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Midterms > Psych-Schizophrenia > Flashcards

Psych-Schizophrenia Flashcards

1
Q

Schizophrenia is from a Greek words ___ and ___

A

“Schizein” (to split) and “Phren” (mind)

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2
Q
  • “PSYHOTIC DISORDER”
  • Disturbances in perception, thought processes, reality testing, feeling, behavior, attention and motivation.
  • not a single disorder but a group of related disorders characterized by disordered thinking.
A

Schizophrenia

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3
Q

Onset: Adolescence or young adulthood
peak→ ___ and
___

A

15 to 25 years of age for men and 25 to 35 years of age for women

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4
Q
  • A psychiatrist that first described schizophrenia as a specific mental illness in 1887
  • He believed that it occurred early in life & is followed by gradual but continuous downhill course leading to deterioration.
  • Organic pathology
A

Emil Kraepelin

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5
Q

Emil Kraepelin named it ___, a fatalistic prognosis

A

Dementia Praecox

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6
Q
  • Coined the term Schizophrenia
  • renamed it Schizophrenia which indicates the “splitting” of various functions.
A

Eugene Bleuler

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7
Q

Bleuler’s 4 A’s

A

A. Associative disturbance or thought disturbance
B. Affective disorders
- flat or blunted affect or inappropriate
C. Autism
- detachment from external reality & withdrawal from fantasies
D. Ambivalence
- or the simultaneous existing of opposing feelings, thoughts & desires

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8
Q

frequently present but not specific to schiz.
Hallucination, delusions, catatonic posturing

A

Accessory Symptoms

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9
Q
  • emphasized the psychological factors in the
    etiology.
  • Hallucination originated from frightening &
    unbearable ideas.
A

Sigmund Freud

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10
Q
  • person’s predisposition. Saw schiz as “introvert”.
  • He also considered psychosomatic factors in
    operation.
  • Proposed that emotional disorder could cause a metabolic disturbance & eventually physical brain damage in psychotic patients.
A

Carl Jung

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11
Q

Biological Theories

% risk of inheriting schizophrenia –
one immediate family member with the disease

Genetic Factors

A

10% to 20%

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12
Q

Approximately ___%, if the disease affects both parents or an identical twin.

Genetic Factors

A

40%

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13
Q
  • a higher incidence rate of schiz occurs in the
    relatives of schiz than in the general population
  • Schiz seems to occur though the interaction of a genetic susceptibility & environmental stress.
A

Genetic Factors

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14
Q

biochemical differences in the NS that cause him to process the info in an abnormal manner, which result to disturbances in ___, ___, & ___

Biochemical Influences

A

attention, isolation &
hypersensitivity

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15
Q
  • Hemispheric dysfunction of the brain, (L)
    hemisphere overreaction, temporal abnormalities & delay processing of sensory info.
  • Impaired modulation of stimulus input,
    allowing too much info to reach higher brain
    centers.
  • (L) hemisphere is less efficient than the (R)
  • Disturbances in the adrenergic system of the brain
  • Overactivity of dopamine or insufficiency of
    norepinephrine at certain synapses of the
    brain
A

Biochemical Influences

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16
Q

through CT scan

A

Neuroanatomic Theories

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17
Q

cerebral atrophy, enlargement of the ventricles of the brain, dist in cerebral metabolism & electrical activity

A

Brain dysfunction

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18
Q

indicated relative metabolic underactivity of the frontal lobes of schiz. They have also shown decreased activity in the basal ganglia that can be reversed w/ neuroleptic treatment.

A

Positron Emission Tomography (PET)

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19
Q

Intrapsychic Influences

an individual becomes a schiz not because of
what others did to him, but ___

A

“because of what
he does w/ what has been done to him”

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20
Q
  • There exists a predisposition of the personality to break down under high levels of stress
  • Certain characteristics (hypersensitivity,
    increased anxiety & emotional detachment) may escalate into suspicion, intolerable fears,
    withdrawal & isolation.
  • Triggering life events such as death of a loved one, may exacerbate a crisis & emotional collapse for a person predisposed to schiz
A

Intrapsychic Influences

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21
Q

Disordered communication within the family may be growth impending; typical of a closed family system.

