Schizophrenia & Psychotic Disorders

Question 1

Is a severe mental condition in which there is disorganization of the personality, deterioration in social functioning, & loss of contact w/ or distortion of reality

There may be evidence of hallucinations & delusional thinking; it can occur w/ or w/o the presence of organic impairment

Answer 1

Psychosis

Question 2

Nature of the disorder

• Also affects social & occupational functioning
• Causes suffering; is a threat to life & happiness; causes long hospitalization; chaos in family life; is an exorbitant cost to individuals & governments
• Thought processes
  > Alters thought content & forming thoughts (i.e., delusions, loose associations)
• Perception
  > Disturbances can include auditory & visual hallucinations

Answer 2

• Affect
  > Emotional tone that’s altered; an incongruence w/situation; an affect that lacks actual emotional tone

Question 3

Predisposing Factors

• Biological & psychological factors
• Environmental influences [i.e., poverty, stressful life events, use of cannabis]

Answer 3

• The cause of schizophrenia remains unclear; it’s viewed as a brain disorder w/little if any emphasis on psychosocial influences
• Having relatives versus the general population; it’s unclear if schizophrenia is inherited

Question 4

Schizophrenia or schizophrenia-like symptoms may be caused by an excess of ___; this notion is reinforced by the effectiveness of antipsychotics which work by blocking the ↑ receptors

Answer 4

dopamine

> Other neurotransmitters include norepinephrine, serotonin, glutamate, and GABA

• The dopaminergic system has been the most widely studied

Question 5

• Some cases of schizophrenia have been observed following infection from prenatal exposure to viral infections
• Anatomical abnormalities like ventricular enlargement

Answer 5

• It’s likely that schizophrenia is multifactorial

Question 6

Schizophrenia spectrum and related disorders

• Schizotypal personality disorder
• Delusional disorder
• Brief psychotic disorder

Answer 6

• Substance-induced psychotic disorder
• Psychotic disorder due to another medical condition
• Schizophreniform disorder
• Schizoaffective disorder

Question 7

This condition reflects an impairment in personality but it’s not severe enough to be called schizophrenia

Answer 7

Schizotypal personality disorder

Question 8

This condition has a sudden onset of psychotic symptoms that may be from a stressor

> These sx’s last at least a day but less than a month. There’s an eventual return to the level of premorbid function

Answer 8

Brief psychotic disorder

Question 9

This is characterized by the presence of delusions experienced for at least 1 month

Hallucinations are not prominent if present at all and the behavior is not bizarre; can include subtypes

Answer 9

Delusional disorder

Question 10

This is from substance intoxication or withdrawal or exposure to a medication or toxin

Answer 10

Substance-induced psychotic disorder

Question 11

This differs in terms of the timeframe

At least 1 month but is less than 6 months of symptoms

Answer 11

Schizophreniform disorder

Question 12

Signs and symptoms of schizophrenia are present along with a strong element of a mood disorder which includes symptoms of depression, mania, or both

Answer 12

Schizoaffective disorder

Question 13

Occurs as a result of CNS infection, like neurosyphilis, also Huntington’s, and brain abscesses

Answer 13

Psychotic disorder due to another medical condition

Question 14

DSM 5 Schizophrenia

Question 15

Positive symptoms of schizophrenia

Positive symptoms are manifestations of things that are not normally present and are the most easily identified symptoms or manifestations

Answer 15

• Disturbances in thought content
• Disturbances in perception (take the form of hallucinations)
  > Sensory, auditory [most common], visual, tactile, olfactory, gustatory
• Disorganized thinking
• Grossly disorganized or abnormal motor behavior

Question 16

?

Are false, fixed beliefs
> They can be persecutory, and this is the belief that one is going to be harmed by others

Answer 16

delusions

Question 17

This is the belief that cues in the environment are specifically referring to the individual

Answer 17

ideas of reference

Question 18

These are beliefs of exceptional greatness

Answer 18

grandiose delusions

Question 19

This is a belief that centers on one’s own body functioning

Answer 19

somatic beliefs

Question 20

Paranoia can manifest as extreme suspiciousness of others & of others’ actions or perceived intention

Question 21

This is when a person believes that his or thoughts or behaviors have control over specific situations or people

Answer 21

magical thinking

Question 22

These are misperceptions or misinterpretations of real external stimuli

Answer 22

Illusions

Question 23

Another form of a disturbance in perception is ___, which is where the client is imitating movements made by others

Answer 23

echopraxia

Question 24

Disorganized thinking

• Often manifested in speech
• Loose association; tangential thinking; circumstantiality; incoherence

