[Exam 2] Chapter 16: Schizo Flashcards
What does schizo cause?
Distorted and bizzarre thoughts, perceptions, emotions, movements, and behavior
Schizo is usually diagnosed when?
In late adolescnce or early adulthood. Peak is at 15 to 25 for men and 25 to 35 for women
Symptoms of schizo are divided into what two categories?
Positive/Hard Symptoms/Signs: Delusions, hallucinations and grossly disorganized thinking, speech, behavior
Negative/Soft Symtpoms/Signs including flat affect, lack of volition, and social withdrawal or discomfort
Positive or Hard Symptoms: What is Ambivalence?
Holding seemingly contraindicatory beliefs or feelings about the same person, event or situation
Positive or Hard Symptoms: What is associative looseness?
Fragmented or poorly related thoughts and ideas
Positive or Hard Symptoms: What are delusions
fixed false beliefs that have no basis in reality
Positive or Hard Symptoms: What is echopraxia?
Imitation of the movements and gestures of another person whom the client is observing
Positive or Hard Symptoms: What is flight of ideas
continuous flow of verbalization in which person jumps rapidly from one topic to another
Positive or Hard Symptoms: what are hallucinations
false sensory perceptions or perceptual experiences that do not exist inr elaity
Positive or Hard Symptoms: what are ideas of reference
false impressions that external events have special meaning for the person
Positive or Hard Symptoms: what is perseveration
persistent adherence to a single idea or topic, verbal repition of a sentence , word, or phrase; resisting attempts to change the topic
Positive or Hard Symptoms: what is bizzare behavior?
Outlandish appearacnce or clothing; repetitive or sterotyped , seemingly purposeless movements
Negative or Soft Symptoms: What is alogia?
Tendency to speak little or to convey little substance of meaning
Negative or Soft Symptoms: what is anhedonia?
feeling no joy or pleasure form life or any activites from relationships
Negative or Soft Symptoms: what is apthy?
feelings of indifference toward people, activites, and events
Negative or Soft Symptoms: what is asociality?
social withdrawal, few or no relationships, lack of closeness
Negative or Soft Symptoms: Wha is blunted affect?
restricted range of emotional feeling, tone, or mood
Negative or Soft Symptoms: what is cataonia?
Psychologically induced immobility occasionally marked by periods of agitation or excitment; client seems motionaless
Negative or Soft Symptoms: what is flaat afect
absence of any facial expression
Negative or Soft Symptoms: what is avolition or lack of volition
absence of will, ambition, or drive to take action or accomplish tasks
Negative or Soft Symptoms: what is inattention?
Inability to concentrate or focus on a topic of activity, regardless of importance
Which symptoms last longer?
Negative persist after postive have been abated
When is Schizoaffective Disorder diagnosed?
When client is severly ill and has mixture of psychotic and mood symptoms
Signs of Schizoaffect Disorder?
Signs and symptoms include those of both schzo and mood disorder such as depression or bipolar
Best treatment for schizoaffective disorder?
2nd generation antipsychotics .
Mood stabilizers or antidepressants may be added if needed
Schizo and Onset: Slowly develop signs that include?
Social Withdrawal
Unusual Behavior
Loss of interest in school or work
Neglected Hygiene
Schizo and Onset: Diagnosis is usually made when person begisn to display what?
More actively positive symptoms of delusions, hallucinations , and disordered thinking (psychosis)
Schizo and Onset: What age fares better with this disease?
Those who develop it later in life
Schizo and Onset: Why do younger people struggle with this?
Have poorer premorbid adjustment, more prominent negative signs and greater cognitive impairments
What two patterns emerge yearsr immediately after onset of symptoms?
- Client experiences ongoing psychosis and never recovers
2. Client experiences episdoes of psychotic symptoms that alternate between episdoes of relatively complete recovery
Schizo and Long-Term coursE: Over time, what happens to disease?
Becomes less disruptive to person’s life and easier to manage.
Schizo and Long-Term coursE: Why do many people struggle with functioning in community?
Due to negative symptoms, impaired cognition, or treatment-refractory postiive symptoms
Schizo and Long-Term coursE: What medications play a crucial role in the disease?
