Schizophrenia Flashcards
(154 cards)
1
Q
Who are the faces of Schizophrenia?
A
John Nash (Math professor at Princeton, Nobel Prize)
- paranoid schizophrenia “A Beautiful Mind”
Nathaniel Ayers (Julliard violinist) “The Soloist”
Elyn Saks (Law and psychiatric professor) “The Center cannot Hold: My Journey Through Madness”
- TedTalks
Ron Power: no one cares about crazy people
2
Q
Schizophrenia is diagnosed when
A
late adolescence or early adulthood
3
Q
Schizophrenia is based on a
A
spectrum or continuum of a broad range of disorders
4
Q
Is schizophrenia acute or chronic?
A
chronic
- more disabling type of mental illness
- affects how a person thinks, feels, and behaves
5
Q
The DSM-5 for Schizophrenia is
A
2+ of the following for 1-month duration
- delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behavior
- negative symptoms
6
Q
Schizophrenia Psychosis s/s
A
hallucinations
delusions - inside their head
disorganized thoughts
abnormal motor behavior
negative symptoms
7
Q
Delusions
A
images or thoughts inside the person’s mind
8
Q
Hallucinations
A
auditory, smell, tactile, see that is not there
Auditory
Voices
Somatic or tactile
Olfactory – gas, smoking
Visual
Gustatory – taste poison in their food
9
Q
What does a schizophrenia patient sound like with disorganized speech?
A
Loose associations
10
Q
Schizophrenia Psychosis is caused by
A
neurocognitive s/s impairing cognitive capacity
- deficits in perception, functioning, and social relatedness
11
Q
Primary psychosis is derived from
A
schizophrenia spectrum disorders
12
Q
Secondary Schizophrenia is derived from
A
substance intoxication and dementia
13
Q
Can Primary and secondary schizophrenia coexist?
A
yes and potentiate the other
14
Q
Schizophreniform Disorder
- duration
A
s/s must last at least 1 month but not more than 6 months
15
Q
Schizophreniform Disorder
- descriptions
A
essential features identical to those of schizophrenia but shorter duration
16
Q
Brief Psychotic Disorder
- duration
A
about a month
- returns to premorbid functioning
- precipitate by extreme stress
17
Q
Brief Psychotic Disorder
- description
A
sudden onset of psychiatric s/s
18
Q
Schizoaffective Disorder
- prognosis
A
better prognosis than schizophrenia
BUT significantly worse than a mood disorder
19
Q
Schizoaffective Disorder
- description
A
Symptoms of a mood disorder:
- major depressive, manic, or mixed episode, concurrent with symptoms that meet the criteria for schizophrenia. Common psychotic disorder
20
Q
Schizotypical Personality Disorder
- progression
A
May progress to developing schizophrenia
21
Q
Schizotypical Personality Disorder
- description
A
Personality disorder considered part of the schizophrenia spectrum disorders (DSM-5); shares common genetics and neuropsychiatric characteristics. Intense discomfort with close relationships.
22
Q
Delusional Disorder
- ranges from
A
Ranges from remission without relapse to chronic waxing and waning; symptoms must last at least 1 month
23
Q
Delusional Disorder
- description
A
Involves nonbizarre delusions such as being followed, infected, loved at a distance, or deceived by a spouse; having some great or unrecognized insight; ability to function is not markedly impaired and behavior is not obviously odd or bizarre. Delusions of persecution are the most common.
24
Q
Substance/Medication-induced Psychotic Disorder
- tx
A
psychosis usually resolves
25
Substance/Medication-induced Psychotic Disorder
- description
caused by ingestion of or withdrawal from a substance
26
Schizophrenia abrupt onset with good premorbid function has what prognosis
better prognosis and greater chance of remission/complete recovery
27
What onset of schizophrenia has a worse prognosis?
slow onset (2-3 years)
28
When schizophrenia is diagnosed as an early age of onset, what can occur?
structural brain abnormalities
more negative and disabling s/s
poorer progonosis
29
What age do men usually get schizophrenia?
18-25
30
What age do females usually get schizophrenia?
25-35
31
What is the comorbidity of schizophrenia?
50% substance use and 50% tobacco use disorder
32
What types of substances are usually used with schizophrenia
cannabis and psychotic disorders strong correlation
- Meth and LSD
33
Schizophrenia increases the abuse of what drug?
Cannabis
34
Why do most schizophrenic patients die prematurely?
non-psychiatric illnesses
- malnutrition
- insomnia
- criminal activity
- medication adverse effects not reported
- cooccurring disorders
35
What is co-occurring with schizophrenia?
