Schizophrenia Spectrum Flashcards
possible causes of schizophrenia
Genetic predisposition
Biochemical dysfunction
Physiological factors
Psychosocial stress
cure for schizophrenia
there is not one
Compared to other mental illnesses, schizophrenia is more likely to increase:
Lengthy hospitalizations
Chaos in family life
suicide risk with schizophrenia
About 1 out of 3 attempt suicide
1 out of 10 die from completed suicide
Severe mental condition
Disorganization of the personality
Deterioration in social functioning
Loss of contact with, or distortion of, reality
May be evidence of hallucinations and delusional thinking
Can occur with or without organic impairment
psychosis
disturbances related to schizophrenia
Thought processes
Perception
Affect
Severe deterioration of social and occupational functioning
factors of person in phase 1: premorbid phase of schizophrenia
Social maladjustment
Antagonistic thoughts and behavior
Shy and withdrawn
Poor peer relationships
Doing poorly in school
Antisocial behavior
factors of person in phase 2: prodromal phase of schizophrenia
Few weeks to a few years
Deterioration in role functioning and social withdrawal
Substantial functional impairment
Sleep disturbance, anxiety, irritability
Depressed mood, poor concentration, fatigue
Perceptual abnormalities, ideas of reference, and suspiciousness herald onset of psychosis
factors of person in phase 3: active psychotic phase of schizophrenia
Schizophrenia is a chronic illness
Acute episodes in which symptoms are more pronounced
Delusions
Hallucinations
Impairment in work, social relations, and self-care
symptoms of phase 4: residual phase of schizophrenia
Symptoms are similar to those of the prodromal phase
Flat affect and impairment in role functioning are prominent
neurotransmitter implication theories
Excess of dopamine activity in brain
Abnormalities in norepinephrine, serotonin, acetylcholine, and GABA
Abnormalities in prostaglandins and endorphins
Excess of serotonin
possibility of a viral infection being predisposed to schizophrenia
effect of autoimmune antibodies
structural brain abnormalities for predisposition to schizophrenia
Ventricular enlargement
Reductions in gray matter
Reduced symmetry of lobes of brain
Reduced size of structures in limbic system
environmental predisposing factors for schizophrenia
Poverty has been linked with development of schizophrenia
Stressful life events may be associated with exacerbation of symptoms and increased rates of relapse
Predisposing Factors: Transaction Model
Theoretical integration and transaction model
Most likely a biologically based disease
Onset is influenced by factors in the internal or external environment
the existence of prominent, nonbizarre delusion
delusional disorder
subcategories of delusional disorders
Erotomanic type
Grandiose type
Jealous type
Persecutory type
Somatic type
Mixed type
brief psychotic disorder
Sudden onset of symptoms
Possibly preceded by a severe psychosocial stressor
Lasts less than 1 month
Evidence of impaired reality testing
Incoherent speech, delusions, hallucinations, bizarre behavior, and disorientation
Catatonic features possible
substance induced psychotic disorder
Presence of prominent hallucinations and delusions
Directly attributable to substance intoxication or withdrawal
signs associated with Psychotic Disorder Due to Another Medical Condition
Prominent hallucinations and delusions
Directly attributable to a general medical condition
Not occurring during course of delirium
examples of Psychotic Disorder Due to Another Medical Condition
CNS infection
Thyroid disorders
Migraine headaches
Renal disease
signs and symptoms of schizophreniform disorder
Same symptoms as schizophrenia
Duration of the disorder has been at least 1 month but less than 6 months
Symptoms of schizophrenia accompanied by a strong element of symptomatology associated with either mania or depression
schizoaffective disorder
assessment of pt with schizophrenia
Positive symptoms - something is added
-Disturbances in thought content
-Disturbances in thought processes manifested in speech
-disturbances in thoughts
-disturbances in thought
-disturbances in perception
negative symptoms
-disturbances in affect
-apathy
-avolition
Lack of interest or skills in interpersonal interaction
Lack of insight
Anergia
Lack of abstract thinking ability
Associated features
Shift of ideas from one unrelated topic to another
loose associations
Made-up words that have meaning only to the person who invents them
neologisms
Literal interpretations of environment
concreteness
Choice of words is governed by sound
clang associations
Group of words put together in a random fashion
word salad
Delay in reaching the point of a communication because of unnecessary and tedious details
circumstantiality
Inability to get to the point of communication due to introduction of many new topics
tangentiality
Persistent repetition of the same word or idea in response to different questions
perseveration
refers to repeating words or phrases spoken by another
echolalia
hallucinations may involve any of the 5 senses
Auditory
Visual
Tactile
Gustatory
Olfactory
positive outcomes for client with schizophrenia
Demonstrates ability to relate satisfactorily with others
Recognizes distortions of reality
Has not harmed self or others
Perceives self realistically
Demonstrates ability to perceive environment correctly
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
Performs self-care activities independently
planning and implementation for schizophrenia
Disturbed sensory perception: auditory/visual
Disturbed thought processes
Risk for violence
evaluations for pt with schizophrenia
Has client established trust with at least one staff member?