Answer 24

Grossly disorganized or abnormal motor behavior

• Can include catatonia; hyperactivity; hypervigilance; hostility; childlike silliness
• Sometimes repetitive movements or unusual mannerisms are also seen as well as posturing

Question 25

Terms to review * word salad * circumstantiality * tangentiality * perseveration * loose association

Answer 25

* neologisms * clang associations * echolalia * ideas of reference * catatonia

Question 26

Is a group of words that're put together randomly without any logical connection

Answer 26

word salad

Question 27

is when the individual delays in reaching the point of communication because of unnecessary & tedious details

Answer 27

circumstantiality

Question 28

Is the person that never gets to the point during communication

Answer 28

tangentiality

Question 29

Is when someone persistently repeats the same word or idea in response to different questions

Answer 29

perseveration

Question 30

Is characterized by communication in which ideas shift from one unrelated topic to another

Answer 30

Loose association(s)

Question 31

Is when words are newly invented; they're meaningless to others, but they have a symbolic meaning to the individual

Answer 31

neologisms

Question 32

Is when words are chosen based on the sound they make; often take the form of rhyming > “It’s very cold. I am cold and bold. Gold has been sold.”

Answer 32

clang associations

Question 33

Refers to repeating words or phrases that are spoken by another

Answer 33

echolalia

Question 34

This is when an individual misconstrues trivial events & attaches personal significance to them such as a man seeing 2 people talking & believing they're talking about him; even if they haven't noticed him

Answer 34

ideas of reference

Question 35

Is a condition by which there's change in muscle tone or activity; typically assoc w/schizophrenia > The individual can experience a defect of motor activity or at times become motionless

Answer 35

catatonia

Question 36

Negative symptoms of schizophrenia Are functions that are missing Are the most difficult to treat & they respond less well to anti-psychotic rx's Are considered the most debilitating b/c they render the client inert & unmotivated

Answer 36

* disturbances in affect * avolition * lack of insight * anhedonia * apathy * lack of interest or skills in interpersonal interaction * anergia * lack of abstract thinking ability

Question 37

Is the inability to experience pleasure > Compels some clients to attempt suicide

Answer 37

anhedonia

Question 38

Is a deficiency of energy; a lack of sufficient energy to carry out ADLs or to interact w/one another

Answer 38

anergia

Question 39

Is impaired volition, or the inability to initiate a goal, especially a goal-directed activity > They have a lack of interest or skills in interpersonal interaction > Become emotionally detached; lack the regard for social interaction w/others; may become socially isolated as well

Answer 39

avolition

Question 40

Is the indifference to or the disinterest in the environment

Answer 40

apathy

Question 41

Disturbances in affect > Can include bland affect, which is a very weak emotional tone or a flat affect, which is even worse (is considered the void of emotional tone)

Question 42

Associated features in schizophrenia * Waxy flexibility > describes a condition in which the client w/schizophrenia allows the body parts to be placed in a bizarre or uncomfortable position; usually assoc w/catatonia * Posturing (manifested by voluntary assumption of inappropriate or bizarre postures) * Pacing & rocking

Answer 42

* Regression (the retreat to an earlier lvl of development) * Eye movement abnormalities > Can manifest in ways like difficulty in maintaining focus on a stationary object & difficulty w/the ability to follow an object w/the eyes

Question 43

Life span development of schizophrenia Premorbid → Prodromal → Active → Residual

Answer 43

* Generally, sx's of schizophrenia appear in late adolescence or early adulthood; may occur in middle or late adult life as well * Before 17 suggests early onset schizophrenia; sx's <13 are very rare & suggests very early onset schizophrenia

Question 44

___ phase * psychotic sx's * impaired social, occupational functioning

Answer 44

Active

Question 45

___ phase * very shy & withdrawn * poor peer relationships * doing poorly in school * demonstrating antisocial behavior * irritability

Answer 45

Premorbid

Question 46

___ phase * negative sx's remain * flat affect * absence of sx's in active stage

Answer 46

Residual

Question 47

___ phase * begins w/a change from premorbid functioning * few wks to a few yrs * depressive sx's * social withdrawal * sleep disturbances * suspiciousness/ideas of reference

Answer 47

Prodromal

Question 48

Nursing diagnoses (& assoc behaviors) * Disturbed sensory perception * Disturbed thought processes * Social isolation * Risk for violence: self-directed or other-directed

Answer 48

* Impaired verbal communication * Disabled family coping * Ineffective health maintenance * Impaired home maintenance * Self-care deficit (common)

