Schizophrenia

Question 1

A devastating brain disease that affects a person’s thinking, language, emotions, social behavior, & ability to perceive reality.

Answer 1

Schizophrenia

Question 2

Early onset of schizophrenia:
A) age
B) occurs more in

Answer 2

A) 18-25 y/o

B) males

Question 3

late onset of schizophrenia:
A) age
B) occurs more in

Answer 3

A) 25-35 y/o

B) female

Question 4

higher prevalence occurs in?

Answer 4

Males and those living in urban areas

Question 5

Schizophrenia results from?

Answer 5

a combination of inherited genetic factors and extreme nongenetic birth factors.

Question 6

Bleuler’s fundamental signs of schizophrenia (THE FOUR A’S)?

Answer 6

• Affect: Flat, blunted, inappropriate affect.
• Associative looseness: disorganized thinking
• Autistic thinking (delusions, hallucinations)
• Ambivalence - holding on to opposing positions on a subject or person (love & hate someone)

Question 7

Two or more of the following symptoms during 1 month is needed for a diagnosis of schizophrenia?

Answer 7

• delusions
• hallucinations
• disorganized speech
• grossly disorganized or catatonic behavior
• negative symptoms (i.e. affective flattening, avolition, alogia)

Question 8

Criteria needed for a diagnosis of schizophrenia?

Answer 8

• Two or more symptoms during a 1 month period
• One or more major areas are markedly below premorbid functioning
• Signs persist for at least 6 months
• R/O Mental diseases & medical conditions

Question 9

Phases of Schizophrenia?

Answer 9

• Acute phase
• Maintenance
• Stabilization

Question 10

Positive Symptoms of Schizophrenia?

Answer 10

Hallucinations
Delusions
Disorganized Speech
Bizarre Behavior

Question 11

.Persecution, Grandiosity, Control, and Thought broadcasting, insertion and withdrawal are examples of ?

Answer 11

delusions

Question 12

The inability to think abstractly?

Answer 12

concrete thinking

Question 13

made up words that hold meaning to the patient, but not to others?

Answer 13

Neologisms

Question 14

pathological repeating of ones words?

Answer 14

Echolalia

Question 15

choice of words base on sound?

Answer 15

Clang association

Question 16

meaningless repetition or imitation of the movements of others

Answer 16

echopraxia

Question 17

a confused or unintelligible mixture of seemingly random words and phrases

Answer 17

word salad

Question 18

perceiving a sensory experience when none exists (i.e. hearing voices)

Answer 18

hallucinations

Question 19

• person has lost their identify

- may believe a body part does not belong to them

Answer 19

depersonalizations

Question 20

a feeling that one’s surroundings are not real

Answer 20

derealization

Question 21

the persistent repetition of an act, especially by an animal, for no obvious purpose.

Answer 21

Stereotypy

Question 22

performance of all simple commands in a robot like manner

Answer 22

Automatic obedience

Question 23

patient continues to hold arm that is raised by the nurse, seen in catatonia?

Answer 23

Waxy Flexibility

Question 24

Negative Symptoms of Schizoprenia?

Answer 24

Anhedonia
Avolition
Alogia
Blunted Affect

Question 25

poverty of speech

Answer 25

Alogia

Question 26

inability to experience pleasure or joy

Answer 26

Anhedonia

Question 27

loss of motivation

Answer 27

Avolition

Question 28

Cognitive Symptoms of Schizo?

Answer 28

Difficulty with attention, memory, and executive functions (i.e., decision making and problem solving

Question 29

Nursing Assessment for Schizo?

Answer 29

- Determine if patient has had a medical work-up. - Assess for co-occuring disorders such as drug abuse. - Assess risk (suicide or harmful to others). - Assess for positive and negative symptoms. - Assess medications

Question 30

Acute Phase Interventions?

Answer 30

Patient safety and medical stabilization

Question 31

Goal of Phase II Interventions (Stabilization)

Answer 31

adhere to medication regimens, understand schizophenia, & participate in available psychoeducational activities.

Question 32

Goal of Phase III Interventions (Maintenance )

Answer 32

Target negative symptoms and participation in social, vocational, and skills training

Question 33

Strategies for communicating with patient who is hallucinating:

Answer 33

- Watch client for cues. - Ask pt. directly about hallucinations. - Focus on reality-based diversions and topics. - Be alert for signs of anxiety. - Thought stopping and dismissal techniques.

