Module 2 - Schizoprenia Flashcards
Define ambivalence (Positive symptoms)
Holding seemingly contradictory beliefs or feelings about the same person, event, or situation
Define associative looseness (positive S)
Fragmented or poorly related thoughts and ideas
Define delusions (positive symptoms)
Fixed false beliefs that have no basis in reality.
Define echopraxia (positive)
Imitation of the movements and gestures of another person whom the client is observing
Define flight of ideas (positive)
Continuous flow of verbalization in which the person jumps rapidly from one topic to another
Define hallucinations (positive)
False sensory perceptions or perceptual experiences that do not exist in reality.
auditory being 1st common and visual 2nd common
Define ideas of reference (positive)
False impressions that external events have special meaning for the person
Define perseveration (positive)
Persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic
Define alogia (negative)
Tendency to speak very little or to convey little substance of meaning (poverty of content)
Define anhedonia (negative)
Feeling no joy or pleasure from life or any activities or relationships
Define apathy (negative)
Feelings of indifference toward people, activities, and events
Define asociality (negative)
social withdrawal, few or no relationships, lack of closeness
Define blunted affect (negative)
Restricted range of emotional feeling, tone, or mood
Define catatonia (negative)
Psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless, as if in a trance
Define flat affect (negative)
Absence of any facial expression that would indicate emotions or mood
Define avolition or lack of volition (negative)
Absence of will, ambition, or drive to take action or accomplish tasks
Define inattention (negative)
Inability to concentrate or focus on a topic or activity, regardless of its importance
Cynthia and Tina love who?
Lis ❤️
What are clang associations?
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.”
What are neologisms?
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?”
What is verbigeration?
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.”
What is echolalia?
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?”
What is stilted language?
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?”
What is word salad?
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.”
Persecutory/paranoid delusions
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.
Grandiose delusions
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.
Religious delusions
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.
Somatic delusions
generally vague and unrealistic beliefs about the client’s health or bodily functions. Factual information or diagnostic testing does not change these beliefs.
Sexual delusions
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.
Nihilistic delusions
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.
Referential delusions (ideas of reference)
involve the client’s belief that television broadcasts, music, or newspaper articles have special meaning for him or her.
Neuroleptics
Antipsychotic medications
Waxy flexibility
Maintenance of posture or position over time even when it is awkward or uncomfortable
Thought withdrawal
A delusional belief that others are taking the client’s thoughts away and the client is powerless to stop it
Tardive dyskinesia
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
Peak incidence of schizophrenia in men
15-25
Peak incidence of schizophrenia in women
25-35
Positive (hard) symptoms of schizophrenia
Delusions, hallucinations, grossly disorganized thinking, speech, and behavior. Also include ambivalence, associate looseness, echopraxia, flight of ideas, ideas of reference, perseveration and bizarre behavior
Negative (soft) symptoms of schizophrenia
Flat affect, lack of volition, and social withdrawal or discomfort. Also include logia, anhedonia, apathy, sociality, blunted affect, catatonia and inattention
schizophrenia is a brain disease that affects…?
thinking, language, emotions, social behavior and the ability to perceive reality accurately
schizophrenia causes
distorted and bizarre thoughts, perceptions, emotions, movement, and behavior.
Akathisia
Intense need to move about; characterized by restless movement, pacing, inability to remain still and the clients report of inner restlessness
diagnosis of schizophrenia is most often made when patient displays more ….
positive symptoms
early diagnosing and treatment may reduce and improve what
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
Patients diagnosed with schizophrenia may be hospitalized because
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
in clients diagnosed with schizophrenia PET scans show
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.
biologic theories of schizophrenia
- genetic factors
- neuroanatomic and neurochemical factors
- immunovirologic factors
what are the two immediate course a client follow once dx (or onset of symptoms) with schizophrenia
- ongoing psychosis - never fulling recovering
2. episodes of psychotic symptoms alternating with episodes of relatively complete recovery
long term course
intensity of psychosis diminished with age. Most with difficulty functioning and few with the ability to live fully independent lives
childhood onset schizophrenia, before age 12
severe form, more difficult to control and interfere with Childs development, increased cognitive impairment.
schizophreniform disorder
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
delusional disorder
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 .
brief psychotic disorder
Sudden onset at least 1 day plus no more than 1 month.
May or may not have identifiable stressor, may follow childbirth
shared psychotic disorder (folie deux)
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
Schizotypal personality disorder
Odd, eccentric behavior
Have transient, self limiting delusional symptoms.
Approx 20% of pmts with this personality disorder will eventually be dx with schizophrenia
schizoaffective disorder
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
Geodon is contraindicated in
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.
Neuroleptic malignant syndrome
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)
Extrapyramidal side effects and treatment
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
Pseudoparkinsonism
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
Acute dystonia
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
Akathisia
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)
Nonneurologic side effect of antipsychotic medication
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)
clozapine (Clozaril)
2nd generation antipsychotic
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
for first gen drugs think
AZINE
for second gen drugs think
APINE & IDONE
TD intervention
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.
