Schizophrenia Flashcards
Affective lability
Abrupt, dramatic, unprovoked changes in the types of emotions expressed
Akathisia
Extrapyramidal side effect characterized by the inability to sit still or restlessness
Alogia
AKA: poverty of speech. Reduced frequency and productivity of thought and speech. Brief, empty verbal responses.
Autistic thinking
Thinking restricted to the literal and immediate so that the individual has private rules of logic and reasoning that makes no sense to others
Avolition
Withdrawal and inability to initiate and persist in goal-directed activity
Catatonic excitement
Hyperactivity characterized by purposeless activity and abnormal movements like grimacing and posturing
Clang association
Repeating word phrases that are similar in sound but in no other way like “right, light, sight, might”
Delusion
Erroneous fixed, false beliefs that can’t be changed by reasonable argument. They usually involve misinterpretation of experience
Echolalia
Repetition of another’s words that is parrot like and inappropriate
Echopraxia
Involuntary imitation of another person’s movements and gestures
Hypofrontality
Reduced cerebral blood flow and glucose metabolism in the prefrontal cortex
Illusions
Disorganized perceptions that create and oversensitivity to colors, shapes, and background activities that occur when the person misperceives/exaggerated stimuli in the external environment
Metonymic speech
Use of words with similar meanings interchangeably
Neologisms
Words that are made up that have no common meaning and are not recognized
NMS
A life-threatening condition that develops in reaction to antipsychotic meds. Severe muscle rigidity, high temp, and the following symptoms 48-72 hrs later: HTN, tachycardia, tachypnea, diaphoresis, incont., mutism, LOC changes, and leukocytosis
Paranoia
Suspiciousness and guardedness that are unrealistic and often accompanied by grandiosity
Pressured speech
Speaking as if the words are being forced out
Prof Roman
An early symptom indicating the development of a disease or syndrome
Psychosis
Freud; category to describe pts with severe mental illness that impaired daily functioning. Today, pt experiences hallucinations, delusions, or disorganized thoughts/speech/behavior
What is referential behavior? Give an example
Neutral stimuli have special meaning to the person
- TV commentator speaking directly to the person
Retrocollis
Neck muscles pull the head back
Stereotypy
Repetitive, purposeless movements that are idiosyncratic to the person and somewhat out the the persons control
Stilted language
Overly and inappropriate artificial formal language
Torticollis
The neck muscles pull the head to the side
Waxy flexibility
Posture held in an odd or unusual fixed position for extended periods of time
Word salad
A string of words that are not connected in any way
What is included in the schizophrenia spectrum?
Schizophrenia, schizoaffective, delusional and shizotypal disorders, brief psychotic d/o, schizophreniform d/o, and substance-med-induced psychotic d/o
What are some positive symptoms of schizophrenia (psychotic symptoms)?
Hallucinations, delusion, disorganized thoughts, speech, or behavior
T/F
People with thought disorders don’t believe they have a mental illness, and their denial makes treatment difficult
True
Prodromal period of schizophrenia
Can begin in early childhood. Most report tension, nervousness, lack of interest in eating, difficulty concentrating, disturbed sleep, decreased enjoyment, restlessness, forgetfulness, depression, social withdrawal, feeling laughed at, increased religion, hearing voices, seeing things
Acute illness of schizophrenia
Occurs in late adolescence, early adulthood. Behaviors can be subtle but eventually very bizarre and disruptive. S/s: staying up all night multiple nights, incoherent conversations, aggressive acts. Eventually the pts are can’t perform ADLs, substance use is common. High suicide risk.
Stabilization of schizophrenia
Occurs after the initiation of treatment. Stabilization of symptoms is the focus. Treatment is intense, medication regimens are established, families cope, use of substances is eliminated, socialization increases.
Recovery of schizophrenia
Ultimate goal. This can include learning to live with the illness and symptoms. No medications cures schizo. Patients and family’s must be educated to anticipate and expect relapse and know how to cope with it.
Relapses with schizophrenia
Can occur at any time during treatment or recovery. Combining meds and psychosocial treatment helps. Reasons are failure to consistently take meds, impaired cognition and coping, limited access to community resources, stigmas within community, and social isolation
How is schizophrenia diagnosed?
Positive and negative symptoms present for 1 month but with continuous signs of disturbance for at least 6 months.
What are positive symptoms with schizophrenia?
