Schizophrenia (329 E1) Flashcards
schizophrenia definition
a psychosis characterized by abnormalities in perception, content of thought and thought process, and extensive withdrawal of one’s interest from individuals and the outside world
a disconnection to the mind
Psychosis definition
a state in which the individual is experiencing hallucinations, delusions or disorganized thoughts, speech or behavior
caused by schizophrenia and mood disorders like bipolar
schizophrenia interferes w/ person’s ability to
-think clearly
-manage emotions
-make decisions
-relate to others
peak onset of schizophrenia
men: 15-25 years of age
women: 25-35 years of age
etiology of schizophrenia
-genetics
-environmental
-brain chemistry (problems w/ neurotransmitter, dopamine & glutamate)
-substance use
comorbidity of schizophrenia
-substance use disorder
-nicotine dependence
-anxiety/depression/SI
-DM
-CVD
-obesity
-malignant neoplasm
-HIV/AIDS
-osteoporosis
-Hep C
schizophrenia: positive symptoms
can be thought of as sx that exist but should not be there
-alterations in perception (paranoia, delusions, hallucinations)
-altered speech
-alterations in behavior
-alterations in thought
paranoia
-an irrational fear, ranging from mild to profound
-a deep mistrust or suspicion of others
-may result in dangerous defensive actions
-paranoia can develop into delusional thoughts
delusions
false beliefs that are held despite a lack of evidence to support them and aren’t corrected w/ reasoning
feels very real to patient
delusions: persecutory
belief that one is being watched, plotted against, ridiculed
delusions: referential
belief that events or circumstances that have no connection to you are somehow related to you
delusions: grandiose
belief that one a powerful or important person
delusions: erotomanic
believing that another person desires you reomantically
delusions: nihilistic
the delusion of nonexistence: a fixed belief that the mind, body or the world at large - or parts thereof - no longer exists
delusions: somatic
belief that the body is changing in unusual ways
delusions: religious
belief that they have a special relationship w/ god or are on a mission for god, or that they are sinners
delusions: control
belief that another person, group or external force controls your thoughts, feelings, impulses or behavior
intervening w/ delusion
-remain calm, acknowledge and accept the patient’s experience and feelings
-encourage pt to express feelings and convey empathy about the patient’s fearfulness
-provide reassurance about intentions & present reality
-focus on helping the pt feel safe, focus on the fear and not the delusion
when communicating w/ the patient having a delusion
build rapport and trust by being open, honest and genuine
-ask pt to describe the delusion
-validate if part of the delusion is real and present reality
-never debate or argue the delusional content
-assess the intensity, frequency and duration
-what triggered
can you clarify a delusion for a pt
it is helpful to clarify misinterpretations of the environment and gently suggest, as tolerated, a more reality based perspective
documenting delusions
-type of delusion experienced, content/theme, and the characteristics
-use the patient’s own words
-the pt behavior
hallucinations
-alterations in perceptions that involve errors in how one interprets perceptions or perceives reality
-occurs when a person perceives a sensory experience for which non external source exists
5 senses of hallucinations
-auditory: hearing voices or sounds
-visual: seeing people or things
-olfactory: smelling odors
-gustatory: experiencing tastes
-tactile: feeling body sensations
command hallucinations
-auditory hallucinations in the form of commands that instruct a patient to act in a specific way
-the content of the commands can range in seriousness from innocuous (not harmful) to dangerous, including commands to cause harm to self or other
intervening w/ hallucinations
-introduce self to pt to gain rapport, trust and to help develop the nurse pt relationship
-approach the pt in a non threatening and calm manner
-reassure the pt that they are safe
-ask direct questions about type and content
assessment for hallucinations
-moving eyes back & forth
-muttering or talking to self or object
-appearing distracted
-suddenly stopping conversation as if interrupted
-intently watching a vacant area of the room
hallucination: documentation
-type experienced, content/theme, & the characteristics
-use pt’s own words
-the pt’s behavior prior to assessment for hallucinations and behaviors during the hallucination
-any actions taken to help the patient during the hallucination
teach pt w/ hallucination to
-manage stress & stim
-use other sounds to compete w/ hallucination
-find out what is and isn’t real
-engage in activities that can take your mind off the hallucination
-talk
-make contact w/ others
-develop a plan for how to cope w/ hallucinations
alterations in speech: circumstantiality
extremely detailed & lengthy conversation about a topic but gets eventually to the point
alterations in speech: tangentiality
wandering off topic or going off on tangents and never reaching the point
alterations in speech: loose associations
absence of normal connectedness of thoughts, ideas & topics
ex: my friend talks about french fries but how can you trust the french
alterations in speech: flight of ideas
topic of conversation changes repeatefly & rapidly w/ only superficial associative connections, making it difficult for others to follow
