Chapter 12: Schizophrenia Spectrum Disorders

Question 1

How long does someone have to experience delusions to have delusional disorder?

Answer 1

1 month or longer

Question 2

How long does someone experiencing a brief psychotic disorder experience symptoms?

Answer 2

longer than a day but less than 1 month

Question 3

What kind of substances can induce delusions and/or hallucinations?

Answer 3

illicit drugs, alcohol, medications, or toxins

Question 4

When does schizophrenia typically begin?

Answer 4

between 15 and 25

Question 5

People may experience diminished school performance and cognitive ability. They may become less socially engaged or adept. They may also demonstrate attenuated (mild) psychotic symptoms, such as suspiciousness and/or eccentric or disorganized speech or thought in which phase of schizophrenia

Answer 5

prodromal phase

Question 6

Does Schizophrenia affect a specific culture/race?

Answer 6

no

Question 7

When are suicide attempts most common when someone is diagnosed with Schizophrenia?

Answer 7

within the first 3 years

Question 8

What are some comorbidities associated with schizophrenia?

Answer 8

substance abuse disorders, anxiety, depression, suicide, polydipsia, and physical illness

Question 9

What symptoms must a person experience and for how long to be considered for a schizophrenia diagnosis?

Answer 9

At least one of these three must be present:
delusions, hallucinations, disorganized speech

These could be present:
grossly disorganized or catatonic behavior, and negative symptoms (diminished emotional expression or abolition)

At least 2 of these symptoms for a significant portion of a one month period

Question 10

What must happen to someone’s level of functioning to be considered for a diagnosis of schizophrenia?

Answer 10

it must be markedly below the level achieved before the onset
(in areas such as: work, interpersonal relationships, or self-care)

Question 11

How long does a person need to have continuous signs of disturbances for consideration of a schizophrenia diagnosis?

Answer 11

at least 6 month with at least 1 month of symptoms

Question 12

What must be ruled out before someone can receive a diagnosis for schizophrenia?

Answer 12

schizoaffective disorder and depressive or bipolar disorder

Question 13

How can schizoaffective and depressive or bipolar disorder be ruled out when attempting to make a schizophrenia diagnosis?

Answer 13

the patient must have either had (1) no depressive or manic episodes occurring concurrently with the active-phase symptoms or (2) if mood episodes have occurred during active phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness

Question 14

What can the disturbances not be attributed to if someone is being considered for a schizophrenia diagnosis?

Answer 14

physiological effects of a substance or another medical condition

Question 15

If the history of autism spectrum disorder or a communication disorder of childhood onset, how can the additional diagnosis of schizophrenia be diagnosed?

Answer 15

only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia are also present for at least a month

Question 16

If there is a sudden increase in psychotic activity, what electrolyte should be looked at?

Answer 16

sodium (specifically hyponatremia)

Question 17

What percentage of the risk of schizophrenia is genetic?

Answer 17

about 80%

Question 18

Which neurotransmitter plays a role in schizophrenia development?

Answer 18

dopamine, serotonin, glutamate, GABA, and acetylcholine

Question 19

What are the differences in brain structure for a patient who has schizophrenia?

Answer 19

reduced volume in the right anterior insula, reduced volume and changes in shape of the hippocampus, accelerated age-related decline in cortical thickness, gray matter deficits, reduced connectivity amount various brain regions, neuronal overgrowth, widespread white matter abnormalities

Question 20

What do PET scans show in a schizophrenic patient?

Answer 20

a lowered rate of blood flow and glucose metabolism in the prefrontal cortex

Question 21

What are prenatal stressors that can increase the risk of schizophrenia?

Answer 21

infection, a father above the age of 35 when conception occurs, and being born during late winter or early spring

Question 22

What are some environmental factors that increase the risk of schizophrenia?

Answer 22

increased cortisol levels, developmental and family stress, toxins such as tetrachloroethylene (found in old water pipes and used in dry cleaning), childhood sexual abuse, exposure to social adversity, migration, and psychological trauma

Question 23

What are factors that are associated with a less positive prognosis for schizophrenia?

Answer 23

a slow onset (more than 2 Years), younger age at onset, longer duration between Symptoms onset and first treatment, longer periods of untreated illness, and more negative symptoms

Question 24

What are factors that improve the prognosis of schizophrenia?

Answer 24

reducing the frequency, intensity, and duration of relapse

Question 25

Symptoms such as hallucinations, delusions, apathy, social withdrawal, diminished affect, anhedonia, disorganized behavior, and impaired judgment and cognition result in functional impairment. The person can have difficulty coping, and symptoms become apparent to others. This phase can last several months.

