Chapter 12: Schizophrenia Spectrum Disorders Flashcards
How long does someone have to experience delusions to have delusional disorder?
1 month or longer
How long does someone experiencing a brief psychotic disorder experience symptoms?
longer than a day but less than 1 month
What kind of substances can induce delusions and/or hallucinations?
illicit drugs, alcohol, medications, or toxins
When does schizophrenia typically begin?
between 15 and 25
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
prodromal phase
Does Schizophrenia affect a specific culture/race?
no
When are suicide attempts most common when someone is diagnosed with Schizophrenia?
within the first 3 years
What are some comorbidities associated with schizophrenia?
substance abuse disorders, anxiety, depression, suicide, polydipsia, and physical illness
What symptoms must a person experience and for how long to be considered for a schizophrenia diagnosis?
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
What must happen to someone’s level of functioning to be considered for a diagnosis of schizophrenia?
it must be markedly below the level achieved before the onset
(in areas such as: work, interpersonal relationships, or self-care)
How long does a person need to have continuous signs of disturbances for consideration of a schizophrenia diagnosis?
at least 6 month with at least 1 month of symptoms
What must be ruled out before someone can receive a diagnosis for schizophrenia?
schizoaffective disorder and depressive or bipolar disorder
How can schizoaffective and depressive or bipolar disorder be ruled out when attempting to make a schizophrenia diagnosis?
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
What can the disturbances not be attributed to if someone is being considered for a schizophrenia diagnosis?
physiological effects of a substance or another medical condition
If the history of autism spectrum disorder or a communication disorder of childhood onset, how can the additional diagnosis of schizophrenia be diagnosed?
only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia are also present for at least a month
If there is a sudden increase in psychotic activity, what electrolyte should be looked at?
sodium (specifically hyponatremia)
What percentage of the risk of schizophrenia is genetic?
about 80%
Which neurotransmitter plays a role in schizophrenia development?
dopamine, serotonin, glutamate, GABA, and acetylcholine
What are the differences in brain structure for a patient who has schizophrenia?
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
What do PET scans show in a schizophrenic patient?
a lowered rate of blood flow and glucose metabolism in the prefrontal cortex
What are prenatal stressors that can increase the risk of schizophrenia?
infection, a father above the age of 35 when conception occurs, and being born during late winter or early spring
What are some environmental factors that increase the risk of schizophrenia?
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
What are factors that are associated with a less positive prognosis for schizophrenia?
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
What are factors that improve the prognosis of schizophrenia?
reducing the frequency, intensity, and duration of relapse
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.
Acute phase
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
stabilization
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
maintenance or residual phase
What are factors that can reduce the risk of developing schizophrenia?
enhanced coping and social skills
What is done in an initial assessment of a schizophrenic patient?
Mental state exam along with a review of spiritual, cultural, biological, psychological, social, and environmental factors that might be affecting the presentation
What are the positive symptoms of schizophrenia?
The presence of symptoms that should not be present. Positive symptoms include hallucinations, delusions, paranoia, or disorganized or bizarre thoughts, behavior, or speech
What are the negative symptoms of schizophrenia?
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
What are cognitive symptoms associated with schizophrenia?
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)
What are affective symptoms associated with schizophrenia?
Symptoms involving emotions and their expression
What is reality testing?
the automatic and unconscious process by which we determine what is and is not real
How do the symptoms of schizophrenia alter a person’s life?
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
What are delusions?
false beliefs that are held despite a lack of evidence to support them
What are the most common delusions?
persecutory, grandiose, or religious ideas
Results from haphazard and illogical thinking where concentration is poor and thoughts are only loosely connected
associative looseness
the most extreme form of associative looseness, is a jumble of words that is meaningless to the listener
word salad
choosing words based on their sound rather than their meaning and often involves words that rhyme or have a similar beginning sound
clang association
words that have meaning for the patient but a different or nonexistent meaning for others
neologisms
What are persecutory delusions?
Believing that one is being singled out for harm or prevented from making progress by others
What are grandiose delusions?
Believing that one is a powerful or important person
What are grandiose delusions?
Believing that one is a powerful or important person
What type of speech pattern is seen when the patient is Including unnecessary and often tedious details in conversation but eventually reaching the point?
circumstantiality
What is thought insertion?
The often uncomfortable belief that someone else has inserted thoughts into the patient’s brain
What is thought deletion?
