Schizophrenia

Question 1

Schizophrenia and other Psychotic Disorders

Answer 1

Given the insidious onset of schizophrenia and the length of time it takes to effectively treat the disorder, it is helpful to be aware of the phases of illness and recognize that treatment occurs across the continuum of care - health promotion and illness prevention, acute care, community care, and tertiary care, in the context of a multidisciplinary team

Question 2

Positive Symptoms

Answer 2

reflect an excess or distortion of normal functions, including delusions and hallucinations
Delusions
Hallucinations

Question 3

Delusions

Question 4

Negative Symptoms

Answer 4

reflect a lessening or loss of normal functions, such as restriction or flattening in the range and intensity of emotion, reduced fluency and productivity of thought and speech, withdrawal and inability to initiate and persist in goal-directed activity, and inability to experience pleasure
- Affective disturbances
- Alogia
- Ambivalence
- Anhedonia
- Avolition
- Apathy
- Social withdrawal

Question 5

Affective flattening or blunting

Answer 5

Restriction or flattening in the range and intensity of emotions

Question 6

Alogia

Answer 6

reduced fluency and productivity of thought and speech. Brief. empty verbal responses; often referred to as poverty of speech.

Question 7

Anhedonia

Answer 7

inability to experience pleasure or gain pleasure from experiences.

Question 8

Ambivalence

Answer 8

presences of two opposing forces, leading to inaction. mixed feelings.

Question 9

Avolition

Answer 9

• inability to complete projects, assignments, or work
• inability to initiate and persist in goal-directed activity

Question 10

Apathy

Answer 10

Reactions to stimuli that are decreased, along wth a diminished interest and desire

Question 11

Hallucinations

Answer 11

• perceptual experiences that occur without actual external sensory stimuli
• Can involve any of the five senses (auditory, visual, olfactory, gustatory, tactile, and somatic, but visual and auditory are more common. auditory hallucinations are more common than visual

Question 12

Delusions

Answer 12

fixed false beliefs that usually involve a misinterpretation of experience. ex. patients believe someone is reading their thoughts or plotting against them.

Question 13

Gradiose Delusions

Answer 13

the belief that one has exceptional powers, wealth, skill, influence, or destiny

Question 14

Nihilistic Delusions

Answer 14

the belief that one is dead or a calamity is impending

Question 15

Persecutory Delusions

Answer 15

the belief that one is being watched, ridiculed, harmed or plotted against

Question 16

Somatic Delusions

Answer 16

beliefs about abnormalities in bodily functions or structures

Question 17

Neurocognitive Impairment

Answer 17

neurocognitive impairment in memory, vigilance, and executive functioning is related to poor functional outcome in schizophrenia
- neurocognition includes short- and long-term memory, vigilance or sustained attention, verbal fluency or the ability to generate new worlds, and executive functioning.
- Long-term memory and intellectual functioning are not necessarily affected.
- symptoms may have interfered with completing educational opportunities.
- often manifested in disorganized symptoms

Question 18

Disorganized symptoms

Answer 18

these symptoms of schizophrenia are those things that make it difficult for the person to understand and respond to the ordinary sights and sounds of daily living. These include disorganized speech and thinking and disorganized behaviour

Question 19

Disorganized thinking

Answer 19

• often create oversensitivity to colours, shapes, and background activities
• illusions (disorganized perceptions that create an oversensitivity to colours, shapes, and background activities, which occur when the person misperceives or exaggerates stimuli in the external environment
• symptoms that may accompany schizophrenia include anxiety, depression, irritability, and hostility

Question 20

Disorganized Behaviour

Answer 20

Disorganized behaviour (which may manifest as a very slow, rhythmic, or ritualistic movement), coupled with disorganized speech, makes it difficult for someone with schizo to partake in daily activities.
- Aggression
- Agitation
- Catatonic excitement (a hyperactivity characterized by purposeless activities and abnormal movements such as grimacing and posturing)
- Echopraxia (involuntary imitation of another person’s movements and gestures)
- Regressed behaviour (behaving in a manner of a less mature life stage; childlike and immature)
- Stereotype (repetitive, purposeless movements that are idiosyncratic to the individual and to some degree outside of the individuals control)
- Hypervigilance (sustained attention to external stimuli as if expecting something important or frightening to happen)
- Waxy flexibility (posture held in odd or unusual fixed positions for extended periods of time)

