Mental Health Exam 3 - Schizophrenia

Question 1

Schizophrenia

Answer 1

Is a syndrome
Is a disabling psychotic disorder
Age of onset typically late teens early twenties

Question 2

Types of schizophrenia

Answer 2

Paranoid
Disorganized
Catatonic
Residual
Undifferentiated
Other: schizoaffective, brief psychotic disorder, schizophreniform disorder, shared psychotic disorder, secondary (induced) psychosis

Question 3

Schizoaffective disorder

Answer 3

Mood disorder along with schizophrenia

Question 4

Brief psychotic disorder

Answer 4

Sudden onset of psychotic symptoms that last less than 1 month

Question 5

Schizophreniform disorder

Answer 5

Similar to schizophrenia but lasts less than 6 months & impairments less noticeable

Question 6

Shared psychotic disorder

Answer 6

Folie a delux

Shared delusion between two people who have a close relationship
Cult phenomenon

Question 7

Secondary (induced) psychosis

Answer 7

Related to substance ingestion, toxins, or medical condition

Question 8

Phases of Schizophrenia

Answer 8

Prodomal
Phase I - Acute Phase
Phase II - Stabilization Phase
Phase III - Maintenance Phase

Question 9

Prodomal Symptoms

Answer 9

Occur 1 month to 1 year prior to psychotic symptoms

Appear as deterioration in function

Question 10

Acute Phase

Answer 10

Florid psychotic symptoms present
Safety & medical stabilization are PRIMARY interventions
Interventions include: meds, limit setting directive care, crisis intervention, work with family

Question 11

Stabilization phase

Answer 11

Symptoms diminishing
Adherence to Tx
Cope with symptoms
Skills training

Question 12

Maintenance Phase

Answer 12

Maintains gains - at or nearing baseline functioning
Relapse prevention
Independence- live in community
Utilize case management

Question 13

ASSESSMENT of Schizophrenia

What are the four characteristic dimensions?

Answer 13

Positive symptoms
Negative symptoms
Cognitive symptoms
Depressive symptoms

Question 14

*Positive signs of schizophrenia

Answer 14

Hallucinations
Delusions
Disorganized speech
Bizarre behavior , motor agitation

better prognosis if only have positive symptoms

Question 15

*Negative signs of schizophrenia

Answer 15

Blunted or flat affect
Poverty of speech (alogia)
Loss of motivation (avolition)
Lack of pleasure (Anhedonia)
Lack of physical energy (Anergia)

neg symptoms indicate a poorer prognosis, bc positive symptoms are easier to treat

Question 16

Blunted affect

Answer 16

Narrow range of normal expression

Question 17

Alogia

Answer 17

Poverty of speech

Question 18

Avolition

Answer 18

Loss of motivation

Question 19

*Anhedonia

Answer 19

Lack of pleasure

Question 20

Anergia

Answer 20

Lack of energy

Question 21

Cognitive symptoms

Answer 21

Disordered thinking
Inability to make decisions 
Poor problem-solving ability
Difficulty concentrating
Memory deficits

Question 22

Depressive symptoms

Answer 22

Hopelessness

Suicidal ideation

Question 23

DELUSIONS - Alterations in Thought/Thinking

Answer 23

False fixed beliefs that cannot be corrected by reasoning and are usually bizarre.

Ideas of reference
Persecution
Grandeur
Somatic delusions
Jealousy
Being controlled
Thought broadcasting
Thought insertion
Thought withdrawal
Religiosity

Question 24

Ideas of reference

Answer 24

Misconstrues trivial events and attaches personal meaning to them.

Paranoia

Question 25

Persecution

Answer 25

Feels as if others might harm him

Question 26

Grandiosity

Answer 26

All powerful god-like qualities

Question 27

Somatic sensations (somatic delusions)

Answer 27

Delusions that body is changing in an unusual way Ex-growing a third arm

Question 28

Thought broadcasting

Answer 28

Believes one's thoughts can be heard by others

Question 29

Thought insertion

Answer 29

Believes that other's thoughts are being inserted into his mind

Question 30

Thought withdrawal

Answer 30

Believes that her thoughts have been removed from her mind by an outside agency.