Question 34

Strategies for delusional patients:

Answer 34

- Be open & honest; respond to suspicions calmly. - Ask to describe delusions. - Avoid arguing content. - Focus on the feelings the delusions generate. - Focus conversation on reality-based topics.

Question 35

Conventional (First Generation) Drugs

Answer 35

``` Thorazine Stelazine Haldol Mellaril phenothiazines ```

Question 36

Newer (Atypical) Drugs

Answer 36

``` Clozaril Risperdal Zyprexa Seroquel Geodon Abilify ```

Question 37

Muscarinic Cholinergic Blocker A/E?

Answer 37

``` Dry mouth blurred vision urinary retention constipation tachycardia ```

Question 38

Alpha 1 blocker A/E?

Answer 38

orthostatic hypotension dizziness reflex tachycardia sexual dysfunction

Question 39

Alpha 2 blocker A/E?

Answer 39

sexual dysfunction | priaprism (persistent and painful erection)

Question 40

Serotonin Blocker A/E?

Answer 40

weight gain hypotension sexual dysfunction

Question 41

Histamine (H1) Blocker A/E?

Answer 41

sedation weight gain orthostatic hypotension

Question 42

blockage of D2 dopamine receptor sites in the motor area cause?

Answer 42

Extrapyramidal Side Effects (EPS)

Question 43

Acute Dystonic reaction:

Answer 43

Oculogyric crisis - looking up Acute contractions of the tongue, face, neck, and back Opisthotonos Laryngeal dystonia

Question 44

spasm of the muscles causing backward arching of the head, neck, and spine

Answer 44

Opisthotonos

Question 45

S/S of Pseudoparkinsonism?

Answer 45

- Rigidity all over the body. - Masked like face. - Tremors (Pill rolling) in hands & wrists. - Short shuffling gait. - Dripping of saliva. - Monotonous and slurred speech. - Loss of postural reflexes which leads to fall & injuries especially in the elderly.

Question 46

Akathisia is characterized by?

Answer 46

- Subjective feelings of restlessness (inner restlessness). - Inability to sit still. - Rocking back and forth on feet. - Crossing and uncrossing legs frequently. - Inability to relax.

Question 47

Tardive Dyskinesia

Answer 47

- It is a jerky irregular movement affecting primarily the lower face (tongue, jaw, and lips), extremities and trunk and includes: - Protrusion of tongue. - Chewing movement. - Puffing of checks. - Smacking movements. - Limbs: Choriec, rapid, purposeless movements. - Hip jerks.

Question 48

General Class Side Effects: Traditional Antipsychotic

Answer 48

- Dry mouth, urinary retention and hesitancy. - Constipation. - Blurred vision. - Dry eyes. - Increased risk for agranulocytosis & seizures. - Photo sensitivity. - Inhibition of ejaculation and impotence in men. - Neuroleptic malignant syndrome (<1%). - Metabolic effects (i.e. weight gain and DB Type II)

Question 49

- Produce minimal to no extrapyramidal side effects or tardive dyskinesia. - Treat both positive and negative symptoms. - Improve the neurocognitive defects associated with schizophrenia. - Decrease affective symptoms and suicidal behaviors

Answer 49

Atypical Antipsychotics

Question 50

Used for early detection of Tardive Dyskinesia?

Answer 50

Abnormal Involuntary Movement Scale (AIMS) exam

Question 51

AIMS areas of examination are?

Answer 51

- facial and oral movements - extremity movements - trunk movement.

Question 52

S/S of Neuroleptic Malignant Syndrome (NMS)?

Answer 52

- decreased LOC - autonomic dysfunction including - hyperpyrexia, tachycardia, diaphoresis, and drooling

Question 53

Tx of Mild NMS?

Answer 53

Parlodel (Bromocriptine).

Question 54

Tx of severe NMS?

Answer 54

Dantrolene (Dantrium) (IV), and ECT.

Question 55

- Is a serious side effect and can be fatal. - Liver impairment may also occur. - Symptoms include sore throat, fever. malaise, and mouth sores. - Mortality is high if the drug is not ceased.

Answer 55

Agranulocytosis

Question 56

S/S of Agranulocytosis?

Answer 56

sore throat, fever, malaise, and mouth sores, possible liver impairment