Schizophrenia Flashcards by xiamin martinez torres

What are the five key features associated with psychotic disorder?

Delusions: Alterations in thought content (what a person thinks about). Delusions are false fixed beliefs that cannot be corrected by reasoning or evidence to the contrary. “Unusual” beliefs maintained by one’s culture or subculture are not delusions.
Hallucinations: Perception of a sensory experience for which no external stimulus exists (e.g., hearing a voice when no one is speaking).
Disorganized thinking: The loosening of associations, manifested as jumbled and illogical speech and impaired reasoning.
Abnormal motor behaviour: Alterations in behaviour, including bizarre and agitated behaviours (e.g., stilted, rigid demeanour; eccentric dress, grooming, and rituals). Grossly disorganized behaviours may include mutism, stupor, or catatonic excitement.
Negative symptoms: The absence of something that should be present but is not—for example, the ability to make decisions or to follow through on a plan. Negative symptoms contribute to poor social functioning and social withdrawal.

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What other than schizophrenia exist in psychotic disorder?

Schizophreniform Disorder
Brief Psychotic Disorder
Schizoaffective Disorder
Delusional Disorder
Substance- or Medication-Induced Psychotic Disorder
Psychosis or Catatonia Associated With Another Medical Condition or Another Mental Disorder

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Define Schizophrenia

It affects thinking, language, emotions, social behaviour, ability to perceive reality accurately.
A chronic syndrome that typically follows a deteriorating course over time.
Not curable; treatments to prevent the illness do not exist either

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Describe the onset of schizophrenia

May begin late in adolescence or early in adulthood, usually before age 30
The younger the client is at the onset of schizophrenia, the more discouraging the prognosis.
However, abrupt onset of illness is greater potential for recovery.

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What are the 3 phases of Schizophrenia?

Phase I—Acute: Onset or exacerbation of florid, disruptive symptoms (e.g., hallucinations, delusions, apathy, withdrawal) with resultant loss of functional abilities; increased care or hospitalization may be required.
Phase II—Stabilization: Symptoms are diminishing, and there is movement toward one’s previous level of functioning (baseline); day hospitalization or care in a residential crisis centre or a supervised group home may be needed.
Phase III—Maintenance: The person is at or nearing baseline (or premorbid) functioning; symptoms are absent or diminished; level of functioning allows the person to live in the community. Ideally, recovery with few or no residual symptoms has occurred

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How do Dr. base their diagnosis with Schizophrenia?

no yet lab to diagnose. 
Psychiatrist comes to diagnose.
The diagnosis is based on symptoms:
- What the person says
- What the family reports
- What health care professionals observe

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What are the criterias for Schizophrenia?

Characteristic symptoms (at least 2 of the following during 1 month): Delusions, Hallucinations, Disorganized speech, Grossly disorganized or catatonic behaviour, Negative symptoms
Social-occupational dysfunction: work, interpersonal, self-care functioning below the level achieved before onset
Duration: continuous signs of the disturbance for at least 6 months
All other mental disease have been rules out
All other medical conditions have been ruled out (not caused by substance use, meds, general medical disorder)

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What are the 2 possible patterns when a patient is experiencing psychotic symptoms?

the patient experiences continued psychosis, with some shift in severity of symptoms, but never fully recovers from the psychosis
The patient experiences episodes of psychotic symptoms followed by relatively complete recovery from the psychosis between episodes

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What are the factors that hinder recovery?

Nonadherence to meds
Late detection
Long duration of untreated psychosis
Fragmented, inadequate care
Little support
Excess stress and conflict in the personal environment
Isolation, loneliness
Neglect of physical health
Abuse of street drugs
Hopelessness and despair

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Describe the positive symptoms of Schizophrenia.

*Hallucinations
Magical thinking (categorized as cognitive symptoms)
Speech patterns (categorized as cognitive symptoms): Loose association, Neologisms, Concrete thinking, Clang associations, Word salad, Tangentiality, Circumstantiality.
Delusions
Bizarre Behaviour: Clotting, appearance, social/sexual behaviour, excited/agitated behaviour, hostile/aggressive behaviour, repetitive/stereotyped behaviour

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Describe negative symptoms of Schizophrenia.