Hallucinations (sensory) and delusions (thoughts)
Grandiose delusion
Belief that one has exceptional powers, wealth, skill, influence, or destiny
Nihilistic delusion
Belief that one is dead or a calamity is impending
Persecutory delusion
The belief that one is being watched, ridiculed, harmed, or plotted against
Somatic delusion
Belief about abnormalities in bodily functions or structures
Command hallucination
Auditory hallucination instructing the patient to act in a certain way. They range from innocuous (eat all of your dinner) or very serious (hurt someone or jump in front of a bus)
Negative symptoms of schizophrenia
Diminished emotional expression and avoltion. Pts affect is flat, they experience ambivalence, and anhedonia. They may have limited speech and difficulty saying anything new/carrying on a conversation. This can cause them to isolate
Neurocognitive impairment
Memory, vigilance or sustained attention, verbal fluency, and executive functioning. Often manifested in disorganized symptoms
______ symptoms make it difficult for the person to understand and respond to ordinary sights and sounds of daily living.
Disorganized
Define “self”
Self-concept, self-consciousness, self-awareness, and self-disturbance (schizo only)
Schizophrenia in kids
Rare to be diagnoses before adolescence; 5-6y/o symptoms are visual hallucinations and less developed delusions. Disorganized speech is common in many childhood disorders, don’t use to diagnose schizophrenia. Developmental: delays in attainment of speech, problems w/social adjustment, poor academic performance
Name a few internal and external risk factors for developing schizophrenia
Genetics, early neuro problems, stress, environmental (migrant, older dad, toxoplasma gondii antibodies, prenatal famine, lifetime cannabis use, winter or spring birth
Age of onset with schizophrenia
Usually late adolescence and early adulthood. Men is 18-25 y/o, women is 25-30 y/o
How does gender affect schizophrenia?
Men have poorer prognosis than women. When women are diagnosed early, they are at higher risk for physical comorbidities than men
Who is schizophrenia over diagnosed in?
African american
First-degree biologic relatives of a person who has schizophrenia have a __ times greater risk for schizophrenia
10
Name a few health conditions that schizophrenia pts are susceptible to
TB, Hep B/C, human immunodeficiency, osteoporosis, impaired lung fxn, reduced pain sensitivity, sexual dysfunction, obesity, DM, thyroid dysfxn, hyperprolactenemia
Etiology of schizophrenia
Interaction of biologic predisposition and environmental factors like pregnancy, migration, unemployment, abuse, isolation
Neuroanatomic findings biological theory
Lateral and 3rd ventricle is larger and total brain volume is less. Thalamus, hippocampus, temporal, prefrontal cortex is smaller
Blocking dopamine would treat what type of symptoms, positive or negative?
Positive (hallucinations, delusions)
T/F schizophrenia does not result from dysregulation of a single neurotransmitter
True
Recover-oriented strategies can address hopelessness associated with suicide attempts, or withdrawal from relationships and encourage an independent lifestyle
Yes
During times of acute illness, what is the priority of care?
Treatment with antipsychotic meds and sometimes hospitalization
Underlying medical disorders associated with schizophrenia
DM, HTN, cardiac disease, family history, emphysema
AIMS, DISCUS, Simpson-Angus Rating scale are all used in assessing abnormal motor movements
Yes
What is this describing? Eccentric/disheveled, poor hygiene, bizarre dress, and posture suggests lethargy or stupor
How the patient may look or appear to us when performing an assessment
List scales used for schizophrenia
SANS, SAPSM, PANSS, AIMS, BPRS, DISCUS, Simpson-Angus Rating scale
Nurses need to rely on indirect evidence for when a patient is having hallucinations, what are some things to look for?
Pausing during conversation, looking towards a perceived source, or responding to the voices
What is important for the nurse to remember about command hallucinations?
Try to find out what they are talking about because they pt could harm you, themselves, or other pts
What type of delusion helps to diagnose schizophrenia?
Bizarre
Examples of bizarre delusions
Control, thought broadcasting, thought insertion, thought withdrawal
Nonbizarre delusions
Themes of jealousy and are derived from plausible life experiences
Is this insight or judgement? Recognizing their hallucinations or delusions are symptoms of a mental disorder
Insight
How can a nurse improve a patients quality of life?
Arranging different roommates and improve access to social activities by meeting transportation needs
What are some questions that can be used when assessing strengths?
What do you do for relaxation/fun? How do you manage stressful events? Who do you talk with when you are upset? Are you hopeful about the future, and if so, what gives you hope for the future?
