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NURS3314 Mental Health Nursing > Chapter 16 Schizophrenia > Flashcards

Chapter 16 Schizophrenia Flashcards

1
Q

Schizophrenia

A

Cannot be defined as a single illness
- Thought of as a syndrome or as a disease process with many varieties and symptoms

Characterized by psychosis:
- Altered cognition, perception, and reality testing
- Affects thinking, language, emotions, social behavior

75%: Develop gradually, presenting at 15 to 25 years of age

Child-onset and late-onset are more rare
- Peak Incidence of Onset: 15-25 years of age for men & 25-35 yrs of age

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2
Q

What are the 3 main categories that schizophrenia affects?

A

Thoughts, behavior, & emotions

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3
Q

Positive/Hard Symptoms

A

Ambivalence
Associative looseness
Bizarre behavior
Delusions
Echopraxia
Flight of ideas
Hallucination
Ideas of reference
Preservation

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4
Q

Ambivalence

A

Holding seemingly contradictory beliefs or feelings about the same person, event, or situation

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5
Q

Associative Looseness

A

Fragmented or poorly related thoughts and ideas

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6
Q

Bizzare Behavior

A

Outlandish appearance or clothing; repetitive or stereotyped, seemingly purposeless movements; unusual social or sexual behavior

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7
Q

Delusions

A

Fixed false beliefs that have no basis in reality

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8
Q

Echopraxia

A

Imitation of the movements and gestures of another person whom the client is observing

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9
Q

Flight of Ideas

A

Continuous flow of verbalization in which the person jumps rapidly from one topic to another

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10
Q

Hallucination

A

False sensory perceptions or perceptual experiences that do not exist in reality

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11
Q

Ideas of Reference

A

False impressions that external events have special meaning for the person

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12
Q

Preservation

A

Persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic

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13
Q

Negative/Soft Symptoms

A

Impedes one’s ability to:
- Initiate and maintain conversations and relationships
- Obtain and maintain employment
- Make decisions and follow through on plans
- Maintain adequate grooming
- Function socially

List of Negative Symptoms:
Alogia
Anhedonia
Apathy
Asociality
Avolition
Blunted Affect

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14
Q

Alogia

A

Tendency to speak little or to convey little substance of meaning (poverty of content)

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15
Q

Anhedonia

A

Feeling no joy or pleasure from life or any activities or relationships

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16
Q

Apathy

A

Feelings of indifference toward people, activities, and events

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17
Q

Asociality

A

Social withdrawal, few or no relationships, lack of closeness

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18
Q

Avolition

A

Absence of will, ambition, or drive to take action or accomplish tasks

19
Q

Blunted Affect

A

Restricted range of emotional feeling, tone, or mood

20
Q

Anergia

A

Lack of energy

21
Q

Schizoaffective Disorder

A

Diagnosed when the client is severely ill & has a mixture of psychotic and mood symptoms

Signs & symptoms include those of both schizophrenia and a mood disorder such as depression or BPD
- May occur simultaneously or may alternate between psychotic and mood disorder symptoms.

Typical 1st line Treatment: Atypical antipsychotics

22
Q

Onset of Schizophrenia

A

Can be abrupt/insidious

Most clients slowly and gradually develop signs and symptoms such as:
- Social withdrawal
- Unusual behavior
- Loss of interest in school or at work,
- Neglected hygiene

Patients w/ earlier onset show worse outcomes
- Younger clients display a poorer premorbid adjustment, more prominent negative signs, and greater cognitive impairment than do older clients.

Those who experience a gradual onset of the disease (about 50%) tend to have a poorer immediate- and long-term course than those who experience an acute and sudden onset

23
Q

DSM V Criteria for Schizophrenia Highlights

A

Two or more of the following for a significant portion of time in 1 month:
- Delusions: False fixed belief
- Hallucinations: Involves 5 senses
- Unusual taste or smell that no one else can sense-> migraine or seizure
- Disorganized speech
- Gross disorganization of behavior or catatonia
- Negative symptoms (diminished emotional expression or avolition)
- Functional impairment of some kind

Continuous disturbance for at least 6 months

24
Q

Immediate Term Course of Schizophrenia

A

Follows either pattern:
- Client experiences ongoing psychosis and never fully recovers, although symptoms may shift in severity over time
or

  • Client experiences episodes of psychotic symptoms that alternate with episodes of relatively complete recovery from the psychosis
25
Q

Long-Term Course of Schizophrenia

A

Intensity of psychosis tends to diminish over time

Many clients with long-term impairment regain some degree of social and occupational functioning.
- Over time, the disease becomes less disruptive to the person’s life and easier to manage, but rarely can the client overcome the effects of many years of dysfunction.

26
Q

Schizophreniform Disorder

A

The client exhibits an acute, reactive psychosis for less than 6 months necessary to meet the diagnostic criteria for schizophrenia.

