Schizophrenia Flashcards
onset
abrupt or insidious
most with slow, gradual development of signs and symptoms
immediate course of schizophrenia (2 patterns)
- ongoing psychosis, never fully recovering
- episodes of psychotic symptoms alternative episodes of relatively complete recover
long-term course of schizophrenia
-intensity of psychosis diminishes with age
-most with difficulty functioning
-few with ability to live fully independent lives
what is psychosis often replaced with as people with schizophrenia age?
dementia
positive symptoms (adding something)
-delusions
-hallucinations
-disorganized speech
-bizarre behavior
negative symptoms (lacking something)
-flattened affect
-reduced speech
-lack of initiative
-poverty of thought (logia)
cognitive symptoms
-inattention, easily distracted
-impaired memory
-poor problem-solving skills
-poor decision-making skills
-illogical thinking
-impaired judgement
biological factors that contribute to schizophrenia
-genetic (multiple genes)
-brain structure abnormalities (larger later and 3rd ventricles, low rate of blood flow & glucose metabolism)
-neurobiology theories
neurotransmitters affecting schizophrenia
-dopamine
-serotonin
-glutamate
environmental factors contributing to schizophrenia
-immunovirologic factors (viral exposure
-research focusing on infections in pregnant women as a possible origin
cultural considerations
-ideas considered delusional in one culture possibly commonly accepted by other cultures
-auditory or visual hallucinations as normal part of religious experiences in some cultures
-culture-bound syndromes
-ethnic differences in response to psychotropic medications
most common type of hallucination
auditory
command hallucination
tells a person to do something
hallucination
false sensory perceptions
delusions
false, fixed beliefs
neologisms
made up words
echolalia
repetition of words of another
echopraxia
mimicking movement of another
clang association
meaningless rhyming of words
word salad
jumble of words together without meaning
depersonalization
feeling that person is unreal
derealization
feeling that environment has changed
bizarre behaviors
extreme motor agitation
stereotypes behaviors
automatic obedience
waxy flexibility
stupor
negativism
flat affect
no emotion displayed
inappropriate affect
emotional response incongruent to situation
blunted affect
minimal emotional response
bizarre affect
grimacing, giggling, mumbling
nursing process - assessment
-History: previous history of schizophrenia; previous suicidal ideation; current support system; patient’s perception of current situation
-General appearance, motor behavior, speech (odd, bizarre; catatonia; echopraxia, psychomotor retardation, word salad, echolalia)
nursing process - outcome identification
-focus on safety of patients and others
-stabilize patient’s thought process
-reality orientation
nursing process - interventions
-safety of patient, others
-therapeutic relationship, therapeutic communication
-interventions for delusional thoughts (focus on reality; no confrontation reinforcement)
-interventions for hallucinations
-management of socially inappropriate behavior
keys that a patient might be hallucinating
darting eyes, tilted head, mumbling to self
communication of client dealing with hallucinations and delusions
-approach client in nonthreatening and nonjudgmental manner
-identify feelings client is experiencing
-clarify reality of client’s experience
-avoid arguing/attempt to reason with client who is delusional
-interact with client about concrete reality
-distract client’s attention from hallucinations and delusions
communication of client who is paranoid
-be honest and consistent
-avoid talking, laughing, whispering when client cannot hear what is being said
communication of client who is dealing with associative looseness
-do not pretend to understand client’s communications when you do not
-tell client you are having difficulty understanding
-look for recurring topics or themes
-emphasize what is going on in the “here and now”
best intervention to use with client who is having auditory hallucination
ask the patient, “Can you tell me what you’re hearing?”
conventional antipsychotics
-targeting positive symptoms
-no observable effects on negative symptoms
-prototypes: Haloperidol & Chlorpromazine
atypical antipsychotics
-diminish positive symptoms
-lessen negative symptoms
-prototype: Clozapine
when is clozapine used?
in severe situations
Chlorpromazine
-first modern antipsychotic
Chlorpromazine adverse effects
-orthostatic hypotension
-sedation
-anticholinergic effects
Haloperidol adverse effects
EPS
sedation
medication side effects
-EPS (more common with conventional antipsychotics)
-acute dystonic reactions (spasms)
-akathisia (restlessness, pacing)
-pesudoparkinsonism
-tardive dyskinex=sia
seizures
-neuroleptic malignant syndrome
neuroleptic malignant syndrome
-rare but serious reaction
-sweating, rigidity, sudden high fever, autonomic instability, diaphoresis, deterioration of mental status
-risk of death without treatment (stop drug)
-monitoru V/S, I/Os, Parkinsonian symptoms
-may be prescribed bromocriptine or dantrolene
clozapine adverse effects
agranulocytosis (significant risk); neutropenia
-seizures
-diabetes
-weight gain
-myocarditis
-effects in older adults patients with dementia
monitoring clozapine protocol
-BP & pulse
-signs of EPS & NMS
-assess FBS, lipids, & BMI
-weekly WBCs for first 6 months of treatment
