schizophrenia Flashcards
schizophrenia
psychotic thinking/ behavior present for ~6 months
begins to affect their life in every aspect
typical age of diagnosis of schizophrenia is…
late teens to early 20s
has occured in young children and later adulthood
schizotypal personality disorder
impairments of personality functioning (self or interpersonal)
condition is not as severe as schizophrenia
delusional disorder
has delusional thinking for ~1 month
self/interpersonal functioning is not as impaired
brief psychotic disorder
has psychotic manifestations that may last 1 day to 1 month
schizophreniform disorder
has s/s similar to schizophrenia but may only last for 1-6 months
social/occupational dysfunction may not be as obvious
schizoaffective disorder
pt meets diagnositics for both schizophrenia and/or depression/bipolar disorder
substance-induced psychotic disorder
pt has psychosis due to substance intoxication/withdrawl
psychotic/catatonic disorder otherwise not specified
pt has psychotic features (impaired reality testing) or bizarre behavior (catatonic) or a significant change in motor activity behavior (catatonic) but doesn’t meet criteria for diagnosis w/another specific psychotic disorder
positive symptoms
manifestation of things that are not normally present
* hallucinations
* delusions
* alterations in speech
* bizarre behavior (walking backward constantly)
negative symptoms
absence of things that are normally present
(more difficult to treat than positive symptoms)
* blunted/flat affect
* alogia: poverty of thought or speech
* anergia: lack of energy
* anhedonia: lack of pleasure or joy in life
* avolition: lack of motivation in activites & hygiene
other common symptoms found in schizophrenia
cognitive s/s:
* disordered thinking
* inability to make decisions
* poor problem-solving skills
* difficulty concentrating to perform tasks
* impaired abstract thinking
* short term memory deficits
affective s/s:
* hopelessness
* suicidial ideation
* unstable or rapidly changing mood
alterations in thought
delusions
false fixed beliefs that can’t be corrected by reasoning & usually bizarre
ideas of reference
misconstrues trivial events and attaches personal significance to them
pt walking by a group of people who are talking about food, are gossiping about the pt
persecution
feels singled out for harm by others
FBI hunting pt down
grandeur
believes that they’re all powerful & important
thinks they’re a god
somatic delusions
believes that their body is changing in an unusual way
thinks they’re growing a third arm
jealousy
belives that their partner is sexually involved w/another individual even though there is not any factual basis for this belief
being controlled
believes that a force outside their body is controlling them
thought broadcasting
believes that their thoughts are heard by others
thought insertion
believes that others’ thoughts are being inserted into their mind
thought withdrawl
believes that their thoughts have been removed from their mind by an outside agency
religiosity
obsession with religion
magical thinking
believes that their actions or thoughts are able to control a situation or affect others
thinks wearing a certain hat makes them invisible to others
associative looseness
unconscious inability to concentrate on a single thought
can progress to flight of ideas (pt’s ideas move so rapidly that their speech is incoherent)
neologisms
made up words that only pt understands
“i tranged and flitted”
echolalia
pt repeats the words spoken to them
clang association
meaningless rhyming of words
“oh fox, box, and lox”
word salad
words jumbled together w/ little meaning to listener
“hip hip hooray, the flip is cast and wide sprinting in the forest”
alterations in perception
hallucinations are sensory perceptions that don’t have any external stimulus
auditory hallucination
hearing voices or sounds
command hallucinations
voice instructs pt to perform an action (usually to hurt themselves or others)
visual hallucinations
seeing persons or things
olfactory hallucinations
smelling odors
gustatory hallucinations
experiencing tastes
tactile hallucinations
feeling bodily sensations
depersonalization
nonspecific feeling that pt has lost their identity; self is different or unreal
derealization
perception that environment has changed
thinks objects around them are shrinking
illusions
misinterpretations or misperceptions of a real experience
stereotyped behaviors
motor patterns that had meaning to pt but now is mechanical and lacks purpose
ex: sweeping the floor
automatic obedience
responding in a robot-like manner
wavy flexibility
maintaining a specific position for a long time
stupor
motionless for long periods of time; coma-like
negativism
doing the opposite of what is requested of them
echopraxia
purposeful imitation of movements made by others
catatonia
pronounced decrease or increase in amt of movement
muscle rigidity or catalepsy may be so severe that the limbs stay in the position they’re in
motor retardation
pronounced slowing of movement
impaired impulse control
reduced ability to resist impulses
gesturing or posturing
assuming unusual & illogical expressions
boundary impairment
impaired ability to see where one person’s body ends and another’s begins
AIMS scale
Abnormal Involuntary Movement Scale
monitors involuntary movements esp tardive dyskinesia for pts on antipsychotics
when a pt is experiencing hallucinations, what should the nurse ask the pt?
