Mental Health N4615 Module II Flashcards
What is Schizophenia Spectrum?
It, and other psychotic disorders are those that distrub the fundamental ability to deteremine what is real or what is not.
All people who have Schizophrenia, have at least one of the following psychotic symptoms
hallucinatioins
delusions
and / or disorganized speech
What is the epidemiology of Schizophrenia
(when does it normally occur)
usually presents in late teens / early twenties.
What are the prodromal signs of schizophrenia
they are the initial signs indicating that a pt. might be leading toward a schizophrenic break
Withdrawal
misinterpreting
poor concentration
preoccupation with religion
What is early on-set Schizophrenia
(18 to 25) occurs more often in males
associated w/poor functioning before onset & more structural brain damage
What is later on-set Schizophrenia
(25 to 35) more likely to be female
less structural brain damage
better outcomes
What are some of the comorbidities associated w/ Schizophrenia
1) Substance abuse disorders - nearly 50% (sucide)
2) Nicotine dependence 70% - 90%
3) Anxiety, depression
4) Physical Health Illnesses
5) Polydipsia - can lead to fatal water intoxication (20% have insatiable thirst) may be due to medications
What is the etiology of Schizophrenia
scientific consesus is that Schizophrenia occurs due to multiple inherited genetic abnormalities combined with nongenetic factors.
called the diathesis-stress model of Schizophrenia
What are some of the genetic factors for Schizophrenia
Increased levels of dopamine (1st generations treat)
Increased levels of serotonin (2nd generation meds treat)
glutamate - which is a major neurotransmitter during neuronmaturation
Brain Structure Abnormalities - reduced volume of “grey matter” (temporal / frontal lobes) — more hallucinations.
What are some of the psychological / environmental
factors associated w/ Schizophrenia
1) prenatal stressors (poor nutrition & hypoxia)
2) psychological stressors (stress w/ incr cortisol level which imped hypothalamic development)
3) environmental stressors (toxins, ie. solvent tetrochoroethylene in dry cleaning)
all increase chances w/ those vulnerable to Schizophrenia
Schizophrenia def.
The most severe form of Schizphenia Spectrum
It is a potentially devastating brain disorder that affects a person’s thinking, language, emotions, social behavior, and ability to perceive reality accurately.
What are the Phases of Schizophrenia
Phase I - Acute
Phase II - Stabilization
Phase III - Maintenance
Def. Phase I - Schizophrenia
Acute
onset or exacerbation of distruptive symptoms (ie. hallucinations, delusions, apathy w/draw)
w/ loss of functional abilities - increased care or hospitalization may be required.
Def. Phase II - Schizophrenia
Stabilization
symptoms are diminishing, and there is movement towards one’s previous level of functioning (baseline)
Def. Phase III - Schizophrenia
Maintenence
pt. is at or near baseline functioning
symptoms are absent or significantly decreased.
What are the 4 main symptom groups of Schizophrenia
Positive symptoms
Negative symptoms
Affective Symptoms
Congnitive Symptoms
What are postive symptoms of Schizophrenia
associated w/acute onset
The presence of something that is not normally present
hallucinations
delusions
disorganized speech
bizarre behavior
will generally respond to medication
What are negative symptoms of Schizophrenia
absence of something that should be present
- Poverty of thought (interest in hygiene)
- Avolition (loss of motivation / energy or drive)
- Blunted affect (minimal emotional response)
- Alogia (poverty of speech)
- Anhedonia (loss of joy in something previously enjoyed)
- Anergia (lack of energy)
more presistent / crippling b/c they reduce motivation & limit social & vocational success
What are cogntitive symptoms of Schizophrenia
often subtle changes in memory, behavior, attention or thinking
ie. impaired executive functioning (ability to set priorities or make decisions)
What are affective symptoms of Schizophrenia
symptoms involving emotions and their expression
dysphoria (dissatisfaction w/ life)
suicidality
hopelessness
Positive symptoms are broken down into
what four categories
alterations in
1) thought
2) speech
3) perception &
4) behavior
What is “concrete thinking”
refers to the impaired ability to think abstractly
ie. When you ask a pt. what brought them to the hospital — they would say “ a cab”
Concreteness reduces one’s ability to understand and address abstract concepts such as love or the passage of time.