Depressive disorders
20% attempt suicide
6-10% commit suicide
Anxiety/panic disorders
Obsessive-compulsive disorders
Schizotypal and paranoid personality disorder may develop into schizophrenia
36
Schizophrenia has what Type of duration
Recurrent acute exacerbations of psychosis
Periods of full or partial remission
37
Schizophrenia Primary Interventions
target people at high risk or see the start of the s/s
38
Schizophrenia Secondary Interventions
intervening early and reducing the duration of untx dx
39
Schizophrenia Phases
Prodromal
Acute
Stabilization
Maintenance
40
Schizo Prodromal Phase
80-90%
- early recognition and tx vital
- usually ignore s/s
41
Acute Phase of Schizophrenia
severe well developed s/s (positive, negative, neurocognitive, mood)
42
Maintenance Phase of Schizophrenia
What to keep in as long as possible
43
Risk Factors of Schizophrenia
Genetic factors
Alteration in brain structure
Brain’s neurotransmitter system disruptions
Alterations to neural circuits
44
Neurochemical Contributing Factors of Schizophrenia
**Hyperactive dopamine transmission in the mesolimbic areas
Hypoactive dopamine transmission in the prefrontal cortex**
Dysregulation in multiple other areas of the brain
Abnormal levels of serotonin may cause some of the negative and mood symptoms
NMDA (N-methyl-D-aspartate) an amino acid is implicated in the psychotic, negative and cognitive symptoms
Glutamate activity insufficiency or excess with other neurotransmitters
45
genetic Contributing Factors of Schizophrenia
One parent with schizophrenia leads to 5-6% chance
Both parents 46% chance
Group of 8 genetically different types of schizophrenia
Synaptic pruning, gene C-4
46
Neuroanatomical Factors of Schizophrenia
Decrease in both gray and white matter especially in the frontal lobe
Decrease brain volume
Larger lateral and third ventricles
Atrophy in the frontal lobe
More cerebral spinal fluid
Lower rate of blood flow and glucose metabolism in the prefrontal cortex
47
Non-genetic Factors of Schizophrenia
Viral infection affecting neurogenesis – in pregnancy
Poor maternal nutrition
Exposure to **toxins**
Perinatal complications and **birth injuries**
Closed head injuries after birth
Advanced paternal age
Overactive Immune system
First and second-generation immigrants - stress
Stress
48
Synaptic pruning
brain cuts back on neurons in adolescents
49
Cultural considerations for schizophrenia
**Rural Africans** may hallucinate about ancestor worship
**Christians** may hallucinate about Christ, Mary, Satan
- **possessions
- punishment from God**
Patients in US may report auditory hallucinations of **violent commands**
- religious, **supernatural** or biomedical
50
Sources of schizophrenia for cultures
Attributed to spiritual versus religious or supernatural, or biomedical
Can affect adherence to medication and other treatment
Hearing Voices Network believes it may be possible to improve relationship with voices by respecting, understanding and adapting to the voices
51
Secondary causes if psychosis
Brain Tumors
Cysts
Dementia
Neurological Diseases
Environmental Toxins
Misuse of and addictions of prescription meds
52
Positive symptoms of Schizophrenia
hallucinations
delusions
bizarre behavior
catatonia
formal thought disorder
53
Negative symptoms of Schizophrenia
apathy
lack of motivation
anhedonia
blunted or flat affect
Poverty and speech
social withdrawal
54
Cognitive symptoms of Schizophrenia
inpaired memory
disruption in social learning
inability to reason, solve problems, and focus attention
55
Mood symptoms of Schizophrenia
depression
anxiety
demoralization
suicidality
excitability
agitation
dysphoria
postpsychotic depressive disorder
demoralization
increase substance use
56
Different types of delusional alternatives in thinking
Mind Reading
Somatic
Ideas of reference
Persecution
Grandiose
Religious
- Jealousy
Control
Thought broadcasting
Thought insertion
Thought withdrawal
57
Mind Reading -
read other minds or others can read their mind
58
Somatic Thinking
false believe the body is changing in an unusual way – little men inside of them, new limb, nose disappears
59
Ideas of reference
misinterpret normal day to day events - 2 people talking and they are plotting to hurt him
60
Persecution
plot of being singled out by others – poisoned, followed
61
Gradiose - Religious
they are some very important and powerful (Jesus, devil, married to an important person)
62
Jealousy
think they are being cheated on but there is no reality proof
63
Control Thinking
being controlled by an outside person or organization (agency)
64
Thought Broadcasting
personal thoughts are heard by others and control the thoughts of others
65
Thought insertion
people are putting thoughts in their heads
66
Thought withdrawal
people are erasing their thoughts
67
Concrete Thinking
only see words at face value
68
Associative Looseness
flight of ideas
- can not tie thoughts together
- start with one thought and move to another thought at the end
69
Tangential:
train of thought wonders off and never returns
70
Clanging:
meaningless rhyming or sound alike words
- tik tak, click clank, monster track
71
Neologisms:
made-up words
72
Echolalia:
repeating words
73
Word Salad:
mix of meaningless words
- Kamala do not form one complete thought
74
Circumstantiality:
excessive detail. Cannot separate relevant from irrelevant.