When thinking in terms of safety, we should always be thinking about the patients…
Hallucinations, delusions, sleep quality, general function and basic care, mood disturbances
If hallucinations are impairing function, then meds become a priority. If they aren’t a problem, what then becomes the priority?
Coping with negative symptoms
Developing a routine can significantly help in combating _____
Avoliton
What is a reason that some people stop taking their medications?
Weight gain
Behavioral management of weight gain includes…
Keeping a food diary, diet teaching, and support groups
Fluid intake with schizophrenia
Polydipsia, watch for water intoxication because their serum sodium levels may be low
2nd gen antipsychotics
Abilify, Saphris, Clozaril, Risperdal, Zyprexa, Invega, Seroquel
1st gen antipsychotics
Haloperidol, chlorpromazine, fluphenazine, loxapine
Generally, how long does it take for antipsychotics to effect a change in symptoms in the initial acute phase?
1-2 weeks
Generally, how long should the adequate trial for a drug regimen take for the stabilization phase before considering a change?
6-12 weeks
For maximum absorption, what 2 drugs should be given with food?
Ziprasidone and lurasidone
What med is this: Take with high-fat meal of 500 calories
Ziprasidone
What med is this: 350 calories should be eaten when administering this
Lurasidone
When is Clozapine used?
When no other 2nd gen antipsychotic is effective
What is the best approach to prevent relapse?
Adhere to med regimen
What circumstances require the discontinuation of meds?
NMS, agranulocytosis, DRESS, and TD
risperidone (Risperdal)
Atypical antipsychotic. Treatment of schizo, acute bipolar, irritability w/autistic kids. Not safe 16mg/day. Insomnia, agitation, extrapyramidal symptoms, ortho hypoTN, weight gain, NMS. BBW= ^ mortality in older pts w dementia. Avoid pregnancy, EKG changes, CV disease
clozapine (Clozaril)
Atypical antipsychotic. Schizo that hasn’t responded to standard antipsychotic trtmnt. Drowsiness, HA, hypo/HTN, dry mouth, constipation. BBW= agranulocytosis, seizures, NMS, ^ mortality in older pts w dementia. Need informed consent. Weekly, biweekly blood draws.
Parkinsonism
5-30 days, dopamine gets blocked. Resting tremor, rigidity, shuffling gait. Treatment is increasing dopamine. Meds to treat and benztropine and trihexyphenidyl
Dystonic reactions
1-5 days. Often starts with oculogyric crisis, then torticollis, or retrocollis. Treatment is benztropine or Benadryl
What is oculogyric crisis?
Muscles that control eye movements tense and pull the eyeball so that the pt is looking at the ceiling
Torticollis
Neck muscles pull head to the side
Retrocollis
Head is pulled back
Benztropine Mesylate
Antiparkinsonism agent. Blocks acetylcholine. Reduces extrapyramidal symptoms caused by neuroleptic drugs like haloperidol. Most effective w/acute dystonia. Dry mouth, tachycardia, urinary hesitancy, heat stroke.
Common side effects of antipsychotics
Ortho hypoTN, hyperprolactinemia, sedation, weight gain, new-onset DM, cardiac arrhythmias, agranulocytosis, DRESS
General, common interactions with other drugs
Other meds, nicotine, grapefruit juice
NMS
2 weeks after meds. Mental status changes, muscle rigidity, hyperthermia, tachycardia, hypo/HTN, hypoxia, diaphoresis, leukocytosis, incontinence. Treatment is benzodiazepine, bromocripitine, ECT.
Cholinergic rebound symptoms
Vomiting, diaphoresis, altered dreams and nightmares
What is used as an antidote to anticholinergic crisis?
Physostigmine
Errorless learning
Directly given correct information and then encouraged to write it down
Schizoaffective disorder
SAD: periods on intense symptom exacerbation alternating with periods of adequate psychosocial functioning. Psychosis and mood disturbance must occur at the same time for diagnosis. Higher functioning, severe negative symptoms, early onset of symptoms. Suicide risk
Delusional disorder
Stable and well-systematized delusions that occur in the absence of other psychiatric disorders. 1 or more delusions for 1 month. Examples include being followed, poisoned, infected, loved @ distance, or deceived by spouse or lover.
Schizophreniform
Same symptoms as schizo with exception to duration of illness. This can be less than 6 months. Symptoms must be present for 1 month. 1/3 recover and the rest develop schizo
Brief psychotic disorder
Length of episode is at least 1 day but less than 1 month. Must include at least 1 positive symptom of schizo. Emotional turmoil, shifts of affect. Suicide risk
