Chapter 12

Question 0

Usually described as odd or eccentric. Do not have hallucinations or delusions. Altered interpersonal boundaries, inappropriate expression of emotion, increased mistrust, difficulty setting goals.

Answer 0

Schizotypal Personality Disorder

Question 1

Experiences non bizarre delusions (situations that could occur in real life: having a disease, being loved by someone, being followed).

Answer 1

Delusional disorder

Question 2

Acute onset of psychosis (delusions, hallucinations, disorganized speech) or grossly disorganized or catatonic behavior in response to extreme stress.

Answer 2

Brief psychotic disorder (lasts less than 1 month, full recovery)

Question 3

Psychosis induced by drugs of abuse, alcohol, medications, or toxins

Answer 3

Substance-induced psychotic disorder

Question 4

Psychosis or catatonia caused by a medical condition (delirium, neurological/metabolic condition, hepatic/renal disease, etc.)

Answer 4

Psychosis or Catatonia associated with another medical condition

Question 5

A person has many features of schizophrenia but has had these for a period of less than six months. May or may not develop into schizophrenia

Answer 5

Schizophreniform disorder

Question 6

An episode of major depression, mania, or mixed depression and mania occur in the presence of symptoms of schizophrenia.

Answer 6

Schizoaffective disorder

Question 7

Comorbidity for Schizophrenia:

Answer 7

Substance abuse (especially nicotine)
Anxiety, depression, and suicide
Physical health illnesses
Polydipsia

Question 8

Neurotransmitters associated with schizophrenia:

Answer 8

Dopamine and Serotonin (high levels)

**Maybe also glutamate and Acetylcholine

Question 9

First-generation anti-psychotics affect which neurotransmitter?

Answer 9

Dopamine

Question 10

Second-generation antipsychotics affect which neurotransmitters?

Answer 10

Serotonin and dopamine

Question 11

Brain abnormalities in patients with schizophrenia include:

Answer 11

Enlargement and asymmetry of ventricles
Reduced gray matter
Temporal and Frontal lope shrinkage

Question 12

______ symptoms appear a month- more than a year before the first psychotic breakdown

Answer 12

Prodromal

Question 13

Symptoms before the illness:

Answer 13

Socially awkward
Lonliness
Depression 
Vague/odd/eccentric expression 
Anxiety, phobias, obsessions, dissociation, compulsions

Question 14

Phase when hallucinations, delusions, apathy, and withdrawal appear. Loss of functional abilities, increased care or hospitalization may be required.

Answer 14

Acute (1)

Question 15

Phase when symptoms diminish and there is movement towards baseline functioning. Partial hospitalization or care in a residential crisis center or supervised group home may be needed.

Answer 15

Stabilization (2)

Question 16

Phase where patient is at or near baseline functioning. Symptoms are diminished and level of functioning allows the patient to live in the community.

Answer 16

Maintenance (3)

Question 17

Recognizing early signs of relapse such as reduced ______ and _________ can help prevent relapse.

Answer 17

Sleep, concentration

Question 18

True or False: Adherence to antipsychotics is more important than the risk of side effects.

Answer 18

True- Most side effects are reversible, whereas consequences of relapse are not.

Question 19

Identify which are positive symptoms and which are negative symptoms of schizophrenia:

1. Delusions
2. Poor hygiene
3. Anhedonia
4. Hallucinations
5. Abnormal movements
6. Decreased motivation (avolition)

Answer 19

1. Delusions: positive
2. Poor hygiene: negative
3. Anhedonia: negative
4. Hallucinations: positive
5. Abnormal movements: positive
6. Decreased motivation: negative

Question 20

Symptoms present that are not normally present.

Answer 20

Positive symptoms

Question 21

Symptoms characterized by the absence of something that should be present.

Answer 21

Negative symptoms

Question 22

Symptoms characterized by subtle changes in memory, attention, or thinking. An example is…

Answer 22

Cognitive symptoms, impaired executive functioning (ability to set priorities or make decisions)

Question 23

Identify if the symptom is positive or negative:

1. Bizarre behavior
2. Paranoia
3. Gross errors in thinking
4. Associative looseness
5. Blunted affect
6. Poverty of thought (alogia)

Answer 23

1. Bizarre behavior- positive
2. Paranoia- positive
3. Gross errors in thinking- positive
   4- Associative looseness- positive
   5- blunted affect- negative
   6- Alogia- negative

Question 24

True or False: Negative symptoms are the first to appear in schizophrenia

Answer 24

False- Positive symptoms

Question 25

Alterations in thought might best be tested by...

Answer 25

reality testing

Question 26

True or False: The patient having a delusion should be offered reality to help diminish affects.

Answer 26

FALSE: this is counterproductive.

Question 27

What should the nurse do when a patient is having a delusion?

