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Psychosocial > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Affective lability

A

Abrupt, dramatic, unprovoked changes in the types of emotions expressed

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2
Q

Akathisia

A

Extrapyramidal side effect characterized by the inability to sit still or restlessness

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3
Q

Alogia

A

AKA: poverty of speech. Reduced frequency and productivity of thought and speech. Brief, empty verbal responses.

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4
Q

Autistic thinking

A

Thinking restricted to the literal and immediate so that the individual has private rules of logic and reasoning that makes no sense to others

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5
Q

Avolition

A

Withdrawal and inability to initiate and persist in goal-directed activity

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6
Q

Catatonic excitement

A

Hyperactivity characterized by purposeless activity and abnormal movements like grimacing and posturing

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7
Q

Clang association

A

Repeating word phrases that are similar in sound but in no other way like “right, light, sight, might”

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8
Q

Delusion

A

Erroneous fixed, false beliefs that can’t be changed by reasonable argument. They usually involve misinterpretation of experience

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9
Q

Echolalia

A

Repetition of another’s words that is parrot like and inappropriate

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10
Q

Echopraxia

A

Involuntary imitation of another person’s movements and gestures

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11
Q

Hypofrontality

A

Reduced cerebral blood flow and glucose metabolism in the prefrontal cortex

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12
Q

Illusions

A

Disorganized perceptions that create and oversensitivity to colors, shapes, and background activities that occur when the person misperceives/exaggerated stimuli in the external environment

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13
Q

Metonymic speech

A

Use of words with similar meanings interchangeably

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14
Q

Neologisms

A

Words that are made up that have no common meaning and are not recognized

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15
Q

NMS

A

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

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16
Q

Paranoia

A

Suspiciousness and guardedness that are unrealistic and often accompanied by grandiosity

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17
Q

Pressured speech

A

Speaking as if the words are being forced out

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18
Q

Prof Roman

A

An early symptom indicating the development of a disease or syndrome

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19
Q

Psychosis

A

Freud; category to describe pts with severe mental illness that impaired daily functioning. Today, pt experiences hallucinations, delusions, or disorganized thoughts/speech/behavior

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20
Q

What is referential behavior? Give an example

A

Neutral stimuli have special meaning to the person
- TV commentator speaking directly to the person

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21
Q

Retrocollis

A

Neck muscles pull the head back

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22
Q

Stereotypy

A

Repetitive, purposeless movements that are idiosyncratic to the person and somewhat out the the persons control

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23
Q

Stilted language

A

Overly and inappropriate artificial formal language

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24
Q

Torticollis

A

The neck muscles pull the head to the side

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25
Q

Waxy flexibility

A

Posture held in an odd or unusual fixed position for extended periods of time

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26
Q

Word salad

A

A string of words that are not connected in any way

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27
Q

What is included in the schizophrenia spectrum?

A

Schizophrenia, schizoaffective, delusional and shizotypal disorders, brief psychotic d/o, schizophreniform d/o, and substance-med-induced psychotic d/o

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28
Q

What are some positive symptoms of schizophrenia (psychotic symptoms)?

A

Hallucinations, delusion, disorganized thoughts, speech, or behavior

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29
Q

T/F
People with thought disorders don’t believe they have a mental illness, and their denial makes treatment difficult

A

True

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30
Q

Prodromal period of schizophrenia

A

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

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31
Q

Acute illness of schizophrenia

A

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.

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32
Q

Stabilization of schizophrenia

A

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.

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33
Q

Recovery of schizophrenia

A

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.

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34
Q

Relapses with schizophrenia

A

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

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35
Q

How is schizophrenia diagnosed?

A

Positive and negative symptoms present for 1 month but with continuous signs of disturbance for at least 6 months.

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36
Q

What are positive symptoms with schizophrenia?