Antipsychotic medications
Schizo and Related Disorders: What is Schizophreniformdisorder?
Client exhibits acute, reactive psychosis for less than 6 months. If over 6, changed to Schzio. Social or occupational functioning may be impaired
Schizo and Related Disorders: What is cataonia?
Marked by psychomotor disturbance, either excessive motor activity or immobility. Excess motor is purposeless and not influenced.
Schizo and Related Disorders: Other behaviors of Catanonia?
Extreme negativism, mutism, pecuilar movements, echolalia, or echopraxia
Schizo and Related Disorders: Waht is delusional disorder?
Client has one or more nonbizzare delusions. Delusions are believable.
Schizo and Related Disorders: What is brief psychotic disorder?
Client experiences suden onset of at least one psychotic symtpom such as delusions, hallucinations, or disorganized speech which leasts anywhere till a month
Schizo and Related Disorders: What is shared psychotic disorder?
Two people share similar delusion. Develops this delusion in context of close relationship with someone who has psychotic delusions
Schizo and Related Disorders: What is schizotypal personality disorder?
Involves odd, eccentric behaviors including transient psychotic symptoms
Schizo and Etiology: Newer scientific studies demonstrate that schizo results from
a type of brain dysfunction . Neurochemical/neurologic theories supported by effects of antipsychotic medication
Schizo and Genetic Factors: Who has the greatest chance between family members of having this?
Twins, have as high as 50% chance.
Kids with one parent has it is 15%. Two = 35%
Schizo and Neuroanatomic and NEurochemical Factors: What changes in the brains do these people have?
Less brain tissue and CSF. Could represent fialure of devleopment .
Schizo and Neuroanatomic and NEurochemical Factors: What does CT show?
Enalrged ventricles in the brain
Schizo and Neuroanatomic and NEurochemical Factors: What do PET scan shows?
glucose metabolism and oxygen are diminished in frontal cortical structures of the brain
Schizo and Neuroanatomic and NEurochemical Factors: What happens on a neurological level?
The network that transmit information by electrical signals form nerve seem to malfunction.
Schizo and Neuroanatomic and NEurochemical Factors: What chemicals are associated with this?
Dopamine, Serotonin, dominately
Schizo and Neuroanatomic and NEurochemical Factors: Why do people believe dopamine is the cause?
Drugs that increase dopamine include paranoid psychotic reaction similar to schizophrenia . Also drugs blocking dopamine reduce ppsychotic symptoms
Schizo and Neuroanatomic and NEurochemical Factors: Why do people believe serotonin is the cause?
Serotonin modulates and helps to control excess dopamine.
Schizo and Cultural Considerations: What is Bouffee Delirante?
Syndrome found in West Africa and Haiti, characterized by sudden outburst of agitated and aggressive behavior, followed by confusion and psychomotor excitment . Sometime accompanied by visual and auditory hallucinations
Schizo and Cultural Considerations: What is Ghost Sickness?
Native American. Preoccupation with death. Symptoms include bad dreams, weakness, feeling of danger, no appetite, fainting, dizziness, fear, anxieety
Schizo and Cultural Considerations: What is Jikoshu-Kyofu.
Japan. Fear of offending others by emitting foul body odor
Schizo and Cultural Considerations: What is Locura ?
Latinos. Includes incoherence, agitation, visual and auditory hallucination, inability to follow social rules, unpredictability and violent behavior
Schizo and Cultural Considerations: What is Qi-gong psychotic reaction?
Chinese. acute, time-limited episode characterized by dissociative, paranoid, or other psychotic symptoms
Schizo and Cultural Considerations: what is zar?
Middle eastern. Expereience of spirits possessing a person. May should, laugh, wail, bang head on wall, or be apethic.
Schizo and Cultural Considerations: What culture needs a higher dose?
Blacks
Schizo and Psychopharamacology: What drugs primarily prescribed?
Antipsychotics known as neuroleptics prescribed because decreasing psychotic symptoms.
