Schizophrenia

Question 1

What is Schizophrenia?

Answer 1

Schizophrenia is a disorder characterised by a major disturbance in thought, perception, cognition, and psychosocial functioning and is one of the most severe mental disorders. (Foster et al, 2021 glossary)

Question 2

What is one challenge when working with someone with schizophrenia?

Answer 2

One of the challenges when working with people with schizophrenia is managing the stigma and discrimination that mythology and media perpetuate.

Question 3

What are the sign and symptoms of schizophrenia?

Answer 3

A diagnosis of schizophrenia requires a person to have experienced at least 6 months of a mixture of positive and negative symptoms.

Delusions

Thought disorder

Hallucinations

Question 4

What is the assumption ‘The Diathesis-stress Model’ has?

Answer 4

The diathesis-stress has the assumption that individuals are exposed to stressful situations during their life and these events may precipitate symptoms in some people that may be predisposition to mental illness.

Essential to this theory is the notion that some people are more vulnerable to mental illness than others. With Schizophrenia this vulnerability may be related to genetics, environmental factors, aberrations in the brain anatomy or biochemistry or a combination of all mentioned.

Question 5

In regards to ‘Biochemical Theories’ what does Neuroanatomical abnormalities mean?

Answer 5

it is thought that either genetics or environmental factors during gestation are responsible for the brain abnormalities with the effects remaining dormant until adolescence.

Question 6

In regards to ‘Biochemical Theories’ what does Genetic Predisposition mean?

Answer 6

that an individuals genetic make leaves them vulnerable to the development of the illness.

Question 7

In regards to ‘Biochemical Theories’ what does Biochemical Differences mean?

Answer 7

Chemicals known as neurotransmitters responsible for the transmission of nerve impulses across the synapse have been also been thought to be responsible for the development of schizophrenia.

Question 8

What Nursing Assessments should be completed on someone with schizophrenia?

Answer 8

Risk assessment, Functional assessment, Mental state examination, Physical health

Medication adherence

What support they have: accommodation, financial, whanau/family

Level of understanding about their illness and treatment.

Question 9

What are positive symptoms?

Answer 9

Positive symptoms are thought processes, emotions and behaviours that are exaggerations of, or additional to, and what an individual experiences when they are well.

Question 10

What are some positive symptoms?

Answer 10

Delusions
Thought disorder
Hallucinations

Question 11

What are negative symptoms?

Answer 11

Negative symptoms are absences or reductions of thought processes, emotions and behaviours that were present prior to the onset of the illness, but have since diminished or are absent following the onset of the illness.

Question 12

What are some negative symptoms?

Answer 12

Anhedonia, Avolition, Aphasia, Anergia, Alogia

Question 13

Why is cognitive behavioural therapy (CBT) considered an appropriate intervention to consider with people to maintain their wellness?

Answer 13

Cognitive behavioural therapy (CBT) the underlying assumption behind CBT is that individuals can positively influence their symptoms by changing their behaviour and thinking. The approach to therapy is therefore to unlearn the destructive ways of the past and to replace them with more constructive approaches for the future. CBT has no adverse effects and has the potential to improve an individual’s quality of life.

Question 14

Why is non-adherence to medication a significant concern in management of schizophrenia?

Answer 14

To ensure that the person does not experience a relapse of the illness it is important that the medication that is prescribed is maintained for at least a year. Most patients stop the medication due to the side effects, or they no longer have symptoms so assume that they are cured,

Question 15

Why do nurses need to assess levels of personal hygiene and nutritional intake?

Answer 15

Nurses need to monitor the personal hygiene and nutritional intake to prevent infections and also to ensure the person is eating a healthy diet.

Question 16

What is the goal of antipsychotic medications?

Answer 16

The primary goal of antipsychotic drug administration is to control the positive symptoms of schizophrenia.

While typical antipsychotic mediations are effective at combating these positive symptoms, they are less effective at targeting negative symptoms.

Question 17

What is the effect of antipsychotics on the negative symptoms?

Answer 17

Anti psychotics can make negative symptoms worse such as emotional blunting, avolition, loss of energy and social withdrawal. In fact, these drugs can make such features worse in some cases

Question 18

What are some examples of Typical Antipsychotics?

Answer 18

Chlorpromazine, Haloperidol

Question 19

What are some examples of Atypical Antipsychotics?

Answer 19

Olanzapine, Clozapine, Respiridone, Zuclopenthixol, Quetiapine

Question 20

What are some examples of Depot Preparations?

