Schizophrenia Flashcards
Antagonistic thoughts and behavior Shy and withdrawn Poor peer relationships Doing poorly in school Antisocial behavior
Phase I
Premorbid phase
Social Maladjustment
Lasts from a few weeks to a few years
Deterioration in role functioning and social withdrawal
Substantial functional impairment
Sleep disturbance, anxiety, irritability
Depressed mood, poor concentration, fatigue
Perceptual abnormalities, ideas of reference, and suspiciousness herald onset of psychosis
Phase II
Prodromal Phase
Baseline
In the active phase of the disorder, psychotic symptoms are prominent
- Delusions
- Hallucinations
- Impairment in work, social relations, and self-care
Phase III
Schizophrenia
Symptoms similar to those of the prodromal phase
Flat affect and impairment in role functioning are prominent
Stabilize phase; may not return to baseline
Phase IV
Residual phase
The existence of prominent, no-bizarre delusions
delusional disorder; types of psychotic disorder
stalkers, believe in a real relationship with person
Erotomanic type; delusional disorder
tales about them being very important or having very expensive things, being the president, God
Grandiose type; delusional disorder
in a relationship; jealousy issues, even with out reason
Jealous type; delusional disorder
Persecuting them
Persecutory type; delusional disorder
feeling to do with the body, in pain
Somatic type; delusional disorder
all of these things, erotomanic, jealous, grandiose, persecutory, somatic
Mixed delusional type
sudden onset of symptoms
may or may not be preceded by a severe psychosocial stressor
can hear voices
severe stressor assoc with extreme anxiety, depression.
Lasts one month!
Return to full premorbid level of functioning
Brief Psychotic Disorder
The presense of prominent hallucinations and delusions that are judged to be directly attributable to substance intoxication or withdrawal.
Substance-Induced Psychotic Disorder
Prominent hallucinations and delusions are directly attributable to a general medical condition
Psychotic Disorder Assoc with Another Medical Condition
Catatonic features may be assoc. with other psychotic disorders, such as brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, and substance-induced psychotic disorder
dementia patients, thyroid disorders too-psychosis
The Catatonic Features Specifier;
stupor and muscle rigidity or excessive, purposeless motor activity.
waxy flexibility, negativism, echolalia, echopraxia
unable to speak, communicate or move.
manic @ 1st then goes catatonic
if live alone, could die.
Symptoms of catatonic disorder
This diagnosis is made when the catatonic symptoms are directly attributable to the physiological consequences of a general medical condition
Catatonic Disorder Assoc. with Another medical condition
Same symptoms as schizophrenia with the exception that the duration of the disorder has been at least 1 month but less then 6 months!
not quite brief then returns to baseline.
Schizophreniform Disorder
schizophrenic symptoms accompanied by a strong element of symptomatology assoc with mood disorders, either mania or depression.
diagnosed after the fact.
Schizoaffective Disorder
A client is admitted with a diagnosis of brief psychotic disorder, with catatonic features. Which symptoms are assoc. with the catatonic specifier?
stupor, muscle rigidity, and negativism
Hallucinations can take over their entire life.
