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Schizophrenia Chapter 15 Flashcards

1
Q

Etiology of Schizophrenia

A

genetic predisposition, biochemical dysfunction, physiological factors, and psychosocial stress.

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2
Q

Agreed upon factors of Schizophrenia

A

Not a homogeneous disease.
There may never be a single treatment that cures the disorder

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3
Q

“Schiz”o”phren”ia

A

Schiz mean split
Phren means mind

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4
Q

Schizophrenia Definition

A

Disturbances in thought processes, perception, and affect invariably result in a severe deterioration of social and occupational functioning.

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5
Q

Psychosis

A

Disorganization of personality
Deterioration in social functioning
Loss of contact with, or distortion of reality
Hallucinations and delusional thinking

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6
Q

Phases of schizophrenia

A

Phase I: Premorbid
Phase II: Prodromal
Phase III: Active/Psychotic Phase (Acute Schizophrenic Episode)
Phase IV: Residual

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7
Q

Premorbid Phase

A

Phase I
Occurs before there is clear evidence of an illness
Personality traits: Shy, Withdrawn, Poor peer relationships

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8
Q

Prodromal Phase

A

Phase II
More clearly manifests as signs of developing illness
Can be a brief period of time- 2 to 5 years on average
Shows significant deterioration in functioning
Depressive or OCD symptoms

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9
Q

Psychotic/Acute Schizophrenic Episode

A

Phase III
Active phase of the disorder
Psychotic symptoms are prominent
Positive and negative symptoms are present

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10
Q

Residual

A

Phase IV
Symptoms of the acute phase are either absent or no longer prominent

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11
Q

Positive Symptoms

A

Symptoms that are added to a persons personality that others do not experience
Delusions
Hallucinations
Disorganized thinking, speech and behaviors
Catatonic/Waxy/Dysarthria

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12
Q

Negative Symptoms

A

Symptoms that are taken away from a person personality that others do have/can experience
Diminished emotional expression or avolition
Flat Affect
Impaired function in ADLs
Social Withdrawal

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13
Q

When does schizophrenia begin to manifest

A

Late adolescence into early adulthood
college age- major life change such as going away to college

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14
Q

Types of schizophrenia

A

Paranoid
Disorganized
Catatonic
Undifferentiated

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15
Q

Paranoid Schizophrenia (SCPT)

A

Paranoia
Food being poisoned
Bad person

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16
Q

Disorganized schizophrenia

A

Not making sense
Cannot organize their thoughts

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17
Q

Catatonic Schizophrenia

A

Statue like
Not talking or responding
Physically not moving

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18
Q

Undifferentiated Schizophrenia (SCUT)

A

Does not fit in to the other schizophrenic categories
May have more than one symptom from each category

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19
Q

Risk of suicide

A

1 in 3 will attempt
1 in 10 will succeed

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20
Q

Types of Hallucinations

A

Auditory (most common)- false perception of sound
Visual- false visual perception. May see people or flashes of light that are not there
Tactile- false sense of touch. Feeling something on or underneath the skin
Gustatory- False sense of taste, typically unpleasant tasting
Olfactory- False sense of smell

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21
Q

Delusional Disorder (most common)

A

Grandiose- exaggerated feeling of importance
Jealous- belief partner is being unfaithful regardless of evidence that states otherwise
Persecutory (most common)- being persecuted, plotted against, cheated, followed, spied on. May involve paranoid delusions. CIA is spying on them.

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22
Q

Paranoid Delusions

A

Extreme suspicion of others and their actions or intentions. Not eating food because it was poisoned.

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23
Q

Delusional Disorder (others)

A

Reference
Influence/Magical thinking
Somatic
Nihilistic
Erotomanic

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24
Q

Delusions of Reference

A

events in the environment are for themselves (song lyrics are speaking to them)