A

Interpersonal Influences

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22
Q
  • Lack of feedback mechanisms
  • Parents faulty relationship
  • Double-bind communication
  • Families are severely fused
  • Undifferentiated ego mass
A

Interpersonal Influences

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23
Q

negative affective climate in the home suggested a stressful factor in the families of
vulnerable individual

A

Expressed Emotions (EE)

Undifferentiated ego mass

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24
Q
  • Hard/deviant symptoms
  • Present but should be absent
A

Positive

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25
Q

Fixed false beliefs that have no basis in reality

A

Delusions

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26
Q

Fragmented or poorly related thoughts and ideas

A

Associative Looseness

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27
Q

False sensory perceptions or perceptual
experiences that do not exist in reality

A

Hallucinations

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28
Q

Imitation of the movements and gestures of another person

A

Echopraxia

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29
Q

False impressions that external events have special

A

Ideas of Reference

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30
Q

refers to an unrealistic sense of superiority, characterized by a sustained view of one’s self as better than others

A

Grandiosity

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31
Q

the exaggerated tendency to believe that other people intend harm, especially to oneself

A

Suspiciousness

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32
Q

a personality or cognitive trait characterized by a negative attitude toward others

A

Hostility

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33
Q

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

A

Ambivalence

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34
Q

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

A

Flight of Ideas

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35
Q

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

A

Perseveration

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36
Q

outlandish appearance or clothing; repetitive or stereotyped, seemingly purposeless movements; unsual social or sexual behavior

A

Bizarre behavior

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37
Q
  • Soft/deficit symptoms
  • Absence of normal characteristics
A

Negative

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38
Q

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

A

Alogia

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39
Q

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

A

Anhedonia

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40
Q

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

A

Catatonia

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41
Q

Absence of any facial expression that would indicate emotions or mood

A

Flat Affect

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42
Q

Feelings of indifference toward people, activities, and events

A

Apathy

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43
Q

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

A

Avolition or Lack of Volition

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44
Q

Restricted range of emotional feeling, tone, or mood

A

Blunted Affect

45
Q

Social withdrawal, few or no relationships, lack of closeness

A

Asociality

46
Q

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

A

Inattention

47
Q

marked disturbance of psychomotor activity (motionless or excessive motor activity)

A

Catatonic Schizophrenia

48
Q

Signs & Symptoms of Catatonic Schizophrenia

A
  • Rigidity
  • Waxy flexibility
  • Stupor
  • Mutism
  • Negativism
  • Posturing or excitement
  • Echolalia
  • Echopraxia
49
Q
  • Most severe subtype
  • Poor prognosis
  • Signs & Symptoms
  • Disorganized/ incoherent speech
  • Flat, silly, inappropriate affect
  • Unusual mannerism (giggling)
  • Hypochondriasis
  • Extremely withdrawn
  • May hallucinate/ have delusions
  • Loosely organized
A

Disorganized Schizophrenia

50
Q
  • Favorable prognosis
  • Signs & Symptoms
    • Preoccupation with delusions of persecution &/or grandeur
    • Ideas of reference
    • Auditory hallucination (persecutory/grandiose)
    • Suspicious
    • Hostile- can possibly be violent
    • Angry
    • Reserved & controlled social interaction
A

Paranoid Schizophrenia

51
Q
  • Characterized by symptoms of schizophrenia but do not meet the criteria for subtypes (paranoid, catatonic, or disorganized)
  • Signs & Symptoms
  • Hallucination
  • Delusion
  • Incoherence
A

Undifferentiated Schizophrenia

52
Q
  • exhibited psychotic symptoms of schizophrenia in the past, but is not psychotic at present.
  • Signs & Symptoms
  • Social withdrawal
  • Emotional blunting
  • Illogical thinking or eccentric behavior
A