75
Pressured speech:
talking fasT
- OTHER PEOPLE cannot say anything
76
Thought blocking:
Patient stops talking in the middle of a sentence and remains silent
- they can not complete their thought
77
Illusions
misinterpretation of real experiences
78
Schizophrenic patients have trouble with personal boundaries because of
Lack of Sense Where Bodies End and Other’s Begin
**Depersonalization
Derealization**
79
Depersonalization –
loss of identity and the body parts are not theirs
80
Derealization –
the environment is different
- larger or smaller than they really are
81
What are the alterations in behavior for schizophrenia patients?
Catatonia
Bizarre behavior
Eccentric dress, grooming, rituals
Agitation or aggressiveness
Impaired boundaries
Impaired impulse control
Odd social or sexual behavior
82
Catatonia –
no mvmt or slow mvmt, to very active strange mvmt (weird posture)
83
Impaired impulse control –
can not stop themselves from experiencing (throat punch)
84
Odd social or sexual behavior –
take off clothes, inappropriate sexual behavior in front of others and do not stop
85
If a person has schizophrenia and starts undressing in the main room, what should the nurse do?
get a blanket and redirect to the room
86
Catatonia consists of
Extreme motor agitation or extreme psychomotor retardation
Stereotyped behaviors
Automatic obedience
**Bizarre posturing
Waxy flexibility – strange posturing**
Negativism
Stupor – do not respond and look like they don’t understand
87
Poverty of speech is aka
alogia
88
Anhedonia
loss of pleasure
89
Asociality
few relationships and no social and don’t mingle with people
90
Avolution
no motivation and will not take care of themselves
91
Neurocognitive/Cognitive Symptoms of schizophrenia
40-60% of people
-**poor executive functioning**
- inability to sustain attention - slow calculations
- problems with working memory
- **inability to reason
- inability to problem solving**
- can not learn new things
92
Postpsychotic depressive disorder
- aware of their illness and become depressed
- deterioration and hopeless
93
Demoralization
disheartened loss of confidence, enthusiasm, and hope
94
Excitability
capable of being readily roused into action
state of excitement or irritability
95
Paranoia Communication
projection
**Speak indirectly. Do not use I and you. Use he or she, directing paranoid symptoms toward external and more general issues**
Identify with the patient, helping patient feel understood. Empathize.
**Share mistrust without supporting delusion. Find something to agree on with patient**
96
Disorganized S/S for Schizophrenia
Poor premorbid functioning – before dx the s/s are bad
Poor prognoses
Social withdraw
Severe cognitive impairment
Require structured and well supervised setting
97
When the schizophrenia patient has delusions and hallucinations, then the nurse would
support the person but not the delusions
98
Schizoaffective Disorder s/s either of
bipolar or major depression
99
With a schizoaffective disorder tx is
treat psychosis and the mood disorder
100
The nurse needs to assess what in schizophrenia patients
Suicide risk (harm to self)
Risk of violence (harm to others)
Command hallucinations
Delusions
Substance use/abuse
Medical workup
Co-occurring disorders: depression, anxiety
Self care and safety
Medication use and adherence
Positive & negative symptoms
Patient’s insight & coping
Support system - need a good one but might have burned those bridges and pushed away family
101
Standardized Screening Tools for Schizophrenia
BPRS –
PANSS –
**AIMS – **
MMSE -
102
Most of the screening tolls for schizophrenia patients are used for physicians, which one used by nurses?