Schizo and Psychopharamacology: What are the conventional or first generation antipsychotic medication?
dopamina antagonists
Schizo and Psychopharamacology: what are the atypical or 2nd gen antipsychotics?
dopamine and serotonin antagonists
Schizo and Psychopharamacology: What do first-generation antipsychotics target?
Positive signs of schizo such as delusions, hallucinations, disturbed thinking and other psychotic symptoms. Don’t affect negative
Schizo and Psychopharamacology: What do 2nd gen antipsychotics target?
diminish positive symptoms and lessen negative signs of lack of volition and motivation, social withdrawal
Schizo and Maintenance Therapy: Which drugs are available as long-acting injections?
Fluphenazine (PRolixin) Haloperidol (Haldol) in decanoate Risperidone (Risperdal) Paliperidone (Invega Sustenna) Olanzapine (Zyprexa) Aripiprazole
Schizo and Maintenance Therapy: How are fluphenazine and haloperidol injected and last?
in sesame oil and are absorbed slowly over time. Last 2-4 weeks
Schizo and Maintenance Therapy: Duration of action for fluphenazine?
7-28 days
Schizo and Maintenance Therapy: duration of action for haloperidol?
4 week s
Schizo and Maintenance Therapy: How are risperidone, paliperidone, olanzapine and aripiprazole injected?
polymer based microspheres that degreade slwoly in body. Take weeks so not suitable for acute psychosis
Schizo and Side Effects: What do serious neurologic effects include?
EPS (Acute Dystonic Reaction, Akathisia, Parkinsonism)
Tardive Dyskinesia
Seizures
NMS
Schizo and Side Effects: Nonneurologic side effects include what?
Weight gain, sedation, photosensitivity, and anticholinergic symptoms such as dry mouth, blurred vision, constipation, urinary retention.
Schizo and Side Effects: What to do is someone has signs of NMS?
Stop antipsychotic meds
Schizo and Side Effects: What are dystonic reactions?
Appear early in tx.
Spasms in discrete muscle groups. Neck Muscles (torticollis) or eye muscles (oculogyric crisis).
May also accompany protrusion of tongue , dysphagia and laryngeal and pharyngeal spasms
Schizo and Side Effects: Tx for dystonic reaction?
Benadryl IM or IV or Benztropine (Cogentin IM
Schizo and Side Effects: When does Pseudoparkinson appear?
First few days after starting or increasing dosage
Schizo and Side Effects: What is Akathisia and how is it developed?
REstless movements, pacing, inability to remain still. Develops when antipsychotics started or dose increased.
Schizo and Side Effects: How is Akathisia treated?
Beta blockers like propranolol
Schizo and Side Effects: What is Tardive Dyskinesia?
Late appear effects characterized by abnorma, involuntary movements sucha s lip smacking, tongue protrusion, chewing.
Schizo and Side Effects: PRoblem with tardive dyskinesia?
irrevisible once it appears.
Schizo and Side Effects: Tx for tardive dyskinesia?
Velbenazine, deutretrabenazine. and Clozapine.
Schizo and Side Effects: What is the Abnormal Involutary Movement Scale?
Used to screen for symptoms of movement disorders. Observed in several positions and rated from 0-4
Schizo and Side Effects: Which drug has the highest chance of causing a seizure?
Clozapine , 5% chance
Schizo and Side Effects: What is NMS?
Serious and fatal condition. Muscle rigidity, high fever, increased muscle enzymes, and leukocytosis
Schizo and Side Effects: What is Agranulocytosis and what causes this?
Failure of bone marrow to produce adequate white blood cells. Clozapine causes this. Must have weekly WBC counts
Schizo and Side Effects: What is Agranulocytosis characterized by?
fever, malaise, ulcerative sore throat, and leukopenia
Schizo and Side Effects: How long for agranulocytosis to appear?
18-24 weeks after initiation. Clozapine must be discontinued immediately.
Schizo and Psychosocial Treatment: What type of therapies used?
Individual and group therapies, family therapy, family education and social skills
Schizo and Psychosocial Treatment: Clients with schizo can improve social competence how?
with social skill training, which means more efective functioning in community
Schizo and Psychosocial Treatment: What does cognitive adaption training do?