A

Hallucinations (sensory) and delusions (thoughts)

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37
Q

Grandiose delusion

A

Belief that one has exceptional powers, wealth, skill, influence, or destiny

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38
Q

Nihilistic delusion

A

Belief that one is dead or a calamity is impending

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39
Q

Persecutory delusion

A

The belief that one is being watched, ridiculed, harmed, or plotted against

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40
Q

Somatic delusion

A

Belief about abnormalities in bodily functions or structures

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41
Q

Command hallucination

A

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)

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42
Q

Negative symptoms of schizophrenia

A

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

43
Q

Neurocognitive impairment

A

Memory, vigilance or sustained attention, verbal fluency, and executive functioning. Often manifested in disorganized symptoms

44
Q

______ symptoms make it difficult for the person to understand and respond to ordinary sights and sounds of daily living.

A

Disorganized

45
Q

Define “self”

A

Self-concept, self-consciousness, self-awareness, and self-disturbance (schizo only)

46
Q

Schizophrenia in kids

A

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

47
Q

Name a few internal and external risk factors for developing schizophrenia

A

Genetics, early neuro problems, stress, environmental (migrant, older dad, toxoplasma gondii antibodies, prenatal famine, lifetime cannabis use, winter or spring birth

48
Q

Age of onset with schizophrenia

A

Usually late adolescence and early adulthood. Men is 18-25 y/o, women is 25-30 y/o

49
Q

How does gender affect schizophrenia?

A

Men have poorer prognosis than women. When women are diagnosed early, they are at higher risk for physical comorbidities than men

50
Q

Who is schizophrenia over diagnosed in?

A

African american

51
Q

First-degree biologic relatives of a person who has schizophrenia have a __ times greater risk for schizophrenia

A

10

52
Q

Name a few health conditions that schizophrenia pts are susceptible to

A

TB, Hep B/C, human immunodeficiency, osteoporosis, impaired lung fxn, reduced pain sensitivity, sexual dysfunction, obesity, DM, thyroid dysfxn, hyperprolactenemia

53
Q

Etiology of schizophrenia

A

Interaction of biologic predisposition and environmental factors like pregnancy, migration, unemployment, abuse, isolation

54
Q

Neuroanatomic findings biological theory

A

Lateral and 3rd ventricle is larger and total brain volume is less. Thalamus, hippocampus, temporal, prefrontal cortex is smaller

55
Q

Blocking dopamine would treat what type of symptoms, positive or negative?

A

Positive (hallucinations, delusions)

56
Q

T/F schizophrenia does not result from dysregulation of a single neurotransmitter

A

True

57
Q

Recover-oriented strategies can address hopelessness associated with suicide attempts, or withdrawal from relationships and encourage an independent lifestyle

A

Yes

58
Q

During times of acute illness, what is the priority of care?

A

Treatment with antipsychotic meds and sometimes hospitalization

59
Q

Underlying medical disorders associated with schizophrenia

A

DM, HTN, cardiac disease, family history, emphysema

60
Q

AIMS, DISCUS, Simpson-Angus Rating scale are all used in assessing abnormal motor movements

A

Yes

61
Q

What is this describing? Eccentric/disheveled, poor hygiene, bizarre dress, and posture suggests lethargy or stupor

A

How the patient may look or appear to us when performing an assessment

62
Q

List scales used for schizophrenia

A

SANS, SAPSM, PANSS, AIMS, BPRS, DISCUS, Simpson-Angus Rating scale

63
Q

Nurses need to rely on indirect evidence for when a patient is having hallucinations, what are some things to look for?

A

Pausing during conversation, looking towards a perceived source, or responding to the voices

64
Q

What is important for the nurse to remember about command hallucinations?

A

Try to find out what they are talking about because they pt could harm you, themselves, or other pts

65
Q

What type of delusion helps to diagnose schizophrenia?

A

Bizarre

66
Q

Examples of bizarre delusions

A

Control, thought broadcasting, thought insertion, thought withdrawal

67
Q

Nonbizarre delusions

A

Themes of jealousy and are derived from plausible life experiences

68
Q

Is this insight or judgement? Recognizing their hallucinations or delusions are symptoms of a mental disorder

A

Insight

69
Q

How can a nurse improve a patients quality of life?