Answer 25

Acute phase

Question 26

In this phase, symptoms are stabilizing and diminishing, and there is movement toward a previous level of functioning. This phase can last for months. Care in an outpatient mental health center or a partial hospitalization program may be needed

Answer 26

stabilization

Question 27

In this phase, the condition has stabilized and a new baseline may be established. Positive symptoms (described later) are usually significantly diminished or absent, but negative and cognitive symptoms continue to be a concern

Answer 27

maintenance or residual phase

Question 28

What are factors that can reduce the risk of developing schizophrenia?

Answer 28

enhanced coping and social skills

Question 29

What is done in an initial assessment of a schizophrenic patient?

Answer 29

Mental state exam along with a review of spiritual, cultural, biological, psychological, social, and environmental factors that might be affecting the presentation

Question 30

What are the positive symptoms of schizophrenia?

Answer 30

The presence of symptoms that should not be present. Positive symptoms include hallucinations, delusions, paranoia, or disorganized or bizarre thoughts, behavior, or speech

Question 31

What are the negative symptoms of schizophrenia?

Answer 31

The absence of qualities that should be present. Negative symptoms include the inability to enjoy activities (anhedonia), social discomfort, or lack of goal-directed behavior

Question 32

What are cognitive symptoms associated with schizophrenia?

Answer 32

Subtle or obvious impairment in memory, attention, thinking (e.g., disorganized or irrational thoughts); impaired executive functioning (e.g., impaired judgment, impulse control, prioritization, and problem solving)

Question 33

What are affective symptoms associated with schizophrenia?

Answer 33

Symptoms involving emotions and their expression

Question 34

What is reality testing?

Answer 34

the automatic and unconscious process by which we determine what is and is not real

Question 35

How do the symptoms of schizophrenia alter a person's life?

Answer 35

the symptoms alter the individual's ability to work, build/maintain interpersonal relationships, self-care abilities, social functioning, and the quality of life that the patient can have

Question 36

What are delusions?

Answer 36

false beliefs that are held despite a lack of evidence to support them

Question 37

What are the most common delusions?

Answer 37

persecutory, grandiose, or religious ideas

Question 38

Results from haphazard and illogical thinking where concentration is poor and thoughts are only loosely connected

Answer 38

associative looseness

Question 39

the most extreme form of associative looseness, is a jumble of words that is meaningless to the listener

Answer 39

word salad

Question 40

choosing words based on their sound rather than their meaning and often involves words that rhyme or have a similar beginning sound

Answer 40

clang association

Question 41

words that have meaning for the patient but a different or nonexistent meaning for others

Answer 41

neologisms

Question 42

What are persecutory delusions?

Answer 42

Believing that one is being singled out for harm or prevented from making progress by others

Question 43

What are grandiose delusions?

Answer 43

Believing that one is a powerful or important person

Question 43

What are grandiose delusions?

Answer 43

Believing that one is a powerful or important person

Question 44

What type of speech pattern is seen when the patient is Including unnecessary and often tedious details in conversation but eventually reaching the point?

Answer 44

circumstantiality

Question 45

What is thought insertion?

Answer 45

The often uncomfortable belief that someone else has inserted thoughts into the patient’s brain

Question 46

What is thought deletion?

Answer 46

A belief that thoughts have been taken or are missing

Question 47

Believing that reality can be changed simply by thoughts or unrelated actions

Answer 47

magical thinking

Question 48

occur when a person perceives a sensory experience for which no external source exists

Answer 48

hallucinations

Question 49

What is clozapine?

Answer 49

anti-psychotic used for schizophrenia that causes agranulocytosis

Question 50

What lab value should a nurse monitor for a patient on clozapine?

Answer 50

ANC (absolute neutrophil count)

Question 51

A feeling of being unreal or having lost an element of one’s person or identity. For example, body parts do not belong, or the body has drastically changed

Answer 51

depersonalization

Question 52

A feeling that the environment has changed

Answer 52

Derealization

Question 53

A pronounced increase or decrease in the rate and amount of movement. Excessive motor activity is purposeless. The most common form is when the person moves little or not at all

Answer 53

catatonia

Question 54

Excited behavior, such as running or pacing rapidly, often in response to internal or external stimuli

Answer 54

motor agitation

Question 55

Repetitive behaviors that do not serve a logical purpose

Answer 55

stereotyped behaviors

Question 56

Echopraxia

Answer 56

the mimicking of movements of another

Question 57

A tendency to resist or oppose the requests or wishes of others

Answer 57

negativism

Question 58

6 As for negative symptoms associated with schizophrenia

Answer 58

Anhedonia, avolition, asociality, affective blunting, apathy, alogia

Question 59

What is anhedonia?

Answer 59

a reduced ability or inability to experience pleasure

Question 60

What is avolition?

Answer 60

reduced motivation or goal-directed behavior

Question 61

What is alogia?

Answer 61

reduction in speech

Question 62

How can affect in schizophrenia be characterized?

Answer 62

flat, blunted, constricted, inappropriate, bizarre

Question 63

What is the biggest provider of mental health services in our country?