Uses environmental supports to improve adaptive functioning in the home setting. This includes signs, calendars, hygiene supplies.
Schizo and Psychosocial Treatment: What is Cognitive Enhancement Therapy?
Combined computer-based cognitive training with group sessions that allows them to practice skills. Designed to improve social and neurocognitive deficits such as attention
Schizo and Psychosocial Treatment: Positive results from CET include
increased mental stamina, active rather than passive information processing, and spontaneous and appropriate negotiaation.
Schizo and History: How does nurse start out meeting?
Asking about client history and how client functioned before crisis. “How do you usualy spend your time”
Schizo and History: How should the nurse ask about suicide?
10% of people commit suicide. So ask if they’ve ever attempted or heard voices telling them to do it.
Schizo and History: What should hte nurse ask about hte support system?
Do you keep in contact with family and friends?
Scheduled groups or therapy appointments?
Been running out of money between paychecks?
Schizo and History: How can nurse end history question?
What do you see as the primary problem now?
What do you need help managing now?
Schizo and General Appearance: A client may present with echopraxia, which is
imitating the movements and gestures of someone whom he or she is observing
Schizo and General Appearance: How will they appear movement wise?
Psychomotor retardation or waxy flexibility.
Schizo and General Appearance: What unusual speech patterns may be presented?
Word Salad (Jumbled words and phrases that are disconnected and incoherent)
echolalia (repetiion or imitation fo what someone else says)
Schizo and Unusual Speech PAtterns: What is Clang Assocations?
Are ideas that are related to one another based on sound or rhyming rather than meaning “I will take a pill if I go up the hill”
Schizo and Unusual Speech PAtterns: Wha tis neologism?
Words invented by the client
“Im afirad of grittiz. Are there any grittiz here?
Schizo and Unusual Speech PAtterns: What is verbigeration?
Stereotyped repetition of words or phrases that may or not have meaning to lisener
“Iw ant to go home , go home, go home”
Schizo and Unusual Speech PAtterns: What is Echolalia?
Client imitation or repeition of what nurse says
Schizo and Unusual Speech PAtterns: What is stilted language?
Use of word or phrases that are flowery, excessive, and pompus
“Would you be so kind, as a representative of florence nightingale, as to do me the honor of..”
Schizo and Unusual Speech PAtterns: What is perseveration?
Persistent adherence toa single idea or topic and verbal repetion of a sentence, phrase, or word.
Schizo and Mood and Affect: How are they described?
Flat Affect or blunted affect (few observable facial expressions).
May also have inappropriate facial reactions.
Schizo and Mood and Affect: Patient may state they are anhedonia, emaning
they report feeling depressed and having no pleasure or joy in life
Schizo and Thought Process: What happens here?
Primary feature of disease. Thought process becomes disordered, and continuity of thoughts and information process is disrupted.
Schizo and Thought Process: What are some different things that client may do?
Thought blocking, thought broadcasting, thought withdrawal, or thought insertion
Schizo and Thought Process: Client may perform tangential thinking, which is
veering into unrelated topics and never answering original questions
Schizo and Thought Process: What is circumstantiality
may be evidenced by client giving unnecessary details or strays from topic
Schizo and Thought Process: Alogia may occur. What is this?
Poverty of content, describing lack of any real meaning or substance in what client says
Schizo and Delusions: What are persecutory / paranoid delusions?
Involve client’s belief that others are planning to harm them or are spying, following ridiculing in some way.
Schizo and Delusions: Example of persecutory / paranoid delusions?
Client may think food has been poisoned or that rooms are bugged with lsitening device
Schizo and Delusions: What is grandiose delusions?