A lessening or loss of normal functions
Affective Flattening, decrease range of affect
Alogia, decrease mental process fluency and production of words
Avolition, (motivation) decrease initiation of goal directed behaviour
Anhedonia, inability to experience pleasure
Asociality, severe impairment in social relationships
Passivity
Difficulty in abstract thinking
Lack of spontaneity
Poor eye contact
Avolition, Apathy, Anhedonia, Physical anergia
Social withdrawal, impaired grooming/hygiene, few recreational interest or activities, impaired intimacy & closeness, little sexual interest or activity

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Describe Cognitive/Disorganized Symptoms

Difficulties in concentration & memory
Disorganized thinking/speech
Difficulty understanding
Difficulty expressing thoughts
Attention deficits

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How do cognitive problems affect daily routine in Schizophrenia?

When problems are mild, the person will have difficulties with reading, writing, watching TV
People with greater degree will be unable to carry out task (cooking, shopping), manage their money, look after themself. This may result in poor hygiene, malnutrition and self-neglect.
The worst type results in potentially dangerous behaviour, walking into traffic, leaving the stone on, mixing up medications
Over time, can lead to unemployment, disability, poverty, debts, excess dependency

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What are the clinical symptoms of cognitive impairment in Schizophrenia?

some experience positive symptoms, others may have more negative symptoms,
it varies between different individuals

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What are the 5 subtypes of scizophrenia?

Paranoid type
Catatonic type (rare)
Disorganized type
Undifferentiated type
Residual type

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Describe the paranoid type of subtype in a Schizophrenic patient.

one or more delusions (persecutory or grandiose delusions) or frequent auditory hallucinations
Ideas of reference
Behavioural change: anger, hostility, violent, unable to trust, guarded, tense, reserved
Defence mechanism used to maintain self-esteem
may pose a threat to the safety of self or others

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Describe the Catatonic type of subtype in a Schizophrenic patient.

Psychomotor disturbance: either extreme motor agitation or extreme psychomotor retardation
bizarre posturing
Patient at risk: extreme withdrawal-> vegetative condition, excessive motor activity-> exhaustion or self-inflicted injury
extreme negativisme & resistance & automatic obedience
Echolalia: Persistently repeating the words of others
Echopraxia: mimicking a movement or gesture of others
May be unresponsive to interventions
May continue to exhibit selective mutism or refuse nursing care, food, meds

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Describe the Disorganized type of subtype in a Schizophrenic patient.

Behaviour: odd- giggling or grimacing response to internal stimuli, bizarre mannerisms, uninhibited behaviour
Grossly inappropriate affect
Looseness of association, incoherent speech, lack of attention to personal hygiene and grooming
Extreme social withdrawal

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Describe the Undifferentiated type of subtype in a Schizophrenic patient.

Atypical symptoms
Positive and negative symptoms
Prognosis is favourable if onset of symptoms is acute or sudden
May have difficulty communicating with these patient due to the presence of atypical, disorganized clinical symptoms

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Describe the Residual type of subtype in a Schizophrenic patient.

As chronic form of the disease
In a stage that follows an acute episode of Schizophrenia
No psychotic symptoms, still evidence of illness: Social isolation, Impairment in personal hygiene, Blunted/inappropriate affect, Apathy

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What are the 2 groups of antipsychotic drugs?

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Conventional (traditional, typical): block dopamine receptors, it targets the positive symptoms of schizophrenia
Atypical (second generation): block the serotonin-dopamine activity, it diminishes some of the negative symptoms, fewer side effect=better tolerated, can help with anxiety, depression, decrease suicidal behaviour, increases neurocognitive function

Describe the Second-Generation Antipsychotics

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Treat positive and negative symptoms
Minimal to no Extrapyramidal side effects or Tardive dyskinesia
Disadvantage: Cause significant weight gain
Metabolic syndrome: cluster condition, increased BP, High CBGM, excess body fat around waist & abnormal cholesterol levels = Increasing risk of heart disease, stroke, diabetes

What are the Older or First generation antipsychotics?