Residual Schizophrenia

53
Q
  • Has psychotic symptoms of schizophrenia and meets the criteria for a major affective or mood disorder (mood and thought disorder)
  • Prognosis is better than schizophrenia
A

Schizoaffective Disorder

54
Q
  • Affective symptoms:
  • Extreme depression or elation
  • Schizophrenic Symptoms:
  • (+) and (-) symptoms
A

Schizoaffective Disorder

55
Q
  • sudden onset of psychotic symptoms following a severe psychosocial stressor that last for a day but less than a month
  • Signs & Symptoms:
  • Incoherent speech
  • Delusions
  • Bizarre behavior
  • Disorientation
  • hallucinations
A

Brief Psychotic Disorder

56
Q

are those with preexisting personality disorder (histrionic, narcissistic, borderline personality)

A

Susceptible individual

57
Q
  • Exhibits features of schizophrenia for at least 1 month but fewer than 6 months
  • Good prognosis
  • Signs & Symptoms
  • Incoherent speech
  • Delusions
  • Bizarre behavior
  • Disorientation
  • Hallucination
A

Schizophreniform Disorder

58
Q
  • Client has one or more non bizarre delusions for at least a month
  • Behavior is not obviously odd or bizarre
A

Delusional Disorder

59
Q

Types of Delusional Disorder

A
  • Erotomanic type
  • Grandiose type
  • Jealous type
  • Persecutory type
  • Somatic type
60
Q

individual believes that someone of a high status is in love w/ him or her. Famous persons are often the subject of this delusion.

A

Erotomanic type

61
Q

irrational ideas regarding their own worth, talent, knowledge or power

A

Grandiose type

62
Q
  • the content of jealous delusions centers on the idea that the person’s sexual partner is unfaithful.
  • The idea is irrational & w/o cause but the deluded individual searches for evidence to justify the belief (imagined infidelity)
A

Jealous type

63
Q
  • most common
  • Individual believes that they are malevolently maltreated in some way. Themes include: being conspired against, cheated, spied on, followed or drugged, harassed
A

Persecutory type

64
Q

believes they have physical defect or disease

A

Somatic type

65
Q

folie a deux

A

Shared Psychotic Disorder

66
Q
  • delusional system that develops in a second person as a result of a close relationship with another person who has psychotic symptoms.
  • the person with primary delusions is the dominant person in the relationship & the delusional thinking is imposed on the passive partner.
  • Types:
  • Erotomanic
  • Grandiose
  • Jealous
  • Persecutory
  • Somatic
A

Shared Psychotic Disorder

67
Q

Presence of prominent hallucinations or delusions resulting from the direct physiologic effects of a specific medical condition

A

Psychotic Disorder Due to General Medical Condition

68
Q

CVD, Huntington’s disease, Epilepsy, Migraine headache, CNS infections

A

Neurological conditions

69
Q

hypo or hyperthyroidism

A

Endocrine disorders

70
Q

hypoxia, hypercarbia, hypoglycemia

A

Metabolic conditions

71
Q

SLE, fluid electrolyte imbalance, hepatic or renal disorder

A

Autoimmune disorder

72
Q

presence of prominent hallucinations & delusions that are judged to be directly attributable to the physiological effects of the substance

A

Substance-Induced Psychosis

73
Q

alcohol, amphetamines, cannabis, cocaine,
hallucinogens, inhalants, opioids, anxiolytics,
sedatives & hypnotics

A

Drug of Abuse

74
Q

anesthetics & analgesics, anticonvulsants,
antidepressants, CV meds, chemotherapeutic
agents, muscle relaxants

A

Medications

75
Q

nerve gases, carbon monoxide, volatile subs (fuel or paint), carbon dioxide

A

Toxins

76
Q

Delusions: persecution, grandeur, reference,
control, somatic, nihilistic, religiosity, paranoia,
magical thinking

A

Content of Thought

77
Q

associative looseness, neologisms, concrete
thinking, clang association, word salad,
circumstantiality, tangentiality, mutism,
perseveration

A

Form of Thought

78
Q
  • Hallucinations: auditory, visual, tactile (formication), gustatory, olfactory.
  • Illusions.
A

Perception

79
Q

Inappropriate, blunt, flat, apathy

A

Affect

80
Q

describes the uniqueness & individuality a
person feels. Because of weak ego boundaries, the schizophrenics** lack this feeling of uniqueness** & experiences a great deal of confusion regarding his identity. They have difficulty knowing where their ego ends & another person’s ego begins.

