Module 2 - Schizoprenia

Question 1

Define ambivalence (Positive symptoms)

Answer 1

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

Question 2

Define associative looseness (positive S)

Answer 2

Fragmented or poorly related thoughts and ideas

Question 3

Define delusions (positive symptoms)

Answer 3

Fixed false beliefs that have no basis in reality.

Question 4

Define echopraxia (positive)

Answer 4

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

Question 5

Define flight of ideas (positive)

Answer 5

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

Question 6

Define hallucinations (positive)

Answer 6

False sensory perceptions or perceptual experiences that do not exist in reality.
auditory being 1st common and visual 2nd common

Question 7

Define ideas of reference (positive)

Answer 7

False impressions that external events have special meaning for the person

Question 8

Define perseveration (positive)

Answer 8

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

Question 9

Define alogia (negative)

Answer 9

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

Question 10

Define anhedonia (negative)

Answer 10

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

Question 11

Define apathy (negative)

Answer 11

Feelings of indifference toward people, activities, and events

Question 12

Define asociality (negative)

Answer 12

social withdrawal, few or no relationships, lack of closeness

Question 13

Define blunted affect (negative)

Answer 13

Restricted range of emotional feeling, tone, or mood

Question 14

Define catatonia (negative)

Answer 14

Psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless, as if in a trance

Question 15

Define flat affect (negative)

Answer 15

Absence of any facial expression that would indicate emotions or mood

Question 16

Define avolition or lack of volition (negative)

Answer 16

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

Question 17

Define inattention (negative)

Answer 17

Inability to concentrate or focus on a topic or activity, regardless of its importance

Question 18

Cynthia and Tina love who?

Answer 18

Lis ❤️

Question 19

What are clang associations?

Answer 19

ideas that are related to one another based on sound or rhyming rather than meaning.
Example: “I will take a pill if I go up the hill but not if my name is Jill, I don’t want to kill.”

Question 20

What are neologisms?

Answer 20

words invented by the client.

Example: “I’m afraid of grittiz. If there are any grittiz here, I will have to leave. Are you a grittiz?”

Question 21

What is verbigeration?

Answer 21

the stereotyped repetition of words or phrases that may or may not have meaning to the listener.
Example: “I want to go home, go home, go home, go home.”

Question 22

What is echolalia?

Answer 22

the client’s imitation or repetition of what the nurse says.
Example: Nurse: “Can you tell me how you’re feeling?”
Client: “Can you tell me how you’re feeling, how you’re feeling?”

Question 23

What is stilted language?

Answer 23

use of words or phrases that are flowery, excessive, and pompous.
Example: “Would you be so kind, as a representative of Florence Nightingale, as to do me the honor of providing just a wee bit of refreshment, perhaps in the form of some clear spring water?”

Question 24

What is word salad?

Answer 24

a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.
Example: “Corn, potatoes, jump up, play games, grass, cupboard.”

Question 25

Persecutory/paranoid delusions

Answer 25

involve the client’s belief that “others” are planning to harm the client or are spying, following, ridiculing, or belittling the client in some way. Sometimes, the client cannot define who these “others” are.

Question 26

Grandiose delusions

Answer 26

characterized by the client’s claim to association with famous people or celebrities, or the client’s belief that he or she is famous or capable of great feats.

Question 27

Religious delusions

Answer 27

often center around the second coming of Christ or another significant religious figure or prophet. These religious delusions appear suddenly as part of the client’s psychosis and are not part of his or her religious faith or that of others.

Question 28

Somatic delusions

Answer 28

generally vague and unrealistic beliefs about the client’s health or bodily functions. Factual information or diagnostic testing does not change these beliefs.

Question 29

Sexual delusions

Answer 29

involve the client’s belief that his or her sexual behavior is known to others; that the client is a rapist, prostitute, or pedophile or is pregnant; or that his or her excessive masturbation has led to insanity.

Question 30

Nihilistic delusions

Answer 30

the client’s belief that his or herorgans aren’t functioning or are rotting away, or that some body part or feature is horribly disfigured or misshapen.