Question 49

Outcomes criteria * Demonstrates ability to relate satisfactorily w/others * Recognizes distortions of reality * Has not harmed self or others * Perceives self realistically * Demonstrates the ability to perceive the environment correctly

Answer 49

* Maintains anxiety at a manageable level * Relinquishes the need for delusions and hallucinations * Demonstrates the ability to trust others * Uses appropriate verbal communication in interactions w/others * Performs self-care activities independently

Question 50

Interventions → **Observe** the client for signs of hallucinations → **Avoid** physical touch → **Convey** an attitude of acceptance → **Attempt** to distract from hallucination

Answer 50

→ **Reinforce** reality → **Provide** routine → **Assess** for suicide risk

Question 51

Treatment Modalities * Individual psychotherapy * Group therapy [has been found promising, esp w/rx's] * Behavior therapy * Family therapy

Answer 51

* Social skills training * Assertive community treatment (ACT) > is an evidence-based program of case management; helps pt w/various teachings on living skills > Helps client work w/community agencies & also helps them develop a social support network

Question 52

→ Recovery Model Recovery in schizophrenia is controversial These pts still deserve instillation of hope & encouragement What does recovery mean? That's a fluid definition

Answer 52

→ RAISE (Recovery After an Initial Schizophrenic Episode) - Incorporates many elements from other treatment approaches, including community treatment, recovery model approaches, & comprehensive care models > It looks for early identification @ the 1st ep of psychosis & is thought to be early & comprehensive & can maybe alleviate some of the long-term debilitating consequences of schizophrenia

Question 53

Psychopharmacological Treatment Typical & atypical [newer] antipsychotics

Answer 53

* Thorazine was the very 1st typical antipsychotic introduced in the US in 1952

Question 54

___ antipsychotic(s) Provide relief of psychosis, improvement in positive sx's, improvement in negative sx's

Answer 54

Atypical

Question 55

___ antipsychotic(s) Provide relief of psychosis, improvement in positive sx's, worsening of negative sx's

Answer 55

Typical

Question 56

Typical antipsychotics * Chlorpromazine * Fluphenazine * Haloperidol (Haldol) * Perphenazine * Loxapine * Pimozide (Orap) * Prochlorperazine * Thioridazine * Thiothixene (Navane) * Trifluoperazine

Answer 56

! Anti-cholinergic effects ! Orthostatic hypotension ! EPS (extrapyramidal symptoms) ! TD (tardive dyskinesia) ! NMS (Neuroleptic Malignant Syndrome) ! Pseudo-parkinsonism ! Dystonia

Question 57

? This is caused by the blockade of dopamine receptors > includes dystonia, which is involuntary, purposeless muscle contraction; akathisia, which is restlessness

Answer 57

EPS (extrapyramidal symptoms)

Question 58

? This involves involuntary facial movements including the mouth, tongue, & lips > can be permanent & irreversible

Answer 58

TD (tardive dyskinesia)

Question 59

? Is life-threatening > results from rx's that block dopamine receptors > characterized by a fever of 103 or greater, BP lability, tachycardia, tachypnea, agitation, & diaphoresis

Answer 59

NMS (Neuroleptic Malignant Syndrome)

Question 60

AIM Scale Abnormal Involuntary Movement Scale

Answer 60

Is a rating scale that was developed to measure involuntary movements associated w/TD

Question 61

Atypical antipsychotics * Aripiprazole (Abilify) * Asenapine (Saphris) * Brexpiprazole (Rexulti) * Cariprazine (Vraylar) * Clozapine (Clozaril) [pts are on a registry; routine bloodwork; excess saliva/drooling] * Iloperidone (Fanapt)

Answer 61

* Lurasidone (Latuda) * Olanzapine (Zyprexa) * Paliperidone (Invega) * Quetiapine (Seroquel) * Risperidone (Risperdal) * Ziprasidone (Geodon)

Question 62

! Sedation ! Wt gain ! Orthostatic hypotension ! QT-interval prolongation

Answer 62

! Agranulocytosis (presents as a low ANC level) ! Metabolic syndrome ! Less EPS, TD, NMS

Question 63

Novel Developments * Aripiprazole (AbilifyMYCITE) w/tracking sensor

Answer 63

* Valbenazine (Ingrezza) Used in TD treatment > Works by reducing the dopamine release @ the synaptic cleft - Has demonstrated some effectiveness in reducing involuntary movements ! This rx is costly ($125,000/yr)

Question 64

Considerations > Smoking > Body temp > Alcohol