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N353: Practice of Nursing II > Module 6 - Thought Disorders / Schizophrenia > Flashcards

Module 6 - Thought Disorders / Schizophrenia Flashcards

1
Q

Thought Disorders

A

Serious and persistent mental illnesses of disorganized thought and speech

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2
Q

What things characterize Thought Disorders?

A

Disturbances in:

  1. Reality Orientation
  2. Thinking
  3. Social Involvement
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3
Q

What is the most prevalent thought disorder?

A

Schizophrenia

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4
Q

Most people with mental health problems are able to …

A

think logically, even when their behaviors are maladaptive

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5
Q

Psychosis

A

the inability to recognize reality, relate to other, and cope with life’s demands

reality is distorted and disturbed for psychosis

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6
Q

What is the most common form of psychosis

A

Schizophrenia - Identified as Schizophrenia Spectrum Disorders

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7
Q

Schizophrenia

A

“Splitting Off” of thoughts from emotions - “disconnected mind”

They lose the ability to think and respond in a logical fashion - very debilitating

There is a lack of coherence in mental functioning, thinking, feeling, perceiving, behaving, and experiencing without the linkages that make mental life comprehensible and effective

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8
Q

General Signs and Symptoms of Schizophrenia

A

Disturbed thinking

Preoccupation with frightening inner experiences

Marked disturbance in affect, behavior, and social interaction

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9
Q

How is Affect, Behavior, and Social interaction markedly disturbed by Schizophrenia?

A

Affect - Flat, Inappropriate

Behavior - unpredictable, bizarre

Social Interaction - Isolation

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10
Q

Is schizophrenia a dissociative disorder?

A

No, do not confuse it with multiple personalities

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11
Q

How many Americans are afflicted with schizophrenia

A

2.5 million

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12
Q

Schizophrenia is a result of …

A

complex genetic influences interacting with environmental factors

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13
Q

What is the major symptom of Schizophrenia

A

Altered sensory perception!

  1. Physical and psychological changes that affect brain functioning, behavior patterns, and the five senses
  2. Hallucinations can occur in any of the senses
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14
Q

When do schizophrenia symptoms begin to occur?

A

symptoms emerge during late adolescence to early 20’s

Has been diagnosed as early as 5 and as late in the 40s

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15
Q

What is the incidence and prevalence of Schizophrenia like among different people?

A

All cultures, races, and social classes are impacted

Disproportionately high in low socioeconomic class

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16
Q

The earlier the schizophrenia onset …

A

the greater the problems

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17
Q

What is the most expensive chronic illness to treat?

A

Schizophrenia (55.1 billion)

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18
Q

Costs in terms of ___ and ___ cannot be measured

A

distress and suffering

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19
Q

What is the etiology of Schizophrenia?

A

EXACT CAUSE UNKNOWN, it is a potential mix of:

Abnormalities that arise early in life, could be before birth that disrupt normal brain development

psychosocial theories

genetics

unbalanced neurobiological processes and neuroanatomical structures

brain development

substance abuse/dual diagnosis

stress

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20
Q

How long must schizophrenia symptoms last for diagnosis?

A

at least 6 months

They must include at least 1 month of two or more active phase symptoms

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21
Q

What is the key hallmark of schizophrenia?

A

Lack of Insight (do not realize they have the issues or symptoms)

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22
Q

Symptoms Symptoms of Schizophrenia

A

bizarre delusions

hallucinations

disorganized speech

grossly disorganized or catatonic behavior

negative behavior

other symptoms that interfere markedly in social and occupational functioning

LACK OF INSIGHT - v common

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23
Q

Closely Related Disorders to Schizophrenia

A

Brief Psychotic Disorder

Schizophreniform Disorder

Schizoaffective Disorders

Schizotypal Personality Disorder

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24
Q

What makes a brief psychotic disorder different from schizophrenia?

A

It only lasts 1-30 days

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25
Q

Schizophreniform Disorder

A

S/S last 1-6 months. (psychotic symptoms)

It can then progress to mania or schizophrenia

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26
Q

Schizoaffective Disorder

A

presence of mood S/S of depression or mania with Schizophrenia s/s as well

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27
Q

Schizotypal Personality

A

S/S not severe enough to be classified as psychosis

DSM V now includes this within the schizophrenia spectrum

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28
Q

3 Dimensions of Psychopathology in Schizophrenia

A
  1. Disorganization
  2. Psychotic (Positive Symptoms)
  3. Negative Symptoms
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29
Q

What things are disorganized in schizophrenia?

