Schizophrenia Flashcards
What are the 5 defined features of psychotic disorders?
- Delusions
- Hallucinations
- Disorganised thinking (reflected in speech)
- Grossly disorganised/abnormal motor activity
- Negative symptoms
What are delusions?
Fixed beliefs that are not based on reality despite conflicting evidence
Persecutory delusions
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
Referential delusions
False belief that certain gestures, comments and environmental cues are directed solely to the individual
Grandiose delusions
False belief that they have exceptional abilities, wealth or fame
Erotomanic delusions
False belief that another person is in love with them
- More common in females but increased threat in males
Nihilistic delusions
False belief that a major catastrophe will occur
Somatic delusions
False beliefs about having illness despite medical screens being normal, or a preoccupation about health or body functions
Delusions of control
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
What are hallucinations?
False perceptual experiences from 5 senses that occur without external stimulus
What are the 5 types of hallucinations?
Visual
Auditory
Tactile
Gustatory
Olfactory
What type of hallucination is most common in psychotic disorders such as schizophrenia?
Auditory hallucinations
What are characteristics of auditory hallucinations in psychotic disorders?
Familiar/unfamiliar
Inside or outside the person’s head
Male, female or both genders
Whispers, normal tone and volume or shouting
Command/derogatory
What is disorganised thinking?
Formal thought disorder (FTD)
- Thoughts and speech are disorganised, non-linear
What is grossly disorganised/abnormal motor activity?
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.
What are common features of negative symptoms?
Diminished emotional expression and avolition (lack of motivation)
What are the 4 A’s?
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
What are the 4 types of psychotic disorders that we need to know?
- Schizophrenia
- Schizo-affective disorder (SAD)
- Drug induced psychosis (substance induced psychosis)
- First episode psychosis (FEP)
What is the prognosis for schizophrenia?
Cannot be predicted and varies between people, however rehabilitation is minimum 18 months, usually around 2 years
What indicators lead to a better schizophrenia prognosis?
-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
What is the first phase of schizophrenia?
Prodromal phase
What are symptoms of the prodromal phase in schizophrenia?
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
How long does the prodromal phase typically go on for and when is it typically identified?
Usually ≥18 months and is identified once person is in acute phase displaying positive symptoms
What symptoms are common in the acute phase of schizophrenia?
Positive symptoms
- Hallucinations
- Delusions: It is possible for someone to only display delusions
- Thought disorder
What are the primary focus of schizophrenia treatment?
Positive symptoms (hallucinations, delusions, thought disorder)
How effective are anti-psychotic medications?
Treat the positive symptoms of schizophrenia, however many patients do not get full relief from these symptoms or are left with residual symptoms
Do anti-psychotics treat negative symptoms?
Mainly ineffective with negative symptoms, and some can make these symptoms worse
What is the continuous phase of schizophrenia?
Long-term acute phase causing disability due to the continuous presence of negative symptoms resulting in declining functioning and independence
Which medication is commonly used in people in a continuous phase of schizophrenia?
Clozapine - used for treatment resistant schizophrenia, but used as a last resort due to adverse side effects
What are common adverse side effects of clozapine?
- Assists with insight therefore risk of post-psychotic depression and suicide
- Agranular cytosis
- Hypersalivation
- Cardiac arrhythmias
What comorbidities are common in schizophrenia?
- 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
What are the common interventions for schizophrenia?
Medication and CBT
Why are atypical antipsychotics preferred to typical?
Broader action (better for positive and negative symptoms)
Less potential for side effects
Tolerated better by patients
What is taken into account when deciding the route of administration for antipsychotic medication?
- Adherence to medication (depot injection if low, or wafer instead of tablet)
- Patient preferences
What are common antipsychotic side effects?
Weight gain, headache, dry mouth, constipation, urinary hesitancy, photophobia, sunburn, sexual dysfunction, sedation, akathisia, lowered seizure threshold (can give benzodiazepines to reduce this risk)
What are the aims of CBT when managing schizophrenia?
- 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
Schizophrenia nursing interventions
- 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
- Assessment - MSE, risk ax, substance misuse, monitor physical health and medication adherence, monitor food + fluid intake
- Education - psychoeducation and medication education, encourage social interaction