A

Sense of Self

81
Q

two opposing emotions. Underlying cause is
difficulty in fulfilling a satisfying human relationship. This difficulty is based on the need-fear dilemma – the simultaneous need for & fear of intimacy

A

Emotional Ambivalence

82
Q

clients with acute schiz cling to others, intrude
on strangers & fail to recognize that excessive
closeness makes other people uncomfortable & likely to pull away.

A

Impaired Interpersonal Functioning & Relationship to the External World

83
Q

focuses inward on a fantasy world while
distorting the external environment

A

Autism

84
Q

untidy & unkempt.

A

Detoriorated Appearance

85
Q
  • Anergia – a deficiency of energy. Lacks energy to carry out ADL
  • Waxy flexibility – passively yields all moveable parts of the body
  • Posturing – inappropriate bizarre postures
  • Pacing & rocking
A

Psychomotor Behavior

86
Q

Anhedonia, regression

A

Associated Features

87
Q
  • Visual hallucinations, headaches & recent
    head injury
  • “what drugs are you using?”

Diagnostic Workup

A

History & Mental Status Examination

88
Q
  • Series of pencil-&-paper tests such as
    write-a-sentence and draw-a-clock
  • Can help identify patients w/ other brain
    diseases
A

Physical & Neurological Examinations

89
Q
  • Blood count – may elicit findings such as
    pernicious anemia, AIDS or lead intoxication
  • Blood Chemical Screens – may screen
    endocrine or metabolic imbalances
  • Order for thyroid function test
  • Routine test to screen for syphilis
  • Urinalysis should include tests for street
    drugs
  • Get baseline EKG – some drugs affect
    the heart
A

Basic Laboratory Work

90
Q

capable of detecting a variety of diseases,
esp. viral diseases of the central nervous
system

A

Lumbar Puncture

91
Q

may detect temporal-lobe epilepsy, which sometimes mimics schizophrenia

A

Electroencephalogram (EEG)

92
Q

Diagnostic Workup

A
  1. History & Mental Status Examination
  2. Physical & Neurological Examinations
  3. Basic Laboratory Work
  4. Physiological Tests
  5. MRI Scan (Magnetic Resonance Imaging) or CT Scan
  6. Lumbar Puncture
  7. Electroencephalogram (EEG)
  8. Others
93
Q
  • Antipsychotics or neuroleptics are prescribed primarily for their efficacy in decreasing psychotic symptoms.
  • First Generation antipsychotics
  • Second Generation antipsychotics
  • Side Effects: EPS and NMS
  • Nursing Responsibilities
A

Psychopharmacology

94
Q
  • Dystonic reactions
  • Tardive dyskinesia
  • Neuroleptic malignant syndrome
  • Akathisia
  • Extrapyramidal side effect or neuroleptic-induced parkinsonism
  • Seizures
  • Sedation
  • Photosensitivity
  • Anticholinergic symptoms
  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary retention
  • Orthostatic hypotension
A

Side Effects of Antipsychotic Medications

95
Q
  • Insight-Oriented Psychotherapy
  • Cognitive Behavioral Therapy
A

Counseling or Supportive Psychotherapy

96
Q

all social behavioral expressions are learned or represent distortions or deficits in the learning process of the growing human being; they are considered to be subject to modification where deficits in behaviors are considered to be the cause of abnormality

A

Cognitive Behavioral Therapy

97
Q
  • Desensitization Technique
  • Reciprocal inhibition technique
  • Reinforcement Methods & Token
    economies
  • Conditional avoidance technique
  • Negative Reinforcement technique
  • Social conditioning – isolation thru detention
  • Extinction technique
  • Negative practice
  • Biofeedback versus Meditation
  • Implosive therapy
A

Treatment Techniques

98
Q

when the onset is acute & confusion & mood
disturbance are present & catatonia from almost any underlying cause; it may also be used in conjunction with an antipsychotic

A

Electroconvulsive Therapy (ECT)

99
Q

gluten-free diet that contains no milk or meat.
Good eating habits & a healthy diet will help
people which schiz to feel better just as they will help anybody to feel better.