Answer 63

the prison system

Question 64

If a nurse asks what brought the patient to the hospital, and the patient answers “a cab” rather than “a suicide attempt," what kind of thinking is this patient demonstrating?

Answer 64

Concrete thinking

Question 65

What does memory impairment typically affect in a schizophrenic patient?

Answer 65

short-term memory and ability to learn

Question 66

What kind of impairment can lead to problems such as delayed responses, misperceptions, or difficulty understanding others?

Answer 66

impaired information processing

Question 67

What kind of impairment can interfere with problem solving and can contribute to inappropriateness in social situations?

Answer 67

impaired executive functioning

Question 68

What is the inability to realize one is ill (this thinking is caused by the illness itself)?

Answer 68

anosognosia

Question 69

What is a serious affective change often seen in schizophrenia?

Answer 69

comorbid major depressive disorder

Question 70

What should outcomes focus on for schizophrenic patients?

Answer 70

illness knowledge, management, coping, and quality of life

Question 71

What is the overall goal of phase 1: acute treatment of schizophrenia?

Answer 71

patient safety and stabilization

Question 72

What does the outcome criteria of phase II: stabilization of schizophrenia focus on?

Answer 72

understanding the illness and treatment, achieving an optimal medication and psychosocial treatment regimen, and controlling and/or coping with symptoms and side effects

Question 73

What is done during phase III: maintenance for schizophrenic patients?

Answer 73

raining and increasing symptom control and optimal functioning

Question 74

What is the best known and strongest consumer and family support organization?

Answer 74

NAMI (the national alliance on mental illness)

Question 75

When would close monitoring, helping the patient to feel safe, and maintaining separation of the patient and potential victim be indicated?

Answer 75

if the patient is experiencing hallucinations

Question 76

Which settings can provide a therapeutic milieu in a less restrictive setting than the hospital?

Answer 76

crisis centers and partial hospitalization programs

Question 77

What kind of drugs are first-generation antipsychotics?

Answer 77

dopamine receptor antagonists

Question 78

What kind of drugs are haloperidol and chlorpromazine?

Answer 78

first-generation antipsychotics

Question 79

What are second-generation antipsychotics also known as?

Answer 79

atypical antipsychotics

Question 80

What are first-generation antipsychotics also known as?

Answer 80

antipsychotics or neuroleptics

Question 81

How do second-generation antipsychotics work?

Answer 81

they are serotonin and dopamine receptor antagonists

Question 82

What kind of drugs are clozapine and risperidone?

Answer 82

second-generation antipsychotics

Question 83

What is the biggest difference between first generation antipsychotics and second-generation antipsychotics?

Answer 83

first-generation antipsychotics primarily treat positive symptoms and have little effect on negative symptoms. Second-generation anti-psychotics treat positive symptoms and can also help negative symptoms

Question 84

Which type of antipsychotic drug tends to produce fewer and better-tolerated side effects?

Answer 84

second-generation antipsychotics

Question 85

How long does it typically take for antipsychotic drugs to become effective?

Answer 85

2-6 weeks

Question 86

Major side effects of antipsychotics

Answer 86

discontinuation syndrome, drooling, orthostatic hypotension, sedation, and gait impairment

Question 87

What does the blockage of dopamine receptors in the motor center of the brain cause (in regards to first-generation antipsychotic drug side effects)?

Answer 87

extrapyramidal side effects

Question 88

What kind of extrapyramidal side effects can occur from first-generation antipsychotics?

Answer 88

acute dystonia, akathisia, and pseudoparkinsonism

Question 89

What is a sudden, sustained contraction of one or several muscle groups (usually in the head or neck)?

Answer 89

acute dystonia

Question 90

What is akathisia?

Answer 90

a motor restlessness that causes pacing and/or inability to stay still or remain in one place

Question 91

What kind of symptoms are seen in pseudoparkinsonism?

Answer 91

tremor, reduced accessory movements, gait impairment, reduced facial expressiveness, and slowing of motor behavior

Question 92

Which two drugs can treat tardive dyskinesia?

Answer 92

valbenazine (ingrezza) and deutrabenazine (austedo)

Question 93

What kind of drugs are valbenazine (ingrezza) and deutrabenazine (austedo)?

Answer 93

selective vesicular monoamine transporter inhibitors

Question 94

What can drugs like trihexyphenidyl (Artane), benztropine (Cogentin) and diphenhydramine (Benadryl) do?

Answer 94

counteract pseudoparkinsonism

Question 95

To provide effective care for the patient who is taking a second-generation antipsychotic, the nurse should frequently assess for

Answer 95

Metabolic syndrome

Question 96

A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?

Answer 96

She should experience a reduction in hallucinations.

Question 97

Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?

Answer 97

Paranoia

Question 98

When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that

Answer 98

They are not actually ill