Schizophrenia Flashcards
Schizophrenia
shattered disinegrated personality
not just a condition, but a syndrome
there is no cure but can be controlled by medications
PCP can cause schizophrenia
Epidemiology of schizophrenia
Lifetime prevalence of schizophrenia is 1% worldwide
there is not a difference in regards to:
- race
- socaial status
- culture
Comorbidity of Schizophrenia
- substance abuse
- nicotine dependance - Anxiety, depression, and suicide
- physical health or illness
- polydipsia
Polydipsia-
drinking massive amount of water
schizophrenics can drink so much water that they pee the bed and end up causing eletrolyte imbalances
Etiology of Schizophrenia
Biological Factors
Genetics- 65-80% is genetic
Neurobiological-
- Dopamine Theory- suggests that there is a
dopamine overload in the brain.
- Other neurochemical hypothesis
Brain Structure abnormalities-
- Usually in the frontal or temporal lobe
- Now use non-invasive PET and MRI scans
- If a family member has it, chances increase
- In Identical twins- if one has it, 50%
chance the other will have it too
- In fraternal twins, 15% chance if one has
it the other will have it too
Psycological and Environmental Factors
- Prenatal Stress- drugs, eating,
environmental
- Psychologicial Stressors- increased
cortisol
- Environmental Stressors- Sexual abuse in
children causes changes in brain
chemistry and so can toxins
-
Prodromal
Before a psycotic break
prepsychotic phase- may act weird or strange to others. My all of the sudden become withdrawn, lonely or depressed.
Phase 1 of schizophrenia
`acute phase
nervous breakdown or 1st psychotic break
this is the onset or exacerbation of symptoms
Phase 2 of schizophrenia
Stabilization phase
symptoms are diminishing, returning to a normal level of functioning
Phase 3 of schizophrenia
Maintenance phase
at or near baseline functioning
(as the disease progresses, the baseline will change with it.)
Assessment
During the prepsychotic phase- Ask them or family how they were before and after their first break
General Assessment: gain isight on Positive symptoms Negative symptoms Cognitive symptoms Affective symptoms
as well as how they are responding to medications
Positive Symptoms
Alterations in thinking
Delusions
Magical Thinking
Paranoia
Religiosity
Alterations In speech
Clang Associations
Word Salad
Neologisms
Echolalia
Alogia
Thought insertion/deletion/blocking
Alterations in perception
Depersonalization
Derealization
Hallucination
Alterations in Behavior
Catatonia
Echopraxia
Impaired impulse control
Gesturing/posturing
Boundary impairmentcircumstantiality
giving excessive details. More than what are needed
positive symptom
Tangentiality
frequently leaving the topic
positive symptom
Cognitive retardation
delay in responding or answering a question. Cannot finish thoughts
positive symptom
clang associations
rhyming words
positive symptom
Word Salad
jumbled speech that doesnt make sense
positive symptom
Neologisms
making up words
positive symptom
Echolalia
repeating like a parrot
positive symptom
Religiosity
preoccupied with religousness
positive symptom
What is best drug for suicide
Ssri
Haldol side effects
Muscle stiffness, tiredness
What is haldol used for
To sedate pts during acute breaks in hospital
Remember
Schizophrenia drugs make you fat except abilify
Chlorpromazine (Thorazine)
Antipsychotic : Non addictive Fast acting
Typical- 1st generation
Concrete Thinking
Alterations in thinking- positive symptom
refers to an over emphasis on specific details and impairment in the ability to use abstract concepts.
example: The nurse acts the patient what brings him to the hospital, and the patient replies “a cab” rather than explaining the reason he his seeking medical or psychiatric aid.
Nursing Intervention:
Ask the client the meaning of a proverb such as “the grass is always greener on the other side” or “people in a glass house shouldn’t throw stones”
A patient with schizophrenia might answer because the window will break.
Amitripyline (Elavil)
Antidepressant: Non Addictive - Slow Acting
Trycyclic Antidepressant
Seratonin
affects sleep appetite and libido
Associative Looseness
Alterations in speech- Positive symptom
Associations are the threads that tie one thought to another and one concept to another are not working properly.
In schizophrenia these threads are missing, and connections are interrupted. This causes thinking to become haphazard, illogical, and confused.
Nurse: are you going to the picnic today?
Patient: I am not an elephant hunter, no tiger teeth for me.
If this happens it is important for the nurse to remain honest with the patient and let them know that they are not being understood, but that you want and will try harder to understand them
Clozapine (Clozaril)
Risperidone (Resperdal)
Atypical Antipsychotics Second generation agents; newer, fewer side effects.