AIMS - see for s/s – abnormal of involuntary mvmts from the medications LIKE TARDIVE DYSKINESIA
103
Nursing Dx for Schizophrenia patients
Risk for self-directed/other-directed violence
Ineffective impulse control
Social isolation
Distorted thinking process
Impaired verbal communication
Impaired family coping
Self care deficit
Difficulty coping
Risk for suicide
Ineffective health maintenance
104
Planning for Schizophrenia patient's order
crisis hospitalization
observe
stabilization
teach relapse prevention
D/C planning
105
Implementation of Schizophrenia
psychopharmacology
milieu
establish trusting relationship
- positive reinforcement
therapeutic communication
health teaching and promotion
- educate frequently and repeated
social services
106
Communication for a Schizophrenia Pt
**Be cautious with touch as it may be perceived as threatening**
Use **calm, quiet tone** of voice
**Elicit description of hallucination/delusions to ensure safety**
**Don’t confront or argue truth/falsehood of their ideas**
Help present and maintain **reality **
Focus on** feelings**
Deal with inappropriate behaviors in non-judgmental manner
**Teach** social skills through education, role-modeling, and practice
107
If a schizophrenia patient is having delusions, what should the nurse ask before going forward?
type of delusions
- when stable give teachings and social skills by role modeling
108
Patients who are highly suspicious & hostile: the nurse should
Allow patient as much control as possible within limits, explain treatments, meds, lab tests before initiating them
Might see as a threat
109
Patients who are aggressive & agitated: the nurse should
increase supervision, decrease stimulus, de-escalate verbally, offer medication
110
Patients with hallucinations/delusions: the nurse should
Ask directly, “Are you hearing voices?” “What are they saying?” Reduce stimulus. Focus on feelings and reality, not delusions
111
Hallucinations nursing interventions
Empathy
Identify the feelings patient is experiencing
**Explain you do not hear voice – do not argue, but validate they do hear them**
Ask the patient to turn away from the voices
**Distract attention
Calm demeanor and milieu**
112
Delusions nursing interventions
Same as hallucination except:
Do not touch patient and use gestures carefully
Do not argue with the patient’s beliefs
113
Paranoia Interventions
Place yourself beside the patient, not face to face
Avoid eye contact
**Offer foods and drinks in closed containers – avoid poisoning**
Distraction with reality-based activities
Use restrictive interventions if anxiety escalates
**avoid confrontation and be at a degree angle and not to look at them for a long time**
114
Associative Looseness Intervention
Do not pretend you understand the patient's communication
**State “I am having difficult understanding” or
State “I am having trouble following what you are saying”**
Piece together what they are saying by looking for recurring topics
Involve patient in **simple reality-based activities**
115
Teach the patients and family about what in schizophrenia
Illness (causes, self-care)
Medication side effects, management and follow-up
Early signs of relapse & develop a prevention plan
Avoiding alcohol and drugs
Building support system
Community resource
116
Recovery Model and Recovery Oriented Care
Anyone can recover and manage their condition successfully
Health
Home
Purpose
Community
117
Recovery after initial schizophrenia episode project
Medication
Psychosocial therapy
Case management
Family involvement
Supportive education
Employment services
118
Psychotherapy and Psychoeducation for Schizophrenia
PACT
ACT
Family Psychoeducation Therapy – engages family, improves caregivers' positive well-being and reduce burden of care.
Cognitive Behavioral Therapy – correct self-defeating behavior – correct how they see things
Cognitive Remediation – improve cognitive skill such as memory, attention
Social Skills Training
119
Family Psychoeducation Therapy –
engages family, improves caregivers' positive well-being and reduce burden of care.
120
Cognitive Behavioral Therapy –
correct self-defeating behavior – correct how they see things
121
Cognitive Remediation –
improve cognitive skill such as memory, attention
122
Therapy of Schizophrenia aims to
- in community, prevents relaspee, reduce hospital, improve quality of life, and med adherence, no criminal activity and out of jail
123
Typical (Conventional or first-generation) Antipsychotics (FGA)
Target + Symptoms
Dopamine (D2) receptor antagonist
Greater risk of EPS symptoms
124
What pharmacology is used for schizophrenia
Antipsychotics (1st and 2nd gen)
125
Atypical (second-generation) Antipsychotics (SGA)
Target + and – symptoms
Serotonin-dopamine antagonists
Higher risk of metabolic syndrome; lower risk of EPS
More costly
126
Typical (Conventional or first-generation) Antipsychotics medication types
Haloperidol (Haldol)
Chlorpromazine (Thorazine)
Trifluoperazine (Stelazine)
Thiothixene (Navane)
Fluphenazine (Prolixin)
Thioridazine (Mellaril) (***QT prolongation)
Loxapine (Loxitane)
Perphenazine (Trilafon)
127
What 1st gen antipsychotic can cause QT prolongation?
