Schizophrenia

Question 1

The Schizophrenias

Answer 1

group of disorders that are devastating brain illnesses
chronic, treatable w/ pd of exacerbations + remission
NO CURE: results in severe deterioration of social + occupational functioning

Question 2

psychosis

Answer 2

thought disorder - unable to recognize reality

hallucinations, delusions, disorganized thinking, disorganization of personality, deterioration of social functioning, loss of contact or distortions of reality/bizarre behaviors

Question 3

biological factors

Answer 3

genetics
psychological
environmental
brain structure abnormalities
neurobiological theories
(dopamine, serotonin, glutamate)

Question 4

prevalence

Answer 4

no differences in race, social status, culture or environment

males: earlier onset (18-25): more structural brain abnormalities, more prominent neg symptoms

females: later (23-35): less structural abnormalities, better outcomes, early onset schizophrenia

Question 5

losses

Answer 5

roles + routine, former relationships, former self, meaningful social + occupational roles, health restoration

Question 6

delusional disorder

Answer 6

erotomanic (someone in love w/ them), grandiose, jealous, persecutory, somatic

Question 7

brief psychotic disorder

Answer 7

symptoms last about 1 day then return to premorbid level of function

Question 8

schizophreniform disorder

Answer 8

sim to schizo but duration at least 1 month but less than 6 mo (if longer = schizo)

Question 9

schizoaffective disorder

Answer 9

schizophrenia with strong symptomatic mood disorder; psychosis can occur in absence of major mood episode

Question 10

substance medication induced psychotic disorder

Answer 10

symptoms directly caused by substance intoxication or withdrawal or exposure to toxin/med (nerve gas)

Question 11

cormodibity

Answer 11

substance abuse
anxiety depression
suicide (1/3 w/ schizo attemp; 1/10 die)
psychogenic polydipsia - compulsive drinking water (severe hyponatremia)

Question 12

medical conditions - acute psychosis

Answer 12

Encephalitis
Meningitis
Neurosyphilis
Stroke
Hepatic encephalopathy
DKA
Vitamin B 12 deficiency
Huntington’s disease
hypo- or hyperthyroidism
Hypoglycemia
Calcium imbalances
Temporal lobe epilepsy
Wilson’s disease
CNS neoplasms

Question 13

course of disorder

Answer 13

prodromal

active psychosis

residual stage

Question 14

prodromal stage

Answer 14

early change - precursor
may begin in childhood
early recognition = early initiation of tx

Question 15

active psychosis

Answer 15

acute psychotic phase; hallucinations + delusions, hospitalization, cognitive s/s

Question 16

residual stage

Answer 16

follows active/acute phase
dec in pos signs
neg symptoms remain - flat affect/impaired role functioning
residual impairment often inc w/ each additional episode of psychosis

Question 17

prognosis

Answer 17

outcome diff to predict
uncommon for patients to return to full premorbid functioning

factors associated w/ pos outcomes: early recognition, fem gender, abrupt onset of symptoms w/ obvious precipitating factors, rapid resolution of active phase, absence of structural brain abnormalities, norm neuro functioning, no fam hx of schizo

cognitive impairments: chronic metabolic conditions, substance abuse, stress, freq + intensity, residual symptoms, social deficits

Question 18

suicide

Answer 18

leading cause of death; 50% attempt, 10% complete

younger more educated @ risk
higher risk = females, high risk among patients w/ multiple exacerbations + repeat hospitalizations

Question 19

speech alteration symptoms

Answer 19

echolalia
circumstantiality
word salad
neologism
clang association
metonymic speech
stilted language
pressured speech

Question 20

echolalia

Answer 20

repetition of another’s words that is parrot-like and inappropriate

Question 21

circumstantiality

Answer 21

extremely detailed and lengthy discourse about a topic

Question 22

Pressured speech

Answer 22

speaking as if the words are being forced out

Question 23

Stilted language

Answer 23

overly and inappropriately artificial formal language

Question 24

clang association

Answer 24

repetition of words or phrases that are similar in sound but in no other way, for example, “right, light, sight, might”

Question 25

Metonymic speech

Answer 25

use of words with similar meanings interchangeably

Question 26

Verbigeration

Answer 26

purposeless repetition of words or phrases

Question 27

Concrete thinking

Answer 27

lack of abstraction in thinking; inability to understand punch lines, metaphors, and analogies