Characterized by clients claim to association with famous people or celebrities
Schizo and Delusions: example of grandiose delusions?
clienet may claim to be engaged to a famous movie star
Schizo and Delusions: What is religious delusions?
center around second coming from christ. are not part of their religious faith or that of others
Schizo and Delusions: example of religious delusions?
client claims to be messiah or some prophet
Schizo and Delusions: what are somatic delusions?
generally vague and unrealistic beliefs about clients health or bodily functions
Schizo and Delusions: example of somatic delusoins?
male client may say he is pregnant
Schizo and Delusions: what are sexual delusions?
belief that their sexual behavior is known to others, or that client is rapist , prostitue or pedophile
Schizo and Delusions: example of sexual delusion?
their excessive masturbation has led to insanity
Schizo and Delusions: what are nihilistic delusions?
client’s belief that his or her organs aren’t functioning or are rotting away
Schizo and Delusions: what are referential delusions?
ideas of reference involve clients belief that televsiion broadcasts, music, have special meaning for him
Schizo and Delusions: example of referential delusions?
clietn reports president was speaking directly to him
Schizo and Delusions: What may nurse ask in regards to this?
Please explain that to me or tell me what you’re thinking about that
Schizo and Intellectual Processes: Example of hallucination?
while walking through woods, person beleives they see snake on path. Upon close rlook, discover its only curved stick
Schizo and Hallucinations: What are auditory hallucinations?
most common type, involve hearings ound, often voices.
Schizo and Hallucinations: What are command hallucinations?
voices demanding that the client take action, often to harm the self or others and considered dangeorus
schizo and Hallucinations: what are visual hallucinations?
invovle seeing imgages that do not exist at all, such as lights or a dead persion
schizo and Hallucinations: what are olfactory hallucinations?
involve smells or odors. May be specific scent or general scent like rotten odor
schizo and Hallucinations: What are tactile hallucinations?
refers to sensations such as electricity running through body or bugs crawling on skin
schizo and Hallucinations: What are gusttory hallucinations?
invovle a taste lingering in mouth or sense that food tastes like something else.
schizo and Hallucinations: What is cenesthetichallucinations?
involve clients report that they feel bodily functions that are undetectable
schizo and Hallucinations: example of cenesthetichallucinations?
sensation of urine forming or impulses being transmitted through brain
schizo and Hallucinations: what are kinesthetic hallucinations?
occur when client is motionless but reports sensation of bodily movement
schizo and Hallucinations: Most common form of disorietnation?
depersonalization. feels like body belongs to so meone else
Schizo and Judgement: What happens to judgement?
Impaired. Often, patient cannot meet their needs for safety and protection. Example is failing to wear warm clothes in cold weather
Schizo and Judgement: How isinsight impaired?
Cannot plan ahead
Schizo and self-Concept: What happens here?
Deterioration , with loss of ego boundaries. Cannot have sense of their own body, mind, and infuence.
Schizo and Self-Care Considerations: What occurs here?
Inatention to hygiene and grooming needs.
Schizo and Self-Care Considerations: Why is malnourishment a problem?
Because they fail to recognize sensations sucha s hunger or thirst and food or fluid intake may be inadequate.
Schizo and Self-Care Considerations: What happens with polydipsia?
Too much water = little sodium. Leads to seziures. Seen in clients with severe and persistent mental illness.
Schzio and Intervention - Promoting Safety: What interventions may nurse do if patient getting hostile?
ADministering medication, moving to quiet place, or temporarily using seclusion or restraints
Schzio and Intervention - Establishing Therapeutic Relationship: Initially, client may only be able to tolerate how much contact?
Only 5-10 minutes. Establish therapeutic relationship.
Schzio and Intervention - Using Therapeutic Communication: How to help patient who is struggling with reality orienttion?
Calling by name, making references to time and day, and commenting on environment
Schzio and Intervention - Using Therapeutic Communication: How to handle client who is speeaking nonsense?
Nurse makes effort to determine meaning client trying to convey. Seek clarifcation to what they are saying.
Schzio and Intervention - Intervention for Delusional Thoughts: Ways to talk when patient fears they may be posioned
DONT PLAY ALONG
“I have seen no oevidence of that”
“IT doesn’t seem that way to me”
Schzio and Intervention - Intervention for Hallucination: Nurse must initially focus on what?
What voices are saying and what client is seeing.
Schzio and Intervention - Intervention for Hallucination: How will nurse respond to someone with hallucinations?
I don’t hear any voices; what are you hearing?
