Schizophrenia Flashcards
What are the 5 schizophrenia spectrum disorders?
- brief psychotic disorder
- psychosis drug-induced/general med condition
- schizophreniform
- schizoaffective disorder
- Schizophrenia
What is schizophrenia characterized by?
psychosis
What is altered in schizophrenia?
- cognition
- perception
- reality
What is the criteria for a diagnosis of schizophrenia?
- 2 or more of the following for a sig portion of time in 1 month:
1. Delusions - fixed false belief.
2. Hallucinations
3. Disorganized speech
4. Gross disorganization or catatonia
5. Negative symptoms (diminished emotional expression or avolition)
6. Functional impairment of some kind - continuous disturbance for at least 6 months
What sex is more affected by schizophrenia?
male
What is the prodromal phase of schizophrenia?
- mild changes
- obsessive thought
- social withdrawal
- poor concentration
What is the acute phase of schizophrenia?
- exacerbation of symptoms
- difficulty coping
- hallucinations
What is the stabilization phase of schizophrenia?
- symptoms diminishing
2. movement toward previous level of functioning.
What is the maintenance or residual phase of schizophrenia?
new baseline is established
What is associative looseness with schizophrenia?
word salad - most etreme form; jumble of words meaningless to a listener
What is clang association with schizophrenia?
words chosen based on sound
What is neologisms with schizophrenia?
meaning for the patient only
What is echolalia with schizophrenia?
pathological repetition of another’s words.
What is circumstantiality with schizophrenia?
Including unnecessary and often tedious details in conversation, but eventually reaching the point.
What is tangentiality with schizophrenia?
Wandering off topic or going off on tangents and never reaching the point.
What is cognitive retardation with schizophrenia?
Generalized slowing of thinking, which is represented by delays in responding to questions or difficulty finishing thoughts.
What is pressured speech with schizophrenia?
Urgent or intense and resists comments from others.
What is flight of ideas with schizophrenia?
Moving rapidly from one thought to the next, often making it difficult for others to follow the conversation.
What is symbolic speech with schizophrenia?
Using symbols instead of direct communication. For example, a patient reports “demons are sticking needles in me” when what he means is that he is experiencing a sharp pain (symbolized by “needles”).
What is thought blocking with schizophrenia?
interruption of thoughts
What is thought insertion with schizophrenia?
someone has inserted thoughts
What is thought deletion with schizophrenia?
thoughts have been taken
What is magical thinking with schizophrenia?
thoughts affect others. They have the magical power to affect others.
What is paranoia with schizophrenia?
irrational fear. Sometimes they will harm others.
Define depersonalization
A feeling of being unreal or having lost identity. Body parts do not belong or the body has drastically changed.
define derealization
A feeling that the environment has changed.
What are hallucinations?
Hallucinations involve perceiving a sensory experience for which no external stimulus exists.
what are command hallucinations?
A command hallucination is a particularly disturbing symptom that directs the person to take an action.
what are illusions?
Illusions are misperceptions or misinterpretations of a real experience.
What are some alterations in behavior when someone has schizophrenia?
- Catatonia
- Motor retardation
- Motor agitation
- Stereotyped behaviors
- Waxy flexibility
- Echopraxia
- Negativism
- Impaired impulse control
- Gesturing or posturing
- Boundary impairment
define anhedonia:
A reduced ability or inability to experience pleasure in everyday life.
define avolition:
Loss of motivation; difficulty beginning and sustaining goal-directed activities
define asociality:
Decreased desire for, or comfort during, social interaction
define affective blunting:
Reduced or constricted affect.
define apathy:
A decreased interest in, or attention to, activities or beliefs that would otherwise be interesting or important.
define alogia:
Reduction in speech, sometimes called poverty of speech.
define affect
Outward expression of a person’s internal emotional state
define flat affect:
Immobile or blank facial expression
define blunted affect:
Reduced or minimal emotional response
define inappropriate affect:
Incongruent with the actual emotional state or situation (e.g., laughing in response to a tragedy)
define bizarre affect:
Odd, illogical, inappropriate, or unfounded; includes grimacing
define constricted affect:
Reduced in range or intensity, e.g., shows sadness or anger but no other moods
What are 4 cognitive symptoms for those with schizophrenia?
- concrete thinking - Impaired ability to think abstractly, resulting in interpreting or perceiving things in a literal manner. Difficulty responding to concepts like love or humor
- impaired memory - impacts short term memory and ability to learn
- impaired information processing - Delayed responses, difficulty understanding others
- impaired executive functioning - difficulty with reasoning, setting priorities, interferes with problem solving
What affective symptom is assessment crucial for?
depression
What is anosognosia in schizophrenia?
inability to realize they are ill.
What may anosognosia result in?
may result in resistance to or cessation of treatment
What are 3 types of self-assessment a nurse needs to do with pt.’s who have schizophrenia?
- anxiety or fear
- frustration
- expectations
Eric becomes anxious and says, “There are worms under my skin eating the hair follicles.” How would you classify this assessment finding?
- Positive symptom
- Negative symptom
- Cognitive symptom
- Depressive symptom
–> positive symptom
The psychiatric nurse conducting Eric’s assessment believes that he is also suffering from command hallucinations. Discuss what kinds of questions could help affirm this.
- What are these voices telling you to do?
- Do you recognize the voices?
- Do you believe the voices are real?
- Do you plan to follow the command?
- Are you going to do what they are telling you to do?
What are 3 positive symptoms of schizophrenia?
- disturbed sensory perception
- risk for self-directed or other-directed violence
- impaired verbal communication
What are 2 negative symptoms of schizophrenia?
- social isolation
2. chronic low self-esteem
What is the nurse’s role during the acute phase (1)?