Question 28

Autistic thinking

Answer 28

restricts thinking to the literal and immediate so that the individual has private rules of logic and reasoning that make no sense to anyone else

Question 29

Referential thinking

Answer 29

a belief that neutral stimuli have special meaning to the individual, such as a television commentator who is speaking directly to the individual

Question 30

Paranoia

Answer 30

suspiciousness and guardedness that are unrealistic and often accompanied by grandiosity

Question 31

Neologisms

Answer 31

words that are made up that have no common meaning and are not recognizable

Question 32

Word salad

Answer 32

stringing together words that are not connected in any way

Question 33

Flight of ideas

Answer 33

the topic of conversation changes repeatedly and rapidly, generally after just one sentence or phrase

Question 34

loose associations

Answer 34

absence of the normal connectedness of thoughts, ideas, and topics; sudden shifts without apparent relationship to preceding topics

Question 35

Circumstantiality

Answer 35

extremely detailed and lengthy discourse about a topic

Question 36

speech alteration interventions

Answer 36

Explain how their behaviors or verbalizations may disturb others Anticipate client’s needs Orient them to reality, call them by name Be concrete in speech avoid abstract phrases, clichés, jokes

Question 37

thinking alterations symptoms

Answer 37

loose associations tangentiality flight of ideas paranoia referential autistic thinking concrete verbigeration

Question 38

perception alterations

Answer 38

depersonalization - lost identity hallucinations - perception w/ no external stimuli (command hallucinations - can be harmful) illusions - misinterpretation of real experience derealization - false perception environment

Question 39

behavior alterations

Answer 39

bizarre behavior stupor stereotyped behaviors automatic obedience waxy flexibility extreme motor agitation negativism aggression, agitation catatonia - posturing, fixed eyes catatonic excitement echopraxia (sim to tics) regressed behavior stereotypy hypervigilance - neg expectation lack of impulse control (agitated behaviors)

Question 40

types of delusions

Answer 40

persecution ideas of reference grandiose erotomaniac - someone in love somatic - beliefs about abnormalities in bodily functions or structures thought insertion - that someone has placed thoughts into one’s mind thought broadcasting - that others can read or hear one’s thoughts delusions of control nihilistic delusion - the belief that one is dead or a calamity is impending paranoia magical thinking

Question 41

delusion interventions

Answer 41

**never argue or agree w/ delusions acknowledge feelings - "must be frightening.." respond to matter-of-fact and calm manner never touch be aware of gestures + non-verbal responses be open, honest, + reliable w/ client neutral stance/introduce neutral topic interject doubt + about delusion if appropriate observe events that trigger delusions distraction from delusion - reality based

Question 42

negative symptoms

Answer 42

diminished emotions avolition - lack of motivation alogia - lack of speech anhedonia asociality - lack of motivation in social

Question 43

positive symptoms

Answer 43

hallucinations delusions

Question 44

types of hallucinations

Answer 44

false sensory perceptions NOT associated w/ real external stimuli + involves 5 senses - auditory, visual, olfactory, gustatory, tactile

Question 45

command hallucinations

Answer 45

**may indicate psychiatric emergency - at risk for violence - must be assessed - can be terrifying to individual - one voice? male or female? if person can give identity - may be greater risk

Question 46

hallucination interventions

Answer 46

ask client what are they seeing, hearing, feeling, smelling - assess command hallucinations - harm self or others? - never react to hallucinations as if they are real - observe for clues that pt is hallucinating - offer own perceptions w/out negating client's experience - focus on reality based diversions - be alert to inc anxiety - avoid touch - try to distract - be empathetic - assess suicide - maintain low level of stimulation - observe behavior freq

Question 47

treatment

Answer 47

team + community approach therapeutic alliance, psychotherapy, group therapy social skills training social services, social support instill hope!! idea to have collaboration between primary provider + psychiatric team

Question 48

health teaching

Answer 48

disease education, treatment, SE, prevention symptoms mgmt medication + SE, compliance essential stress mgmt mgmt of medical conditions skills of daily living social skills training (SST) hope instillation

Question 49

teaching strategies

Answer 49

avoid alcohol, drugs reduce stress learn about illness treatment plan

Question 50

antipsychotic meds

Answer 50

alleviate symptoms of schizo but cant cure underlying psychotic processes psychotic symptoms return w/ meds non-adherence effective in - acute exacerbationor schizo, prevent or mitigate relapse