Delusions: false personal beliefs
Religiosity: excessive demonstration of obsession with religious ideas and behavior
Paranoia; extreme suspiciousness of others (dangerous)
Magical thinking: ideas that ones’ thoughts or behaviors have control over specific situations
Positive Symptoms
Content of thought
false personal beliefs
delusions
excessive demonstration of obsession with religious ideas and behavior
Religiosity
extreme suspiciousness of others (dangerous)
Paranoia
ideas that one’s thoughts or behaviors have control over specific situations
Magical thinking
Associative looseness (aka loose association): shift ideas from one unrelated topic to another
Neologisms: made up words that have meaning only to the person who invents them
Concrete thinking: literal interpretations of the environment
Clang associations: choice of words is governed by sound (often rhyming)
Word salad: group of words put together in a random fashion
Circumstantiality: delay in reaching the point of a communication because of unnecessary and tedious details
Tangentiality: inability to get to the point of communication due to introduction of many new topics
Mutism: inability or refusal to speak
Perseveration; persistent repetition of the same word or idea in response to different questions
Positive Symptoms
Form of thought
shift of ideas from one unrelated topic to another
Assoc. looseness (aka loose association)
made up words that have meaning only to the person who invents them
Neologisms
literal interpretations of the environment
Concrete thinking
choice of words is governed by sound (often rhyming)
Clang associations
group of words put together in a random fashion
Word salad
delay in reaching the point of a communication because of unnecessary and tedious details
Circumstantiality
inability to get to the point of communication due to introduction of many new topics
Tangentiality
inability or refusal to speak
Mutism
interpretation of stimuli through the senses
Perception
false sensory perceptions not assoc. with real external stimuli
- Auditory
- Visual
- Tactile
- Gustatory
- Olfactory
- Illusions: misperceptions of real external stimuli
Positive Symptoms: Perception
- Sense of self; the uniqueness & individuality a person feels
- Echolalia: repeating words that are heard (Brick)
- Echopraxia: repeating movements that are observed
- Identification and imitation: taking on the form of behavior one observes in another
- Depersonalization: feelings of unreality
Positive Symptoms
the uniqueness and indiv. a person feels
sense of self
repeating words that are heard (brick)
echolalia
repeating movements that are observed
echopraxia
taking on the form of behavior one observes in another
identification and imitation
feelings of unreality
depersonalization
Delusions hard to treat;
Voices easier to treat with meds
side note
the feeling state or emotional tone.
Affect
emotions are incongruent with the circumstances
Inappropriate affect
weak emotional tone
bland affect
appears to be void of emotional tone
flat affect
disinterest in the environment
apathy affect
Affect: the feeling state or emotional tone
- inappropriate affect; emotions are incongruent with the circumstances; says happy, but sounds sad
- bland; weak emotional tone
- flat; appears to be void of emotional tone
- apathy; disinterest in the environment
Negative Symptoms; Affect
Volition: impairment in the ability to initiate goal-directed activity
Emotional ambivalence: coexistence of opposite emotions towards same object, person, or situation
Deterioration in appearance: impaired personal grooming and self-care activities
Not moving or doing anything all day
Negative Symptoms; Volition
impairment in the ability to initiate goal-directed activity
volition
coexistence of opposite emotions towards same object, person, or situation
emotional ambivalence
impaired personal grooming and self-care activities
Deterioration in appearance
Impaired interpersonal functioning and relationship to the external world
- Impaired social interaction: clinging and intruding on the personal space of others, exhibiting behaviors that are not culturally and socially acceptable.
- Social isolation: a focus inward on the self to the exclusion of the external environment
Negative Symptoms; Impaired interpersonal functioning & relationships to the external world
clinging and intruding on the personal space of others, exhibiting behaviors that are not culturally and socially acceptable
Impaired social interaction
a focus inward on the self to the exclusion of the external environment
Social isolation
Anergia: deficiency of energy
Waxy flexibility; passive yielding of all movable parts of the body to any effort made at placing them in certain positions
Posturing: voluntary assumption of inappropriate or bizarre postures
Pacing and rocking: pacing back and forth and rocking the body
Negative Symptoms
Psychomotor behavior
deficiency of energy
Anergia
passive yielding of all movable parts of the body to any effort made at placing them in certain positions
Waxy flexibility (catatonic)
voluntary assumption of inappropriate or bizarre postures
Posturing
pacing back and forth and rocking the body
Pacing and rocking
Anhedonia: inability to experience pleasure
Regression: retreat to an earlier level of development
Negative Symptoms
Associated Features
inability to experience pleasure
Anhedonia
retreat to an earlier level of development
regression
A patient who has disorganized thinking assoc with schizophrenia. Which area of the brain is to blame for this dysfunction?
Frontal Lobe
Typical antipsychotics exert their influence primarily over what neurotransmitter to achieve effect?
Dopamine
Patients taking the atypical antipsychotic Clozaril (clozapine), must have which blood test completed ea. week?
CBC;
WBC decrease; get levels
A patient taking an antipsychotic develops restlessness and an uncontrollable urge to move the bottom half of their body. The extrapyramidal side effect is called?
