Schizophrenia Flashcards
Schizophrenia probably causes more white out of all the mental illnesses
Lengthy hospitalizations
Chaos and family life
Cost to individual government
Fear
What is a major concern in risk of in about 1/3 of people with schizophrenia
Suicide
What is psychosis?
A severe mental condition in which there is a disorganization of the personality, deterioration and social functioning in loss of contact with distortion of reality
Hallucinations and delusional, thinking
What are the four phases of schizophrenia?
Premorbid
Prodromal
Active psychotic phase
Residual phase
What is the pre-morbid phase
Signs that occur before there is clear evidence of illness and may include distinctive, personality, traits, or behaviors
Shy withdrawn, poor peer, relationships, doing poorly in school demonstrating antisocial behavior
What is phase 2 the prodromal phase
 Individual begins to show signs of significant deterioration and function. Social withdrawn is not uncommon some have sudden onset of OCD.
Recognition of behaviors provides opportunity for early intervention
Can last for 2 to 5 years
What is the active psychotic phase of schizophrenia?
Psychotic symptoms are typically prominent
Delusions, hallucinations, disorganized, speech, behavior, decrease level of functioning, and work relationships, or self-care
What is the residual phase of schizophrenia?
Active psychotic face symptoms are either absent or no longer prominent
Positive symptoms remain
Flat affect and impairment are common
Can the phases of schizophrenia go through exacerbations
Yes, they can be exacerbations and remissions the more likely this happens the more likely they are to have residual effects
Harder to get out of the active phase
What are the DSM five criteria for diagnosis of schizophrenia?
Two or more of the following each present for a significant portion of time during one month period. At least one of these must be one two or three.
1. Delusions.
2. Hallucinations.
3. Disorganized speech.
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms.
What is delusional disorder?
Presence of delusions experience for at least one month
Hallucinations are not prominent
Behavior is not bizarre
Types of delusional disorder include erotomanic grandiose, jealous, persecutory somatic, and mixed
What is a brief psychotic disorder?
Sudden onset of psychotic symptoms that may or not be proceeded by several psychosocial stressors
Symptoms less at least a day, but less than a month there is an eventual fall return to the preorbital level of functioning
What is substance medication induced psychotic disorder?
Prominent hallucinations and and illusions are directly attributed to substance and intoxication or withdrawal, or exposure to a medication or toxin
What is psychotic disorder due to another medical condition?
Prominent hallucinations and delusions that can be directly attributed to another medical condition
What is catatonic disorder due to another medical condition
Symptoms, such as super catalepsy, waxy flexibility, mutism in negativism or present catatonic disorder may be associated with with other psychotic disorders
Hepatic encephalopathy
Hypo or hyperthyroidism
Vitamin B 12 deficiency
What is catatonia?
Refers to a significant motor disturbance that may range from stupor no motor activity to excessive motor activity and agitation
What is schizophreniform disorder
Identical to schizophrenia, except that the duration, including prodromal, active and residual phrases, is at least one month, but less than six months
If you are diagnosed with schizophreniform can it ever be changed to schizophrenia?
The diagnosis has changed to schizophrenia. The clinical picture persist on six months.
What is schizoaffective disorder?
Signs and symptoms of schizophrenia, along with a strong element associated with a mood disorder
What is the decisive factor in the diagnosis of schizoaffective disorder?
The presence of hallucinations or delusions that occur for at least two weeks in the absence of a major mood episode
Prominent mood disorder symptoms must be evident for most of the time
A patient is admitted with a diagnosis of brief psychotic disorder with catatonic features which symptoms are sociable with the catatonic specifier
Strong, ego boundaries, and abstract thinking
Ataxia and a akinesia
Stupor Muscle rigidity and negativism
Substance abuse, and cache is
Stupor
Muscle rigid
Negativism
What are positive symptoms of schizophrenia?
Delusions, disturbances, and thought content
Disturbances and thought process manifested in speech
Disturbances and perceptions hallucinations
What is a delusion?
Fixed false beliefs that are irrational, and that the individual maintains are true, despite evidence to the contrary
What is delusions of persecution?
