Schizophrenia Flashcards
*What is schizophrenia?
Breakdown in the relation between thought, emotion and behaviour that leads to a faulty perception of reality
*Differentiate between positive and negative symptoms of schizophrenia
Positive symptoms (manifestations of psychosis):
-Delusions
-Hallucinations
-Disorganized thinking/speech/behaviour
“things that are there and shouldn’t be”
Negative symptoms:
- Flat affect (affective blunting)
- Anhedonia
- Avolition
- Alogia
Anhedonia =
Avolition =
Alogia?
= inability to feel pleasure
= is the decrease in the motivation to initiate and perform self-directed purposeful activities
= poverty of speech, is a general lack of additional, unprompted content seen in normal speech.
Diagnostic criteria for individual with schizophrenia?
LO
2 or more…
delusions, hallucinations, disorganized speech, grossly disorganized behaviour; catatonic behaviour; or negative symptoms
for significant portion of 1 month
1 or more…
major social or occupational reduction in functioning (such as work, interpersonal relations, self care)
Persisting for 6 months
Absence of major depressive or manic episode occurring at the same time with active symptoms
*Epidemiology for schizophrenia
When is most likely diagnosed?
Incidence and prevalence similar across cultures
“lowest social classes” and “homelessness” (cause or effect?)
Most are diagnosed in late adolescence or early adulthood
Males diagnosed earlier than females
Risk factors for Schizophrenia? (LO)
Perinatal stress
Parental age
Family history/genetics
50% have a comorbid medical condition
Substance abuse is common
Increase risk of diabetes? Cause or effect?
Distorted Water Balance
What is psychosis? (LO)
a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.
*What are the 3 phases of first break psychosis?
Phase 1: Prodromal Period
person slowly losing social skills, not finishing work, behavior getting a bit odd…often seen in hindsight
Phase 2: Acute Phase (clear psychotic symptoms) - first break psychosis, acutely ill, POSITIVE symptoms arise; very vulnerable time, need speedy treatment for better prognosis (if stays in psychosis for long time, recovery is very hard)
Phase 3: Recovery Phase (pattern varies but probable)
teaching, hope, lifestyle, management
*Key components of treatment of first break schizophrenic episode
Antipsychotic medications (1-2 wks to take effect) Vigilant care (esp. until med effective) Safety - Suicide assessment Restore sleep Reduce substance use Interdisciplinary Psychosocial interventions Education and support for client & family
*Schizophrenia treatment 3-5yrs afer onset?
Early Intervention Programs:
- Reduce duration of untreated psychosis (DUP)
- Intervene appropriately at early stage of illness
- Prevent subsequent relapse & minimize disability
Treatment
- Symptom relief with medication
- Decreasing risk with safety measures
- Family acceptance of client’s disease
- Focus to stabilize symptoms
- Understand/manage medication side effects
Stabilization and Maintenance:
- Adapt/manage medications
- Often intense treatment
- Move beyond the illness and take control of their life
- Live with chronic illness – continuous medication management & other psychotherapeutic activities
- Adapt to chronic illness with family/caregiver
- Socialization
- Minimize stresses
*What is the concern with schizophrenia relapses?
What contributes to these relapses?
How does duration + recovery change with each relapse?
Major concern
Nonadherence
Vulnerable to stressors, lack of community resources
For each relapse, rehab time is prolonged, recovery time longer
Medication and psychosocial support required
*What sort of symptoms are you assessing for in individual with schizophrenia?
(what are the 3 most common/prominent?)
Delusions, hallucinations, disorganized behaviour (the big three)
Staying up all night, incoherent, irritable, aggressive acts
Unable to care for basic needs (eating, bathing); social and work functional deficits
Substance use; limiting social participation;
Cognitive deficits (patterns, executive function, short-term memory loss)
*Nursing diagnoses r/t schizophrenia?
Self-care deficit Disturbed sleep pattern Ineffective therapeutic regimen management Imbalanced nutrition Excess fluid volume Sexual dysfunction Risk of violence, suicide Disturbed thought processes Disturbed sensory perceptions Disturbed body image Low self-esteem Disturbed personal identity Ineffective coping
*Key nursing interventions for pt’s with schizophrenia
1) Promotion of self-care activities –> Develop routine of hygiene activities
2) Activity, exercise and nutritional interventions –> Help counteract effects of psychiatric medications
3) Thermoregulation interventions –> Teach patient to wear clothing according to the weather and seasons, Observe patient’s response to temperature.
4) Promotion of normal fluid balance and prevention of water intoxication
5) Self-monitoring and relapse prevention –> Monitor events, time, place, etc. of recurrence of symptoms
6) Enhancement of cognitive functioning –> Improve attention (computer programs, one-to-one); Help memory (make lists, write down information); Improve executive functioning-stimulation
7) Behavioural interventions –> Organize routine, daily activities, Reinforce positive behaviours
8) Stress and coping skills development –> Counselling sessions, Teach & reward positive coping skills
9) Patient education –>
Errorless learning environment, Minimal distractions, Clear visual aids, Skills training
10) Social support groups; community resources; support network
What sort of family interventions for pt with schizophrenia?
Family support
Educate family regarding lifelong disorder of schizophrenia
Emphasize consistency of medication
Encourage to participate in support groups
Inform re local community and provincial resources
Help negotiate provider system
*How should the disturbed thoughts of schizophrenia pt be seen?
What should a pt be taught regarding this?
Assessment content of hallucinations/ delusions
Outcomes
Decreased frequency and intensity
Recognize as symptoms of disorder
Develop strategies to manage recurrence
Experiences real to patient
Validate that experiences are real
Identify meaning and feeling that are provoked
Teach patient that hallucinations and delusions are symptoms of illness
- Considerations for schizophrenia in children:
- How does it manifest?
- Diagnosis rare in children
- Manifestations similar to adults
- Hallucinations visual, delusions less developed
- Developmental abnormalities
1) Delays in speech and motor development
2) Problems in social adjustment
3) Poorer academic performance
4) Biopsychosocial symptoms as in adults - Other disorders considered first
1) Word salad:
2) Echolalia:
3) Clang associations:
1) seemingly random words and phrases
2) meaningless repetition of another person’s spoken words as a symptom of psychiatric disorder.
3) In psychology and psychiatry, clanging refers to a mode of speech characterized by association of words based upon sound rather than concepts. For example, this may include compulsive rhyming or alliteration without apparent logical connection between words.
1) Hyper-vigilance:
2) Pressured speech:
1) enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats
2) Pressure of speech is a tendency to speak rapidly and frenziedly, as if motivated by an urgency not apparent to the listener.
WHat is first episode psychosis?
When does this typically occur?
- first episode psychosis or initial episode of psychosis which is most common in adolescence or YA life.
- This stage defined as the first 3-5yrs following onset of symptoms
- critical time for intervention
How are prodromal symptoms often seen?
may be subtle, often begin in late adolescence and can be confused w moodiness of teenage yrs
• Changes in thought and behaviour eventually so disruptive/bizarre they cant be ignored (this heralds the beginning of psychosis)
What trends will you see if length of duration of untreated psychosis (DUP) is prolonged?
dec self-care, eating, sleeping, substance use common, work/school fx dec, inc dependence on family and friends
High risk of what during acute phase psychosis?
suicide
Focus of initial tx of schizophrenia/
thorough assessment and alleviation of symptoms through:
- beginning meds
- dec risk for suicide by safety meas
- normalizing sleep
- dec substance use
