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Module 6 (Psych Mental Health) > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

Who are the faces of Schizophrenia?

A

John Nash (Math professor at Princeton, Nobel Prize)
- paranoid schizophrenia “A Beautiful Mind”
Nathaniel Ayers (Julliard violinist) “The Soloist”
Elyn Saks (Law and psychiatric professor) “The Center cannot Hold: My Journey Through Madness”
- TedTalks
Ron Power: no one cares about crazy people

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2
Q

Schizophrenia is diagnosed when

A

late adolescence or early adulthood

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3
Q

Schizophrenia is based on a

A

spectrum or continuum of a broad range of disorders

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4
Q

Is schizophrenia acute or chronic?

A

chronic
- more disabling type of mental illness
- affects how a person thinks, feels, and behaves

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5
Q

The DSM-5 for Schizophrenia is

A

2+ of the following for 1-month duration
- delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behavior
- negative symptoms

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6
Q

Schizophrenia Psychosis s/s

A

hallucinations
delusions - inside their head
disorganized thoughts
abnormal motor behavior
negative symptoms

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7
Q

Delusions

A

images or thoughts inside the person’s mind

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8
Q

Hallucinations

A

auditory, smell, tactile, see that is not there
Auditory
Voices
Somatic or tactile
Olfactory – gas, smoking
Visual
Gustatory – taste poison in their food

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9
Q

What does a schizophrenia patient sound like with disorganized speech?

A

Loose associations

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10
Q

Schizophrenia Psychosis is caused by

A

neurocognitive s/s impairing cognitive capacity
- deficits in perception, functioning, and social relatedness

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11
Q

Primary psychosis is derived from

A

schizophrenia spectrum disorders

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12
Q

Secondary Schizophrenia is derived from

A

substance intoxication and dementia

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13
Q

Can Primary and secondary schizophrenia coexist?

A

yes and potentiate the other

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14
Q

Schizophreniform Disorder
- duration

A

s/s must last at least 1 month but not more than 6 months

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15
Q

Schizophreniform Disorder
- descriptions

A

essential features identical to those of schizophrenia but shorter duration

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16
Q

Brief Psychotic Disorder
- duration

A

about a month
- returns to premorbid functioning
- precipitate by extreme stress

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17
Q

Brief Psychotic Disorder
- description

A

sudden onset of psychiatric s/s

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18
Q

Schizoaffective Disorder
- prognosis

A

better prognosis than schizophrenia
BUT significantly worse than a mood disorder

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19
Q

Schizoaffective Disorder
- description

A

Symptoms of a mood disorder:
- major depressive, manic, or mixed episode, concurrent with symptoms that meet the criteria for schizophrenia. Common psychotic disorder

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20
Q

Schizotypical Personality Disorder
- progression

A

May progress to developing schizophrenia

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21
Q

Schizotypical Personality Disorder
- description

A

Personality disorder considered part of the schizophrenia spectrum disorders (DSM-5); shares common genetics and neuropsychiatric characteristics. Intense discomfort with close relationships.

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22
Q

Delusional Disorder
- ranges from

A

Ranges from remission without relapse to chronic waxing and waning; symptoms must last at least 1 month

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23
Q

Delusional Disorder
- description

A

Involves nonbizarre delusions such as being followed, infected, loved at a distance, or deceived by a spouse; having some great or unrecognized insight; ability to function is not markedly impaired and behavior is not obviously odd or bizarre. Delusions of persecution are the most common.

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24
Q

Substance/Medication-induced Psychotic Disorder
- tx

A

psychosis usually resolves

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25
Q

Substance/Medication-induced Psychotic Disorder
- description

A

caused by ingestion of or withdrawal from a substance

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26
Q

Schizophrenia abrupt onset with good premorbid function has what prognosis

A

better prognosis and greater chance of remission/complete recovery

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27
Q

What onset of schizophrenia has a worse prognosis?

A

slow onset (2-3 years)

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28
Q

When schizophrenia is diagnosed as an early age of onset, what can occur?

A

structural brain abnormalities
more negative and disabling s/s
poorer progonosis

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29
Q

What age do men usually get schizophrenia?