Question 31

Alterations in speech

Answer 31

``` Loose associations (connections between thoughts are absent, haphazard, or illogical) Flight of ideas Neologisms Echolalia Clang association Word salad ``` *Need to let the pt know if you do not follow or understand them

Question 32

Neologisms

Answer 32

Made up words that only have meaning to the client

Question 33

Echolalia

Answer 33

Client repeats words spoken to them

Question 34

*Alterations in perception

Answer 34

Hallucinations: auditory, visual, olfactory, gustatory, tactile * Personal boundary difficulties: * Depersonalization * Derealization ``` Alterations in behavior: Stereotyped behaviors Automatic disobedience Waxy flexibility Stupor Negativism Echopraxia ```

Question 35

*Command hallucinations

Answer 35

*Ask pt what voices are telling them to do

Question 36

*Depersonalization

Answer 36

Nonspecific feeling that a person has lost their identity; self is different or unreal

Question 37

*Derealization

Answer 37

Perception that environment has changed

Question 38

Alterations in Behavior

Answer 38

``` Extreme agitation, including pacing and rocking Stereotyped behaviors Automatic obedience Waxy flexibility Stupor Negativism Echo praxis ```

Question 39

Stereotypical behaviors

Answer 39

Motor patterns that once had meaning to the pt, but now are mechanical and lack purpose. "hammering, sweeping"

Question 40

Automatic obedience

Answer 40

Responding in a robot-like manner Seen in catatonia

Question 41

Waxy flexibility

Answer 41

Excessive maintenance of position. Seen in catatonia

Question 42

Stupor

Answer 42

Motionless for long periods of time

Question 43

*Echopraxia

Answer 43

Purposeful imitation of movements made by others

Question 44

*Neuroleptic Malignant syndrome (NMS)

Answer 44

Caused by reduction in brain dopamine activity Occurs in 1% or less of pts Fatal in 10% medical emergency *Know that it is emergent

Question 45

**Symptoms of NMS

Answer 45

``` Decreased LOC Muscle rigidity *Hyperpyrexia (fever) *Tachycardia Tachypnea Autonomic instability *HTN ```

Question 46

*Tardive Dyskinesia

Answer 46

Involuntary muscle movements of the trunk, face, and extremities Usually not reversible Women are more prone *AIMS test is used to screen* baseline & routinely

Question 47

What is the purpose of the AIMS exam?

Answer 47

Used to screen for Tardive dyskinesia | Observing for muscle twitching/movement to indicate positive response

Question 48

Polydipsia

Answer 48

Excessive thirst

Question 49

Autism

Answer 49

Thinking is not bound to reality but reflects the private perceptual world of the individual. Ex-delusions, hallucinations, neologisms

Question 50

Ambivalence

Answer 50

Simultaneously holding two opposing emotions, attitudes, ideas, or wishes towards the same person, situation, or object. Occurs in all relationships but becomes pathological and paralyzing when a person vacillates between opposing positions.

Question 51

What are significant findings of the AIMS exam

Answer 51

.

Question 52

*Appropriate interventions for an pt that is hallucitating / delusions

Answer 52

Ask client directly about hallucinations **Do not argue with client about hallucinations/delusions but FOCUS ON FEELINGS Provide safety if experiencing command hallucinations Focus conversation on reality based subjects Identify symptoms & triggers Be genuine & empathetic

Question 53

*Akathisia

Answer 53

Regular rhythmic movements, usually of the lower limbs; constant pacing may also be seen; often noticed in people taking antipsychotic medication.

Question 54

*Akinesia

Answer 54

Absence or diminution of voluntary motion. Akinesia is usually accompanied by a parallel reduction in mental activity.

Question 55

*Eps symptoms

Answer 55

Dystonia Parkinsonisms Akinesia Akathesia

Question 56

*Institutionalization

Answer 56

The provision of psychiatric care in a custodial setting, typically viewed as a restrictive environment. When overused or used inappropriately it can result in apathy, dependency, and stagnation and impede a person's ability to function normally outside the institution.

Question 57

Transinstutionalization

Answer 57

The shifting of a person or population from on form of institution to another, such as from state hospitals to jails, prisons, nursing homes, or shelters.

Question 58

Dystonic episode.? And antidote

Answer 58

Abnormal muscle tonicity resulting in impaired voluntary movement. May occur as an acute side effect of neuroleptic (antipsychotic) medication, in which it manifests as muscle spasms of the face, head neck and back.

Question 59

First priority

Answer 59

Establish relation ship with pt = establish rapport