Thioridazine
128
Typical Antipsychotics Black box warnings
Not approved for dementia-related psychosis
129
Typical antipsychotic side effects
**anticholinergic effects**
wt gain
sexual or reproductive organ issues
**increased prolactin levels
seizures
sedation**
agranulocytosis
NMS
cardiac events
**EPS**
drug-induced liver disease
130
Agranulocytosis
decrease in WBCs
131
EPS
akathesia - restless msucles
pseudoparkinsonism- shuffling and rigidity
acute dystonia torticollis
132
Torticollis is treated
Treat right away as it can cause aspiration when eating
-IM Benadryl is used for tx
133
Tardive Dyskinesia
Serious and **irreversible** EPS side effect after prolonged treatment that consists of involuntary tonic muscle spasms involving the face, lips, tongue, trunk, and extremities.
134
Tardive Dyskinesia symptoms
may subside after meds are discontinued or may be permanent.
135
Anticholinergic effects
Red as a beet – flushed
Dry as a bone – everything dries up
Blind as a bat – blurry visiosn
Hot as a hare – increase temp
Full as a flask – difficulty urinating
136
Atypical (2nd generation)Antipsychotics medications
Clozapine (Clozaril) (***agranulocytosis) – wt gain
Risperidone (Risperdal)
Olanzapine (Zyprexa) - wt gain
Quetiapine (Seroquel) -
Ziprasidone (Geodon) (***QT prolongation)
Less for wt gain
Paliperidone (Invega)
Lurasidone (Latuda)
Iloperidone (Fanapt)
Cariprazine (Vraylar)(considered 3rd generation by some sources)
Aripiprazole (Abilify) (considered 3rd generation by some sources)
Less for wt gain
137
Atypical antipsychotics have wt gains
Clonzapine
Olanzapine
138
Atypical antipsychotics have less wt gain
Zisperadone
Aripiprazole
139
Atypical antipsychotics have what agranulocytosis
Clozapine
140
Atypical antipsychotics have what QT Prolongation
Ziprasidrone
141
Black box warning for Atypical antipsychotics
Not approved for dementia-related psychosis
142
2nd gen antipsychotics side effects
anticholinergics
EPS less common
gynecomastia
seizures
**NMS
metabolic syndrome**
sedation
sexual problems
cardiac events
143
Metabolic syndrome
Cluster of conditions that ↑ risk for heart disease, diabetes, stroke. Dx with 3 or more of the following:
Obesity: **excess weight**, ↑ BMI, **↑ abdominal girth
↑ B/P
High blood sugar level
High cholesterol: Triglyceride** at least 150mg/dL, HDL less than 40mg/dL (women) & 50mg/dL (men)
144
Long-acting Antipsychotics - Depot medication types
Haloperidol decanoate (Haldol)
Fluphenazine decanoate (Prolixin)
Risperadone (Risperdal Consta)
Paliperidone palmitate (Invega Sustenna)
Olanzapine pamoate (Zyprexa Relprevv)
145
Why are depot shots given for schiophrenia patients
noncomplicance
146
AIMS is the
Abnormal involuntary movement scale (AIMS): **assessment screen for tardive dyskinesia**
When should this be used?
Rates movement of facial/oral, extremities, and trunk) on a scale of 0-4
147
NMS frequency increases with
high potency antipsychotics and cognitive impairment (stroke, dementia, etc)
148
NMS is an
emergency
149
NMS s/s
low consciousness, muscular rigidity, ↑ muscle enzymes, hyperpyrexia (103 or above), hypertension, tachycardia, tachypnea, diaphoresis, drooling.
150
NMS Tx
admit, stop the drug, antipyretics **Dantrolene - spasms** and IV fluids, for muscle spasms,TX OTHER COMPLICATIONS
151
Memory TOOL for NMS
Fever >103F
Elevated CPK/WBC
Vital sign instability (autonomic instability)
Fluctuating BP, pallor, tachycardia
Sweating, salivation, tremors, incontinence
Encephalopathy
Confusion, altered level of consciousness
Rigidity muscle
152
Antiparkinson Drugs
Trihexyphenidyl (Artane)
**Benztropine (Cogentin)
Diphenhydramine (Benadryl)**
Biperiden (Akineton)
153
Evaulation for Schizophrenia effectiveness
Have symptoms lessoned? Why or why not?
Is the patient taking medications? If not, why?
Explore issues with nonadherence.
Are the family involved? Do they understand the disease and treatment?
Are the patient and family aware of relapse issues?
Are the patient and family utilizing community resources available to them?
Promote recovery model focusing on patient’s goals and strengths
154
Self-Awareness Issues with Schizophrenia
Challenges: A patient who is psychotic may be intensely anxious, fearful, or agitated and can evoke strong emotions in caregivers
May experience fear, anxiety, avoidance
Frustration if patient nonadherent
Need not take patient’s success or failure personally
Focus on patient’s strengths, time out of hospital
No nurse has all answers