A

18-25

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30
Q

What age do females usually get schizophrenia?

A

25-35

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31
Q

What is the comorbidity of schizophrenia?

A

50% substance use and 50% tobacco use disorder

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32
Q

What types of substances are usually used with schizophrenia

A

cannabis and psychotic disorders strong correlation
- Meth and LSD

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33
Q

Schizophrenia increases the abuse of what drug?

A

Cannabis

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34
Q

Why do most schizophrenic patients die prematurely?

A

non-psychiatric illnesses
- malnutrition
- insomnia
- criminal activity
- medication adverse effects not reported
- cooccurring disorders

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35
Q

What is co-occurring with schizophrenia?

A

Depressive disorders
20% attempt suicide
6-10% commit suicide
Anxiety/panic disorders
Obsessive-compulsive disorders
Schizotypal and paranoid personality disorder may develop into schizophrenia

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36
Q

Schizophrenia has what Type of duration

A

Recurrent acute exacerbations of psychosis
Periods of full or partial remission

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37
Q

Schizophrenia Primary Interventions

A

target people at high risk or see the start of the s/s

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38
Q

Schizophrenia Secondary Interventions

A

intervening early and reducing the duration of untx dx

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39
Q

Schizophrenia Phases

A

Prodromal
Acute
Stabilization
Maintenance

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40
Q

Schizo Prodromal Phase

A

80-90%
- early recognition and tx vital
- usually ignore s/s

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41
Q

Acute Phase of Schizophrenia

A

severe well developed s/s (positive, negative, neurocognitive, mood)

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42
Q

Maintenance Phase of Schizophrenia

A

What to keep in as long as possible

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43
Q

Risk Factors of Schizophrenia

A

Genetic factors
Alteration in brain structure
Brain’s neurotransmitter system disruptions
Alterations to neural circuits

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44
Q

Neurochemical Contributing Factors of Schizophrenia

A

Hyperactive dopamine transmission in the mesolimbic areas
Hypoactive dopamine transmission in the prefrontal cortex
Dysregulation in multiple other areas of the brain
Abnormal levels of serotonin may cause some of the negative and mood symptoms
NMDA (N-methyl-D-aspartate) an amino acid is implicated in the psychotic, negative and cognitive symptoms
Glutamate activity insufficiency or excess with other neurotransmitters

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45
Q

genetic Contributing Factors of Schizophrenia

A

One parent with schizophrenia leads to 5-6% chance
Both parents 46% chance
Group of 8 genetically different types of schizophrenia
Synaptic pruning, gene C-4

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46
Q

Neuroanatomical Factors of Schizophrenia

A

Decrease in both gray and white matter especially in the frontal lobe
Decrease brain volume
Larger lateral and third ventricles
Atrophy in the frontal lobe
More cerebral spinal fluid
Lower rate of blood flow and glucose metabolism in the prefrontal cortex

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47
Q

Non-genetic Factors of Schizophrenia

A

Viral infection affecting neurogenesis – in pregnancy
Poor maternal nutrition
Exposure to toxins
Perinatal complications and birth injuries
Closed head injuries after birth
Advanced paternal age
Overactive Immune system
First and second-generation immigrants - stress
Stress

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48
Q

Synaptic pruning

A

brain cuts back on neurons in adolescents

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49
Q

Cultural considerations for schizophrenia

A

Rural Africans may hallucinate about ancestor worship
Christians may hallucinate about Christ, Mary, Satan
- possessions
- punishment from God
Patients in US may report auditory hallucinations of violent commands
- religious, supernatural or biomedical

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50
Q

Sources of schizophrenia for cultures

A

Attributed to spiritual versus religious or supernatural, or biomedical
Can affect adherence to medication and other treatment
Hearing Voices Network believes it may be possible to improve relationship with voices by respecting, understanding and adapting to the voices

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51
Q

Secondary causes if psychosis

A

Brain Tumors
Cysts
Dementia
Neurological Diseases
Environmental Toxins
Misuse of and addictions of prescription meds