ask the pt directly about the hallucinations but avoid arguing or agreeing with their views
“I don’t hear anything, but you seem to be feeling frightened”
what hallucinations puts the pt at higher risk of harm to self or others?
command hallucinations
which hallucinations may increase risk of violence against others
paranoid delusions
1st generation/conventional antipsychotics
used to mainly treat positive psychotic symptoms
* haloperidol
* loxapine
* chlorpromazine
* fluphenazine
nursing actions: monitor for extrapyramidal effects (EPS) esp dystonia (involuntary muscle contractions), akathisia (inability to remain still), pseudoparkinsonism, tardive dyskinesia
client education: chew sugarless gum, eat foods high in fiber, drink 2-3 L of fluid, monitor for postural hypotension and orthostatic hypotension
2nd generation/ atypical antipsychotics
first line of choice for med t/x
treats both positive & negative symptoms
* risperidone
* olanzapine
* quetiapine
* ziprasidone
* clozapine
pt education: manage weight gain by following low calorie diet and exercise; pt needs to report signs of agitation, dizziness, sedation, and sleep distruption
monitor blood tests for agranulocytosis
3rd generation antipsychotics
used to treat both positive & negative symptoms; improves cognitive function
* aripiprazole
nursing actions: decreased risk of EPSs or tardive dyskinesia; lower risk of weight gain & anticholinergic effects
antidepressants
can be used to treat depression w/psychotic disorder
* paroxetine
nursing action: monitor for suicidal ideation esp when first taking it & notify HCP of deepened depression
PT NEEDS TO KNOW NOT TO STOP MED ABRUPTLY
mood stabilizing agents & benzodiazepines
used to treat anxiety and some of the pos/neg symptoms
* valproate
* lamotrigine
* lorazepam
nursing action: use w/ caution in elderly pts
client education: educate pt about sedative effects; abstinence of alcohol & other substances; keep log of feelings/changes in behavior to help med efficacy; emphasize group, family, & individual psychoeducation
when is the most common time a person seeks initial t/x for schizophrenia
during the active phase
when pt is having delusions…
use distracting techniques
alogia
tendency to speak little or to convey little substance of meaning (poverty of content)
negative symptom
ambivalence
holding seemingly contradictory beliefs or feelings about the same person, event, or situation
positive symptom
inattention
inability to concentrate or focus on a topic or activity, regardless of its importance
negative symptom
perseveration
persistent adherence to a single idea or topic; verbal repetition of sentence, word, phrase
positive symptom
ideas of reference
positive symptom
echopraxia
imitation of movements & gestures of another person whom the client is observing
positive symptom
asociality
social withdrawl, few or no relationships, lack of closeness
negative symptom
delusions
fixed, false beliefs that have no basis in reality
positive symptom
bizarre behavior
outlandish appearance/clothing; repetitive/stereotyped, purposeless movements, unusual social behavior
positive symptom
flat affect
abscence of any facial expression that would indicate emotions or mood
negative symptom
avolition or lack of volition
absence of will, ambition, drive to take action or accomplish tasks
negative symptom
associative looseness
fragmented or poorly related thoughts and ideas
positive symptom
anhedonia
feeling no joy or pleasure from life or any activities or relationships
negative symptom
flight of ideas
continuous flow of verbalization in which person jumps rapidly from one topic to another
positive symptom
hallucinations
false sensory perceptions or perceptual experiences that do not exist in reality
positive symptom
apathy
feelings of indifference toward people, activities, and events
negative symptom
blunted affect
restricted range of emotional feeling, tone, or mood
negative symptom
verbigeration
stereotyped repetition of words or phrases that may or may not have meaning to listener
stilted language
use of words or phrases that are flowery, excessive, and pompous
perseveration
persistent adherence to a single idea or topic and verbal repetition of a sentence
nihilistic
organ or body part are not functioning, are rotting, or is disfigured
somatic
vague and unrealistic beliefs about health or bodily functions
sexual delusion
client’s belief that sexual behavior is known to others; is rapist; prostitute; pedophile; is pregnant
referential delusion
client’s belief that TV broadcasts, music, or newspaper articles have special meaning to him/her
religious delusion
center around second coming of a significant religious figure or prophet
persecutory delusion
client’s belief that others are planning to harm him/her; spying, following, ridiculing, belittling