A belief that thoughts have been taken or are missing
Believing that reality can be changed simply by thoughts or unrelated actions
magical thinking
occur when a person perceives a sensory experience for which no external source exists
hallucinations
What is clozapine?
anti-psychotic used for schizophrenia that causes agranulocytosis
What lab value should a nurse monitor for a patient on clozapine?
ANC (absolute neutrophil count)
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
depersonalization
A feeling that the environment has changed
Derealization
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
catatonia
Excited behavior, such as running or pacing rapidly, often in response to internal or external stimuli
motor agitation
Repetitive behaviors that do not serve a logical purpose
stereotyped behaviors
Echopraxia
the mimicking of movements of another
A tendency to resist or oppose the requests or wishes of others
negativism
6 As for negative symptoms associated with schizophrenia
Anhedonia, avolition, asociality, affective blunting, apathy, alogia
What is anhedonia?
a reduced ability or inability to experience pleasure
What is avolition?
reduced motivation or goal-directed behavior
What is alogia?
reduction in speech
How can affect in schizophrenia be characterized?
flat, blunted, constricted, inappropriate, bizarre
What is the biggest provider of mental health services in our country?
the prison system
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?
Concrete thinking
What does memory impairment typically affect in a schizophrenic patient?
short-term memory and ability to learn
What kind of impairment can lead to problems such as delayed responses, misperceptions, or difficulty understanding others?
impaired information processing
What kind of impairment can interfere with problem solving and can contribute to inappropriateness in social situations?
impaired executive functioning
What is the inability to realize one is ill (this thinking is caused by the illness itself)?
anosognosia
What is a serious affective change often seen in schizophrenia?
comorbid major depressive disorder
What should outcomes focus on for schizophrenic patients?
illness knowledge, management, coping, and quality of life
What is the overall goal of phase 1: acute treatment of schizophrenia?
patient safety and stabilization
What does the outcome criteria of phase II: stabilization of schizophrenia focus on?
understanding the illness and treatment, achieving an optimal medication and psychosocial treatment regimen, and controlling and/or coping with symptoms and side effects
What is done during phase III: maintenance for schizophrenic patients?
raining and increasing symptom control and optimal functioning
What is the best known and strongest consumer and family support organization?
NAMI (the national alliance on mental illness)
When would close monitoring, helping the patient to feel safe, and maintaining separation of the patient and potential victim be indicated?
if the patient is experiencing hallucinations
Which settings can provide a therapeutic milieu in a less restrictive setting than the hospital?
crisis centers and partial hospitalization programs
What kind of drugs are first-generation antipsychotics?
dopamine receptor antagonists
What kind of drugs are haloperidol and chlorpromazine?
first-generation antipsychotics
What are second-generation antipsychotics also known as?
atypical antipsychotics
What are first-generation antipsychotics also known as?
antipsychotics or neuroleptics
How do second-generation antipsychotics work?
they are serotonin and dopamine receptor antagonists
What kind of drugs are clozapine and risperidone?
second-generation antipsychotics
What is the biggest difference between first generation antipsychotics and second-generation antipsychotics?
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
Which type of antipsychotic drug tends to produce fewer and better-tolerated side effects?
second-generation antipsychotics
How long does it typically take for antipsychotic drugs to become effective?
2-6 weeks
Major side effects of antipsychotics
discontinuation syndrome, drooling, orthostatic hypotension, sedation, and gait impairment
What does the blockage of dopamine receptors in the motor center of the brain cause (in regards to first-generation antipsychotic drug side effects)?
extrapyramidal side effects
What kind of extrapyramidal side effects can occur from first-generation antipsychotics?
acute dystonia, akathisia, and pseudoparkinsonism
What is a sudden, sustained contraction of one or several muscle groups (usually in the head or neck)?
acute dystonia
What is akathisia?
a motor restlessness that causes pacing and/or inability to stay still or remain in one place
What kind of symptoms are seen in pseudoparkinsonism?
tremor, reduced accessory movements, gait impairment, reduced facial expressiveness, and slowing of motor behavior
Which two drugs can treat tardive dyskinesia?
valbenazine (ingrezza) and deutrabenazine (austedo)
What kind of drugs are valbenazine (ingrezza) and deutrabenazine (austedo)?
selective vesicular monoamine transporter inhibitors
What can drugs like trihexyphenidyl (Artane), benztropine (Cogentin) and diphenhydramine (Benadryl) do?
counteract pseudoparkinsonism
To provide effective care for the patient who is taking a second-generation antipsychotic, the nurse should frequently assess for
Metabolic syndrome
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?
She should experience a reduction in hallucinations.
Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?
Paranoia
When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that
They are not actually ill