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52
Q

Positive symptoms of Schizophrenia

A

hallucinations
delusions
bizarre behavior
catatonia
formal thought disorder

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53
Q

Negative symptoms of Schizophrenia

A

apathy
lack of motivation
anhedonia
blunted or flat affect
Poverty and speech
social withdrawal

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54
Q

Cognitive symptoms of Schizophrenia

A

inpaired memory
disruption in social learning
inability to reason, solve problems, and focus attention

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55
Q

Mood symptoms of Schizophrenia

A

depression
anxiety
demoralization
suicidality
excitability
agitation
dysphoria
postpsychotic depressive disorder
demoralization
increase substance use

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56
Q

Different types of delusional alternatives in thinking

A

Mind Reading
Somatic
Ideas of reference
Persecution
Grandiose
Religious
- Jealousy
Control
Thought broadcasting
Thought insertion
Thought withdrawal

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57
Q

Mind Reading -

A

read other minds or others can read their mind

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58
Q

Somatic Thinking

A

false believe the body is changing in an unusual way – little men inside of them, new limb, nose disappears

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59
Q

Ideas of reference

A

misinterpret normal day to day events - 2 people talking and they are plotting to hurt him

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60
Q

Persecution

A

plot of being singled out by others – poisoned, followed

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61
Q

Gradiose - Religious

A

they are some very important and powerful (Jesus, devil, married to an important person)

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62
Q

Jealousy

A

think they are being cheated on but there is no reality proof

63
Q

Control Thinking

A

being controlled by an outside person or organization (agency)

64
Q

Thought Broadcasting

A

personal thoughts are heard by others and control the thoughts of others

65
Q

Thought insertion

A

people are putting thoughts in their heads

66
Q

Thought withdrawal

A

people are erasing their thoughts

67
Q

Concrete Thinking

A

only see words at face value

68
Q

Associative Looseness

A

flight of ideas
- can not tie thoughts together
- start with one thought and move to another thought at the end

69
Q

Tangential:

A

train of thought wonders off and never returns

70
Q

Clanging:

A

meaningless rhyming or sound alike words
- tik tak, click clank, monster track

71
Q

Neologisms:

A

made-up words

72
Q

Echolalia:

A

repeating words

73
Q

Word Salad:

A

mix of meaningless words
- Kamala do not form one complete thought

74
Q

Circumstantiality:

A

excessive detail. Cannot separate relevant from irrelevant.

75
Q

Pressured speech:

A

talking fasT
- OTHER PEOPLE cannot say anything

76
Q

Thought blocking:

A

Patient stops talking in the middle of a sentence and remains silent
- they can not complete their thought

77
Q

Illusions

A

misinterpretation of real experiences

78
Q

Schizophrenic patients have trouble with personal boundaries because of

A

Lack of Sense Where Bodies End and Other’s Begin
Depersonalization
Derealization

79
Q

Depersonalization –

A

loss of identity and the body parts are not theirs

80
Q

Derealization –

A

the environment is different
- larger or smaller than they really are

81
Q

What are the alterations in behavior for schizophrenia patients?

A

Catatonia
Bizarre behavior
Eccentric dress, grooming, rituals
Agitation or aggressiveness
Impaired boundaries
Impaired impulse control
Odd social or sexual behavior

82
Q

Catatonia –

A

no mvmt or slow mvmt, to very active strange mvmt (weird posture)

83
Q

Impaired impulse control –

A

can not stop themselves from experiencing (throat punch)

84
Q

Odd social or sexual behavior –

A

take off clothes, inappropriate sexual behavior in front of others and do not stop

85
Q

If a person has schizophrenia and starts undressing in the main room, what should the nurse do?

