Schizophrenia Flashcards by Carmen Dawson

What is schizophrenia?

Combination of delusional ideations, hallucinations, disorganized speech/thinking, and bizzare behaviors

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DSM-V criteria for schizophrenia

1: 2 of the following– (delusions, hallucinations, disturbed speech, disturbed behavior/catatonic, negative symptoms) ONE must be: delusions, hallucinations, or disturbed speech
2: ongoing for at least 6 months and ACTIVE sx for 1 month
3: not attributed to another condition

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brain structure abnormalities associated with schizophrenia

large brain ventricles

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What neurotransmitter plays a part in schizophrenia?

excess dopamine

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Overactivity of what pathway causes positive sx?

mesolimbic pathway

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Dysfunction of what pathway causes negative and cognitive sx?

mesocortical pathway

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3 phases of schizophrenia

Prodromal
Active
Residual

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What happens in the prodromal phase of schizophrenia?

social withdrawal and isolation
inappropriate affect
poor communication patterns
neglect of personal grooming

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What happens in the active phase of schizophrenia?

full blown sx
psychotic break: delusions, hallucinations….
high risk of suicide
usually hospitalized

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What happens in the residual phase of schizophrenia?

sx are no longer prominent, but haven’t gone away

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5 types of schizophrenia

Catatonic
Paranoid
Residual
Disorganized
Undifferentiated

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Catatonic schizophrenia

will usually need help with all ADLs
no speech
slow motor movement (statue like)
stupor
excessive negativism
inappropriate/bizarre posture
waxy flexibility
echolalia
echopraxia
don't respond to antipsychotics
respond better to benzos like lorazepam

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echolalia

involuntary parrot like repetition of words spoken by others

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echoprazia

meaningless imitation of motions made by others

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Paranoid schizophrenia

auditory hallucinations
preoccupied with one or more delusion usually of persecutory nature
appear hostile, angry, scared, nervous
increased risk of violence
respond well to antipsycotics

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Disorganized schizophrenia

inappropriate or flat affect
disorganized behavior
disorganized speech (word salad)
usually look unkept, dirty, and primitive
severe cognitive impairment
looseness of associations
extreme social withdrawal

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Residual schizophrenia

past hx of at least 1 episode of psychosis
eccentric behavior
absence of prominent positive sx
social withdrawal and inappropriate affect (neg sx)

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Undifferentiated schizophrenia

usually a mix of all other types of schizophrenia
disorganized behavior
positive sx (delusions and hallucinations)

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4 sx groups of schizophrenia

positive
negative
cognitive
affective

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positive sx of schizophrenia

adding something that normally isn’t there
hallucinations
delusions
illusions
disorganized speech (associative looseness)
bizarre behavior

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negative sx of schizophrenia

take away something (harder to tx)
blunted affect
alogia (povery of thought)
avolition (loss of motivation)
anhedonia
anergia
social withdrawal

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cognitive sx of schizophrenia

easily distracted
impaired memory
poor problem-solving skills
poor decision-making skills
illogical thinking
impaired judgment
word salad
inability to think abstractly

affective sx of schizophrenia

dysphoria
suicidality
hopelessness

assessment for schizophrenia

alterations in thinking (delusions…)
alterations in speech (word salad…)
alterations in perception (hallucinations…)
alterations in behavior

Why is it important to assess a patient for command hallucinations?

DTO | DTS

nursing dx for positvie sx of schizophrenia

disturbed sensory perception risk for self-directed violence disturbed thought process

nursing dx for negative sx of schizophrenia

``` social isolation impaired social interaction risk for loneliness chronic low self-esteem ineffective coping ```

interventions for phase one (acute) of schizophrenia

``` focus on :crisis interventions, acute sx stabilization (meds), safety limit setting supportive and directive care psych, medical, neuro evaluations meet with family psychopharmacological tx ```

interventions for phase two (stabilization) of schizophrenia

focus on: understanding/accepting illness support and teaching med teaching; side effect management id phases (prodromal, acute, residual)

interventions for phase three (maintenance) of schizophrenia

focus on: social, vocational, self-care, learning, adaptations cognitive and social skill enhancement med compliance!! encourage outpatient support attention to details of self-care, social, and work encourage family interaction

therapeutic communication for schizophrenic patients

lower anxiety decrease defensive patterns raise self-worth increase med compliance

EPS

extrapyramidal symptoms - akathisia - dystonia - parkinsonism - tardive dyskinesia

akathisia

EPS pacing, motor restlessness, rocking, foot tapping fidgeting

dystonia

EPS | muscle cramps of head and neck

torticolis

EPS | neck muscle contraction; pulls head to the side

Parkinsonism sx

``` EPS tremors shuffling gait pill-rolling drooling stooped posture masked face ```

tardive dyskinesia

``` EPS late occuring; usually irreversible usually involves mouth constant lip smacking or sucking uncontrollable biting, chewing, or sucking motions ```

Neuroleptic malignant syndrome (NMS)

``` dangerous response to antipsychotics decreased LOC increased muscle tone autonomic dysfunction increased temp, BP, CPK delirium dehydration ```

tx of EPS and NMS

alert medical staff anticholinergic agent may be used usually dipenhydramine (Benadryl) benztropine (Congentin)

What is schizophreiform disorder?

total duration of illness at least 1 month but less than 6 months

What is brief psychotic disorder?

sudden onset of psychosis lasts at least one day but less than a month

What is schizoaffective disorder?

MDD + schizophrenia

What is delusional disorder?

non bizarre delusions for at least one month; functioning not impaired ex: woman convinced a man is in love with her although they've never met

What is induced or secondary psychosis?

induced by drugs (like bath salts/huffing) or caused by medical condition (infection)

Anger

an emotional response to frustration of desires, threat to one's needs (emotional or physical), or a challenge

Aggression

action or behavior that results in verbal or physical attack | acting out anger

Why is there more violence in the health care setting?

stress fear threat to needs lack of control

assessment of anger

``` rate of speech, tone, volume red face clenched fists clapping hx of violence coping skills triggers ```

nursing dx for anger

ineffective coping stress overload risk for self-directed violence risk for other-directed violence

interventions for anger

``` teach coping mechanisms figure out triggers anger management anxiolytics antipsychotics ```

cycle of violence

tension building acute battering (explosion) honeymoon

interventions for abuse

``` educate pt show video about domestic violence safety plan report of abuse community resources ```

crisis

mentally healthy people experiencing disequilibrium loss of balance in life not pathological usually 4-6 wks