A

speech

behavior

incongruent affect

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30
Q

What are some Psychotic symptoms/dimensions of Schizophrenia?

A

Delusions and hallucinations

Positive symptoms - distortion or excess of normal functioning - often the initial symptoms

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31
Q

What are some Negative symptoms/dimensions of Schizophrenia:

A

loss of or lack of normal functioning - tend to develop over time:

alogia

affective blunting

avolition

anhedonia

attentional impairment

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32
Q

Alogia

A

lack of speech / poverty of speech (from disrupted thought process often)

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33
Q

Avolition

A

total lack of motivation that makes it hard to get anything done

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34
Q

What are some Bizarre and Disorganized Speech/Thought Patterns in Schizophrenia

A

loos associations

perseveration

clanging

neologisms

thought blocking

distractibility

word salad

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35
Q

Loose Associations

A

Absence of normal connectedness of thoughts ideas and topics - you’ll see sudden shifts in thoughts and topics with no connection

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36
Q

Perseveration

A

Stays on one topic and it is very hard for them to come off that topic

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37
Q

Clanging

A

repetition of words or phrases that sound similar, but they may rhyme, but they do not make sense

ex: My back likes to pat a rat

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38
Q

Neologisms

A

makes up own meaning for words

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39
Q

Thought Blocking

A

common in practice

individual is awake and coherent but the thought process is not connecting

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40
Q

Word Salad

A

Random words are said with absolutely no connections

“Yellow 49 carpet yesterday”

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41
Q

What are some key components of the cognitive impairment in schizophrenia?

A

difficulty concentrating and remembering

inability to organize time and events

inability to plan

inability to problem solve

difficult focusing enough to read, watch TV or a movie

difficulty or instability to follow direction, requires frequent to constant cueing

inability to make decisions for self

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42
Q

Goals and Treatment of Schizophrenia

A

Pharmacology and Psychosocial interventions, skills training

Social support building

Continuity of care - everyone on the same page

Discharge planning - prevent revolving door

Safety

Stabilization - can be hard, need help

Client and family education

Physical care

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43
Q

What is the suicide rate like in Schizophrenia

A

high risk for suicide

10-15% succeed

50% attempt

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44
Q

What gives the highest mortality rate for schizophrenics?

A

accidents and medical illnesses

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45
Q

What kind of issues and comorbidities are common i Schizophrenia?

A

smoking

weight gain

type II diabetes

cardiac issues

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46
Q

What leads to revolving door syndrome with schizophrenia?

A

medication non compliance

substance abuse

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47
Q

What is the typical treatment for Schizophrenics

A

Traditional Antipsychotic Medications that primarily treat hallucinations and delusions

Can also use atypical antipsychotics, neuroleptics

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48
Q

Haldol

A

common traditional antipsychotic medication for schizophrenia

primarily treats hallucinations and delusions

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49
Q

What are some side effects of Traditional Antipsychotic Medications

A
  1. EPS
  2. Tardive Dyskinesias

Orthostatic Hypotension (fall worry)

Dry mouth

blurred vision

erectile dysfunction

constipation

breast enlargement

weight gain

agranulocytosis

50
Q

What is a major life threatening issue that can occur when taking traditional antipsychotic medications?

A

Neuroleptic Malignant Syndrome (NMS)

51
Q

Extrapyramidal Side Effects (EPS)

A

Akathisia

Dystonia

Chronic Motor Problems

Pseudo parkinsonian symptoms

52
Q

Tardive Dyskinesia

A

type of extra pyramidal side effect that causes involuntary irregular movements, lip smacking, neck twisting

can occur after several months to years of treatment

53
Q

The best treatment for schizophrenia is?