A

get a blanket and redirect to the room

86
Q

Catatonia consists of

A

Extreme motor agitation or extreme psychomotor retardation
Stereotyped behaviors
Automatic obedience
Bizarre posturing
Waxy flexibility – strange posturing
Negativism
Stupor – do not respond and look like they don’t understand

87
Q

Poverty of speech is aka

A

alogia

88
Q

Anhedonia

A

loss of pleasure

89
Q

Asociality

A

few relationships and no social and don’t mingle with people

90
Q

Avolution

A

no motivation and will not take care of themselves

91
Q

Neurocognitive/Cognitive Symptoms of schizophrenia

A

40-60% of people
-poor executive functioning
- inability to sustain attention - slow calculations
- problems with working memory
- inability to reason
- inability to problem solving
- can not learn new things

92
Q

Postpsychotic depressive disorder

A
  • aware of their illness and become depressed
  • deterioration and hopeless
93
Q

Demoralization

A

disheartened loss of confidence, enthusiasm, and hope

94
Q

Excitability

A

capable of being readily roused into action
state of excitement or irritability

95
Q

Paranoia Communication

A

projection
Speak indirectly. Do not use I and you. Use he or she, directing paranoid symptoms toward external and more general issues
Identify with the patient, helping patient feel understood. Empathize.
Share mistrust without supporting delusion. Find something to agree on with patient

96
Q

Disorganized S/S for Schizophrenia

A

Poor premorbid functioning – before dx the s/s are bad
Poor prognoses
Social withdraw
Severe cognitive impairment
Require structured and well supervised setting

97
Q

When the schizophrenia patient has delusions and hallucinations, then the nurse would

A

support the person but not the delusions

98
Q

Schizoaffective Disorder s/s either of

A

bipolar or major depression

99
Q

With a schizoaffective disorder tx is

A

treat psychosis and the mood disorder

100
Q

The nurse needs to assess what in schizophrenia patients

A

Suicide risk (harm to self)
Risk of violence (harm to others)
Command hallucinations
Delusions
Substance use/abuse
Medical workup
Co-occurring disorders: depression, anxiety
Self care and safety
Medication use and adherence
Positive & negative symptoms
Patient’s insight & coping
Support system - need a good one but might have burned those bridges and pushed away family

101
Q

Standardized Screening Tools for Schizophrenia

A

BPRS –

PANSS –

**AIMS – **

MMSE -

102
Q

Most of the screening tolls for schizophrenia patients are used for physicians, which one used by nurses?

A

AIMS - see for s/s – abnormal of involuntary mvmts from the medications LIKE TARDIVE DYSKINESIA

103
Q

Nursing Dx for Schizophrenia patients

A

Risk for self-directed/other-directed violence
Ineffective impulse control
Social isolation
Distorted thinking process
Impaired verbal communication
Impaired family coping
Self care deficit
Difficulty coping
Risk for suicide
Ineffective health maintenance

104
Q

Planning for Schizophrenia patient’s order

A

crisis hospitalization
observe
stabilization
teach relapse prevention
D/C planning

105
Q

Implementation of Schizophrenia

A

psychopharmacology
milieu
establish trusting relationship
- positive reinforcement
therapeutic communication
health teaching and promotion
- educate frequently and repeated
social services

106
Q

Communication for a Schizophrenia Pt

A

Be cautious with touch as it may be perceived as threatening
Use calm, quiet tone of voice
Elicit description of hallucination/delusions to ensure safety
Don’t confront or argue truth/falsehood of their ideas
Help present and maintain reality **
Focus on feelings**
Deal with inappropriate behaviors in non-judgmental manner
Teach social skills through education, role-modeling, and practice

107
Q

If a schizophrenia patient is having delusions, what should the nurse ask before going forward?

A

type of delusions
- when stable give teachings and social skills by role modeling

108
Q

Patients who are highly suspicious & hostile: the nurse should

A

Allow patient as much control as possible within limits, explain treatments, meds, lab tests before initiating them
Might see as a threat

109
Q

Patients who are aggressive & agitated: the nurse should

A

increase supervision, decrease stimulus, de-escalate verbally, offer medication

110
Q

Patients with hallucinations/delusions: the nurse should

A

Ask directly, “Are you hearing voices?” “What are they saying?” Reduce stimulus. Focus on feelings and reality, not delusions

111
Q

Hallucinations nursing interventions

A

Empathy
Identify the feelings patient is experiencing
Explain you do not hear voice – do not argue, but validate they do hear them
Ask the patient to turn away from the voices
Distract attention
Calm demeanor and milieu

112
Q

Delusions nursing interventions

A

Same as hallucination except:
Do not touch patient and use gestures carefully
Do not argue with the patient’s beliefs

