Psych-Schizophrenia Flashcards
1
Q
Schizophrenia is from a Greek words ___ and ___
A
“Schizein” (to split) and “Phren” (mind)
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
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
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
5
Q
Emil Kraepelin named it ___, a fatalistic prognosis
A
Dementia Praecox
6
Q
- Coined the term Schizophrenia
- renamed it Schizophrenia which indicates the “splitting” of various functions.
A
Eugene Bleuler
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
8
Q
frequently present but not specific to schiz.
Hallucination, delusions, catatonic posturing
A
Accessory Symptoms
9
Q
- emphasized the psychological factors in the
etiology. - Hallucination originated from frightening &
unbearable ideas.
A
Sigmund Freud
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
11
Q
Biological Theories
% risk of inheriting schizophrenia –
one immediate family member with the disease
Genetic Factors
A
10% to 20%
12
Q
Approximately ___%, if the disease affects both parents or an identical twin.
Genetic Factors
A
40%
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
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
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
16
Q
through CT scan
A
Neuroanatomic Theories
17
Q
cerebral atrophy, enlargement of the ventricles of the brain, dist in cerebral metabolism & electrical activity
A
Brain dysfunction
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)
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”
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
21
Q
Disordered communication within the family may be growth impending; typical of a closed family system.
A
Interpersonal Influences
22
Q
- Lack of feedback mechanisms
- Parents faulty relationship
- Double-bind communication
- Families are severely fused
- Undifferentiated ego mass
A
Interpersonal Influences
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
24
Q
- Hard/deviant symptoms
- Present but should be absent
A
Positive
25
Fixed false beliefs that have no basis in reality
Delusions
26
Fragmented or poorly related thoughts and ideas
Associative Looseness
27
False sensory perceptions or perceptual
experiences that do not exist in reality
Hallucinations
28
Imitation of the movements and gestures of another person
Echopraxia
29
False impressions that external events have special
Ideas of Reference
30
refers to an unrealistic sense of superiority, characterized by a sustained view of one's self as better than others
Grandiosity
31
the exaggerated tendency to believe that other people intend harm, especially to oneself
Suspiciousness
32
a personality or cognitive trait characterized by a negative attitude toward others
Hostility
33
holding seemingly contradictory beliefs or feelings about the same person, event or situation
Ambivalence
34
continuous flow of verbalization in which the person jumps rapidly from one topic to another
Flight of Ideas
35
persistent adherence to a single idea or topic; verbal repition of a sentence, word or phrase; resisting attempts to change the topic
Perseveration
36
outlandish appearance or clothing; repetitive or stereotyped, seemingly purposeless movements; unsual social or sexual behavior
Bizarre behavior
37
* Soft/deficit symptoms
* Absence of normal characteristics
Negative
38
Tendency to speak little or to convey little
substance of meaning (poverty of content)
Alogia
39
Feeling no joy or pleasure from life or any activities or relationships
Anhedonia
40
Psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless, as if in a trance
Catatonia
41
Absence of any facial expression that would indicate emotions or mood
Flat Affect
42
Feelings of indifference toward people, activities, and events
Apathy
43
Absence of will, ambition, or drive to take action or accomplish tasks
Avolition or Lack of Volition
44
Restricted range of emotional feeling, tone, or mood
Blunted Affect
45
Social withdrawal, few or no relationships, lack of closeness
Asociality
46
Inability to concentrate or focus on a topic or activity regardless of its importance
Inattention
47
marked disturbance of psychomotor activity (motionless or excessive motor activity)
Catatonic Schizophrenia
48
Signs & Symptoms of Catatonic Schizophrenia
* Rigidity
* Waxy flexibility
* Stupor
* Mutism
* Negativism
* Posturing or excitement
* Echolalia
* Echopraxia
49
* 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
Disorganized Schizophrenia
50
* 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
Paranoid Schizophrenia
51
* Characterized by symptoms of schizophrenia but do not meet the criteria for subtypes (paranoid, catatonic, or disorganized)
* Signs & Symptoms
- Hallucination
- Delusion
- Incoherence
Undifferentiated Schizophrenia
52
* 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
Residual Schizophrenia
53
* 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
Schizoaffective Disorder
54
* Affective symptoms:
- Extreme depression or elation
* Schizophrenic Symptoms:
- (+) and (-) symptoms
Schizoaffective Disorder
55
* 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
Brief Psychotic Disorder
56
are those with preexisting personality disorder (histrionic, narcissistic, borderline personality)
Susceptible individual
57
* 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
Schizophreniform Disorder
58
* Client has one or more non bizarre delusions for at least a month
* Behavior is not obviously odd or bizarre
Delusional Disorder
59
Types of Delusional Disorder
* Erotomanic type
* Grandiose type
* Jealous type
* Persecutory type
* Somatic type
60
individual believes that someone of a high status is in love w/ him or her. Famous persons are often the subject of this delusion.
