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NSG 470 - Exam 3 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

The Schizophrenias

A

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

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2
Q

psychosis

A

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

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3
Q

biological factors

A

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

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4
Q

prevalence

A

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

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5
Q

losses

A

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

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6
Q

delusional disorder

A

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

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7
Q

brief psychotic disorder

A

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

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8
Q

schizophreniform disorder

A

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

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9
Q

schizoaffective disorder

A

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

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10
Q

substance medication induced psychotic disorder

A

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

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11
Q

cormodibity

A

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

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12
Q

medical conditions - acute psychosis

A

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

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13
Q

course of disorder

A

prodromal

active psychosis

residual stage

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14
Q

prodromal stage

A

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

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15
Q

active psychosis

A

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

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16
Q

residual stage

A

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

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17
Q

prognosis

A

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

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18
Q

suicide

A

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

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

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19
Q

speech alteration symptoms

A

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

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20
Q

echolalia

A

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

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21
Q

circumstantiality

A

extremely detailed and lengthy discourse about a topic

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22
Q

Pressured speech

A

speaking as if the words are being forced out

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23
Q

Stilted language

A

overly and inappropriately artificial formal language

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24
Q

clang association

A

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

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25
Q

Metonymic speech

A

use of words with similar meanings interchangeably

26
Q

Verbigeration

A

purposeless repetition of words or phrases

27
Q

Concrete thinking

A

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

28
Q

Autistic thinking

A

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

29
Q

Referential thinking

A

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

30
Q

Paranoia

A

suspiciousness and guardedness that are unrealistic and often accompanied by grandiosity

31
Q

Neologisms

A

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

32
Q

Word salad

A

stringing together words that are not connected in any way

33
Q

Flight of ideas

A

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

34
Q

loose associations

A

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

35
Q

Circumstantiality

A

extremely detailed and lengthy discourse about a topic

36
Q

speech alteration interventions

A

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

37
Q

thinking alterations symptoms

A

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

38
Q

perception alterations

A

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

39
Q

behavior alterations

A

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)

40
Q

types of delusions

A

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

41
Q

delusion interventions

A

**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

42
Q

negative symptoms

A

diminished emotions

avolition - lack of motivation

alogia - lack of speech

anhedonia

asociality - lack of motivation in social

43
Q

positive symptoms

A

hallucinations
delusions

44
Q

types of hallucinations

A

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

45
Q

command hallucinations

A

**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
46
Q

hallucination interventions

A

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

47
Q

treatment

A

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

48
Q

health teaching

A

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

49
Q

teaching strategies

A

avoid alcohol, drugs
reduce stress
learn about illness
treatment plan

50
Q

antipsychotic meds

A

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

51
Q

conventional (1st gen)/typical antipsychotics

A

targets pos symptoms

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

52
Q

atypical (2nd gen) antipsychotics

A

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)

53
Q

extrapyramidal symptoms (EPS)

A

caused by dopamine blockade

  1. acute dystonia
  2. pseudo parkinsonism
  3. akathisia
  4. tardive dyskinesia
54
Q

acute dystonia

A

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

55
Q

pseudo parkisonism

A

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

56
Q

tardive dyskinesia

A

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

57
Q

tx of eps

A

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

58
Q

clozapine (clozaril)

A

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

59
Q

SGAs (atypical antipsychotic)

A

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

60
Q

metabolic syndrome

A

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

61
Q

neuroleptic malignant syndrome

A

*RARE MED EMERGENCY - 10%

possible cause - acute reduction in DA
s/s: hyperthermia
muscle rigidity
tremors
fluctuating BP’s
altered consciousness

62
Q

antipsychotic med edu

A

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

NSG 470 - Exam 3 (7 decks)

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