I don’t see anything but you must be frightened. You are safe here in the hospital
Schzio and Intervention - Intervention for Hallucination: What is a helpful strategy for intervening with hallucinations?
To engage client in reality-based activity such as playing cards. Difficult to pay attention to reality and hallucination at same time
Schzio and Intervention - Intervention for Hallucination: Hallucinations are often related to what?
Anxiety levels, therefore monitoring and intervening should be focused on this
Schzio and Intervention - Intervention for Hallucination: Examples on how to lower anxiety levels?
LEarn to relax when voices occur, engage in diversions, correct negative talk, or seek out or avoid social interaction
Schzio and Intervention - Intervention for Hallucination: What is the cell phone trick?
To deal with voices, thye talk into the cellphone in order to appear normal among the street. They are able to verbalize resistance
Schzio and Intervention - Intervention for Hallucination: One primary intervention for managing auditory hallucination is dismissal intervention what is this?
telling the voices to go away. Teach the client to talk back to the voices
Schzio and Intervention - Coping with Inappropriate Behaviors: These patients often an expeirence of loss of what?
Ego boundaies. This results in bizzare or strang ebehaviors including touching others without warning, or engaging in socially inappropriate behaviors
Schzio and Intervention - Coping with Inappropriate Behaviors: Nurses job here?
Protecting the client from retaliation by others who expeirence clients intrusions
Schzio and Intervention - Coping with Inappropriate Behaviors: What would nurse say if client was undressing themselves?
Lets go to you rorom and you can put your clothes back on
Schzio and Intervention - Coping with Inappropriate Behaviors: What is essential to do with reintergration?
Reintegrate the client into the treatment milieu as soon as possible.
Schizo and Intervention - Teaching Client and Fam: Early signs of relapse?
Lack of sleep
Impaired cause-and-effect reasoning
Lack of control, irritability
Ineffective medication management
Anxiety and worry
Schizo and Intervention - Teaching Client and Fam: What education is taught to them?
Avoid alcohol
Develop plan to recognize signs
Seek assistance to avoid or manage stressful situations
Maintain contact with community
Schizo and Intervention - Txing Self-Care: What is the important part here?
Because of apathy or lack of energy, poor person hygiene can occur .
When psychotic, may pay little attention to hygiene
Schizo and Intervention - Txing Social Skills: Nurse can help develop social skills through what?
education, role modeling, and practice.
Schizo and Intervention - Txing Social Skills: What social skills can be practiced?
Eye contact, attentive listening, and taking turns alking can increase the cllients ability to socialize
Schizo and Intervention - Medication Management: What can be done to help manage uncomfotable side effects?
Eating proper diet, drinking enough fluids, using stool softener ,sucking on hard candy, and using sunscreen
Schizo and Intervention - Medication Management: What are some things nurse can say if client doesn’t want to take meds?
“This medicaition help syou think more clearly”
” taking this medication will make it less likely that you’ll hear troubling voices”
Schizo and Intervention - Medication Management: Some tips to manage this?
Avoid calorie drinks
Use sunscreen
Rise slowly
Monitor drowsiness
If dose forgetting, take up to 3-4 hours late.
Schizo and Elder Considerations: Late-onset schizo refers to development of disease after
45
Schizo and Elder Considerations: Psychotic symptoms that appear later in life are associated with
depression or dementia
Schizo and Community: Assertive community tx programs have decreased hospital admission by managing what?
symptoms and meds, assisting clients with social, recreational, and vocational needs.
Schizo and Community: Nurse in assertive community tx program focuses on what?
management of medication and their side effects and promotion of health and wellness.
Schizo and Mental Health Promotion: Psychiatric rehabilitation has the goal of what?
recovery for clients with major metnal illness that goes beyond symptom control and medication management
Schizo and Mental Health Promotion: Mental health promotion involves whaht?
strengthening client’s ability to bounce back from adversity and to manage the inevitable obstacles encountered in life
Schizo and Mental Health Promotion: Strategies for mental health promotion?
fostering self-efficacy and empowering client to have control over his or her life , improving clients resiliency or ability to bounce back