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25
Delusions of Influence
Another person or objects control their behavior, magical thinking.
26
Magical Thinking
their thoughts/behaviors control situations/people
27
Nihilistic
false idea about body/function
28
Erotomanic
Someone of higher status is in love with them
29
Religiosity
excessive demonstration of or obsession with religious ideas and behaviors that cause distress and impress ability to function
30
Concrete thinking
literal interpretations of the environment "it's raining cats and dogs"
31
Recovery Model
Functional Recovery RAISE (Recovery After Initial Schizophrenic Episode)
32
Functional Recovery
Focuses on the individual’s level of functioning in such areas as relationships, work, independent living, and other kinds of life functioning.
33
RAISE (Recovery After Initial Schizophrenic Episode)
Early comprehensive treatment to decrease debilitating results of schizophrenia. Includes community treatment, recovery model approaches, family approaches, and comprehensive care models
34
Individual Psychotherapy
Reality based orientation Honest, simple directness which respects privacy and dignity Help identify real and perceived dangers
35
Group Therapy
More effective in outpatient settings when combined with medications Can be counterproductive in early treatment Most useful over the long term course of the illness
36
Psychological Treatments
Individual Group- effective as outpatient Behavior- lessens bizarre behaviors Social Skills- manage relationships and communications- use of role playing
37
Social Treatments
Family Therapy- long term program Assertive Community Treatment (ACT)
38
Assertive Community Treatment (ACT)
case management that takes a team approach in providing comprehensive treatment, rehab and support to the patient
39
Loose Associations
Speech where ideas shift from one unrelated subject to another. When the condition is severe, speech may be incoherent “We wanted to take the bus, but my lunch was cold. The FBI is watching me. No one needs to pay to get to heaven. We have it all in our pockets”.
40
Neogisms
The person invents new words, or neologisms, that are meaningless to others but have symbolic meaning to the individual “She wanted to give me a ride in her new uniphorum”.
41
Clang Associations
Choice of words is governed by sounds. Clang associations often take the form of rhyming. “It is very cold. I am cold and bold. The gold has been sold.”
42
Word Salad
A group of words that are put together randomly, without any logical connection “Most forward action grows life double plays circle uniform”.
43
Circumstantiality
Unnecessary and tedious details which delay the point of communication
44
Tangentiality
Veering away from the topic, difficulty maintaining focus and attention
45
Perseveration
Persistently repeating the same word or idea in response to different questions
46
Echolalia
Repeating words or phrases said by someone else
47
Illusions
Misperceptions or misinterpretations of real external stimuli.
48
Echopraxia
Imitates movements made by others.
49
Affect
Behavior associated with an individuals feeling state or emotional tone
50
Inappropriate Affect
Emotional tone is incongruent with circumstances Laughs when told of the death of a loved one
51
Bland/Flat Affect
Emotional tone is very weak Void of emotion or feeling
52
Apathy
Indifference or disinterest
53
Avolition
Inability to initiate goal-directed activity Lack of motivation Neglect of ADLs
54
Anosognosia
Lack of Insight The most common predictor of non adherence to treatment, high relapse, involuntary treatments, poorer psychosocial functioning, aggression and poorer course of illness Lack of awareness of having an illness or disease Pt is brought to ED and tells the nurse they were in the apartment and the police told them they had to go to the ED
55
Anergia
Lack of energy to perform ADLs or interact with others
56
Anhedonia
Inability to experience pleasure Increases the risk of suicide
57
Waxy Flexibility
a condition in which the client with schizophrenia allows body parts to be placed in bizarre or uncomfortable positions
58
Posturing
This symptom is manifested by the voluntary assumption of inappropriate or bizarre postures.
59
Organic Treatments for Schizophrenia
Psychopharmacology Antipsychotics aka neuroleptics; major tranquilizers
60
Antipsychotics Indications
Effective for the treatment of acute and chronic symptoms of schizophrenia and other psychotic disorders Typical and Atypical
61
Antipsychotic Mechanism of Action
Blocks dopamine to decrease positive symptoms
62
Antipsychotic Side Effects
Interferes with normal movement (EPS) Acute dystonia Tardive Dyskinesia Increased prolactin levels Cholinergic symptoms Caution when used in elderly population
63
Extrapyramidal Symptoms (EPS)
Responses that originate outside the pyramidal tracts and in the basal ganglion of the brain. tremors, chorea, dystonia, akinesia, akathisia, and others.
64
Dystonia
Involuntary muscular movements (spasms) of the face, arms, legs, and neck
65
Tardive Dyskinesia
bizarre facial and tongue movements, a stiff neck, and difficulty swallowing
66
Cholinergic symptoms
dry mouth, blurred vision, constipation, urinary retention, and tachycardia
67
Antipsychotic Medication Patient Education
Use caution while driving Do not stop abruptly Use sunblock and wear protective clothing Rise slowly to avoid orthostatic hypotension Maintain hydration and eat hard candy for dry mouth Good oral care Avoid smoking
68
Neuroleptic Malignant Syndrome
A rare but potentially fatal complication of treatment with neuroleptic drugs. Symptoms include severe muscle rigidity high fever tachycardia fluctuations in blood pressure diaphoresis rapid deterioration of mental status to stupor and coma.
69
Atypical Antipsychotic Medication
Clozapine
70
Clozapine Special Considerations
Risk of agranulocytosis Baseline WBC level Used in patients who fail to respond to other antipsychotic medications
71
Theory Burst
Normal WBC levels: 5-10 Clozapine potential adverse reaction: agranulocytosis (1-2% of pts) Protocol for this med: weekly CBC fir 6 months then q 2 weeks for 2 weeks then monthly Only given a 7 day supply at a time notify physician S/S of infection- sore throat, fever, malaise
72
Medication for non compliant patients
Long acting risperidone (Perseris) 90mg or 120mg once a month
73
First Generation Antipsychotics
Haldol 1-100mg
74
Second Generation Antipsychotic Medications
Aripiprazole (Abilify): 10-30mg risperidone- Risperdal*: 4-8mg quetiapine fumarate- Seroquel*: 300-400mg clozapine (Clozaril): 300-900mg iloperidone (Fanapt): 12-24mg lurasidone (Latuda): 40-80mg olanzapine (Zyprexa): 5-20mg paliperidone (Invega): 6-12mg ziprasidone (Geodon): 40-160mg

Mental Health (3 decks)

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