Answer 27

-Look for and address underlying themes or needs

Question 28

Concreteness can be assess through...

Answer 28

The patient's interpretation of proverbs

Question 29

Positive symptoms are categorized into:

Answer 29

Alterations in thought, speech, perception, and behavior

Question 30

Alteration in speech where threads are interrupted and disjointed

Answer 30

Associative looseness

Question 31

Delusions in which the patient believes that another person, group of people, or external force controls thoughts, feelings, impulses or behavior have the underlying theme of...

Answer 31

control

Question 32

Delusions in which the patient gives personal significance to unrelated or trivial events, perceives events as relating to themselves when they do not have the underlying theme of...

Answer 32

Ideas of reference

Question 33

Believing that one is being singled out for harm by others, especially by those in positions of power are delusions with the underlying theme of

Answer 33

Persecution

Question 34

Believing that one is very powerful or important are delusions with the underlying theme of...

Answer 34

Grandeur

Question 35

Believing that the body is changing in unusual ways (such as rotting from the inside) is a delusion with the underlying theme of...

Answer 35

Somatic

Question 36

Believing that another person desires you romantically has the underlying them of...

Answer 36

Erotomanic

Question 37

Believing that one's mate is unfaithful has the underlying theme of...

Answer 37

Jealousy

Question 38

Choosing words based on their sound rather than their meaning. Often words rhyme or have similar beginning sound.

Answer 38

Clang association

Question 39

A jumble of words that is meaningless to the listener and possibly speaker. Extreme levels of disorganization

Answer 39

Word salad

Question 40

Made-up words that have meaning to the patient but a different or non-existent meaning to others.

Answer 40

Neologisms

Question 41

The pathological repeating of another's words. Often seen in catatonia

Answer 41

Echolalia

Question 42

An irrational fear of others, ranging from mild (wariness, guardedness) to profound (thinking someone will kill you)

Answer 42

Paranoia

Question 43

Alterations in perception include...

Answer 43

Depersonalization Derealization Hallucinations Illusions

Question 44

A feelings that one is somehow different or unreal or has lost his identity.

Answer 44

Depersonalization

Question 45

A false perception that the environment has changed (everything bigger or smaller, or familiar surroundings feeling strange)

Answer 45

Derealization

Question 46

____________ is perceiving a sensory experience for which no external stimulus exists while _________ are misperception or misinterpretation of a real experience.

Answer 46

Hallucinations, Illusions

Question 47

___________ hallucinations direct the person to take action. They are a ______________ and the nurse should assess....

Answer 47

Command, psychiatric emergency, assess what the patient heard and the patient's ability to recognize it as not real and ability to resist

Question 48

A patient tilts his head and often stops activity and moves lips silently. The nurse should...

Answer 48

Suspect hallucinations and assess the patient for command hallucinations

Question 49

True or False: Visual hallucinations should be assessed as a sign of mental illness

Answer 49

False: Usually in organic disorders (withdrawal, dementia)

Question 50

The four affects of schizophrenia:

Answer 50

Flat Blunted Inappropriate Bizarre

Question 51

Affective symptoms include those related to _______ and nurse should assess for __________.

Answer 51

Mood, depression

Question 52

True or False: The nurse should speak to coworkers about frustration felt when dealing with schizophrenic patients.

Answer 52

True- helps avoid countertransference

Question 53

An inability to realize oneself as ill.

Answer 53

Anosognosia (often caused by the illness itself)

Question 54

The overall goal for the acute phase is...

Answer 54

Patient safety and stabilization

Question 55

Outcomes for the stabilization phase:

Answer 55

- Understand illness and treatment - Become stabilized on medication - Control or cope with symptoms

Question 56

Outcomes for the maintenance phase:

Answer 56

- Maintain achievements - Adhere to treatment - Prevent relapse - Achieve independence and satisfactory quality of life

Question 57

Nursing diagnosis for positive symptoms of schizophrenia:

Answer 57

Disturbed sensory perception (auditory/visual) Risk for self-directed/other-directed violence Impaired verbal communication

Question 58

Nursing diagnosis for negative symptoms:

Answer 58

``` Social isolation Risk for loneliness Chronic low self-esteem Risk for self-directed violence Ineffective coping Constipation Self-care deficit ```

Question 59

Effective care provides:

Answer 59

Protection and structure

Question 60

____________ may enhance the effectiveness of antipsychotics. ________ is used during acute exacerbations of psychosis to hasten response to antipsychotics. ________ may be given with clozapine to improve effects, and _______________ and __________ are very important for patients with schizoaffective disorder.

Answer 60

Mood stabilizing agents, Valporate, Lamotrigine, antidepressants, mood stabilizers

Question 61

True or False: The nurse should involve the family in care for the patient with schizophrenia

Answer 61

True (if the patient agrees)