Question 21

Extrapyramidal side effects (EPS)

Answer 21

• Parkinsonism or pseudoparkinsonism (resting tremor, rigidity, bradykinesia/akinesia, masklike face, shuffling gait and decreased arm swing)
• Acute dystonia (Intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk and extremities)
• Akathisia (obvious motor restlessness evidenced by pacing, rocking, and shifting from foot to foot; subjective sense of not being able to sit or be still; these symptoms may occur together or separately)
• Tardive dyskinesia (abnormal dyskinetic movements of the face, mouth, and jaw; choreoathetoid movements of the legs, arms and trunk)
• Tardive dystonia (persistent sustained abnormal postures in the face, eyes, tongue, neck, trunk, and limbs)
• Tardive akathsia (persisting, unabating sense of subjective and objective restlessness)

Question 22

Definition: Schizophrenia

Answer 22

schizophrenia is a severe and chronic mental disorder characterized by disturbances in perceptions, thought, and behaviour

Question 23

Definition: Schizoaffective disorder

Answer 23

a complex and persistent psychiatric disorder with varying degrees of symptoms of both schizophrenia and mood disorders

Question 24

Aetiologies/Theories: Spiritual

Answer 24

1. spiritual confusion as auditory hallucinations seem from a higher power
2. delusions may be religious in content

Question 25

Aetiologies/Theories: Biologic

Answer 25

1. Genetic predisposition 2. dopaminergic dysfunction 3. Hyperfrontality 4. Cognitive deficits 5. Immune dysfunction 6. Neuroanatomic changes

Question 26

Aetiologies/Theories: Psychological

Answer 26

1. difficulties in relaxing 2. affective blunting (decreased emotional expression) 3. Difficulties with decision making 4. self-concept changes 5. decreased stress response and coping 6. loss of family relationships

Question 27

Aetiologies/Theories: Social

Answer 27

1. Decreased financial status 2. family and caregiver stress 3. Homelessness 4. Stigma and community isolation

Question 28

Disorganized Thinking: Alterations in thought processes evident through speech

Answer 28

- Loosening of associations - circumstantiality - tangentiality - thought blocking - neologisms - flight of ideas - perseveration - pressured speech - word salad - clang associations - Echolalia

Question 29

Disorganized thinking

Answer 29

delusions of control bizzare delusions religious delusions depersonalization magical thinking

Question 30

Disorganized behaviour

Answer 30

aggression agitation

Question 31

Nursing Assessment: Biological domain

Answer 31

- current & past health history - physical functioning - nutritional assessment - fluid imbalance assessment - pharmacologic assessment

Question 32

Nursing Diagnosis: Biological Domain

Answer 32

- self care deficit - disturbed sleep patterns - excessive fluid volume - imbalanced nutrition - constipation - sexual dysfunction

Question 33

Nursing Assessments: Psychological Domain

Answer 33

- assess for positive and negative symptoms (Standardized scales) - MSE - Behavioural responses - Self-concept - Stress & coping patterns - Risk assessment

Question 34

Nursing Diagnosis: Psychological Domain

Answer 34

- disturbed thought processes - disturbed sensory perception - Disturbed body image - Low self- esteem - Disturbed personal identity - Risk for violene - Knowledge deficit - Ineffective coping

Question 35

Nursing Assessment & Diagnosis: Social Domain

Answer 35

- social systems - quality of life - family assessment - impaired social interactions - ineffective role performance - disabled family coping - interrupted family processes

Question 36

Treatment

Answer 36

most effective treatment approach for individual with schizophrenia involves a variety of disciplines... pharmacologic management is the responsibility of physicians and nurses; all the members of the mental health team can implement various psychosocial interventions

Question 37

Side Effects of Antipsychotic Medications - EPS

Answer 37

- Akathisia - Akinesia - Dystonia - Pseudo-parkinsonism - - Tradive dyskinesia - Neuroleptic Malignant Syndrome - Metabolic Syndrome