fast acting
hypotension insomnia sedation sexual dysfuntion weight gain
Negative Symptoms
Affective Flattening
Unchanging facial expression
Decreased spontaneous movements
Paucity of expressive genstures
Poor Eye contact
Inappropriate affect
Lack of vocal expressions
Alogia
Poverty of speech
Poverty of content of speech
Blocking
Avolition, Apathy
Impaired grooming and hygiene
Lack of persistance in work or school
Physical anergia
Anhedonia, Asociality
Fewer recriational interests or activities
Little sexual interest or activity
Impaired intamacy or closeness
Few relationships with friends or peers
Attention Deficits
Social inattentivenessDoxepin (Adapin Sinequan)
Protriptyline (Vivactil)
Clomipramine (Anafranil)
Tricyclic Antidepressants
Non addicting
Slow acting
norepinephrine
increases energy, pain perception, stress regulator
Hallucinations
Delusions
Disorganized Speech
Bizarre Behavior
are all __________ symptoms of schizophrenia
positive
Inattention, easily distracted Impaired memory Poor Problem Solving skills Poor decision making skills Illogical thinking Impaired judgement
Are all __________ symptoms of Schizophrenia
Cognitive, associated with negative
Dysphoria
Sucicidality
Hoplessness
Are considered ________ and other ________ symptoms of schizophrenia
depressive, mood
Buspar
Visaril
Atarax
Non- benzodiazepines
Buspar is safer to use that any other antianxiety meds
Non Addictive
Blunted affect
Poverty of thought
Loss of motivation
Inability to experience pleasure or Joy
Are considered _________ symptoms of schizophrenia
negative
Positive, Negative, Cognitive, depressive and other mood symptoms can alter the individuals:
ability to work interpersonal relationships self care abilities social functioning quality of life
Citalophram (Celexa) Fluvoxamin (luvox) Seraline (Zoloft) Fluxetine (Prozac) Paroxeline ( Paxil, Pexeva) Escitalopram (Lexapro)
SSRI
Slow acting
Used for depression
Alogia
Loss of thought
Avolition
Loss of Motivation
Anhedonia
Inability to experience pleasure or Joy
Delusions
Alterations in thinking : Positive symptoms
Defined as false fixed beliefs that cannot be corrected with reasoning
In schizophrenia the most common delusions are perecutory and grandiose as well as involving thoughts of religiosity and hypochondriacal ideas
Thought of broadcasting
delusion- positive symptom
the belief that one’s thoughts can be heard by others
example: my brain is connected to the world mind. I can control all of the head of state through my thoughts
Throught Insertion
delusion- positive symptom
the belief that thoughts of others are being inserted into ones mind.
Example- they make me think bad thoughts
Thought Withdrawl
delusion- positive symptom
the belief that thoughts have been removed from ones mind by an outside agency
example- the devil takes my thoughts away and leaves me empty
Delusion of being controlled
Delusion- positve symptom
the belief that ones mind or body is being controlled by an outside agency
example- There is a man from the darkness that controls my thoughts with electrical waves
Imipramine (Tofranil)
Trimipramine (Surmontil
Desipramine (Norpramin)
Nortriplyine (Pamelor)
Tricyclic antidepressants
Tricyclic and tetracyclic antidepressants ease depression by affecting naturally occurring chemical messengers (neurotransmitters), which are used to communicate between brain cells.
They’re effective, but they’ve generally been replaced by antidepressants that cause fewer side effects.
Somatic Delusion
Positive symptom
The false belief that one’s body is changing in an unusual way
Example- David told the doctor that his brain was rotting away
Ideas of reference
Positive Symptom- Delusion
Miscontruing trivial events and remarks and giving them personal significance
example: when maria saw the doctor and nurse talking together, she believed that they were plotting against her
when she heard that there was a hurricane coming, she believed that it was really a message that harm was going to befall her.
Personal Boundary difficulties
People with schizophrenia often lack a sense of where their bodies end in a relationship and where others begin.
Phenelzine (Nardil)
Tranylcypromine (Parnate)
MAOI
Amoxapine (ascendin) Mirtazapine (Remeron) Trazodone (Desyrel) Bupropion (Wellbutrin) Nefazodone (Serzone) Venlafaxine (Effexor) Maprotiline (Ludiomil) Pexeva Cymbalta Selegiline (Emsam, Serafem)
Antidepressants Non Addicting Slow acting
Waxy flexibility
seen in catatonia, is evidenced by excessive maintenance of posture. Clients can hold unusual postures for long periods.
positive symptom- alteration in behavior
Stupor
refers to a state in which the catatonic client is motionless for long periods and may even appear to be in a coma
postitve symptom- alteration in behavior
Negativism
is the equivalent to resistance. The patient does exact opposite of what they are told.
Positive Symptom- Alteration in behavior
anergia
lack of energy
Self Assessment
It is important for the nurse to identify personal feelings and responses to clients with schizophrenia; otherwise, the nurse may experience helplessness and increased anxiety.
Without support and the opportunity and willingness to explore these reactions with more experienced nursing staff, the nurse may adopt defensive behaviors such as denial, withdrawl, and avoidance.
Abilify
Atypical antipsychotic
Little or no weight gain or increase in glucose, HDL, LDL, or triglyceride level
Quetiapine ( Seroquel)
Atypical antipsychotic
weight gain
headache
drowsiness
orthostasis
Zyprexa
Atypical antipsychotic
significant weight gain drowsiness insomnia agitation restlessness parkinsinism
Palperidone ( Invega)
Atypical antipsychotic
fast acting
Haldol
Typical antipsychotic
used in large doses for assultive clients to avoid the severe side effect of hypotension
Tegretol Depakote Lithium Triliptal Lamictal
Mood stabilizers
Non addictive
Depersonalization
non specific feeling that a person has lost their identity. That self is different or unreal
example- looking in the mirror and seeing someone different
Derealization
is the false perception that something has changed
