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schizophrenia psurg Flashcards

1
Q

4 phases in developing schizophrenia

A

Premorbid, prodromal, schizophrenia, residual phase

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2
Q

premorbid phase 1

A

social maladjustment, social withdrawal, irritibility, and antagonistic thoughts and behavior; shyness, family hx, mild s/s, functioning

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3
Q

prodromal phase 2

A

length 2-5 yrs; begins with a change from premorbid and extends until onset of frank pyschotic s/s; substantial functional impairment, sleep disturbance, anxiety, irritability, depressed mood, poor concentration, fatigue, deterioration in role function, social withdrawal; Positive s/s perceptual abnormaliites, ideas of reference, suspiciousness; herald onset of phase 3 schizophrenia; no school, no friends, no sleep

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4
Q

Schizophrenia phase 3

A

Active phase; +/- psychotic s/s prominent; consist of characteristic sypmtoms, social/occupational dysfunction, duration, schizoaffective and mood d/o; substance/GMC, relationship to a pervasive developmental d/o

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5
Q

Residual phase 4

A

(+) s/s of active phase absent; (-) s/s remain

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6
Q

Criteria for Schizophrenia: Characteristic s/s

A

lasting 1 mon, 2+ of s/s: delusions, hallucinations, disorganized speech (frequent derailment or incoherence), grossly disorganized or catatonic behavior, negative psychotic s/s (affective flattening, alogia/no words, or avolition/no drive)

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7
Q

criteria for Schizophrenia: social occupational dysfunction

A

work and self-care markedly below level before onset, or failure to achieve expected level of interpersonal, academic, or occupational achievement

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8
Q

criteria for schizophrenia: duration

A

continuous for at least 6 mon disturbance, with 1 mon of criteria 1

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9
Q

3 characteristics of psychosis

A

disorganization (thought and action not congruent), social functioning, lost contact with reality

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10
Q

Typical onset of pyschosis

A

teens and early 20s

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11
Q

with schizophrenia, rate of suicide is

A

higher

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12
Q

Predisposing factors

A

biological: genetic, neurotransmitter, anatomical and associated dz; Psychological: family (lack of love NOT a cause), stress (precipitate flare up but NOT a cause); Environmental: sociocultural

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13
Q

Major neurotransmitter in psychosis

A

Dopamine D2; then serotonin 5-HT

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14
Q

anatomical & associated dz are

A

flu virus during pregnancy, epilepsy, born with smaller frontal lobe for higher function

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15
Q

Transactional Model for schizophrenia

A

Start with precipitating event stressful/threatening to a weak ego; genetic influence; prenatal viral infx; abn brain structure and epilepsy/Huntington’s dz, brain tumor, Parkisonism, Inadequate Coping Skills; Primary Cognitive Appraisal: perceived threat to self; Secondary Cognitive Appraisal: weak ego, poor coping mechanism so initiate Defense Mechanism: denial, regression, projection, identification, religiosity; Response is Adaptive or Maladaptive; Maladaptive = psychotic episode and exacerbation of s/s (hallucination, delusions, social isolation, violence, inapporpriate affect, bizarre behavior, apathy, autism

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16
Q

Positive s/s of schizophrenia

A

content of thought: delusions, religiosity, paranoia, magical thinking; form of thought associative looseness, neologism, concreate thinking, clang associations, word salad, circumstantiality, tangentiality, mutism, perseveration; sense of self: echolalia, echopraxia, identification and imitation, depersonalization

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17
Q

Negative s/s of schizophrenia

A

Affect: inappropriate affect, bland or flat affect, apathy; Volition: inability to initiate goal-directed activity, emotional ambivalence; Impaired interpersonal functioning and relationship to the external world: autism, deteriorated appearance; Psychomotor Behavior: anergia, waxy flexibility, posturing, pacing and rocking; Associated features: anhedonia, regression

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18
Q

delusion

A

positive: fixed false belief (e.g. persecution from FBI, grandeur of I am Jesus, reference of I must break the code, control or influence of this dental filling controls what I think, somatic of the 70 yo pregnancy, nihilistic of I have no stomach)

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19
Q

religiosity

A

positive: praying all the time, affects functionality; culture appropriate

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20
Q

Paranoia

A

positive: my food has been poisoned

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21
Q

magical thinking

A

positive: it’s raining, the sky is sad.

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22
Q

erotomania

A

positive: Brad Pitt loves me.