Question 31

Referential delusions (ideas of reference)

Answer 31

involve the client’s belief that television broadcasts, music, or newspaper articles have special meaning for him or her.

Question 32

Neuroleptics

Answer 32

Antipsychotic medications

Question 33

Waxy flexibility

Answer 33

Maintenance of posture or position over time even when it is awkward or uncomfortable

Question 34

Thought withdrawal

Answer 34

A delusional belief that others are taking the client’s thoughts away and the client is powerless to stop it

Question 35

Tardive dyskinesia

Answer 35

A late onset, irreversible neurological side effect of antipsychotic medications characterized by abnormal involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet

Question 36

Peak incidence of schizophrenia in men

Answer 36

15-25

Question 37

Peak incidence of schizophrenia in women

Answer 37

25-35

Question 38

Positive (hard) symptoms of schizophrenia

Answer 38

Delusions, hallucinations, grossly disorganized thinking, speech, and behavior. Also include ambivalence, associate looseness, echopraxia, flight of ideas, ideas of reference, perseveration and bizarre behavior

Question 39

Negative (soft) symptoms of schizophrenia

Answer 39

Flat affect, lack of volition, and social withdrawal or discomfort. Also include logia, anhedonia, apathy, sociality, blunted affect, catatonia and inattention

Question 40

schizophrenia is a brain disease that affects…?

Answer 40

thinking, language, emotions, social behavior and the ability to perceive reality accurately

Question 41

schizophrenia causes

Answer 41

distorted and bizarre thoughts, perceptions, emotions, movement, and behavior.

Question 42

Akathisia

Answer 42

Intense need to move about; characterized by restless movement, pacing, inability to remain still and the clients report of inner restlessness

Question 43

diagnosis of schizophrenia is most often made when patient displays more ….

Answer 43

positive symptoms

Question 44

early diagnosing and treatment may reduce and improve what

Answer 44

Reduce chronicity, improve prognosis, improve insight and improve social functioning .
Early intervention improved outcome and lower relapse rate thus quality of life is improved.
Aggressive treatment is necessary when identified, must verify other possible causes prior to making dx

Question 45

Patients diagnosed with schizophrenia may be hospitalized because

Answer 45

they are in danger of hurting themselves or to be harmed by others due to their behavior. (risk for injury)
They are unable to care for themselves and need constant supervision.
have 20% lower life expectancy due to bizarre behavior and poor judgement

Question 46

in clients diagnosed with schizophrenia PET scans show

Answer 46

enlarge ventricles in the brain and cortical atrophy.
studies suggest that glucose metabolism and oxygen are diminished in the frontal cortical structure of the brain, also some studies consistently show decreased brain volume and abnormal brain function in the frontal and temporal areas of a person with schizophrenia.

Question 47

biologic theories of schizophrenia

Answer 47

1. genetic factors
2. neuroanatomic and neurochemical factors
3. immunovirologic factors

Question 48

what are the two immediate course a client follow once dx (or onset of symptoms) with schizophrenia

Answer 48

1. ongoing psychosis - never fulling recovering

2. episodes of psychotic symptoms alternating with episodes of relatively complete recovery

Question 49

long term course

Answer 49

intensity of psychosis diminished with age. Most with difficulty functioning and few with the ability to live fully independent lives

Question 50

childhood onset schizophrenia, before age 12

Answer 50

severe form, more difficult to control and interfere with Childs development, increased cognitive impairment.

Question 51

schizophreniform disorder

Answer 51

Acute psychosis; occurring less than 6 months in duration.
If symptoms persistent over 6 months dx is changed to schizophrenia
Social and occupation functioning may or may not be impaired

Question 52

delusional disorder

Answer 52

Delusion may be believable; not bizarre, does not impair function.
Its behavior is not obviously off or bizarre.
The delusion may be persecutory, egomaniac, grandiose, jealous or somatic in content .

Question 53

brief psychotic disorder

Answer 53

Sudden onset at least 1 day plus no more than 1 month.

