thinking)
-add language/language issues:
……creating words that are not real (neologisms), word salad, echolalia, etc
A person with schizophrenia has a strange sense of self. Here are some ways this manifests:
…….echopraxia (imitating others to identify with them)
….depersonalization - unstable self identity leads to unreality - feels like limbs have changes size or they are seeing themselves from a distance)
Negative symptoms are?
(go unnoticed longer)
negative (-) minus, removing
- removing emotions=becomes flat, apathetic, anhedonia, ambivalent or INAPPROPRIATE, AUTISTIC
- removing themselves from society and others
- remove posture - slumped
- remove movement - becomes catatonic
- remove attention - harder time concentrating,
- remove motivation - avolition and lacks goal oriented behavior, ambivalent (can’t make decision)
- remove hygiene - deteriorated appearance
- remove energy - anergia
“Negative appearances”
Appearances - Postures/waxy flexibiity, pacing, rocking
If schizophrenia and bipolar had a baby, what would he be called?
schizoaffective disorder
some will only have major depressive, manic or mixed episode of depr&manic + schizophrenia
How long must you have signs/symptoms to be diagnosed with schizophrenia?
6 months.
What is negativism?
doing the opposite of a request or instructions OR no response to request or instructions
What is it called when you have hallucinations, delusions, disorganized speech, and possibly disorganized/catatonic behavior for one day to one month’s time?
brief psychotic disorder
What is is called when you think someone of a higher status loves you?
erotomanic
What is is called when a person has erotomanic beliefs, grandiose beliefs, is jealous and thinks their partner is unfaithful, feel that they are being persecuted, believes they have a medical condition (somatic), OR A COMBINATION of those listed above for at least one month but less than six months?
delusional disorder
In delusional disorder:
- hallucinations are NOT prominent.
- Behavior is NOT bizarre.
Bizarre = clearly implausible, not understandable, nor derived from ordinary life experiences
If a person is in alcohol withdrawal and begins to hallucinate, what is the disorder called?
substance/medication induced psychotic disorder
A person has a tumor on their occipatal lob of the brain and has visual disturbances. What is the name of the disorder?
psychotic d/o due to medical condition
catatonia examples (negativism, waxy flexibilty, etc)
https://www.youtube.com/watch?v=_s1lzxHRO4U
How can you remember what is part of catatonic?
catatonic (like a cat in pajamas, they lay there frozen)
or copy cat - person copies (actions, words, etc)
What are some causes of catatonia?
-metabolic disorders
(encephalopathy, hypo/hypothyroid, hypo/hyperadrenalism, b12 deficiency)
-neurological disorders
(epilepsy, tumors, cerebrovascular disease, head trauma and encephalitis)
What is the difference between schizophreniform and delusional disorder?
Same: Timeframe is minimum one month. Delusions present.
Difference: Schizophreniform is identical to schizophrenia. Behavior will be bizarre.
If a patient has schizophreniform, but they do not have blunted or flat affect, does this person have a better or worse prognosis?
better
If rapid onset of symptoms or premorbid social life and occupational was good, also good sign
If a patient has schizophreniform and their condition does not get better by 6 months, what happens?
Diagnosis changes to schizophrenia
Can a person be labeled schizoaffective if the symptoms are related to substance or medical condition?
no
What is the disorder called when a patient has hallucinations and/or delusions that occur for at least two weeks in the absence of a mood disorder BUT the prominent mood disorder symptoms are evident for the majority of time?
schizoaffective
If you see two disorders, likely it is schizoaffective
Positive symptoms are things the patient _____ or ____. Negative symptoms are the things we ____
thinks or says
see (when we look at them - physically or socially)
In the positive signs of schizophrenia, we notice eccentricities of language (some weird/odd stuff). What are they ?
Loose associations (tangential, circumstanstial) "When I go outside with my halo on I can see the wind blow. When I was nineteen my brother lived here. BUt my halo helps me communicate with trees."
Blocking - trouble expressing thought/blocked thought
Clanging - rhyming…. Jane rains pain
Echolalia - yelling into the canyon echoes…same stuff
Neologisms - neo=new, makes up new words
Perserveration - repeating the same word or idea in response to different questions.