If symptoms persist over 6 months, the diagnosis is changed to schizophrenia
- Social or occupational functioning may or may not be impaired

27
Q

Catatonia

A

Characterized by marked psychomotor disturbance and either excessive motor activity or virtual immobility and motionlessness.

Motor immobility may include catalepsy (waxy flexibility) or stupor

Excessive motor activity is apparently purposeless and not influenced by external stimuli.

Other behaviors include extreme negativism, mutism, peculiar movements, echolalia, or echopraxia.

Can occur with schizophrenia, mood disorders, or other psychotic disorders

28
Q

Delusional Disorder

A

The client has one or more nonbizarre delusions
- Focus of the delusion is believable

Delusion may be persecutory, erotomanic, grandiose, jealous, or somatic in content

Psychosocial functioning is not markedly impaired, and behavior is not obviously odd or bizarre

29
Q

Brief-Psychotic Disorder

A

The client experiences the sudden onset of at least one psychotic symptom, such as delusions, hallucinations, or disorganized speech or behavior, which lasts from 1 day to 1 month.

The episode may or may not have an identifiable stressor or may follow childbirth

30
Q

Shared Psychotic Disorder

A

2 people share a similar delusion

The person w/ this diagnosis develops this delusion in the context of a close relationship with someone who has psychotic delusions, most commonly siblings, parent, and child or partners/spouses

The more submissive or suggestible person may rapidly improve if separated from the dominant person

31
Q

Clinical Picture of Schizophrenia in Children/Adolescents

A

Children/Adolescents have atypical/prodromal signs for years before diagnosis

Children Prodromal Signs:
- Do less well in school as compared to siblings
- Less socially engaged
- Less positive
- Unusual motor development

Carries worse prognosis than adult-onset
Diagnosed before age 12
Occurring in 1 out of 40,000 children

32
Q

Adolescent Prodromal Signs

A

Gradual process lasting a few months or few years

Social withdrawal

Irritability

Depression

Antagonistic

Conduct problems

Academic decline
**Suspicious and low level of distorted thinking

33
Q

Prodromal Signs

A

Early symptoms that indicate a problem may be developing

34
Q

Etiology of Schizophrenia: Genetic Factors

A

Schizophrenia is the most inheritable out of all mental health disorders
- Largest genetic component

Recent studies indicate that the genetic risk of schizophrenia is polygenic, meaning several genes contribute to the development

35
Q

Etiology of Schizophrenia: Neuroanatomic & Neurochemical Factors

A

Findings have demonstrated that people with schizophrenia have relatively less brain tissue and cerebrospinal fluid than those who do not have schizophrenia

CT Scan: Enlarged ventricles in the brain & cortical atrophy

Glucose metabolism & oxygen are diminished in the frontal cortical structures of the brain

Dopamine Theory: Excess dopamine activity
- Drugs that increase activity in the dopaminergic system sometimes induce a paranoid psychotic reaction similar to schizophrenia
- The greater the ability of the drug to block dopamine receptors, the more effective it is in decreasing symptoms of schizophrenia

36
Q

Cultural Considerations for Patients w/ Schizophrenia

A

Ideas that are considered delusional in one culture, such as beliefs in sorcery or witchcraft, may be commonly accepted by other cultures.

Also, auditory or visual hallucinations, such as seeing the Virgin Mary or hearing God’s voice, may be a normal part of religious experiences in some cultures.

37
Q

Cultural Concepts of Distress

A

The ways in which people experience distress in the context of their lives and surroundings

38
Q

Schizophrenia Prognosis: Better Prognosis

A

NOTE: Prognosis worsens each acute episode!!
- Severity of course r/t Tx adherence & other factors

Late or sudden diagnosis onset
Good pre-illness functioning
Family hx of mood disorders vs. schizophrenia
Paranoid schizophrenia subtype or many positive symptoms
Female
Minimal cognitive impairment

39
Q

Schizophrenia Prognosis: Negative Prognosis

A

Onset: Early age at onset

Pre-Illness Level of Functioning: Poor pre-illness functioning

Family hx of schizophrenia

Disorganized schizophrenia subtype with many negative symptoms

Male

Significant cognitive impairment

40
Q

Phases of Schizophrenia

A

Prodromal: Onset, mild changes
- Onset of symptoms begin one month to a year before first psychotic break or full-blown illness

Acute: Crisis Stabilization Unit
- Exacerbation of symptoms

Stabilization: Outpatient
- Symptoms diminishing
- Movement toward previous level of functioning

Maintenance or Residual: New baseline is established
- Relapses may occur at any time

41
Q

Treatment for Schizophrenia: Psychopharmacology

A
42
Q

Maintenance Therapy for Schizophrenia Treatment

A
43
Q
A

NURS3314 Mental Health Nursing (30 decks)

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