Question 51

conventional (1st gen)/typical antipsychotics

Answer 51

targets pos symptoms *blocks postsynaptic dopamine receptors in basal ganglia, hypothalamus, limbic system, brainstem + medulla *high affinity for cholinergic, alpha 1 adrenergic + histamine receptors

Question 52

atypical (2nd gen) antipsychotics

Answer 52

target positive + negative symptoms fewer motor side effects tx anxiety, depression, + dec suicidal behavior Haloperidol (Haldol) - least sedating chlorpromazine (thorazine) - most sedating fluphenazine (prolixin) min anticholinergic effect - chew sugarless gum, high fiber foods,get up + down slowly risperidone (Risperdal) quetiapine (Seroquel) Olanzapine (Zyprexa) zapine (Zyprexa) clozapine (Clozaril) paliperidone (Invega) ziprasidone (Geodon)

Question 53

extrapyramidal symptoms (EPS)

Answer 53

caused by dopamine blockade 1. acute dystonia 2. pseudo parkinsonism 3. akathisia 4. tardive dyskinesia

Question 54

acute dystonia

Answer 54

Painful muscle spasm of tongue, jaw, face or neck Frightening for pt Onset –within hours or days of starting antipsychotics young males opisthotonos – tetanic spasm in which head and heels are bent backward and body forward Oculogyric crisis – eyes locked upward Torticollis – spasm of the neck in which head is tilted to 1 side with chin pointed to other side tx: Benadryl 25 – 50 mg IM stat - relief in mins

Question 55

pseudo parkisonism

Answer 55

shuffling gait, tremor, drooling, masklike facies, “pill-rolling”, akithesia, muscle rigidity, numbness, tingling sensations Feels slowed down, like a “zombie” Passive range of motion exercise will produce cogwheel rigidity of arms Appears early in drug therapy Cause: too little DA and excess cholinergic activity in basal ganglia –result is tremors Treat with anticholinergic agent like Artane or Cogentin or dopamine agonist or lower dose of antipsychotic

Question 56

tardive dyskinesia

Answer 56

prolonged treatment (Mild, moderate or severe) may be irreversible and disfiguring Involuntary tonic muscular spasms (tongue, mouth, fingers, toes, neck, trunk, pelvis) Early - lip smacking or tongue movements Affects 50% clients using long term antipsychotics AIMS scale for detection of early TD Anticholinergics can worsen s/sx

Question 57

tx of eps

Answer 57

Lowering the dose Prescribing antiparkinsonian drugs: * trihexyphenidyl (Artane) * benztropine mesylate (Cogentin) * diphenhydramine hydrochloride (Benadryl) * amantadine hydrochloride (Symmetrel) *SE early in therapy + can be min

Question 58

clozapine (clozaril)

Answer 58

Used more in treatment resistant cases Not first-line d/t severe adverse reactions: agranulocytosis Severe reduction in WBC -> results IN neutropenia Rare can be fatal S/s : sore throat, fever, malaise, mouth sores Any flu-like sss. should be carefully evaluated

Question 59

SGAs (atypical antipsychotic)

Answer 59

Serotonin -dopamine antagonists (SGA’s) Fewer S/E, better tolerated Lessen negative symptoms Decrease suicidal behavior Improve neurocognitive functioning May cause more weight gain r/t abnormal glucose metabolism Anticholinergic SE Mon weight, BMI, glucose Minimal EPS – exceptions Sexual dysfunction Very expensive

Question 60

metabolic syndrome

Answer 60

SE: Weight gain Type 2 diabetes inc LDL cholesterol triglycerides Dec HDL cholesterol DKA

Question 61

neuroleptic malignant syndrome

Answer 61

*RARE MED EMERGENCY - 10% possible cause - acute reduction in DA s/s: hyperthermia muscle rigidity tremors fluctuating BP’s altered consciousness

Question 62

antipsychotic med edu

Answer 62

dont drive if drowsy dont stop abruptly can cause photosensitivity get routine blood work reports symptoms of sore throat, fever, malaise, unusual bleeding, bruising, n/v, HA, tachy, diff urination, dark urine, excess urine, pale stools, jaundice, skin rash sugarless gum/hard candy good oral care avoid alc/drugs take meds even in feel better orthostatic hypotension precautions