Schizophrenia

Question 1

What are the 5 defined features of psychotic disorders?

Answer 1

1. Delusions
2. Hallucinations
3. Disorganised thinking (reflected in speech)
4. Grossly disorganised/abnormal motor activity
5. Negative symptoms

Question 2

What are delusions?

Answer 2

Fixed beliefs that are not based on reality despite conflicting evidence

Question 3

Persecutory delusions

Answer 3

False belief that they are going to be harmed, harassed or disadvantaged by an individual, organisation or system
- Systemised delusions: police, FBI etc. are after them despite not committing a crime

Question 4

Referential delusions

Answer 4

False belief that certain gestures, comments and environmental cues are directed solely to the individual

Question 5

Grandiose delusions

Answer 5

False belief that they have exceptional abilities, wealth or fame

Question 6

Erotomanic delusions

Answer 6

False belief that another person is in love with them
- More common in females but increased threat in males

Question 7

Nihilistic delusions

Answer 7

False belief that a major catastrophe will occur

Question 8

Somatic delusions

Answer 8

False beliefs about having illness despite medical screens being normal, or a preoccupation about health or body functions

Question 9

Delusions of control

Answer 9

False belief that their body or actions are being manipulated or controlled by an external force
- Examples are thought insertion, thought withdrawal and thought broadcasting

Question 10

What are hallucinations?

Answer 10

False perceptual experiences from 5 senses that occur without external stimulus

Question 11

What are the 5 types of hallucinations?

Answer 11

Visual
Auditory
Tactile
Gustatory
Olfactory

Question 12

What type of hallucination is most common in psychotic disorders such as schizophrenia?

Answer 12

Auditory hallucinations

Question 13

What are characteristics of auditory hallucinations in psychotic disorders?

Answer 13

Familiar/unfamiliar
Inside or outside the person’s head
Male, female or both genders
Whispers, normal tone and volume or shouting
Command/derogatory

Question 14

What is disorganised thinking?

Answer 14

Formal thought disorder (FTD)
- Thoughts and speech are disorganised, non-linear

Question 15

What is grossly disorganised/abnormal motor activity?

Answer 15

There are a variety of displays. Motor activity from childlike silliness to unpredictable agitation (psychomotor agitation), can also be catatonia (rigid, bizarre posture with mutism and stupor evident).
This activity is not goal directed.

Question 16

What are common features of negative symptoms?

Answer 16

Diminished emotional expression and avolition (lack of motivation)

Question 17

What are the 4 A’s?

Answer 17

Describe negative symptoms
1. Affect blunting - reduced facial animation and reduced spontaneous reactions to interactions
2. Avolition - decreased in motivation self-initiated activities such as ADL’s
3. Alogia - diminished speech output
4. Anhedonia - reduction in ability to experience pleasure from positive stimuli; current or past

Question 18

What are the 4 types of psychotic disorders that we need to know?

Answer 18

1. Schizophrenia
2. Schizo-affective disorder (SAD)
3. Drug induced psychosis (substance induced psychosis)
4. First episode psychosis (FEP)

Question 19

What is the prognosis for schizophrenia?

Answer 19

Cannot be predicted and varies between people, however rehabilitation is minimum 18 months, usually around 2 years

Question 20

What indicators lead to a better schizophrenia prognosis?

Answer 20

-Good premorbid functional state
-Maintenance of high level of functioning between episodes
-Short periods of acute phase/s or psychosis
-Sudden and later onset of schizophrenia
-Good insight
-Ability to identify triggers for psychosis
-Good adherence with treatment
-Female
-Early intervention with anti-psychotic meds
-Concurrent mood disturbance
-Family history of mood disorders but not schizophrenia

Question 21

What is the first phase of schizophrenia?

Answer 21

Prodromal phase

Question 22

What are symptoms of the prodromal phase in schizophrenia?

Answer 22

Early symptoms of the disorder
- Most commonly negative symptoms with a gradual decline in functioning, such as socially withdrawing from activities and routines.
- Sometimes symptoms of low grade psychosis, depression and disorganisation which are typically passed off as a teenage developmental period
- Difficulty making and keeping relationships, continue schooling and employment and becomes increasingly dependent of parents financially and for ADLs

Question 23

How long does the prodromal phase typically go on for and when is it typically identified?

Answer 23

Usually ≥18 months and is identified once person is in acute phase displaying positive symptoms

Question 24

What symptoms are common in the acute phase of schizophrenia?

Answer 24

Positive symptoms
- Hallucinations
- Delusions: It is possible for someone to only display delusions
- Thought disorder

Question 25

What are the primary focus of schizophrenia treatment?

Answer 25

Positive symptoms (hallucinations, delusions, thought disorder)

Question 26

How effective are anti-psychotic medications?

Answer 26

Treat the positive symptoms of schizophrenia, however many patients do not get full relief from these symptoms or are left with residual symptoms

Question 27

Do anti-psychotics treat negative symptoms?

Answer 27

Mainly ineffective with negative symptoms, and some can make these symptoms worse

Question 28

What is the continuous phase of schizophrenia?

Answer 28

Long-term acute phase causing disability due to the continuous presence of negative symptoms resulting in declining functioning and independence

Question 29

Which medication is commonly used in people in a continuous phase of schizophrenia?

Answer 29

Clozapine - used for treatment resistant schizophrenia, but used as a last resort due to adverse side effects

Question 30

What are common adverse side effects of clozapine?

Answer 30

• Assists with insight therefore risk of post-psychotic depression and suicide
• Agranular cytosis
• Hypersalivation
• Cardiac arrhythmias

Question 31

What comorbidities are common in schizophrenia?

Answer 31

• Substance misuse disorders (some stimulants can worsen psychosis symptoms)
• Anxiety disorders
• Depression and suicide
• T2DM, CVD, dental caries
• Lowering of seizure threshold for patients with a history of seizures

Question 32

What are the common interventions for schizophrenia?

Answer 32

Medication and CBT

Question 33

Why are atypical antipsychotics preferred to typical?

Answer 33

Broader action (better for positive and negative symptoms)
Less potential for side effects
Tolerated better by patients

Question 34

What is taken into account when deciding the route of administration for antipsychotic medication?

Answer 34

• Adherence to medication (depot injection if low, or wafer instead of tablet)
• Patient preferences

Question 35

What are common antipsychotic side effects?

Answer 35

Weight gain, headache, dry mouth, constipation, urinary hesitancy, photophobia, sunburn, sexual dysfunction, sedation, akathisia, lowered seizure threshold (can give benzodiazepines to reduce this risk)

Question 36

What are the aims of CBT when managing schizophrenia?

Answer 36

• Applying a positive approach towards their symptoms by changing the ways they think and react/behave
• Change ingrained habits and maladaptive approaches to constructive, healthy ones
• Breaking down hallucinations as a symptom of the illness
• Challenge stigma and emphasise stress management for the patient

Question 37

Schizophrenia nursing interventions

Answer 37

1. Establish a therapeutic relationship - effective communication, don’t argue against false beliefs, provide safe and quiet environment, be mindful of touch, spend time even if mute to promote reassurance and support, person-centred, TIC
2. Assessment - MSE, risk ax, substance misuse, monitor physical health and medication adherence, monitor food + fluid intake
3. Education - psychoeducation and medication education, encourage social interaction