What is “clang association”
choosing words based on their sound rather then their meaning
ie. rhyming “on the track… have a Big Mac”
What is “word salad” (schizohasia)
jumbled words that are meaningless to the listener and possible to the speaker
ie. “red chair out town board”
What are Neologisms?
made-up words that have meaning to the pt. but a different or nonexistent meaning to others
What are Echolalia
pathological repeating of anothers words
ie. Nurse…Mary, come get your medication
Mary…come get your medication
What is Depersonalizaiton
feeling that one is somehow different or unreal or has lost his / her identity
may feel body parts don’t belong to them.
What is Derealization
a false perception that the environment has changed - surroundings seem strange and unfamilar
What is associative looseness
refers to jumbled thoughts inchoherently expressed to the listener.
Illusion is def as
A false belief about a perception
Based on a real perception (sight, sound, taste or feeling) that is misinterpreted
ex. the person actually sees something but believes they see something else
Hallucinations are def as
Perceptions involving the senses (sight, sound, odor, taste or feeling on the skin)
The body’s ability to detect things in the environment that are not detected by others.
Hallucinations vs. Illusions
both are perceptions
Hallucinations involve perceiving a sensory experience for which no external stimulus exist
Illusions are misperceptions or misinterpretations of a real experience (external stimulus); a false belief about a perception
ie. pts see the coat rack, but believes it is a bear
What are the types of hallucinations
experienced by 60% of pts. with Schizophrenia
Auditory: hearing voices or sounds
Visual: seeing persons or things
Olfactory: smelling odors
Gustatory: experiencing taste
Tactile: feeling bodily sensations
ex. I see; I hear; I taste; I smell; I feel
What are the worst types of hallucinations
Command hallucinations
those that direct pts to take action. voices may command the pt. to hurt themselves or others.
What is the MOST EFFECTIVE intervention for hallucinaitons?
Medications
RN-patient relationship
Reduce environmental stimuli
Increase internal stimuli (exercise) - tell the hallucinations to go away…listen to my voice or music
What is “Catatonia”
pronounced decrease in the rate and amount of movement
Generally pts. may move little if at all
What is Echopraxia
mimicking the movements of another
What is Anosognosia
inability to realize they are ill (caused by the illness itself)
The resulting lack of insight can make assessment / treatment challenging.
What does the “recovery model” stress
stresses hope, living a full and productive life, and eventually recovery rather than focusing on controlling symptoms and adapting to the disability
What is the overall goal for the acute phase
patient safety and stabilization
What goals does phase II (stabilization) focus on
helping the pt understand the illness and treatment, become stabilized on medications, and be able to control or cope with symptoms.
What goals does phase III (maintenance) focus on
adhering to medication, preventing relapse, and achieving independence and a satisfactory quality of life.
What is “waxy flexiblity”
the ability to hold distorted postures for extended periods of time.
What are some of the signs of a potential relapse in schizophrenia
feeling tense
difficultly concentrating
trouble sleeping
increased w/drawal
increased bizarre or magical thinking
Relapse can occur even w/ medication compliance
Delusions are def. as
false fixed beliefs that cannot be corrected by reasoning. Pt will agree w/ RN about facts but disagree w/ interpretation.
75% of those w/ schizophrenia experience these
persecutory
gradiose or
those involving religious or hypochondriacal ideas
ex. I think; I believe; I interpret; My opinion
Delusion vs. Illusion
A delusion (false belief) does not change w/ the use of logic.
An illusion (false belief about a perception) can often change once a person is given evidence that the belief is not true.
Delusions may be bizarre or non-bizarre
Bizarre type are unreal and impossible beliefs
i. e. Pt believes body organs replaced in absence of scars
i. e. Pt believes they are another animal (not human)
Non-bizarre types of delusions
- Delusions of control
- Ideas of reference
- Persecution
- Grandeur
- Somatic
- Erotomanic
- Jealousy
Def. of control delusions
Believing that another person, group of people, or external force controls thoughts, feelings, impulses, or behavior
i.e. Pt covers his apartment walls w/ aluminum foil to block government efforts to control his thoughts
Def. of ideas of reference
Giving personal significance to unrealated or trivial events; perceiving events as relating to you when they are not
i.e. Pt believes that birds sing when she walks down the street just for her.
Def. of persecution delusions
Believing that one is being singled out for harm by others; this belief often takes the form of a plot by people in power.
i.e. Pt believes the Secret Service was planning to kill him by poisoning his food; therefore, he would eat only prepackaged food.
Def. of grandeur delusions
Believing that one is a very powerful or important person
i.e. Pt believed he was a famous playwright and tennis pro
Def. of somatic delusions
Believing that the body is changing in unusual ways (i.e. rotting inside)
i.e. Pt said his heart had stopped and was rotting away.