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chlorpromazine Largactil
flupenthixol Fluanxol
fluphenazine Modecate
zuclopenthixol Clopixol
loxapine Loxapac
haloperidol Haldol
pimozide Orap
trifluoperazine Stelazine
methotrimeprazine Nozinan

Any meds finishing by “ixol” or “ine”

What are the Newer or Second-generation antipsychotics?

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clozapine Clozaril
olanzapine Zyprexa
risperidone Risperdal
quetiapine Seroquel
aripiprazole Abilify
Injectable: invega Sustana

What are the disadvantages and advantage of First generation antipsychotics?

``` DISADVANTAGES Extrapyramidal side effects (EPS) Anticholinergic (ACh) adverse effects Tardive dyskinesia Weight gain, sexual dysfunction, endocrine disturbance ``` ADVANTAGE less expensive than second generation

What are the Extrapyramidal effects?

Akathisia: Feeling restless like you can't sit still Dystonia: When your muscles contract involuntarily Parkinsonism: Symptoms are similar to Parkinson's disease Tardive dyskinesia: Facial movement happen involuntarily

What are the treatments for Extrapyramidal side effects?

Benztropine (cogentin) Improves muscle control and reducing stiffness Anticholinergic Recommended dose is 1 - 4 mg PO once or twice a day

Describe Tardive Dyskinesia.

``` Facial grimacing (commonly involving lower facial muscles) Finger movement (piano playing movement) Rocking or thrusting of the pelvis Jaw swinging Repetitive chewing Rapid eye blinking Tongue thrusting Restlessness ```

What are the treatments for Tardive Dyskinesia?

Clonazepam (benzodiazepine) 0.5 mg daily, titrated by 0.5mg increments every 5 days according to response and as tolerated Maximum of 3 to 4 mg daily Addictive Side effects: Sedation, confusion, ataxia, fall risk (elderly especially), worsening cognitive function, tolerance, dependence

Describe acute dystonia and the treatment used ?

is a muscle cramps of head and neck, | Use: benadryl, Cogentin (benztropine mesylate)

Describe Akathisia and treatments used?

Restlessness, pacing, fidgeting | Treatment: Beta-blockers (propranolol), benzodiazepine (Ativan)

Describe Pseudoparkinsonism and treatment used?

Tremor, shuffling gait, rigidity | Treatment: Kemadrin, Cogentin

What are the troubling side effects of Tardive dyskinesia?

Early symptoms: movement of the tongue or constant lip smacking Can develop into uncontrollable biting, chewing, sucking motions, open mouth, lateral movement of the jaw Varies from mild to moderate & can be disfiguring or incapacitating No cure exist

What are the negative effects of antipsychotic medications?

Those who are nonadherent are prone to frequent relapse and candidates for long-lasting injectable formulations Usually take effects 3 to 6 weeks after regimen is started Without drug treatment 70-80% of individuals will relapse within a year Abrupt onset of the illness has a greater potential for recovery

Describe Neuroleptic Malignant Syndrome and its treatment.

Acute, life-threatening, can occur when using antipsychotic, especially early in the treatment process or if dosage levels are rapidly increased Muscle rigidity High fever Increase muscle enzymes (CPK) Increased leukocytes, it is an inflammatory response where the body rejects the medication TREATMENT: early detection, discontinuation of the antipsychotic agent