Answer 20

Flupenthixol, Zuclopenthixol, Paliperidone, Olanzapine

Question 21

What is Neuroleptic Maligant Syndrome (NMS)

Answer 21

Neuroleptic Malignant Syndrome (NMS) is a rare disorder that resembles a severe form of parkinsonism with coarse tremor and catatonia, fluctuating in intensity, accompanied by signs of autonomic instability (labile pulse, and BP, hyperthermia), stupor, elevation of creatinine kinase in serum and sometimes myoglobinaemia.

Question 22

What can happen if Neuroleptic Maligant Syndrome (NMS) is left untreated?

Answer 22

Immediate medical intervention is required as if left untreated increase risk of death (more than 10%).

Question 23

What is Agranulocytosis?

Answer 23

A blood disorder characterised by severe depletion of white blood cells, rendering the body almost defenceless against infection

Question 24

What are symptoms of Agranulocytosis?

Answer 24

Flu-like symptoms

Question 25

How often are blood tests needed to monitor Agranulocytosis?

Answer 25

Bloods are monitored weekly for 18 weeks, then monthly there after.

Question 26

Is Constipation a serious side effect of Clozapine?

Answer 26

Yes

Question 27

How can you treat constipation?

Answer 27

Assess For/To:
Regular bowel movements
Current diet, exercise
Other medication

Advise to:
Drink 6-8 glasses of water per day
Increase fibre in diet
Increase exercise
Use available pharmacological products as needed.

Question 28

Aetiology of Schizophrenia: the diathesis-stress model

Answer 28

individuals are exposed to stressful events in the course of their life and these events may precipitate the symptoms in some people who have predisposition to mental health

Question 29

Aetiology of Schizophrenia: Biochemical theories

Answer 29

chemicals known as neurotransmitters responsible for the transmission of nerve impulses across synapse have also been thought to be responsible for the development of schizophrenia

Question 30

Delusion

Answer 30

fixed false belief that are inconsistent with one’s social, cultural and religious beliefs and not amenable to change despite conflicting evidence or argumentation

Question 31

Disorganised thinking

Answer 31

The symptoms must be severe enough to substantially impair effective communication. this is evident if:
- the person switches topids erratically (derailment or loose association)
- their response to questions are unrelated (tangentially)
- their speech is incoherent or disorganised
the ideas fail to follow one another with a logical flow and sequence; this results in shifting from one subject to another resulting in loss of significant meaning.

Question 32

perceptual disturbance

Answer 32

vivid involuntary perceptions that are experienced as “normal” and occur without external stimuli

Question 33

Affect: emotional blunting

Answer 33

being “flat” or inappropriate; voice is a monotone and face is imobile

Question 34

Bizarre Behaviour: catatonia

Answer 34

a marked decrease in reactivity to the environment, behaviour induced resistance to instructions, ridgid posture

Question 35

Bizarre Behaviour: Abnormal motor behaviour

Answer 35

can rage from agitation to childlike silliness, which leads to difficulties in performing activities of daily living

Question 36

Bizarre Behaviour: Clothing and Appearence

Answer 36

reflects mental state: can be dishevelled, poorly groomed, quiet and immobile or screaming and agitated; may be; inappropriately dressed for the occasion, environment and temperature

Question 37

Bizarre Behaviour: social or sexual behaviour

Answer 37

loss of ego boundaries can cause confusion in relationship with others,

Question 38

positive symptoms of psychotic disorders and schizophrenia

Answer 38

• hallucinations, delusions, disordered speech, bizarre behaviour

Question 39

negative symptoms of psychotic disorders and schizophrenia

Answer 39

diminished emotional expression (reduced facial expression, eyecontact, head/hand movement), avolition, alogia. anhedonia, asoslity, poverty of ideas and anergia

Question 40

Schizophrenia- introduction

Answer 40

prevalence, approx 1% population
- predominantly young people (18-24)
- high presence in the socially disadvantaged and homeless
- research yet to determine cause of schizophrenia
- increasingly viewed as a neurological illness rather than a disorder of the mind
- most debilitating and misunderstood disorder

Question 41

Biological theories Theories

Answer 41

Genetic predisposition
-
Biochemical theories
-

Question 42

The Diathesis-stress model

Answer 42

• brings much of what is known into one model of understanding
• exposure to stress
• environmental and family
• expressed emotion

Question 43

Schizophrenic disorder- considerations

Answer 43

Not just schizophrenia; psychosis is the main set of symptoms associated with schizophrenia
diagnosis dependent on
- specific symptoms
- length of time experienced
individual experience is unique
needs to be contextual
consider cultural identity