A

Prevention

54
Q

What to do to treat difficult SE or adverse effects of traditional antipsychotic medications

A

decrease or discontinue therapy

55
Q

Medications can be sedative in nature, so …

A

it is important to keep fall risk in mind since even young patients can fall due to this

56
Q

Neuroleptic Malignant Syndrome (NMS)

A

an emergency condition that can be induced by an antipsychotic or other neuroleptic medication

somewhat rare in practice

high safety risk

57
Q

Symptoms of NMS

A

muscle rigidity

hyperthermia

mental status changes

vital sign changes

diaphoresis

incontinence

tremors

elevated creatinine phosphokinase (CPK) labs

58
Q

How to treat NMS

A

withhold further doses of antipsychotic medication and any other anticholinergic medication and notify provider

lower temperature

maintain hydration

prepare to transfer to medical unit or ICU

59
Q

Atypical Antipsychotics for Schizophrenics

A

relieves both negative and positive symptoms

less distressing extrapyramidal side effects

60
Q

Clozapine

A

atypical antipsychotic

used for refractory schizophrenia, 30% of the total population whom are particularly prone to violence and suicide

requires regular WBC monitoring for agranulocytosis

61
Q

A life threatening condition that can occur from Atypical Antipsychotics?

A

Agranulocytosis

62
Q

S/S of Atypical Antipsychotics

A

hypotension

lowered seizure threshold (HIGHER SEIZURE INCIDENCE IN AA)

sedation

elevated liver enzymes

anxiety

constipation

weight gain (can lead to metabolic syndrome)

63
Q

What are some classifications of meds used to treat schizophrenia?

A

Traditional Antipsychotics/Neuroleptics

Atypical Antipsychotics/Neuroleptics

Medications to treat side effects and prevent side effects

64
Q

How do Neuroleptics/Antipsychotics work?

A

They block the NTs dopamine and serotonin

S/S of psychosis appear to be from excessive activity of cells sensitive to dopamine and serotonin, so we must block these sites

65
Q

Unlike with antidepressants, risk of overdose with antipsychotics is ___ …

A

low (even with large amounts)

66
Q

Assessment of the Schizophrenic client should look at ?

A

SAFETY of client and others - is there a history of violence or suicidal behavior

medical history and recent medical workup

positive, negative, cognitive, mood symptoms and insight

behavior including range emotional expressiveness, sleep, recent stressors

current meds and compliance to it

chemical dependency

family response and the support system

67
Q

Potential Nursing Diagnoses r/t Schizophrenia

A

Risk for self-directed or other-directed violence

Disturbed sensory perception

Disturbed thought processes

Impaired verbal communication

Ineffective coping

Interrupted Family Process

Social Isolation

Noncompliance with medication, treatment

68
Q

It is important to reinforce ___ with schizophrenics

A

reality

69
Q

When listening to schizophrenics speak it is important to…

A

understand language content, listen for themes and reflect back

watch their verbal and nonverbal cues

70
Q

How should one go about intervening in hallucinations with schizophrenics?

A

do not argue with them, dismiss them, or ignore them

Make it clear that its not seen or heard

do not leave the client alone

draw them into reality based activities

71
Q

The main 3 things to do when implementing care for someone with schizophrenia is…

A
  1. DEVELOP TRUST
  2. initiate interactions
  3. model behaviors
72
Q

Interventions for Acute Phase Schizophrenia

A

safety

psychiatric and medical interventions

individual and group therapy

cognitive behavioral therapy (CBT)

family education

73
Q

Interventions for Maintenance and Stabilization Phases

A

Health teaching

health promotion and maintenance

vocational rehabilitation

assertive community treatment (ACT)

intensive case management (ICM) - for housing, food, occupation

continuum of care

74
Q

Activities done in inpatient milieu therapy for schizophrenics?

A

provide support and structure

encourage development of social skills and friendships (as well as how to do ADLs)

75
Q

Safety is important with schizophrenics because there is a potential for physical violence due to …

A

hallucinations or delusions

76
Q

What priorities for safety are least to most restrictive ?

A
  1. Verbal de escalation
  2. Medications
  3. seclusion or restraints
77
Q

The most common hallucination?

A

Hearing voices

78
Q

How to act when someone schizophrenia is having a hallucination

A

Approach client in nonthreatening and nonjudgmental manner

Do not challenge delusions or hallucinations

Assess if messages are suicidal or homicidal

Initiate safety measures if needed

Client is anxious, fearful, lonely, brain not processing stimuli accurately so allow time to process information, USESHORT SIMPLE EXPLANATIONS IN CONVERSATION

79
Q

How to act when a client is having a delusion?

