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Nursing Theory III > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

Definition of Schizophrenia

A

Schizophrenia is a syndrome or a disease process of the brain causing distorted and bizarre thoughts, perceptions, emotions, movements, and behaviour

  • It is usually diagnosed in late adolescence and early adulthood
  • Prevalence is 1% of total population, or 3 million in US; same prevalence throughout the world
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2
Q

Symptoms of Schizophrenia: Hard or Positive

A

Hard or Positive symptoms include:

  • Delusions
  • Hallucinations
  • Grossly disorganized thinking, speech and behaviour
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3
Q

Symptoms of Schizophrenia: Soft or Negative

A

Soft of Negative symptoms include:

  • Flat affect
  • Avolition
  • Social withdrawal or discomfort
  • Apathy
  • Alogia
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4
Q

Types of Schizophrenia: Paranoid / Disorganized

A

Paranoid type: persecutory or grandiose delusions and hallucinations; sometimes excessive religiosity; hostile and aggressive behaviour
Disorganized type: grossly inappropriate or flat affect, incoherence, loose associations, extremely disorganized behaviour

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5
Q

Types of Schizophrenia: Catatonic / Undifferentiated / Residual

A

Catatonic: marked psychomotor disturbance, motionless, or excessive motor activity; extreme negativism; mutism; peculiarities of voluntary movement (echolalia, echopraxia)
Undifferentiated: mixed schizophrenic symptoms along with disturbances of thought, affect, and behaviour
Residual: at least one previous psychotic episode but not currently; social withdrawal, flat affect, loose associations

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6
Q

Clinical Course

A

Most clients experience a slow and gradual onset of symptoms
Younger age of onset associated with poor outcome
In first years after diagnosis, client may have relatively symptom - free periods between psychotic episodes or fairly continuous psychosis with some shift in severity of symptoms
Most clients with schizophrenia have difficulty functioning in the community and few lead fully independent lives
Early detection and aggressive treatment of the first psychotic episode improves outcomes

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7
Q

Related Disorders

A

Schizophreniform Disorder: symptoms of schizophrenia are experienced for less than 6 months required for a diagnosis of schizophrenia
Schizoaffective Disorder: symptoms of psychosis and thought disorder along with all the features of a mood disorder
Delusional Disorder: one or more non-bizarre delusions with no impairment in psychosocial functioning

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8
Q

Related Disorders

A

Brief Psychotic Disorder: one psychotic symptom lasting 1 day to 1 month; may or may not have an identifiable stressor, such as child birth
Shared Psychotic Disorder (folie a deux): similar delusion shared by two people, one of whom has psychotic delusions

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9
Q

Etiology

A

Current etiologic theories focus on biological theories:

  • Genetic factors
  • Neuroanatomic theories
  • Neurochemical theories
  • Immunovirologic theories
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10
Q

Cultural Considerations

A

Ideas that are considered delusional in one culture may be commonly accepted in another
Auditory or visual hallucinations may be a normal part of religious experiences in some cultures
Ethnicity may be a factor in the way a person responds to psychotropic medications:
- African Americans, Caucasian Americans, and Hispanic Americans appear to require comparable therapeutic doses of antipsychotic medications
- Asian clients need lower doses of drugs such as haloperidol (Haldol) to obtain the same effects

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11
Q

Treatment

A

Primary treatment involves antipsychotic (neuroleptic) medications
Conventional antipsychotics target the positive signs
- Delusions
- Hallucinations
- Disturbed thinking
- Other psychotic symptoms
- - But have no observable effect on the negative signs
Atypical antipsychotics diminish positive symptoms, and they lessen the negative signs:
- Avolition
- Social withdrawal
- Anhedonia

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12
Q

Maintenance Therapy

A

Two antipsychotics are available in depot injection forms for maintenance therapy
- Fluphenazine (Prolixin) in decanoate and enanthate preparations
- Haloperidol (Haldol) in decanoate
The effects of the medications last from 2-4 weeks, eliminating the need for daily oral antipsychotic medication

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13
Q

Side Effects of Antipsychotic Medications

A 
Neurologic Side Effects
- Extrapyramidal side effects (acute dystonic reactions, akathisia, and parkinsonism)
- Tardive dyskinesia 
- Seizures
- Neuroleptic malignant syndrome
Non-Neurological Side Effects
- Weight gain
- Sedation
- Photosensitivity
- Anticholinergic symptoms (dry mouth, blurred vision, constipation, urinary retention)
- Orthostatic hypotension
- Agranulocytosis (clozapine)
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14
Q

