NUR 144 - WEEK 3 "MH" - Schizophrenia and Psychosis

Question 1

Schizophrenia

Question 2

Schizophrenia:

s&s / Clinical presentation

Answer 2

Positive Symptoms:
- Hallucinations
- Delusions
- Disorganized speech

Negative symptoms:
- Alogia
- Anergia
- Anhedonia - disinterest, lack of enjoyment

Cognitive Symptoms:
- Poor concentration
- Slow thinking
- Poor memory

Question 3

Schizophrenia:

Assessment

Answer 3

Positive symptoms:
- Hallucination
- Delusions
- Disorganized speech
- Thought disorders

Negative Symptoms:
- Loss of motivation
- Anhedonia - disinterest, lack of enjoyment
- Social withdrawal
- Avolition - Difficulty planning, beginning, sustaining activity

Cognitive symptoms:
- Trouble focusing or paying attention
- Difficulty following conversation
- Difficulty learning new things

Question 4

Schizophrenia:

Etiology / cause / Risk factors

Answer 4

Genetics: several genes

Physiological: neurodevelopment, associated with hypoxia, infections

Biochemical: Chronic exposure to cortisol

Environmental: Cannabis use

Question 5

Schizophrenia:

Nursing interventions

Answer 5

• Creating safe, therapeutic environment
• Supporting early detection of psychosis
• Providing support to client toward recovery

Question 6

Schizophrenia:

Diagnostics

Answer 6

DSM-5

Schizophrenia is diagnosed when two or more of the following characteristics are present for a significant portion of time:

• delusions
• hallucinations
• Disorganized speech
• Disorganized or catatonic behavior
• Negative symptoms = reduced motivation,

Question 7

Schizophrenia:

Treatment

Answer 7

No cure, treatment focuses on managing symptoms

• Cognitive behavioral therapy
• Family education & support

Question 8

Psychosis:

What is it?
Cause?

Answer 8

Loss of contact with reality

Cause:
- Mental illness
- Sleep deprivation
- Medical condition (ex: hyperglycemia, hyperthyroidism)
- Side effects of meds
- Alcohol / drugs

Question 9

Psychosis:

s&s / Manifestations

Answer 9

Delusion: False perception, unchanged by logic

Hallucination: Altered sensory perception (auditory, visual, touch)

Question 10

Psychosis:

Treatment

Answer 10

• Antipsychotic meds
• Psychotherapy
• Cognitive Behavioral therapy

Question 11

Clozapine

Answer 11

Side effect:
- Agranulocytosis, potentially life threatening

Question 12

Neuroleptic Malignant Syndrome:

What is it?
Cause?
Clinical Manifestations

Answer 12

What is it:
- Potentially life threatening reaction to antipsychotic drugs

Cause:
- Initial exposure or abrupt discontinuation of antipsychotic medication

Clinical manifestations:
- Muscle rigidity
- Hyperthermia
- Vital sign instability
- Elevated creatine kinase

Question 13

Neuroleptic Malignant Syndrome:

Nursing Interventions

Answer 13

• Discontinue antipsychotic medication
• Monitor fluid and electrolytes
• Initiate cooling measures
• Cardiac monitor

Question 14

Extrapyramidal symptoms:

What is it
Cause
Clinical Manifestations

Answer 14

What is it:
- A set of manifestations caused by blocking dopamine in the midbrain to the brainstem

Clinical manifestations:
Acute Dystonia: Muscle rigidity or spasms caused by use of antipsychotics

Akathisia: Feelings of severe restlessness not relieved by movement caused by the use of antipsychotics

Pseudo-parkinsonism: Mimic Parkinson’s

Question 15

Extrapyramidal symptoms:

Management
Nursing interventions

Answer 15

• Symptoms relieved by administration of anticholinergic drugs (benztropine, diphenhydramine)
• Monitoring if EPS do not resolve after antipsychotic medication

Question 16

What are command hallucinations?

Answer 16

Person having auditory hallucinations, and the voices are telling them to do something

• Needs to be addressed immediately, especially if commanding something dangerous to themselves or others