A

Be open, honest, matter-of-fact, and calm

Have client describe delusion

Avoid arguing about content

Interject doubt if client is able to process information

Validate the part of the delusional thoughts expressed that are real

Listen for reality based thought and steer it back toward there

80
Q

How to act in regard to loose associations?

A

Do not pretend that you understand

Look for reoccurring topics and themes

Emphasize what is going on in the client’s environment

Involve client in simple, reality-based activities

Reinforce clear communication of needs, feelings, and thoughts

81
Q

Coping Techniques to teach the Schizophrenic Client during maintenance?

A

Distraction (using external stimuli)

Interaction (avoid isolation)

Activity

Social involvement - tasks, games

Physical activity

82
Q

Things to teach and do with the client and family regarding the client’s schizophrenia?

A

Educate about the illness

Develop a relapse prevention plan (prevent decomposition)

Encourage avoidance of alcohol and drugs

Learn ways to address fears and losses

Learn new ways of coping

Comply with treatment

Maintain communication with supportive people

Stay healthy by managing illness, sleep, and diet

83
Q

What is the incidence and prevalence of suicide in the US and worldwide?

A

38,000 commit suicide annually in US, one deathe very 13.7 minutes

1 million complete suicide annually worldwide

84
Q

What gender has a higher rate for committing suicide?

A

males

4 times more likely

85
Q

What gender has a higher rate for attempting suicide?

A

Females

2-3x more likely to attempt

86
Q

What type of person has the highest suicide risk?

A

White males 85+

(LGBTQ are at a very high risk as well)

87
Q

Common comorbidities that attempt suicide?

A

severe mood disorders - particularly major depression

schizophrenia

substance abuse

borderline and antisocial personality disorders

panic disorders

88
Q

Suicide

A

act of killing oneself

89
Q

Suicidal Ideations

A

thoughts of injury or demise of self but without a plan

90
Q

Suicidal Intent

A

degree to which the person intends to act on his suicidal ideations

91
Q

Suicidal Threat

A

verbalization of an imminent self destructive action

92
Q

Suicidal Gesture (Parasuicide)

A

acts that result in little or no injury but communicate a message of suicidal intent

93
Q

Suicidal Plan

A

refers to organization of a time frame and method for killing oneself

94
Q

Self Mutilation

A

causing deliberate harm to your body without intent to commit suicide

Causes tissue damage (ex: cutting) or other types of mutilation like biting nails and/or cuticles, injurious masturbation, head banging or rocking

May use scissors, razors, knives, or other sharp objects to cut or may burn self

95
Q

Self mutilation is common in what population?

A

adolescents

96
Q

Increase in self mutilation in adolescents parallels…

A

prevalence of depression, hostility, and anxiety

97
Q

Self mutilation can be used as a …

A

coping mechanisms

to cope with despair, hopelessness, distress, low self esteem, and intense emotional states

98
Q

Direct Patterns for Killing Oneself/ Harming Oneself

A

suicide

anorexia

alcohol and substance abuse

self mutilation

99
Q

Indirect Patterns for Killing oneself/ Harming oneself

A

unsafe sexual practices

abusive relationships

dangerous sports

compulsive gambling

100
Q

Medical Conditions Associated with Suicide

A

HIV/AIDS

Cancer

Cardiovascular Disease

Cerebrovascular Disease

Chronic Renal Failure with Dialysis

Cirrhosis

Dementia

Head Injury

Multiple Sclerosis

Epilepsy

101
Q

2 Biggest Risk Factors for Suicide Attempts

A
  1. prior suicide attempts
  2. family history of suicide
102
Q

What are some risk factors for suicide?