Is anxiety level maintained at a manageable level?
Is delusional thinking still prevalent?
Is client able to interrupt escalating anxiety with adaptive coping mechanisms?
Is client easily agitated?
Is client able to interact with others appropriately?
2 psychological treatments for schizophrenia
Individual psychotherapy
Group therapy
Behavior therapy
Social skills training
Family therapy
ACT
Recovery model
Recovery after an initial schizophrenia episode (RAISE)
Psychopharmacological treatment
Long-term therapeutic approach; difficult because of client’s impairment in interpersonal functioning
individual psychotherapy
Some success if occurring over the long-term course of the illness; less successful in acute, short-term treatment
group therapy
Difficult to generalize to community setting after client has been discharged from treatment
behavior therapy
Use of role play to teach client appropriate eye contact, interpersonal skills, voice intonation, posture
Aimed at improving relationship development
social skills training
Aimed at helping family members cope with long-term effects of the illness
family therapy
Evidence-based program of case management
Team approach
Providing comprehensive, community-based psychiatric treatment
Providing rehabilitation and support to individuals with serious and persistent mental illness
assertive community treatment (ACT)
Concept of healing and transformation enabling a person with mental illness to live a meaningful life in the community
Striving to achieve his or her full potential
recovery model
Program of case management
Team approach
Providing comprehensive, community-based psychiatric treatment
Providing rehabilitation and support to persons with serious and persistent mental illness
Early intervention at first episode of psychosis
Recovery after an initial schizophrenia episode (RAISE)
typical antipsychotics
Thorazine (chlorpromazine)
Prolixin (fluphenazine)
Prolixin Deconoate
Haldol (haloperidol)
Haldol Deconoate
atypical antipsychotics
Clozaril (clozapine) agranulocytosis
Geodon (ziprasidone)—prolonged Q-T
Risperdal (risperdone)
Seroquel (quetiapine)—sedation
Abilify (aripiprazole)
Zyprexa (olanzapine)—metabolic syndrome
Invega (paliperidone)
Antipsychotic Adverse Effects
Anticholinergic effects
Nausea; gastrointestinal upset
Skin rash
Sedation
Orthostatic hypotension
Photosensitivity
Hormonal effects
Electrocardiogram changes
Hypersalivation
Weight gain
Hyperglycemia/diabetes
Reduction in seizure threshold
Agranulocytosis
Extrapyramidal symptoms
Tardive dyskinesia
Neuroleptic malignant syndrome
Black Box Warning: Increased risk of mortality in elderly clients with dementia!!!!
examples of extrapyramidal symptoms associated with antipsychotics
Pseudoparkinsonism
Akinesia
Akathisia
Dystonia
Oculogyric crisis
agents that may be prescribed to counteract EPS
antiparkinsonian agents
mimicking movements
echopraxia