May or may not have identifiable stressor, may follow childbirth

Question 54

shared psychotic disorder (folie deux)

Answer 54

Person having paranoid delusions and someone close to them not dx with mental illness believes their delusion.
The more submissive or suggestive person may rapidly improve if separated from the dominant person

Question 55

Schizotypal personality disorder

Answer 55

Odd, eccentric behavior
Have transient, self limiting delusional symptoms.
Approx 20% of pmts with this personality disorder will eventually be dx with schizophrenia

Question 56

schizoaffective disorder

Answer 56

is diagnosed when the client is severely ill and has a mixture of psychotic and mood symptoms. The S&S include both of schizophrenia and mood disorder such as depression or bipolar disorder. Sometimes symptoms may occur simultaneously or may alternate between psychotic and mood disorder
Often second get antipsychotic are the best first choice, mood stabilizer or antidepressant may be added if needed

Question 57

Geodon is contraindicated in

Answer 57

If the patient has known hx of QT prolongation, recent myocardial infarction or uncompensated heart failure, it should not be used with other QT prolonging drugs.

Question 58

Neuroleptic malignant syndrome

Answer 58

Rigidity, high fever, autonomic instability such as unstable BP, diaphoresis and pallor; delirium and elevated levels of enzyme particularly creatine phosphokinase. clients are usually confuse and often mute; they may fluctuate from agitation to stupor.
High doses increase chances of development
Most often occur in 2 weeks after starting, but can occur any time
Dehydrating, poor nutrition and concurrent medical illness increase the risk of development
Treatment includes to stop medication, treat symptoms and prevent complication (notify physician immediately)

Question 59

Extrapyramidal side effects and treatment

Answer 59

Include Dystonia, pseudoparkinsonmism and akathisia
First generation antipsychotic drugs cause greater incidence of EPS than 2nd gen.
Lowering dosages, changing to different antipsychotic medication or administration of prophylaxis anticholinergic medication.
Benadryl and Cogentin may prevent EPS

Question 60

Pseudoparkinsonism

Answer 60

resembles Parkinson’s disease and include stiff neck, stooped posture; mask like facies; decreased arm swing; a shuffling festinating gait (with small steps), cogwheel rigidity (ratchet-like movement of joint); drooling, tremor, bradycardia, course pill-rolling movement of the thumb and finger while at rest.
Usually appear in the first few days of starting med or increase in dosage

Question 61

Acute dystonia

Answer 61

Acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing and in severe cases laryngospasm and respiratory difficulty.
Most likely occurs in the first week of treatment
Torticollis (twisted head and neck), Opisthotonus (tightness in the entire body), or Oculogiric crisis (eyes rolled back in the locked position)
Immediate treatment is Anticholinergic drugs IM, or IM/IV Benadryl

Question 62

Akathisia

Answer 62

Clients report increase/intense need to move about. They appear restless or anxious and agitated, often with rigid posture or gait and a lack of spontaneous gesture. This feeling may lead to discontinuation of medication.
It is treated with Beta Blocker (propranolol)

Question 63

Nonneurologic side effect of antipsychotic medication

Answer 63

Weight gain, sedation, Photosensitivity, anticholinergic symptoms (can’t see, can’t pee, can’t poop, orthostatic hypotension, dry mouth). Hyperlipidemia, diabetes (initiation or aggravation of DM)

Question 64

clozapine (Clozaril)

2nd generation antipsychotic

Answer 64

May cause agranulocytosis, before treatment starts must have baseline WBC count and differentials. Increase risk for infection, cardiac problems and DVT
WBC count every week throughout treatment and 4 weeks after discontinuation.
Advantages include improvement of negative symptoms without causing EPS.
Contraindicated in patient with bone marrow depression and life threatening decrease in WBC

Question 65

for first gen drugs think

Answer 65

AZINE

Question 66

for second gen drugs think

Answer 66

APINE & IDONE

Question 67

TD intervention

Answer 67

TD is a late appearing side effect of antipsychotic, using assessment took such as AIMS (abnormal involuntary movement scale) the client is observed in several positions and the severity of symptoms is rated 0-4, can be done every 3-6 months. Report occurrence and/or if score increased to physician.