A

Prior suicide attempts

Family history of suicide

Misuse and abuse of alcohol and other drugs

Mental disorders, particular depressions and other
mood disorders

Access to lethal means

Social isolation

Chronic disability and disease

Lack of access to behavioral health care

History of child and sexual abuse

103
Q

Environmental Risk Factors for Suicide

A

Job or financial loss

Relational or social loss

Easy access to lethal means

Local clusters of suicide that have a contagious
influence

Natural disasters

Veterans returning from war with PTSD

104
Q

Sociocultural Risk Factors for Suicide

A

Lack of social support and sense of isolation

Stigma associated with help-seeking behavior

Barriers to accessing health care, especially mental health and substance abuse treatment

Certain cultural and religious beliefs (for instance, the belief that suicide is a noble resolution of a personal dilemma)

Exposure to, including through the media, and influence of others who have died by suicide

105
Q

Mnemonic for Suicide Warning Signs

A

IS PATH WARM

106
Q

IS PATH WARM

A

Ideation
Substance Abuse

Purposelessness
Anxiety
Trapped
Hopelessness

Withdrawal
Anger
Recklessness
Mood changes

107
Q

Protective Factors against suicide

A

Effective clinical care for mental, physical and substance use disorders

Easy access to a variety of clinical interventions and support for help-seeking

Restricted access to highly lethal means of suicide

Strong connections to family and community support

Support through ongoing medical and mental health care relationships

Skills in problem solving, conflict resolution and nonviolent handling of disputes

Cultural and religious beliefs that discourage suicide and support self preservation

108
Q

ALMOST all suicidal persons…

A

send out clues

109
Q

Clues that a suicidal person may give out ?

A
  1. Overt Statements (I wish I was dead)
  2. Covert Statements (You wont have to worry about me anymore)
  3. Non Verbal Cues - sudden brightening of mood with more energy
110
Q

Asking someone if they are thinking of suicide…

A

WILL NOT GIVE THAT PERSON IDEAS

*there is a far greater risk of not assessing or asking

111
Q

When assessing the risk for suicide, always determine what things?

A
  1. Intent to die
  2. severity of ideation
  3. availability of means
  4. degree of planning
112
Q

Things to ask in order to assess lethality

A

Do you have plans for the time, place and method for suicide?

Do you own a gun or have access to firearm?

Do you have access to potentially harmful medications?

Have you imagined your funeral and how people will react to your death?

Have you “practiced” your suicide? (e.g., put the gun to your head or held the medications in your hand)?

Have you changed your will or life insurance policy or given away your possessions?

If person psychotic, assess for command hallucinations ordering him/her to kill him/her self

History of attempts

Need to complete full mental status evaluation

113
Q

Suicide Related Nursing Diagnoses

A

Risk for suicide

Powerlessness

Hopelessness

Chronic low self-esteem

Ineffective coping

114
Q

Interventions (and levels) for Suicide/Ideation

A

Primary - Prevention!!!

Secondary - Treat acute suicidal crisis

Tertiary - interventions with family and friends of those who have committed suicide

115
Q

What sort of therapy may be beneficial to a suicidal eprson

A

Milieu therapy

116
Q

What are some suicide precautions to enact?

A
  1. SAFETY comes first! Always act safely
  2. May need a staff 1:1 observation within arms reach
  3. Document verbalizations and behaviors every 15-30 minutes
  4. Carefully watch client swallow their medications
  5. No unsafe objects around the patient (sharp or dangerous objects)
  6. Remove clothing that could be used as a tourniquet (belt, stockings, etc)
117
Q

Interventions regarding Counseling of Suicidal Person

A

Commitment to treatment statement (CTS)

No-Suicide Contract

Therapeutic communication- develop rapport

Interventions for underlying disorder

118
Q

Interventions regarding Health Teaching of suicidal person

A

teach about underlying disorders they have

teach coping skills

teach appropriate expressions of anger

119
Q

Interventions for Survivors of Completed Suicide

A

Ascertain how the loss has affected them

Encourage survivors to get counseling or survivor support groups

Loss of a loved one by suicide is not the same as the loss of a loved one to a physical health problem or even an accidental death - keep that in mind

120
Q

What to evaluate regarding suicidal person outcomes

A

Development of coping alternatives

Denial of desire to commit suicide

Support system in place

121
Q

What may occur when a client does commit suicide?

A
  1. can be devastating to nurses, other health professionals, and families
  2. feelings of guilt, helplessness, inadequacy and anger are common staff and family responses
  3. family may project anger on healthcare professionals
  4. self anger and guilt for failing to prevent suicide is common

N353: Practice of Nursing II (14 decks)

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