What are the assessment when a patient is experiencing schizophrenia symptoms?

``` Appearance: no hygiene, scanning, Affect: flat, distracted, paranoid, delusion, grandiose Behaviour Communication: short period of time, short sentences, repeating, allow time to response Social skills Delusions Hallucinations Orientation Memory: Short term affected Judment/Insight: consernign hospitalization Response to meds Sleep? ```

What are the nursing diagnosis for a Schizophrenic patient?

Unmet need for self-esteem Unmet need for social interaction Unmet need for rest and sleep Unmet need for safety

What are the expected outcomes for a schizophrenic patient?

Patient will be safe Patient will show improved self-esteem Patient will show effective functioning Patient will show improved communication skills Patient will comply with prescribed medications

What would the patient show if he/she has memory impairment with schizophrenia?

PAtient seek validation of the correctness of task accomplishment Patient frequently ask if it time to attend a group function or to go to an appointment Patient ask permission to make a phone call just to verify if they remember phone numbers RN should requested info, that do not cause embarrassment or decrease the person's self-worth Encourage the pt to make lists,

What would the patient show if he/she has Disturbances in attention with schizophrenia?

Patient have difficulty completing tasks Difficulty on concentrating on work Patients are easily distracted Set small goals

What would the patient show if he/she has difficulties with decision making with schizophrenia?

``` Lack insight Difficulty following through on decision Difficulty initiating task Pt logic is faulty Judment is impaired RN role: nonpunitive supportive manner, provide info clearly & concretely as possible Simple words short ```

Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia? a. Always afraid another student will steal her belongings b. An unusual interest in numbers and specific topics c. Demonstrates no interest in athletics or organized sports d. Appears more comfortable among males

b. An unusual interest in numbers and specific topics

Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia? a. Screening a group of males between the ages of 15 and 25 for early symptoms b. Forming a support group for females ages 25 to 35 who are diagnosed with substance use issues c. Providing a group for patients between the ages of 45 and 55 with information on coping skills that have proven to be effective d. Educating the parents of a group of developmentally delayed 5- to 6-year-olds on the importance of early intervention

a. Screening a group of males between the ages of 15 and 25 for early symptoms

To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated conditions? Select all that apply. a. Alcohol use disorder b. Major depressive disorder c. Stomach cancer d. Polydipsia e. Metabolic syndrome

a. Alcohol use disorder b. Major depressive disorder d. Polydipsia e. Metabolic syndrome

A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms? a. Her memory problems will likely decrease. b. Depressive episodes should be less severe. c. She will probably enjoy social interactions more. d. She should experience a reduction in hallucinations.

b. Depressive episodes should be less severe.

Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia? a. Depersonalization b. Pressured speech c. Negative symptoms d. Paranoia

d. Paranoia

Gilbert, age 19, is described by his parents as a “moody child” with an onset of odd behaviour at about age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered: a. Favourable with medication b. In the relapse stage c. Improvable with psychosocial interventions d. To have a less positive outcome

d. To have a less positive outcome

Which therapeutic communication statement might a psychiatric mental health registered nurse use when a patient’s nursing diagnosis is Altered thought processes? a. “It must be difficult to hear voices like that, though I cannot hear them.” b. “Stop listening to the voices, they are NOT real.” c. “You say you hear voices; what are they telling you?” d. “Just tell the voices to leave you alone for now.”

a. “It must be difficult to hear voices like that, though I cannot hear them.”

When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that: a. Medications provided are ineffective. b. Nurses are trying to control their minds. c. The medications will make them sick. d. They are not actually ill.

d. They are not actually ill.

Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are BP 170/100, P 110, T 40.1°C/104.2°F. What is the priority nursing intervention? a. Hold his medication and contact his prescriber. b. Wipe him with a washcloth wet with cold water or alcohol. c. Administer a medication such as benztropine IM to correct this dystonic reaction. d. Reassure him that although there is no treatment for his tardive dyskinesia, it will pass. e. Hold his medication for now and consult his prescriber when he comes to the unit later today.

a. Hold his medication and contact his prescriber.

Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas’s nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with: a. Generally good health despite the mental illness b. An aversion to drinking fluids c. Anxiety and depression d. The ability to express his needs

c. Anxiety and depression

Schizophrenia Flashcards

(51 cards)