Most common type of delusion in which individual believes they are being persecuted or male violently treated in someway
The FBI bugged my room and intense to kill me
What is a paranoid delusion?
Extreme suspicion of others in their actions, or perceived intentions
I won’t eat this food. I know it’s been poison.
Aggression and violence may occur
What is grandiose delusions
Individual has an exaggerated feeling of importance power, knowledge or identity
I am Jesus
What is a delusion of reference?
Someone is trying to get a message to me through the articles in this magazine. I must break the code so I can receive the message
What is ideas of reference?
Less rigid than delusions of reference for example, an individual with ideas may think that other people in the room, who are giggling, must be laughing about him, but with additional information there could be other explanations for their laughter
What is delusions of control or influence?
Individual believes certain objects, or people have control over his or her behavior
Dentist put a pill in my tooth now I received transmissions through the filling and control what I think and do
Common magical, thinking
What is magical thinking?
Ideas that one’s thoughts or behaviors have control over specific situation
I am sad so it is raining
What is somatic delusions?
The individual has a false idea about the functioning of his or her body
The doctor says I am not pregnant, but I know I am
What is Nihilistic delusions
The individual has a false idea that the self, a part of the self, or others of the world are nonexistent, or has been destroyed
The world no longer exist. I have no heart.
What is erotomanic delusions
Individuals falsely believe that someone usually a higher status is in love with them
Famous people are often subjects
Individuals may follow contact or otherwise try to pursue
What is a jealous delusion
Centers on the idea that a person sexual partner is unfaithful
Irrational and without cause, but individual will search for evidence to justify the belief
Individual may attack lover
What what does loose associations?
Speech by which idea shift from one unrelated subject to another
Individual is unaware topics are unconnected
We wanted to take the bus but the airport took all the traffic driving is the ticket when you want to get somewhere we have it all in our pockets
What is neologisms
Newly invented words that are meaningless to others, but have some ballot meaning to individual
What is clang association?
Choice of words is covered by sounds often form of rhyming
It is very cold. I am cold and bold. The gold has been sold.
What is word salad
Group of words that appear to be put together randomly without any logical connection
What is circumstantiality?
Individual delays in reaching the point of communication because of unnecessary and tedious details
Patient cannot get to the point to keep patient on track
What is tangentiality?
Refers to a veering away from the topic of discussion and demonstrates difficulty, maintaining focus and attention
What is preservation?
Persistently repeats the same word or idea in response to a different question
Person gets stuck on a particular thought
What is echolalia
Refers to repeating words or phrases spoken by others
What is a hallucination?
False sensory perceptions not associated with real external stimuli involves any of the five senses
What is an auditory hallucination?
False perceptions of sound
Most commonly these are voices, may report clicks music or other noises
What is a command hallucination
Voices that issues commands to the individual
Potentially dangerous when commands are for violence to sell for others
What are visual hallucinations?
False visual perceptions that may consist of formed images, such as people or light
What are tactile hallucinations?
False perception of sense of touch often something under the skin
What is formication?
Specific, tactile hallucination with a sensation that something is crawling or under the skin
What is a gustatory hallucination?
False perception of taste
What is an olfactory hallucination?
False perception of sense of smell
What is an illusion?
Miss perception, or misinterpretation of real external stimuli
May occur during Prodomal phase and persist in residual phase as well during active
What is the difference between an illusion and hallucination?
A hallucination is a monster in the corner not real
An illusion is that someone turns into a monster is a real person
What are more dangerous illusions or hallucinations?
Illusions because they are real objects someone is seeing a different way can cause harm to themselves or others
What is echopraxia?
Imitates movements made by others
What is mutism?
Individuals, inability, or refusal to speak
The patient here is the word match. The patient replies, a match, I like matches they are the light of the world. God will light the world let your light shine which communication pattern does the nurse identify.