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23
Q

associative looseness

A

positive: ideas kinda connect

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24
Q

neologism

A

positive: made up words; RN find the meaning

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25
concreate thinking
positive: very literal; RN don't use abstract thought
26
clang associations
positive: rhyme
27
word salad
positive: random words with no connection between words
28
circumstantiality
positive: so many details, can't get to the point
29
tangentiality
positive: moves from subject to subject, no point
30
Mutism
positive: inability/refusal to speak
31
hallucinations
positive: false sensory perception; auditory hear voices, visual flashes of light, tactile crawling under skin, gustatory tastes of poop, olfactory smells like burning
32
Illusion
positive: misinterpret object; the real trash can is a dog illusion
33
echolalia
positive: copy what is said
34
echopraxia
positive: mimic action
35
Identification
positive: unconscious imitation (dress like BFF)
36
Imitation
positive: conscious imitation (dress like marilyn monroe)
37
depersonalization
positive: beside myself watching things happen to me.
38
Inappropriate affect
negative: emotional tone incongruent with situation
39
Bland/blunted or flat affect
negative: bland is emotional tone is weak; flat is void of emotional tone (masking)
40
apathy
negative: indifference or disinterest
41
Impaired volition: goal directed activity
negative: can't start goal directed activity; RN give step-by-step
42
Impaired volition: emotional ambivalence
negative: need-fear dilemma for intimacy; back and forth between room and community room
43
autism
negative: retreat to own private world
44
deteriorated appearance
negative: neglected hygiene, grooming, self-care
45
anergia
negative: no energy
46
waxy flexibility
negative: leave arm out of BP, even if uncomfortable
47
posturing
negative: voluntary bizarre position; resist unposturing
48
pacing and rocking
negative: purposeless, rhythmic swaying of trunk from hips when sitting
49
anhedonia
negative: no pleasure; suicide risk
50
regression
negative: retreat to earlier level of development.
51
types of schizophrenia
disorganized, catatonic, paranoid, undifferentiated
52
disorganized schizophrenia
hebephrenic schizophrenia: onset before 25, chronic, regressive, poor reality testing, flat affect then silly; facial grimace bizarre, personal appearance neglected, social impairment extreme
53
Catatonic stupor schizophrenia
mutism, waxy flexibility, posturing
54
catatonic excitement schizophrenia
frenzied, spastic, incoherent shouting, die from exhaustion; RN give meds or mechanical restraints
55
paranoid schizophrenia
persecutory/gradeur delusion, auditory hallucination r/t FBI, suspicious gaurded, argumentative, aggressive; onset late 20s-30s; can be minimal social/occupational/living impairment
56
Undifferentiated schizophrenia
don't fit criteria for schizophrenia perfectly
57
Residual schizophrenia
1 schizophrenic event; evidence of illness; no psychotic s/s
58
Schizoaffective d/o
pyschosis + mood d/o (depressed or manic); this is more complicated
59
Brief psychotic d/o
sudden onset, later age, precipitating event, duration < 1 mon
60
Schizophreniform d/o
meets schizophrenia criteria, but not yet 6 mon of s/s
61
Shared psychotic d/o
folie a deux; alpha in relationship imposes delusions on passive partner (women); occurs in long-term relationships, socially isolated
62
list 5 delusional d/o
eromatic, grandiose, jealous type, persecutory, somatic
63
psychotic d/o d/t GMC
head injury, PTSD, brain tumor, lupus, AIDS; NOT in delirium/chronic progressive dementia
64
substance-induced psychotic d/o
meth + no reality testing (if with reality testing, dx substance-related d/o)
65
Phases of tx
active, maintenance, rehabilitation
66
active phase of tx
establish trust, promote safety, alleviate s/s
67
Maintenance phase of tx
improve quality of life; teach coping strategy
68
rehabilitation phase
restore to highest capacity
69
Nursing Dx for schizophrenia
risk for violence: self/other directed, altered thought process, disturbed sensory perception, social isolation, impaired verbal communication, self-care deficit, disabled familiy coping, ineffective health maintenance
70
Attitude tx
be calm so pt calm; ask what's your plan for the day, in appropriate tone, body language
71
Teaching r/t schizophrenia
nature of illness: illness progression, s/s, ways for family to respond to behaviors; management of illness: connection of s/s to times of stress, medication management, importance of not stopping meds, when to contact MD, relaxation tips, social skills training, daily living skills training; support services: financial assistance, legal assistance, caregiver, support groups, respite care so caregiver as day off, home health care
72
Treatment modalities
pyschopharmacology with neuroleptics (typical and atypical); social treatment with millieu and family tx; psychological with group tx, social skills training, behavior tx
73
Prognosis of schizophrenia
unfavorable course
74
millieu tx
aka therapeautic community, therapeautic environment; manipulate environment so pt experience is therapeautic to improve psychological health and functioning; this is why staff wears neutral colors.
75
family tx
reduces likelihood of relapse or emergence of mental illness to previously nonaffected family member; reduce family anger/guilt; set limits; increase for family to anticipate and solve problems
76
social skill training
focus on role-play; emphasis on ADLs
77
group tx
for inpatient not good because it adds stimuli; for outpatient it offers a supportive environment, social interaction, identification, and reality testing
78
behavior tx
reduce frequency of bizarre, disturbing, and deviant behaviors, and increasing appropriate behaviors; RN simple concrete instruction, attach positive/negative/aversive to adaptive/maladaptive behavior; clearly defined goals and how they are measured.
79
psychotherapy
reality oriented; decrease anxiety and increase trust (do not be overly warm/professional; it looks fake); exploration of behavior within relationships; improve interpersonal communication, emotional expression, and frustration tolerance; teach how to react appropriately to real vs. perceived danger.
80
lithium interacts with which 4 drugs
NSAID, haldol, diuretic, carbamazepine

Psurg (15 decks)

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