Schizophrenia

Question 1

onset

Answer 1

abrupt or insidious
most with slow, gradual development of signs and symptoms

Question 2

immediate course of schizophrenia (2 patterns)

Answer 2

1. ongoing psychosis, never fully recovering
2. episodes of psychotic symptoms alternative episodes of relatively complete recover

Question 3

long-term course of schizophrenia

Answer 3

-intensity of psychosis diminishes with age
-most with difficulty functioning
-few with ability to live fully independent lives

Question 4

what is psychosis often replaced with as people with schizophrenia age?

Answer 4

dementia

Question 5

positive symptoms (adding something)

Answer 5

-delusions
-hallucinations
-disorganized speech
-bizarre behavior

Question 6

negative symptoms (lacking something)

Answer 6

-flattened affect
-reduced speech
-lack of initiative
-poverty of thought (logia)

Question 7

cognitive symptoms

Answer 7

-inattention, easily distracted
-impaired memory
-poor problem-solving skills
-poor decision-making skills
-illogical thinking
-impaired judgement

Question 8

biological factors that contribute to schizophrenia

Answer 8

-genetic (multiple genes)
-brain structure abnormalities (larger later and 3rd ventricles, low rate of blood flow & glucose metabolism)
-neurobiology theories

Question 9

neurotransmitters affecting schizophrenia

Answer 9

-dopamine
-serotonin
-glutamate

Question 10

environmental factors contributing to schizophrenia

Answer 10

-immunovirologic factors (viral exposure
-research focusing on infections in pregnant women as a possible origin

Question 11

cultural considerations

Answer 11

-ideas considered delusional in one culture possibly commonly accepted by other cultures
-auditory or visual hallucinations as normal part of religious experiences in some cultures
-culture-bound syndromes
-ethnic differences in response to psychotropic medications

Question 12

most common type of hallucination

Answer 12

auditory

Question 13

command hallucination

Answer 13

tells a person to do something

Question 14

hallucination

Answer 14

false sensory perceptions

Question 15

delusions

Answer 15

false, fixed beliefs

Question 16

neologisms

Answer 16

made up words

Question 17

echolalia

Answer 17

repetition of words of another

Question 18

echopraxia

Answer 18

mimicking movement of another

Question 19

clang association

Answer 19

meaningless rhyming of words

Question 20

word salad

Answer 20

jumble of words together without meaning

Question 21

depersonalization

Answer 21

feeling that person is unreal

Question 22

derealization

Answer 22

feeling that environment has changed

Question 23

bizarre behaviors

Answer 23

extreme motor agitation
stereotypes behaviors
automatic obedience
waxy flexibility
stupor
negativism

Question 24

flat affect

Answer 24

no emotion displayed

Question 25

inappropriate affect

Answer 25

emotional response incongruent to situation

Question 26

blunted affect

Answer 26

minimal emotional response

Question 27

bizarre affect

Answer 27

grimacing, giggling, mumbling

Question 28

nursing process - assessment

Answer 28

-History: previous history of schizophrenia; previous suicidal ideation; current support system; patient's perception of current situation -General appearance, motor behavior, speech (odd, bizarre; catatonia; echopraxia, psychomotor retardation, word salad, echolalia)

Question 29

nursing process - outcome identification

Answer 29

-focus on safety of patients and others -stabilize patient's thought process -reality orientation

Question 30

nursing process - interventions

Answer 30

-safety of patient, others -therapeutic relationship, therapeutic communication -interventions for delusional thoughts (focus on reality; no confrontation reinforcement) -interventions for hallucinations -management of socially inappropriate behavior

Question 31

keys that a patient might be hallucinating

Answer 31

darting eyes, tilted head, mumbling to self

Question 32

communication of client dealing with hallucinations and delusions

Answer 32

-approach client in nonthreatening and nonjudgmental manner -identify feelings client is experiencing -clarify reality of client's experience -avoid arguing/attempt to reason with client who is delusional -interact with client about concrete reality -distract client's attention from hallucinations and delusions

Question 33

communication of client who is paranoid

Answer 33

-be honest and consistent -avoid talking, laughing, whispering when client cannot hear what is being said

Question 34

communication of client who is dealing with associative looseness

Answer 34

-do not pretend to understand client's communications when you do not -tell client you are having difficulty understanding -look for recurring topics or themes -emphasize what is going on in the "here and now"

Question 35

best intervention to use with client who is having auditory hallucination

Answer 35

ask the patient, "Can you tell me what you're hearing?"

Question 36

conventional antipsychotics

Answer 36

-targeting positive symptoms -no observable effects on negative symptoms -prototypes: Haloperidol & Chlorpromazine

Question 37

atypical antipsychotics

Answer 37

-diminish positive symptoms -lessen negative symptoms -prototype: Clozapine

Question 38

when is clozapine used?

Answer 38

in severe situations

Question 39

Chlorpromazine

Answer 39

-first modern antipsychotic

Question 40

Chlorpromazine adverse effects

Answer 40

-orthostatic hypotension -sedation -anticholinergic effects

Question 41

Haloperidol adverse effects

Answer 41

EPS sedation

Question 42

medication side effects

Answer 42

-EPS (more common with conventional antipsychotics) -acute dystonic reactions (spasms) -akathisia (restlessness, pacing) -pesudoparkinsonism -tardive dyskinex=sia seizures -neuroleptic malignant syndrome

Question 43

neuroleptic malignant syndrome

Answer 43

-rare but serious reaction -sweating, rigidity, sudden high fever, autonomic instability, diaphoresis, deterioration of mental status -risk of death without treatment (stop drug) -monitoru V/S, I/Os, Parkinsonian symptoms -may be prescribed bromocriptine or dantrolene

Question 44

clozapine adverse effects

Answer 44

agranulocytosis (significant risk); neutropenia -seizures -diabetes -weight gain -myocarditis -effects in older adults patients with dementia

Question 45

monitoring clozapine protocol

Answer 45

-BP & pulse -signs of EPS & NMS -assess FBS, lipids, & BMI -weekly WBCs for first 6 months of treatment