Word, salad
Cling association
Loose association
Ideas of reference
Lucas association
A patient diagnosed with schizophrenia experiences, identity, confusion, and communicates with the nurse using echolalia is the patient attempting to do by using this form of speech
Identify with the person speaking
Imitate the nurses movements
Alleviate, Alogia
Alleviate avolition
Identify with the person speaking
What are negative symptoms of schizophrenia
Disturbances in affect
Lack of interest or skills in interpersonal interaction
Lack of insight
Lack of abstract, thinking
What is an inappropriate affect
Inappropriate when the individuals emotional tone is incongruent with the circumstance
Young woman who laughs when told of death of mother
What is a bland or flat affect?
Described as bland when the emotion tone is very weak individual with flat affect, appears to void of emotional tone
What is apathy in a negative symptom of schizo aaron
Demonstrates and indifference to or disinterest in the environment
Bland or flat effect is a manifestation of emotional apathy
Negative symptom
What is avolition of a negative symptom of schizophrenia
Impaired volition has to do with the inability to initiate goal directed activities
Neglect activities of daily living, including personal hygiene, and appearance
Negative sumptom
What is lack of interest or skills in interpersonal interaction as a negative symptom of schizophrenia
Cling to others in intrude on the personal space of others, exhibiting behaviors that are not socially and culturally acceptable
Negative symptom
What is asociality
Ambivalence in social relationships, or made withdrawal from relationship altogether
Negative symptom
What is anosognosia
Individuals, lack of awareness of having an illness or disorder, even when symptoms appear obvious to others
Negative symptom
What is the most common predictor of non-adherence to treatment which predicts higher higher relapse rates increase number of involuntary treatments, poor psychosocial functioning, aggression, and poor course of ill
Anosognosia -lack of awareness of having illness
Negative symptom
What is anergia
Deficiency of energy
Negative symptom
What is anhedonia
Inability to experience pleasure
Distressing symptoms may increase one’s risk for suicide
Negative symptom
What is lack of abstract, thinking ability
Concrete thinking, or literal interpretations of environment represents a regression to an earlier level of cognitive development
Have a great difficulty describing abstract, meanings of saying such as it’s raining cats and dogs
Negative symptom
What is waxy flexibility
Condition in which the client allows body parts to be placed in bizarre or uncomfortable positions
Associated with catatonia
Once placed in position, remains in position for long periods
What is posturing?
Manifested by the voluntary assumption of inappropriate or bizarre postures
Negative symptom
What is pacing and rocking?
Slow, rhythmic back and forward swinging of the trunk from the hips usually well sitting common psychomotor behaviors
Negative symptom
What is regression?
Retreat to earlier level of development
Primary defense mechanism of schizophrenia to attempt to reduce anxiety
Negative symptom
What does eye movement abnormalities?
Manifest in several ways, including difficulty, maintaining focus on stationary object, and difficulty with smooth pursuit of a moving object
Negative
What are some outcomes when we had a patient with schizophrenia
Recognizes distortions of reality
Has not harmed self or others
Perceived self and environment realistically
Anxiety, manageable
Relinquishes need for delusions and hallucinations
Ability to trust
Perform self-care
What are some goals when treating disturbed sensory perception including hallucinations?
Helping patient to find and test reality verbalizing understanding that hallucinations are result of illness
Attitude of acceptance accept
Distracting patient from hallucinations
What is a short term goal for disturbed thought processes
By the end of two weeks, patient will recognize and verbalize symptoms escalate at times of increasing anxiety
What are some long-term goals of disturbed thought processes
By the time discharge, patient verbalize is will reflect reality based thinking with no evidence of delusional ideation
Patient will be able to differentiate between delusional thinking, and reality
What is a short term goal for risk of violence
Patient will be able to recognize signs of increasing anxiety and agitation, and report to staff for assistance
Patient will not harm himself or others
What is a long-term goal for risk of violence?
