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NRSG 331 > Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders > Flashcards

Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders Flashcards

1
Q

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

A

Genetic predisposition
Biochemical dysfunction
Physiological factors
Psychosocial factors
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

Fear

Majority of people do w/ it will be dead 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

Four 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Social maladjustment, antagonistic thoughts and behavior, shy and withdrawn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

Four phases of schizophrenia: Phase Two

A

Prodromal phase
A distinct change
Lasts from a few weeks to a few years
Deterioration in role functioning and social withdrawal
Substantial 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

Four phases of schizophrenia: Phase Three

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

Four Phases of Schizophrenia: Phase Four

A

Residual phase
Symptoms similar to those off the prodomal 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 may 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 development 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 biological predisposing factors for schizophrenia

A

Factors that have been implicated:

Viral infection
Anatomical abnormalities
Electrophysiology
Epilepsy
Huntingtons disease
Birth trauma, head injury in adulthood, alcohol abuse, cerebral tumor, cerebrovascular accident, Lupus

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12
Q

Psychosis. Predisposing factors of 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 biological 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

Complication of Clozapine

A

Can cause agranulocytosis which one can die from. Rare.
It is an 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 on 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, non bizarre delusions

Erotomanic type (someone like a celebrity is in love with them)

Grandiose

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, schism affective 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 honking ability

35
Q

Assessment: Negative symptoms: Extra ones

A

Wavy 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 (28 decks)

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