A

Nutritional Treatments

100
Q
  1. Recognize barriers to nursing effectiveness
    including mutual withdrawal & plan approaches to enhance therapeutic interaction w/ withdrawn & autistic clients.
  2. Using the ng process with individual experiencing autistic withdrawal w/ their families to assess, identify problems & needs; plan individualized, theory based intervention & evaluate care
A

Objectives

101
Q
  1. . Current level of functioning in regards to physical & safety needs, especially during psychotic episodes, when perception & judgment are severely distorted.
  2. Psychosocial needs & deficits. Clients strengths should be assessed
  3. Prior level of adjustments & functioning
  4. Family & environment is assessed (support system)
  5. Social History
    - Description of premorbid personality
    - Major life events & clients responses
    - Significant stressors & description of behavior
    - Precipitants
A

Assessment

102
Q
  1. Intolerance & diminished capacity to cope w/ stress & anxiety
  2. Low self-esteem
  3. Family problems
A

Problem Identification

103
Q

establish trust & relatedness through a therapeutic relationship

A

Nursing Intervention

104
Q
  • Elements related to establishing trust (priority
    goal)
    a. Show continuous interest & commitment to client
    b. Nurse must be honest & trusting in self in
    order to generate confidence & credibility
    c. Nurse should not break a promise to the client
    d. Touch should be used w/ caution for
    suspicious clients may perceive it as sexually
    or aggressively threatening
    e. Clients’ inadequate intake can be coupled w/ matter-of-fact offer so client will feel secure in eating.
    f. Restraining the client for his safety must be
    explained clearly
A

Client Focus Intervention

105
Q
  • (related to autistic & thought
    disorder)
    1. Goal: Decipher client’s unclear messages
    2. Promote client’s awareness that he must
    learn to express himself more clearly
A

Communication

106
Q
  • Simplicity, clarity & concreteness
    are important tools for the nurse to
    avoid client confusion. Clarification
    techniques are helpful. (requires
    patience & effort to listen to confusing
    speech)
  • Non-verbal communication is a powerful means for conveying nurturance & security. This decoding client’s verbalization.
A

Intervention

107
Q

a) Acutely disorganized client may need to
have one consistent person on each shift
assigned to provide reassurance & reality
interpretation (channeling or focusing)
b) Give brief clear explanation/communication
c) Antipsychotic drugs are beneficial
d) Careful observation & knowledge of client
behavior alerts the nurse to identify increasing anxiety levels
e) Focus of therapy is on the ‘here & now’
experiences & feelings (present reality)
f) Involve client in occupational, recreational
therapy, social activities – this reduces the
tendency to focus attention inward on
fantasy

A

Reinforce Reality

108
Q
  1. Acknowledge clients strengths – building
    blocks to develop other areas & skills &
    builds self-esteem
  2. Plan a variety of physical activities aimed at
    improving coordination & enjoyment of
    bodily activities
  3. Provide non-verbal modes of expression ex:
    painting, music, dance, writing
  4. Manage stress & anxiety
    a. teach client to recognize problem
    levels of anxiety & manage them
    preventively to avoid disorganization
    b. Recognize situational &
    developmental milestone likely to
    induce stress & anxiety
    c. Teach individualized skills for
    managing anxiety
    d. Monitor long term antipsychotics drug
    therapy to control excessive anxiety
    e. Family involvement is valuable in all
    phases of care
A

Long Term Goals

109
Q
  1. Maintain health & safety
  2. Establish a trusting interpersonal relationship
A

General Principles for Interaction & Intervention

Midterms (3 decks)

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