113
Q

Paranoia Interventions

A

Place yourself beside the patient, not face to face
Avoid eye contact
Offer foods and drinks in closed containers – avoid poisoning
Distraction with reality-based activities
Use restrictive interventions if anxiety escalates
avoid confrontation and be at a degree angle and not to look at them for a long time

114
Q

Associative Looseness Intervention

A

Do not pretend you understand the patient’s communication
State “I am having difficult understanding” or
State “I am having trouble following what you are saying”
Piece together what they are saying by looking for recurring topics
Involve patient in simple reality-based activities

115
Q

Teach the patients and family about what in schizophrenia

A

Illness (causes, self-care)
Medication side effects, management and follow-up
Early signs of relapse & develop a prevention plan
Avoiding alcohol and drugs
Building support system
Community resource

116
Q

Recovery Model and Recovery Oriented Care

A

Anyone can recover and manage their condition successfully
Health
Home
Purpose
Community

117
Q

Recovery after initial schizophrenia episode project

A

Medication
Psychosocial therapy
Case management
Family involvement
Supportive education
Employment services

118
Q

Psychotherapy and Psychoeducation for Schizophrenia

A

PACT
ACT
Family Psychoeducation Therapy – engages family, improves caregivers’ positive well-being and reduce burden of care.
Cognitive Behavioral Therapy – correct self-defeating behavior – correct how they see things
Cognitive Remediation – improve cognitive skill such as memory, attention
Social Skills Training

119
Q

Family Psychoeducation Therapy –

A

engages family, improves caregivers’ positive well-being and reduce burden of care.

120
Q

Cognitive Behavioral Therapy –

A

correct self-defeating behavior – correct how they see things

121
Q

Cognitive Remediation –

A

improve cognitive skill such as memory, attention

122
Q

Therapy of Schizophrenia aims to

A
  • in community, prevents relaspee, reduce hospital, improve quality of life, and med adherence, no criminal activity and out of jail
123
Q

Typical (Conventional or first-generation) Antipsychotics (FGA)

A

Target + Symptoms
Dopamine (D2) receptor antagonist
Greater risk of EPS symptoms

124
Q

What pharmacology is used for schizophrenia

A

Antipsychotics (1st and 2nd gen)

125
Q

Atypical (second-generation) Antipsychotics (SGA)

A

Target + and – symptoms
Serotonin-dopamine antagonists
Higher risk of metabolic syndrome; lower risk of EPS
More costly

126
Q

Typical (Conventional or first-generation) Antipsychotics medication types

A

Haloperidol (Haldol)
Chlorpromazine (Thorazine)
Trifluoperazine (Stelazine)
Thiothixene (Navane)
Fluphenazine (Prolixin)
Thioridazine (Mellaril) (***QT prolongation)
Loxapine (Loxitane)
Perphenazine (Trilafon)

127
Q

What 1st gen antipsychotic can cause QT prolongation?

A

Thioridazine

128
Q

Typical Antipsychotics Black box warnings

A

Not approved for dementia-related psychosis

129
Q

Typical antipsychotic side effects

A

anticholinergic effects
wt gain
sexual or reproductive organ issues
increased prolactin levels
seizures
sedation
agranulocytosis
NMS
cardiac events
EPS
drug-induced liver disease

130
Q

Agranulocytosis

A

decrease in WBCs

131
Q

EPS

A

akathesia - restless msucles
pseudoparkinsonism- shuffling and rigidity
acute dystonia torticollis

132
Q

Torticollis is treated

A

Treat right away as it can cause aspiration when eating

-IM Benadryl is used for tx

133
Q

Tardive Dyskinesia

A

Serious and irreversible EPS side effect after prolonged treatment that consists of involuntary tonic muscle spasms involving the face, lips, tongue, trunk, and extremities.

134
Q

Tardive Dyskinesia symptoms

A

may subside after meds are discontinued or may be permanent.

