Schizophrenia Flashcards
Schizophrenia and other Psychotic Disorders
Given the insidious onset of schizophrenia and the length of time it takes to effectively treat the disorder, it is helpful to be aware of the phases of illness and recognize that treatment occurs across the continuum of care - health promotion and illness prevention, acute care, community care, and tertiary care, in the context of a multidisciplinary team
Positive Symptoms
reflect an excess or distortion of normal functions, including delusions and hallucinations
Delusions
Hallucinations
Delusions
Negative Symptoms
reflect a lessening or loss of normal functions, such as restriction or flattening in the range and intensity of emotion, reduced fluency and productivity of thought and speech, withdrawal and inability to initiate and persist in goal-directed activity, and inability to experience pleasure
- Affective disturbances
- Alogia
- Ambivalence
- Anhedonia
- Avolition
- Apathy
- Social withdrawal
Affective flattening or blunting
Restriction or flattening in the range and intensity of emotions
Alogia
reduced fluency and productivity of thought and speech. Brief. empty verbal responses; often referred to as poverty of speech.
Anhedonia
inability to experience pleasure or gain pleasure from experiences.
Ambivalence
presences of two opposing forces, leading to inaction. mixed feelings.
Avolition
- inability to complete projects, assignments, or work
- inability to initiate and persist in goal-directed activity
Apathy
Reactions to stimuli that are decreased, along wth a diminished interest and desire
Hallucinations
- perceptual experiences that occur without actual external sensory stimuli
- Can involve any of the five senses (auditory, visual, olfactory, gustatory, tactile, and somatic, but visual and auditory are more common. auditory hallucinations are more common than visual
Delusions
fixed false beliefs that usually involve a misinterpretation of experience. ex. patients believe someone is reading their thoughts or plotting against them.
Gradiose Delusions
the belief that one has exceptional powers, wealth, skill, influence, or destiny
Nihilistic Delusions
the belief that one is dead or a calamity is impending
Persecutory Delusions
the belief that one is being watched, ridiculed, harmed or plotted against
Somatic Delusions
beliefs about abnormalities in bodily functions or structures
Neurocognitive Impairment
neurocognitive impairment in memory, vigilance, and executive functioning is related to poor functional outcome in schizophrenia
- neurocognition includes short- and long-term memory, vigilance or sustained attention, verbal fluency or the ability to generate new worlds, and executive functioning.
- Long-term memory and intellectual functioning are not necessarily affected.
- symptoms may have interfered with completing educational opportunities.
- often manifested in disorganized symptoms
Disorganized symptoms
these symptoms of schizophrenia are those things that make it difficult for the person to understand and respond to the ordinary sights and sounds of daily living. These include disorganized speech and thinking and disorganized behaviour
Disorganized thinking
- often create oversensitivity to colours, shapes, and background activities
- illusions (disorganized perceptions that create an oversensitivity to colours, shapes, and background activities, which occur when the person misperceives or exaggerates stimuli in the external environment
- symptoms that may accompany schizophrenia include anxiety, depression, irritability, and hostility
Disorganized Behaviour
Disorganized behaviour (which may manifest as a very slow, rhythmic, or ritualistic movement), coupled with disorganized speech, makes it difficult for someone with schizo to partake in daily activities.
- Aggression
- Agitation
- Catatonic excitement (a hyperactivity characterized by purposeless activities and abnormal movements such as grimacing and posturing)
- Echopraxia (involuntary imitation of another person’s movements and gestures)
- Regressed behaviour (behaving in a manner of a less mature life stage; childlike and immature)
- Stereotype (repetitive, purposeless movements that are idiosyncratic to the individual and to some degree outside of the individuals control)
- Hypervigilance (sustained attention to external stimuli as if expecting something important or frightening to happen)
- Waxy flexibility (posture held in odd or unusual fixed positions for extended periods of time)
Extrapyramidal side effects (EPS)
- Parkinsonism or pseudoparkinsonism (resting tremor, rigidity, bradykinesia/akinesia, masklike face, shuffling gait and decreased arm swing)
- Acute dystonia (Intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk and extremities)
- Akathisia (obvious motor restlessness evidenced by pacing, rocking, and shifting from foot to foot; subjective sense of not being able to sit or be still; these symptoms may occur together or separately)
- Tardive dyskinesia (abnormal dyskinetic movements of the face, mouth, and jaw; choreoathetoid movements of the legs, arms and trunk)
- Tardive dystonia (persistent sustained abnormal postures in the face, eyes, tongue, neck, trunk, and limbs)
- Tardive akathsia (persisting, unabating sense of subjective and objective restlessness)
Definition: Schizophrenia
schizophrenia is a severe and chronic mental disorder characterized by disturbances in perceptions, thought, and behaviour
Definition: Schizoaffective disorder
a complex and persistent psychiatric disorder with varying degrees of symptoms of both schizophrenia and mood disorders
Aetiologies/Theories: Spiritual
- spiritual confusion as auditory hallucinations seem from a higher power
- delusions may be religious in content
Aetiologies/Theories: Biologic
- Genetic predisposition
- dopaminergic dysfunction
- Hyperfrontality
- Cognitive deficits
- Immune dysfunction
- Neuroanatomic changes
Aetiologies/Theories: Psychological
- difficulties in relaxing
- affective blunting (decreased emotional expression)
- Difficulties with decision making
- self-concept changes
- decreased stress response and coping
- loss of family relationships
Aetiologies/Theories: Social
- Decreased financial status
- family and caregiver stress
- Homelessness
- Stigma and community isolation
Disorganized Thinking: Alterations in thought processes evident through speech
- Loosening of associations
- circumstantiality
- tangentiality
- thought blocking
- neologisms
- flight of ideas
- perseveration
- pressured speech
- word salad
- clang associations
- Echolalia
Disorganized thinking
delusions of control
bizzare delusions
religious delusions
depersonalization
magical thinking
Disorganized behaviour
aggression
agitation
Nursing Assessment: Biological domain
- current & past health history
- physical functioning
- nutritional assessment
- fluid imbalance assessment
- pharmacologic assessment
Nursing Diagnosis: Biological Domain
- self care deficit
- disturbed sleep patterns
- excessive fluid volume
- imbalanced nutrition
- constipation
- sexual dysfunction
Nursing Assessments: Psychological Domain
- assess for positive and negative symptoms (Standardized scales)
- MSE
- Behavioural responses
- Self-concept
- Stress & coping patterns
- Risk assessment
Nursing Diagnosis: Psychological Domain
- disturbed thought processes
- disturbed sensory perception
- Disturbed body image
- Low self- esteem
- Disturbed personal identity
- Risk for violene
- Knowledge deficit
- Ineffective coping
Nursing Assessment & Diagnosis: Social Domain
- social systems
- quality of life
- family assessment
- impaired social interactions
- ineffective role performance
- disabled family coping
- interrupted family processes
Treatment
most effective treatment approach for individual with schizophrenia involves a variety of disciplines… pharmacologic management is the responsibility of physicians and nurses; all the members of the mental health team can implement various psychosocial interventions
Side Effects of Antipsychotic Medications - EPS
- Akathisia
- Akinesia
- Dystonia
- Pseudo-parkinsonism -
- Tradive dyskinesia
- Neuroleptic Malignant Syndrome
- Metabolic Syndrome