Psychosocial Treatment

A 
Group therapies:
- Supportive, medication management, use of community supports
Social Skills Training
- Cognitive adaptation training
- Cognitive enhancement therapy (CET)
Family therapy
Family education
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15
Q

Assessment

A

Previous Hx with schizophrenia
Previous suicidal ideation
Current support system
Client’s perception of current situation
General appearance, motor behaviour, and speech
Mood and affect: flat or blunted affect, anhedonia
Thought processes and content: disordered
Delusions
Sensorium and intellectual processes: hallucinations, disorientation, concrete or literal thinking
Judgement and insight: impaired judgement, limited insight
Self-Concept: may be distorted, with depersonalization, loss of ego boundaries resulting in bizarre behaviours

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16
Q

Assessment

A

Roles and relationships: often socially isolated, have difficulty fulfilling life roles
Psychologic and self-care considerations: may have multiple self-care deficits (inattention to hygiene, nutrition, sleep needs; polydipsia occasionally seen in longer-term clients)

17
Q

Data Analysis

A

Common nursing diagnosis for positive symptoms include:

  • Risk for other-directed violence
  • Risk for suicide
  • Disturbed thought processes
  • Disturbed sensory perception
  • Disturbed personal identity
  • Impaired verbal communication
18
Q

Data Analysis

A

Common nursing diagnosis for negative symptoms and functional abilities include:

  • Self-care deficits
  • Social isolation
  • Deficient diversional activity
  • Ineffective health maintenance
  • Ineffective therapeutic regimen management
19
Q

Outcome Identification

A

Expected outcomes for the acute, psychotic phase; the client will:

  • Not injure self or others
  • Establish contact with reality
  • Interact with others
  • Express thoughts and feelings in a safe and socially acceptable manner
  • Participate in prescribed therapeutic interventions
20
Q

Outcome Identification

A

Expected outcomes for continued care; the client will:

  • Participate in the prescribed regiment (including medication and follow-up appointments)
  • Maintain adequate routines for sleeping and food and fluid intake
  • Be independent in self-care activities
  • Communicate effectively with others in the community to meet his or her needs
  • The client will seek or accept assistance to meet his or her needs when indicated
21
Q

Intervention

A 
Promote safety of clients and others
Establish a therapeutic relationship
Use therapeutic communication
Interventions for delusional thoughts
Interventions for hallucinations
Protecting the client who has socially inappropriate behaviours
Client and family teaching
22
Q

Evaluation

A

Have the client’s psychotic symptoms disappeared? Or can the client carry out his or her daily life despite the persistence of some psychotic symptoms
Does the client understand the prescribed medication regimen? Is he or she committed to adherence to the regimen?
Does the client possess the necessary functional abilities for community living?
Are community resources adequate to help the client live successfully in the community?

23
Q

Evaluation

A

Is there a sufficient after-care or crisis plan in place to deal with recurrence of symptoms or difficulties encountered in the community?
Are the client and family adequately knowledgeable about schizophrenia?
Does the client believe that he or she has a satisfactory QOL?

24
Q

Elder Considerations

A

Psychotic symptoms that appear in later life are usually associated with depression or dementia, not schizophrenia
Elderly people with schizophrenia experience a variety of long-term outcomes
- 20-30% of clients experience dementia, resulting in a steady, deteriorating decline in health
- 20-30% experience a reduction in positive symptoms, somewhat like a remission
- 40-60% remain mostly unchanged

25
Q

Community-Based Care

A

Assertive Community Treatment (ACT)
Behavioural Home Health
Community Support Programs
Case management

26
Q

Self-Awareness Issue

A

May be challenging if client is suspicious or mistrustful or nurse is frightened
Nurse may become frustrated if client is noncompliant
Nurse must not take client’s success or failure personally; the client’s remarks and behaviour or noncompliance are not personal towards the nurse but are part of the illness

27
Q

Self-Awareness Issue

A

Focus on clients strengths and time out of the hospital, not just on symptoms and need for acute care
No nurse has all the answers

Nursing Theory III (17 decks)

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