Patient will not harm self or others
What is an intervention for disturbed thought process
Convey acceptance of patients need for false belief, but indicate that you do not share the belief
Do not argue or deny belief
Reinforce and focus on reality
What are some interventions of risk for violence
Maintain low level of mental stimuli
Observe patients behavior frequently
Assess for presence of suicidal ideation, or command hallucinations
What are some short term girls for impaired verbal communication
Demonstrate ability to remain on one topic using appropriate intermittent iContact for five minutes with nurse
What are some long-term goals for impaired verbal communication
By discharge patient will demonstrate ability to carry verbal communication and socially acceptable manner
What are some interventions for? Impaired verbal communication
Facilitate trust and understanding in non-threatening manner
Anticipate and fulfill patients need
Orient patient to reality as required
To deal with a client, hallucinations therapeutically, which nursing intervention should be implemented
Reinforce the perceptual distortions until the patient develops new defenses
Provide an unstructured environment
Avoid making connections between anxiety producing situations and hallucinations
Distract the patient’s attention
Distract the patient’s attention
A patient is diagnosed with paranoids schizophrenia. States my roommate is plotting to have others kill me, which is the appropriate nursing response.
I find that hard to believe
What would make you think such such a thing?
I know your roommate he would do no such thing
I can see why you feel that way
I find that hard to believe
How can individual psychotherapy help schizophrenia?
Successful intervention may be achieved with honesty, simple, directness, and manner that respects the clients privacy and human dignity
Once relationship has been establish reality, orientation is maintained throughout exploration of clients behavior
Primary focus reflect efforts to decrease anxiety and increase trust
How was group therapy helpful in a patient with schizophrenia
Focuses on real life, plans, problems, and relationships effective in reducing social isolation in increasing sense of cohesiveness and improving reality
How is group therapy less productive in schizophrenic patients
Group therapy can be intensive and highly stimulating. It may be counterproductive.
How was behavior, therapy, helpful, and schizophrenia?
Reducing the frequency of bizarre, disturbing, and deviant behaviors in increasing appropriate behaviors
How is social skills training beneficial in a patient with schizophrenia?
Patient struggle with interpersonal relationships and communication, often have inability to receive response
Teaches patients how to have those skills
I was cognitive remediation therapy, helpful, and schizophrenia
Based on behavioral training, aim to help the client mend areas of cognitive dysfunction, including attention, memory and social cognition, and executive functions
How is family therapy beneficial in schizophrenia?
 There is a notable impact on mental health and physical health of the family when member is sick
Including family can prevent or delay, relapse and help maintain client in the community
Use as resource rather than stressor
What is ACT?
Program of case management that takes a team approach and providing comprehensive psychiatric treatment, rehabilitation, and support to the person with serious and persistent mental illness
Tailored to each patient
What are antipsychotic used for in schizophrenia?
Decrease agitation and psychotic symptoms of schizophrenia
What are some common antipsychotics?
Olanzapine
Aripirazole
Chlorpromazine
Risperidone
Asenapine
Ziprasidone 
 what are some side effects of antipsychotics
Orthostatic, hypertension
Photosensitivity
We gain/loss
Reduction and seizure threshold
Agranulocytosis
Extrapyramidal symptoms
Tradive dyskinesia
What are the signs and symptoms of agranulocytosis?
Fever
Tachycardia
Tachypnea
Sore throat
Sores and mouth
What is EPS extra pyramidalsymptoms?
Pseudoparkinsonism
akinesia
Akathisia
Dystonia
Anti-Parkinsonian agents may be prescribed
A client who’s been taking chlorpromazine
For seven months presents in the emergency department with EPS of restless, drooling and tremors. What medication will the nurse expect the physician to order?
Paroxetine
Carbamazepine
Benztropine
Lorazepam
Benztropine
 recent research on the raise approach to the treatment of schizophrenia incorporates which of the following elements is important to improving outcomes select
Early intervention at the first episode of psychosis
Support for employment or educational pursuits
Rapid high dose loading with psychotic medication
Court ordered sanction for treatment
Recovery, focused, psychotherapy
Early intervention at the first episode of psychosis
Support for employment or educational pursuits
Recovery focus psychotherapy
Which of the following is a primary goal and working with an actively psychotic suspicious client
Promote interaction with others
Decreases anxiety and increased trust
Improve his relationship with his parents
Encourage participants and therapy activity
Decrease his anxiety and increased his trust
