Schizophrenia

Question 1

What is the definition of schizophrenia?

Answer 1

A severe and chronic mental disorder characterized by disturbances in perceptions, thought, and behaviour

Question 2

What is the definition of schizoaffective disorder?

Answer 2

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

Question 3

What are the different stages of schizophrenia?

Answer 3

Acute Illness
Stabilization
Maintenance and recovery
Relapse

Question 4

Acute Illness stage

Answer 4

Sleep disruption
Pacing
Talking to self
Responding to external/internal stimuli
Social withdrawal
Poverty of speech

Question 5

Stabilization stage

Answer 5

Initiation and mitigation of side effects of medication
Baseline of target symptoms
Assess for substance use

Question 6

Maintenance and recover stage

Answer 6

Adherence to medication regime or routine
Family and patient education
Looking at learning new skills so that people can cope better in the future

Question 7

What are the positive symptoms of schizophrenia?

Answer 7

Delusions (Grandiose, nihilistic, persecutory, somatic)
Hallucinations (auditory, visual, tactile, gustatory, olfactory)

Question 8

Grandiose Delusions

Answer 8

People who experience these delusions are convinced of their own greatness and importance

Question 9

Nihilistic Delusions

Answer 9

characterized by the delusional belief of being dead, decomposed or annihilated, having lost one’s own internal organs or even not existing entirely as a human being

Question 10

Persecutory Delusions

Answer 10

They strongly believe people or groups, like the government, intend to harm them

Question 11

Somatic Delusions

Answer 11

the individual believes something is wrong with part or all of their body

Question 12

Negative symptoms

Answer 12

Anhedonia – inability to experience pleasure
Alogia – reduced fluency in productivity of thought and speech
Anergia – abnormal lack of energy
Avolition – lack of motivation
Ambivalence – state of having mixed feelings or contradictory ideas about something or someone (feeling stuck)
Affective disturbances – idea of having a blunted affect (inability to demonstrate affect)
Social withdrawal

Question 13

Disorganized thinking (evident through speech)

Answer 13

Loosening of associations
Circumstantiality
Tangentiality
Thought blocking
Neologisms
Flight of ideas
Perseveration
Pressured speech
Word salad
Clang associations
Echolalia

Question 14

Disorganized thinking (delusions)

Answer 14

Delusions of control
Bizarre delusions
Religious delusions
Depersonalization
Magical thinking

Question 15

Disorganized behaviour

Answer 15

Agression
Agitation

Question 16

Biologic sources of schizophrenia

Answer 16

Genetic predisposition
Dopaminergic dysfunction
Hypofrontality
Cognitive deficits
Immune dysfunction
Neuroanatomic changes

Question 17

Social sources of schizophrenia

Answer 17

Decreased financial status
Family and caregiver stress
Homelessness
Stigma and community isolation

Question 18

Psychological sources of schizophrenia

Answer 18

Difficulties in relating
Affective blunting (decreased emotional expression)
Difficulties with decision making
Self-concept change
Decreased stress response and coping
Loss of family relationship

Question 19

Spiritual sources of schizophrenia

Answer 19

Spiritual confusion as auditory hallucinations seem from a higher power
Delusions may be religiously oriented

Question 20

DSM 5

Answer 20

Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3)
1. delusions
2. hallucinations
3. disorganized thinking
4. disorganized behaviour
5. negative symptoms

• Schizoaffective disorder, depressive disorder and bipolar disorder has been ruled out
• not attributed to drugs

Question 21

Biological assessments

Answer 21

Current and past health history
Physical functioning
Nutritional assessment
Fluid imbalance assessment
Pharmacologic assessment

Question 22

Psychological assessments

Answer 22

Assess for positive and negative symptoms (standardized scales)
Mental Status Exam
Behavioural responses
Self-concept
Stress and coping patterns
Risk assessment

Question 23

Social assessments

Answer 23

Social systems
Quality of life – their perspective on it
Family assessment

Question 24

Biological diagnoses

Answer 24

Self-care deficit
Disturbed sleep patterns
Imbalanced nutrition
Excess fluid volume
Constipation
Sexual dysfunction

Question 25

Psychological diagnoses

Answer 25

Disturbed thought processes Disturbed body image Low self-esteem Disturbed personal identity Risk for violence Ineffective coping Knowledge deficit

Question 26

Social diagnoses

Answer 26

Impaired social interactions Ineffective role performance Disabled family coping Interrupted family processes

Question 27

Biological interventions

Answer 27

Monitor medications Minimize side effects Decrease impact of movement disorders Address immune function Address nutritional status Modify cognitive deficits Address sleep

Question 28

Psychological interventions

Answer 28

Address social skills Address problem-solving skills Address self-concept Increase stress management skills Address symptom management and relapse prevention skills Address family relationships

Question 29

Social interventions

Answer 29

Promote economic stability Decrease family/caregiver stress Provide family education Maintain housing Increase social contact

Question 30

Spiritual interventions

Answer 30

Guard dignity of patient Support hope and meaning Support helpful sacred activities

Question 31

What are the different types of health care professionals involved in the recovery process?

Answer 31

The most effective treatment approach for individuals with schizophrenia involves a variety of disciplines Pharmacologic management is the responsibility of physicians, and nurses – all members of the mental health team can implement various psychological interventions

Question 32

What are side effects of antipsychotic meds?

Answer 32

Akathisia Akinesia Pseudo-parkinsonism Tardive dyskinesia NMS

Question 33

Akathisia

Answer 33

motor restlessness, inability to remain still, can also occur as a subjective feeling

Question 34

Akinesia

Answer 34

absence of movement or difficulty with movement

Question 35

Pseudo-parkinsonism

Answer 35

shuffling and slow gait; mask-like facial expressions; tremors; pill-rolling; movements of the hands; stooped posture; rigidity

Question 36

Tardive dyskinesia

Answer 36

involuntary and abnormal movements of the mouth, tongue, face, and jaw; may progress to the limbs, irreversible condition; may occur in months after discontinuation of antipsychotic medication

Question 37

Neuroleptic Malignant Syndrome

Answer 37

a potentially lethal side effect of antipsychotic medications that requires emergency treatment; manifested symtoms include: hyperthermia, muscle rigidity, tremors, change in mental state, tachycardia, hypertension, diaphoresis, incontinence, creatinine phosphokinase elevation, leukoocytosis, metabolic acidosis