A

Arranging different roommates and improve access to social activities by meeting transportation needs

70
Q

What are some questions that can be used when assessing strengths?

A

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?

71
Q

When thinking in terms of safety, we should always be thinking about the patients…

A

Hallucinations, delusions, sleep quality, general function and basic care, mood disturbances

72
Q

If hallucinations are impairing function, then meds become a priority. If they aren’t a problem, what then becomes the priority?

A

Coping with negative symptoms

73
Q

Developing a routine can significantly help in combating _____

A

Avoliton

74
Q

What is a reason that some people stop taking their medications?

A

Weight gain

75
Q

Behavioral management of weight gain includes…

A

Keeping a food diary, diet teaching, and support groups

76
Q

Fluid intake with schizophrenia

A

Polydipsia, watch for water intoxication because their serum sodium levels may be low

77
Q

2nd gen antipsychotics

A

Abilify, Saphris, Clozaril, Risperdal, Zyprexa, Invega, Seroquel

78
Q

1st gen antipsychotics

A

Haloperidol, chlorpromazine, fluphenazine, loxapine

79
Q

Generally, how long does it take for antipsychotics to effect a change in symptoms in the initial acute phase?

A

1-2 weeks

80
Q

Generally, how long should the adequate trial for a drug regimen take for the stabilization phase before considering a change?

A

6-12 weeks

81
Q

For maximum absorption, what 2 drugs should be given with food?

A

Ziprasidone and lurasidone

82
Q

What med is this: Take with high-fat meal of 500 calories

A

Ziprasidone

83
Q

What med is this: 350 calories should be eaten when administering this

A

Lurasidone

84
Q

When is Clozapine used?

A

When no other 2nd gen antipsychotic is effective

85
Q

What is the best approach to prevent relapse?

A

Adhere to med regimen

86
Q

What circumstances require the discontinuation of meds?

A

NMS, agranulocytosis, DRESS, and TD

87
Q

risperidone (Risperdal)

A

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

88
Q

clozapine (Clozaril)

A

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.

89
Q

Parkinsonism

A

5-30 days, dopamine gets blocked. Resting tremor, rigidity, shuffling gait. Treatment is increasing dopamine. Meds to treat and benztropine and trihexyphenidyl

90
Q

Dystonic reactions

A

1-5 days. Often starts with oculogyric crisis, then torticollis, or retrocollis. Treatment is benztropine or Benadryl

91
Q

What is oculogyric crisis?

A

Muscles that control eye movements tense and pull the eyeball so that the pt is looking at the ceiling

92
Q

Torticollis

A

Neck muscles pull head to the side

93
Q

Retrocollis

A

Head is pulled back

94
Q

Benztropine Mesylate

A

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.

95
Q

Common side effects of antipsychotics

A

Ortho hypoTN, hyperprolactinemia, sedation, weight gain, new-onset DM, cardiac arrhythmias, agranulocytosis, DRESS

96
Q

General, common interactions with other drugs

A

Other meds, nicotine, grapefruit juice

97
Q

NMS

A

2 weeks after meds. Mental status changes, muscle rigidity, hyperthermia, tachycardia, hypo/HTN, hypoxia, diaphoresis, leukocytosis, incontinence. Treatment is benzodiazepine, bromocripitine, ECT.

98
Q

Cholinergic rebound symptoms

A

Vomiting, diaphoresis, altered dreams and nightmares

99
Q

What is used as an antidote to anticholinergic crisis?

A

Physostigmine

100
Q

Errorless learning

A

Directly given correct information and then encouraged to write it down

101
Q

Schizoaffective disorder

A

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

102
Q

Delusional disorder

A

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.

103
Q

Schizophreniform

A

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

104
Q

Brief psychotic disorder

A

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

Psychosocial (5 decks)

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