Word salad - incoherent groups of words, not logically connected “Shoes live toads cold sandwiches”
Mutism - can’t talk or refuses to talk
What is it called when a schizophrenic person asks, “did you hear that?”
reality checking
This is SUPER important to do when they client says they hear, smell, see, etc something!
What is it called when someone thinks their thoughts are heard by others?
thought broadcasting
nihilism
https://www.youtube.com/watch?v=zX9OTDzyNdQ
A person says “I am dead” and they ACTUALLY think they are dead?
nihilism
self, part of self or others, or world is non existent
No reality here…..
Which of the symptoms listed are positive signs of schizophrenia? Select all that apply:
A. Visual hallucinations B. Making up words C. Withdrawal D. Agitation E. Introducing unrelated topics
A,B,D,E
Which of the symptoms listed are negative signs of schizophrenia? Select all that apply:
A. loos associations B. religious delusions C. Woman laughs when told her friend died D. Man lives in own fantasy world E. Body part stuck in one position F. Lack of motivation to get up
C - inappropriate affect (negative/remove emotions)
D - autism (withdrawn into self)
E - waxy flexibilty (negative appearances, removal of movement)
F - anergia (remove energy)
What are some causes of acute exacerbation?
- non compliance with meds
- social isolation (becomes preoccupied with thoughts, feels rejected and lonely)
- lack of support
- STRESS
When a patient states “I hear voices” you should say which of the following:
A. What are the voices telling you?
B. What are they telling you?
A.
referring to the voices as “they” validates them.
we want the patient to realize that the voices are not real. If they do not get to that point, the hallucinations will not be fixed.
Should you have a paranoid schizophrenic attend group meetings?
no.
When should you intervene with a schizophrenic patient?
at the first sign of increased anxiety, agitation or aggression.
If a patient is sitting alone laughing and talking to self or staring into space, what should you do?
Ask them what they are experiencing and provide for their support and safety. They may be responding to internal stimuli.
Name some key interventions we should use for schizophrenia patients….
- establish trust and rapport
- reality check
- help patient realize feelings/triggers
- do not challenge or agree with hallucinations/delusions
- start 1 to 1 before moving to group
- protect from harm (assess for DTS/DTO)
- Psychopharmacology
- model appropriate behavior (naked, redirect)
A schizophrenic client begins masturbating in the day room. What is the initial action of the nurse?
A. Tell everyone else to leave the room
B. Tell the client his behavior is inappropriate
C. Ask the client if he is feeling anxious
D. Ask the client if he needs privacy and escort him to his room.
D.
A. Correct his behavior NOT the group
B. Model behavior, show them the way but do not shame them. Masturbating is not inappropriate, the environment was.
C. Really? Does he look anxious (LOL)
D. Yep. Model behavior, let’s go do this in private.
T or F: Antipsychotics, major tranquilizers and neuroleptics are all the same thing
Yes.
Drugs affecting the CNS. By any name, they are the same.
How do antipsychotic meds work (the mechanism of action)?
Decreases dopamine
Blocks postsynaptic receptors
What is a common side effect of antipsychotic meds called that causes a blue rash?
photosensitivity
If a person taking antipsychotics states that they feel like they have the flu, what should we check for?
Blood dyscrasias/agranulocytosis
can also cause thrombocytopenia (causing bruises and petechia)
What are the meds in 1st generation antipsychotics?
zines
chlorpromazine (Thorazine) prochlorperazine (Compazine) trifluoperazine (Stelazine) fluphenazine (Prolixin) thioridazine (Mellaril) perphenazine (Trilafon)
thiothixene (Navane)
haliperidol (Haldol)
What are the meds in the 2nd generation antipsychotics?
idone/apine
clozapine (Clozaril) olanzapine (Zyprexa) quetiapine (Seroquel) ziprasidone (Geodon) asenapine (Saphris) Ilioperidone (Fanapt)...feel ill take a nap paliperidone (Invega) risperidone (Risperdal)
What are the meds in the 3rd generation antipsychotics?
aripriprazole (Abilify)
