Schizophrenia Flashcards
Schiz DSM-5
A. 2+ of the following sx for signif amt of time during a month (delus, halluc, disorg speech, bx, sx)
B. social or occupational fxn below previous achievement levels
C. continuous signs over 6M
D. absense of indig duration of MDD, manic, or mixed concurrent w/ active sx
E. not direct phys fx of sub use or other condx
F. Delus/halluc present when prior hx autistic dx or other dev dx exists
Schizophrenia
psychosis char by abnorm in perception, content of thought, thought processes, extensive w/d of one’s interests from ind and outside world
- varied functioning
- interfere w/ think clear, manage emo, make decisions, relate to others
What populations have higher rates of schiz
male and urban
etiology of schiz
Genetics, enviro (malnut in birth), autoimmune, Dp and glut, sub use (esp mind altering while young)
Vulnerability stress model
Genetics and psych predis PLUS life stress causes accel schiz process
- if life stress low, may avoid sx of psychosis
Schiz comorbidity
Sub use in 1/2 psychosis, nicotine use, alc, dep, suicide, premature death from CVD, DM, malig neoplasm, hep C, HIV/AIDS, osteoporosis, obesity, worse medical tx
Positive sx
exist but shouldn’t be there
Which symptoms are alterations in perception
Paranoia, delusions, hallucinations
Pranoia
irrational fear and deep sus of others
- may cause dangerous, defensive actions like harming others
- can become delusional
Delusions
False beliefs held despite lack of evidence and aren’t corrected with reasoning
Persecutory delusions
being watched and plotted against
referential delusions
events are somehow r/t you (birds sing song for you)
grandiose delusion
You are powerful/important
Erotomaniac delusions
Someone desires you
nihilistic delusion
world at large is ending or gone (give away all stuff bc comet is coming)
somatic delusion
body changing (heart dead)
religious delusion
God speaking
control delusion
someone is telling you to do something or controlling you
NC for delusion interventions
pt scared; need to accept pt experience, encourage feelings and sharing, validate what isn’t real and reorient, help pt feel safe, focus on the emotions, don’t argue
Delusion documentation
- freq, intensity, duration of delusions - find the trigger
- can introduce doubts in delusion as they improve
- use pt own words if can and say what you did to help
Hallucination
alteration in how to perceives reality; perceive sensory experience for which no ext source exists
Command hallucinations
tell pt to do things
- can be dangerous
- can cause SI or HI–immediate intervention
Physical signs of hallucinations
eye tracking, mutter, distract, stop talk, watch vacant area of room
What should you tell the pt to say to the voices?
Not real, go away; tell yourself you are safe no matter what you hear
NC for hallucinations
- introduce self
- calm and nonthreatening
- reassure pt safety
- acknowledge feelings
- distract
- making coping plan
- take mind off it
How to assess risk of command hallucination
Ask “is there a voice telling you what to do”
Ask “do you believe what you hear is true”
If yes, immediate safety measures
Categories of positive symptoms
alterations in perception, disorganized or alterations in speech, though, and bx
Circumstnatiality
detailed and lengthy conversation but gets to the point
tangentiality
tangent and does not get to a point
loose association
lack connectedness in thoughts
flight of ideas
rapid chx topic and hard to follow
echolalia
repeat others words
clang associataion
put words together by alliteration or rhyme
symbolic speech
use words based on symbol not meaning
- ex: ppl sticking needles in me (feel a poke)
pressured speech
urgency in speech, don’t let others talk
word salad
total disconnect in words, meaningless
neologisms
make up words, meaning only for pt
- ex: mannerologies
thought blocking
reduction or stopped thoughts; pt stops then starts new topic
thought insertion
believe someone else inserted thoughts into brain
thought deletion
someone took thoughts or they are missing
paranoia
suspicion of others
catatonia
inc or dec in rate or amt of mvt; excess purposeless mvt
echopraxia
invol imitation of others mvt and gestures
motor retardation
slow mvt
motor agitation
excited behavior, run, pace, quick often from int or ext stimuli
negativism
resist or oppose requests of others
stereotyped bx
repetitive purposeless mvt that are peculiar to the person and serve no purpose
impaired impulse control
can’t control impulses
gesture/posturing
posture held in fixed position
boundary impairment
doesn’t understand where their body is in reference to another
mood
A person’s emotions or feeling experienced in their own words
- psych documentation: elated, euphoric, depressed, labile, dysthymic, cyclathymic, euthymic
Incongruent mood
Mood and affect do no match
Negative sx
should be there but aren’t
affective blunting
dec affect (may shed some tears…)
affect
physical, observable incl nonverbal
Examples of affect
flat, blunted, constricted (shows anger and sadness but no others), inappropriate, bizarre (grimace)
apathy
dec activity and belief in interests
alogia
dec speech; blocking and poverty of speech
avolition
dec or lose motivation or goal-directed bx; can’t sustain activity
anhedonia
loss of pleasure
asociality
lack of desire for social intx or social w/d
- often d/t discomfort
Apathy and avolition negatively affect…
ADLs
concrete thinking
can’t think abstractly; literal
impaired memory
short term affect of schiz
impaired information processing
delayed response, misperceptions, prob understanding others due to schiz
Impaired exec fxn
lack reasoning, planning, decision making from schiz
anosognosia
don’t realize they are ill
- often leads to relapse
- often with paranoia
Affective sx of schiz
Altered experience of emotion
- unstable mood, labile, erratic