Erotomanic type
61
irrational ideas regarding their own worth, talent, knowledge or power
Grandiose type
62
* 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)
Jealous type
63
* most common
* Individual believes that they are malevolently maltreated in some way. Themes include: being conspired against, cheated, spied on, followed or drugged, harassed
Persecutory type
64
believes they have physical defect or disease
Somatic type
65
folie a deux
Shared Psychotic Disorder
66
* 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
Shared Psychotic Disorder
67
Presence of prominent hallucinations or delusions resulting from the direct physiologic effects of a specific medical condition
Psychotic Disorder Due to General Medical Condition
68
CVD, Huntington’s disease, Epilepsy, Migraine headache, CNS infections
Neurological conditions
69
hypo or hyperthyroidism
Endocrine disorders
70
hypoxia, hypercarbia, hypoglycemia
Metabolic conditions
71
SLE, fluid electrolyte imbalance, hepatic or renal disorder
Autoimmune disorder
72
presence of prominent hallucinations & delusions that are judged to be directly attributable to the physiological effects of the substance
Substance-Induced Psychosis
73
alcohol, amphetamines, cannabis, cocaine,
hallucinogens, inhalants, opioids, anxiolytics,
sedatives & hypnotics
Drug of Abuse
74
anesthetics & analgesics, anticonvulsants,
antidepressants, CV meds, chemotherapeutic
agents, muscle relaxants
Medications
75
nerve gases, carbon monoxide, volatile subs (fuel or paint), carbon dioxide
Toxins
76
Delusions: persecution, grandeur, reference,
control, somatic, nihilistic, religiosity, paranoia,
magical thinking
Content of Thought
77
associative looseness, neologisms, concrete
thinking, clang association, word salad,
circumstantiality, tangentiality, mutism,
perseveration
Form of Thought
78
* Hallucinations: auditory, visual, tactile (formication), gustatory, olfactory.
* Illusions.
Perception
79
Inappropriate, blunt, flat, apathy
Affect
80
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.
Sense of Self
81
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
Emotional Ambivalence
82
clients with acute schiz cling to others, intrude
on strangers & fail to recognize that excessive
closeness makes other people uncomfortable & likely to pull away.
Impaired Interpersonal Functioning & Relationship to the External World
83
focuses inward on a fantasy world while
distorting the external environment
Autism
84
untidy & unkempt.
Detoriorated Appearance
85
* **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**
Psychomotor Behavior
86
Anhedonia, regression
Associated Features
87
* Visual hallucinations, headaches & recent
head injury
* “what drugs are you using?”
| Diagnostic Workup
History & Mental Status Examination
88
* Series of pencil-&-paper tests such as
write-a-sentence and draw-a-clock
* Can help identify patients w/ other brain
diseases
Physical & Neurological Examinations
89
* 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
Basic Laboratory Work
90
capable of detecting a variety of diseases,
esp. viral diseases of the central nervous
system
Lumbar Puncture
91
may detect temporal-lobe epilepsy, which sometimes mimics schizophrenia
Electroencephalogram (EEG)
92
Diagnostic Workup
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
* **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
Psychopharmacology
94
* 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
Side Effects of Antipsychotic Medications
95
* Insight-Oriented Psychotherapy
* Cognitive Behavioral Therapy
Counseling or Supportive Psychotherapy
96
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
Cognitive Behavioral Therapy
97
* 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
Treatment Techniques
98
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
Electroconvulsive Therapy (ECT)
99
**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.
Nutritional Treatments
100
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
Objectives
101
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
Assessment
102
1. Intolerance & diminished capacity to cope w/ stress & anxiety
2. Low self-esteem
3. Family problems
Problem Identification
103
establish trust & relatedness through a therapeutic relationship
Nursing Intervention
104
* 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
Client Focus Intervention
105
* (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
Communication
106
* **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.
Intervention
107
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
Reinforce Reality
108
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
Long Term Goals
109
1. Maintain health & safety
2. Establish a trusting interpersonal relationship
General Principles for Interaction & Intervention