ex: a man begins talking about his business but quickly shifts to discussing the economy, the government and other countries
alterations in speech: echolalia
repetition of another’s words, pathological repetition of another word
alterations in speech: clang association
choosing words based on their sound rather than their meaning; often involves a rhyme or similar beginning sounds
ex: “i heard the bell. Well hell then i fell”
alterations in speech: symbolic speech
using words based on what they symbolize, not what they mean
ex: a pt reports “demons are sticking needles in me” when what he means is he is experiencing a sharp pain
alterations in speech: pressured speech
urgent or intense speech; reluctance to allow comments from others
alterations in speech: world salad
string of words totally unconnected, jumble of words meaningless to a listener
ex: agents want strength of policy on a boat reigning supreme
alterations in speech: neologisms
made up words, meaning for the patient only
ex: “his mannerologies are poor”
thought blocking
a reduction or stoppage of thought
ex: in the middle of talking about his childhood, the patient abruptly pauses, after which he can’t remember what he was saying
thought insertion
the belief that someone else has inserted thoughts into the patient’s brain
ex: the patients repeatedly complains of having disturbingly violent thoughts, which, she claims are being sent to her by satan
thought deletion
a belief that thought have been taken or are missing
paranoia
an irrational fear, ranging from mild to profound. fear may result in dangerous defensive actions, such as harming another person before that person can harm the pt
catatonia
a pronounced increase or decrease in the rate and amount of movement. Excessive motor activity is purposeless
echopraxia
involuntary imitation of another’s movements & gestures
motor retardation
a pronounced slowing of movement
motor agitation
excited behavior, such as running or pacing rapidly, often in response to internal or external stimuli
negativism
a tendency to resist or oppose the requests or wishes of other
negative symptoms
ones that should be there but aren’t
harder to treat than positive symptoms
interfere greatly with function on a daily basis
negative symptoms: affective blunting
reduced or constricted affect
ex: face doesn’t move, lack of eye contact
negative symptoms: apathy
a decreased interest in activities or beliefs that would otherwise be interesting or important or little attention to them
ex: no longer interested in favorite sport
results in loss of activities like personal hygiene
negative symptoms: alogia
a reduction in speech
ex: hard to get words out
negative symptoms: avolition
reduced or loss of motivation or goal directed behavior; difficulty beginning or sustaining goal directed activities
ex: hard to go to school
results in loss of activities like personal hygiene
negative symptoms: anhedonia
a reduced ability or inability to experience pleasure or joy
negative symptoms: asociality
a decreased desire for social interaction or discomfort while doing it; social withdrawal
cognitive symptoms: concrete thinking
impaired ability to think abstractly resulting in interpreting or perceiving things in a literal manner
cognitive symptoms: impaired memory
impacts short term memory and the ability to learn
cognitive symptoms: impaired information processing
delayed responses, misperceptions or difficulty understanding others
cognitive symptoms: impaired executive functioning
difficulty w/ reasoning, setting priorities, comparing options, plannings…
cognitive symptoms: anosognosia
inability to realize one is ill; an inability caused by the illness itself; may result in resistance to or cessation of treatment; often combined w/ paranoia so that accepting help is impossible
affective symptoms
involve an altered experience and expression of emotions -> mood may be unstable, erratic, labile or incongruent
schizoaffective disorder
a chronic mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions and symptoms of a mood disorder such as mania and depression
an uninterrupted period of illness during which at some time there is either a major depressive episode, a manic episode, or a mixed episode w/ symptoms of schizophrenia
affective disorders
mental health conditions that heavily affect a person’s mood and feelings
bipolar type schizoaffective disorder
individuals experience a combination of symptoms from both schizophrenia and bipolar disorder. typically, this means individuals experience both depressive and manic espisodes alongside their schizophrenia sx
depressive type schizoaffective disoder
individuals suffer form the psychotic symptoms of schizophrenia as well as depressed moods that come w/ major depressive disorder. those living w/ depressive type do not experience highs and lows but instead experience long periods of intense depression
depresssive sx of schizoaffective disorder
-feelings of lethargy or not wanting to do anything
-no longer deriving pleasure from your favorite activities
-inability to sleep or sleeping excessively
-loss of appetite
-a feeling that you will never be happy again
schizophrenia sx of schizoaffective disorder
-delusions
-hallucinations
-difficulty holding work or staying enrolled in school
-problems w/ personal hygiene or taking care of yourself
-difficulty communicating w/ individuals
treatments of schizoaffective disorder
-medications (antipsychotic, mood stabilizing or antidepressant)
-cognitive behavioral therapy
-group therapy sessions