Echopraxia
Uncontrollable urge to move the bottom half of their body. what is the cause of the EPS?
Dopamine blocking effects
A nurse administering antipsychotics medications should monitor for additional adverse effects if the patient also has which of the following health problems?
- Diabetes
- Parkinson’s Disease
- Osteoarthritis
- Epilepsy
- Grave’s Disease
A patient receiving the atypical antipsychotic Risperdal (risperidone) reports severe muscle stiffness mid morning. During lunch he has difficulty swallowing food and speaking, and when vital signs are taken 30 minutes later, he is found stuporous and diaphoretic. Temperature is 38.8 C, pulse 110, B/P 159/90
The nurse should suspect ___________ & should _________.
Neuroleptic malignant syndrome and initiate measures to decrease fever, notify MD.
Phase I: the premorbid phase-social withdrawal & antagonistic thoughts
Phase II: the prodromal phase- frank onset of psychotic symptoms (Baseline)
Phase III: Schizophrenia: Delusions, Hallucinations, disorganized speech, catatonic behaviors, (Negative syptoms)
Phase IV: Residual Phase: symptoms similar to prodromal phase, flat affect. May not return to baseline
Phases of Schizophrenia Spectrum Disorder
Family hx Abnormal brain chemistry viral infection anatomical abnormalities stressful life events
Biological, biochemical, physiological, and environmental factors of developing schizophrenia
Which dopamine pathway is responsible for positive symptoms??
Mesolimbic pathway; only good one blocked
Which dopamine pathway is responsible for negative symptoms??
Mesocortical pathway
Level of dopamine in the mesolimbic system is thought to exert a strong influence over human mood & behavior.
-lacking this causes failure of cells firing and being charged.
Mesolimbic system
involve pathology of prefrontal cortex and the limbic system; Hippocampus, the amylgdala and hypothalamus and cingulate gyrus.
Mood disorders
plays a major role in the discharge of emotions
Limbic system
limbic system thalamus basal ganglia hippocampus frontal cortex
Changes in the brain regions
Probably not a homogeneous disease entity with a single cause but results from a variable combination of genetic predisposition, biochemical dysfunction, physiological factors and psychosocial stress.
Schizophrenia
A severe mental condition in which there is disorganization of the personality, deterioration
psychosis
outcome different to predict but a complete return to full premorbid functioning not common.
Prognosis
cause uncertain
no single factor implicating
etilogy: combination of influences: biological, psychological, and environmental factors.
predisposing factors
originates in the ventral tegmentrum area and projects to area of the limbic system; including the nucleus accumbens, amygdala, and hippocamus.
-mesolimbic assoc. with memory, emotion, arousal and pleasure.
Excess activity in mesolimbic tract implicated in the positive symptoms of schizophrenia (hallucination delusions)
Mesolimbic pathway
originates in the Ventral tegmentum area and has projections into the cortex. Concerned with cognition, social behavior, planning problem-solving, motivation and reinforcement in learning. Negative symptoms of schizophrenia. (flat affect, apathy lack of motivation, and ahedonia)
Mesocortical pathways
originates in the substantia nigra and terminates in the striatum of the basal ganglia. The pathway is assoc. with the function of motor control.
-Degeneration in this pathway is assoc. with Parkinson’s disease and inoluntary psychomotor symptoms of schizophrenia.
Nigrostriatal pathway
originates in the hypothalamus and projects to the pituitary gland. Assoc with endocrine function, digestion, metabolism, hunger, thirst, temp, sexual arousal. Implicated in certain endocrine abnormalities assoc with schizophrenia.
Tuberoinfundibular pathway
is a biological disease, influenced by factors with in the environment.
Schizophrenia
Evidence shows a multiple causation in development
characterized by the presence of delusions that have been experienced by the individuals for at least a month.
Delusional Disorder
delusion, ind. usually believes that someone (normally of higher status) is in love with him/her.
Erotomanic type
irrational ideas regarding their own worth, talent, knowledge & power.
Grandiose Type
individual has a false idea that the self, a part of the self, others or the world is nonexistent.
Nihilistic delusion