135
Q

Anticholinergic effects

A

Red as a beet – flushed
Dry as a bone – everything dries up
Blind as a bat – blurry visiosn
Hot as a hare – increase temp
Full as a flask – difficulty urinating

136
Q

Atypical (2nd generation)Antipsychotics medications

A

Clozapine (Clozaril) (agranulocytosis) – wt gain
Risperidone (Risperdal)
Olanzapine (Zyprexa) - wt gain
Quetiapine (Seroquel) -
Ziprasidone (Geodon) (QT prolongation)
Less for wt gain
Paliperidone (Invega)
Lurasidone (Latuda)
Iloperidone (Fanapt)
Cariprazine (Vraylar)(considered 3rd generation by some sources)
Aripiprazole (Abilify) (considered 3rd generation by some sources)
Less for wt gain

137
Q

Atypical antipsychotics have wt gains

A

Clonzapine
Olanzapine

138
Q

Atypical antipsychotics have less wt gain

A

Zisperadone
Aripiprazole

139
Q

Atypical antipsychotics have what agranulocytosis

A

Clozapine

140
Q

Atypical antipsychotics have what QT Prolongation

A

Ziprasidrone

141
Q

Black box warning for Atypical antipsychotics

A

Not approved for dementia-related psychosis

142
Q

2nd gen antipsychotics side effects

A

anticholinergics
EPS less common
gynecomastia
seizures
NMS
metabolic syndrome
sedation
sexual problems
cardiac events

143
Q

Metabolic syndrome

A

Cluster of conditions that ↑ risk for heart disease, diabetes, stroke. Dx with 3 or more of the following:
Obesity: excess weight, ↑ BMI, ↑ abdominal girth
↑ B/P
High blood sugar level
High cholesterol: Triglyceride at least 150mg/dL, HDL less than 40mg/dL (women) & 50mg/dL (men)

144
Q

Long-acting Antipsychotics - Depot medication types

A

Haloperidol decanoate (Haldol)
Fluphenazine decanoate (Prolixin)
Risperadone (Risperdal Consta)
Paliperidone palmitate (Invega Sustenna)
Olanzapine pamoate (Zyprexa Relprevv)

145
Q

Why are depot shots given for schiophrenia patients

A

noncomplicance

146
Q

AIMS is the

A

Abnormal involuntary movement scale (AIMS): assessment screen for tardive dyskinesia
When should this be used?
Rates movement of facial/oral, extremities, and trunk) on a scale of 0-4

147
Q

NMS frequency increases with

A

high potency antipsychotics and cognitive impairment (stroke, dementia, etc)

148
Q

NMS is an

A

emergency

149
Q

NMS s/s

A

low consciousness, muscular rigidity, ↑ muscle enzymes, hyperpyrexia (103 or above), hypertension, tachycardia, tachypnea, diaphoresis, drooling.

150
Q

NMS Tx

A

admit, stop the drug, antipyretics Dantrolene - spasms and IV fluids, for muscle spasms,TX OTHER COMPLICATIONS

151
Q

Memory TOOL for NMS

A

Fever >103F
Elevated CPK/WBC
Vital sign instability (autonomic instability)
Fluctuating BP, pallor, tachycardia
Sweating, salivation, tremors, incontinence
Encephalopathy
Confusion, altered level of consciousness
Rigidity muscle

152
Q

Antiparkinson Drugs

A

Trihexyphenidyl (Artane)
Benztropine (Cogentin)
Diphenhydramine (Benadryl)
Biperiden (Akineton)

153
Q

Evaulation for Schizophrenia effectiveness

A

Have symptoms lessoned? Why or why not?
Is the patient taking medications? If not, why?
Explore issues with nonadherence.
Are the family involved? Do they understand the disease and treatment?
Are the patient and family aware of relapse issues?
Are the patient and family utilizing community resources available to them?
Promote recovery model focusing on patient’s goals and strengths

154
Q

Self-Awareness Issues with Schizophrenia

A

Challenges: A patient who is psychotic may be intensely anxious, fearful, or agitated and can evoke strong emotions in caregivers
May experience fear, anxiety, avoidance
Frustration if patient nonadherent
Need not take patient’s success or failure personally
Focus on patient’s strengths, time out of hospital
No nurse has all answers

Module 6 (Psych Mental Health) (12 decks)

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