Patient safety and medical stabilization
What is the nurse’s role during the stabilization phase (2)?
- Help patient understand illness and treatment
- Stabilize medications
- Control or cope with symptoms
What is the nurse’s role during the acute phase (3)?
- Maintain achievement
- Prevent relapse-after being stable for a period of time
- Achieve independence, satisfactory quality of life
After an acute admission, discharge is being planned for Eric. What are some things that need to be considered?
- Some things to be considered are external factors, such as the patient’s living arrangement, economic resources, social supports, and family relationships, and important internal factors, such as resilience and range of coping skills.
- Another important factor is connecting the patient and family with (not simply refer them to) community resources that provide therapeutic programming and social, financial, and other needed support.
- Relapse symptoms=not taking meds, behavior deterioration, decreased sleep, difficulty concentration, hallucinations
What is the nurse’s role during the acute phase (1) for planning?
Best strategies to ensure patient safety and provide symptom stabilization
What is the nurse’s role during the maintenance phase (3) for planning?
- Provide patient and family education
2. Relapse prevention skills are vital
What is the nurse’s role during the acute phase (1) for implementation?
- Psychiatric, medical, and neurological evaluation
- Psychopharmacological treatment
- Support, psychoeducation, and guidance
- Supervision and limit setting in the milieu
- Monitor fluid intake
- Treat all patients with dignity
- Working with aggression
- -> Regularly assess for risk and take safety measures
What are interventions for restlessness and agitation?
Reduce stimuli
Treat EPS
Provide safe outlets for energy
Calming meds
What are interventions for other and self-directed violence?
- Remove others for their safety
- Reassurance of safety
- Avoid touching or hand gestures
What is the nurse’s role during the stabilization and maintenance phases for implementation?
- Medication administration/adherence
- Relationships with trusted care providers
- Community-based therapeutic services
- Teamwork and safety
- Activities and groups
What are first-generation antipsychotics?
dopamine antagonists
What do first-generation antipsychotics target?
positive symptoms of schizophrenia
What is an advantage of first-generation antipsychotics?
Less expensive than second generation
What are 4 disadvantages of first-generation antipsychotics?
- Extrapyramidal side effects (EPS)
- Anticholinergic (ACh) side effects
- Tardive dyskinesia-pg 211-213
- Weight gain, sexual dysfunction, endocrine disturbances
What are second-generation antipsychotics?
Serotonin (5-HT2A receptor) and dopamine (D2 receptor) antagonists
What do second-generation antipsychotics target?
positive and negative symptoms of schizophrenia
What is there minimal to no of with second-generation antipsychotics?
Minimal to no EPS or tardive dyskinesia
What is a disadvantage of second-generation antipsychotics?
- tendency to cause significant weight gain
2. risk of metabolic syndrome
What happens with metabolic syndrome?
includes weight gain (especially in the abdominal area), dyslipidemia, increased blood glucose, and insulin resistance
true or false: second-generation antipsychotics are often chosen as first-line antipsychotics because they are equally effective for positive symptoms and also help negative symptoms
true
What are 3 third-gen antipsychotics?
- Aripiprazole (Abilify)
- brexpiprazole (Rexulti
- cariprazine (Vraylar)
What are third-gen antipsychotics?
Dopamine system stabilizers
What do third-gen antipsychotics do?
May improve positive and negative symptoms and cognitive function
What is there little risk of with third-gen antipsychotics?
Little risk of EPS or tardive dyskinesia
What are 5 potential dangerous responses to antipsychotics?
- ACh toxicity
- Neuroleptic malignant syndrome (NMS)
- Agranulocytosis
- Prolongation of the QT interval
- Liver impairment
What are some examples of advanced practice interventions?
- Individual and group therapy
- Psychoeducation
- Medication prescription and monitoring
- Basic health assessment
- Cognitive remediation
- Family therapy
What are ways to evaluate outcomes with patients who have schizophrenia?
- Reevaluate progress regularly and adjust treatment when needed
- Even after symptoms improve outwardly, inside the patient is still recovering.
- Set small goals; recovery can take months.
- Active, ongoing communication and caring is essential.
Case study:
Eric M, 18, has always been a good student. How, however, in his second semester of college, he begins, for the first time in his life, to have trouble concentrating. When his family doesn’t hear from Eric, they contact the school, only to discover that his roommate says Eric is “talking weird.”
Asked what he means, the roommate says, “Well, you know, he says stuff that doesn’t connect, doesn’t make any sense. I asked him if he was high or something, but he said no, and I believed him.”
On further investigation, Eric’s professors say he’s been missing class, after starting out so well.
How would you describe Eric’s speech?
disorganized speech
Negative symptom
flat affect
What are 4 common comorbidities of schizophrenia?
- Substance abuse disorders
- -> Nicotine dependence - Anxiety, depression, and suicide
- Physical health or illness (higher cholesterol, higher blood pressure)
- Polydipsia (constant thirst and drinking)
Eric agrees to see a psychiatrist and an initial assessment and history indicate that he has only been experiencing some mild changes in his thinking and mood for about a month—ever since returning from the winter holiday. The examiner confirms that his speech is sometimes disorganized and his ability to concentrate and study is diminished from his previous longstanding as a strong student.
- What phase is Eric in?
the prodromal phase
During assessment, Eric has trouble staying on topic zipping rapidly from one thought to the next, making it hard to follow what he is trying to say. What type of speech is he exhibiting?
flight of ideas
loos
poorly organized thinking
What assessment finding represents a negative symptom of schizophrenia?
apathy
Signs and symptoms of metabolic syndrome?
- weight gain
2. dyslipidemia.
