Flashcards in Schizophrenia Deck (56):
A devastating brain disease that affects a person’s thinking, language, emotions, social behavior, & ability to perceive reality.
Early onset of schizophrenia:
B) occurs more in
A) 18-25 y/o
late onset of schizophrenia:
B) occurs more in
A) 25-35 y/o
higher prevalence occurs in?
Males and those living in urban areas
Schizophrenia results from?
a combination of inherited genetic factors and extreme nongenetic birth factors.
Bleuler’s fundamental signs of schizophrenia (THE FOUR A’S)?
- Affect: Flat, blunted, inappropriate affect.
- Associative looseness: disorganized thinking
- Autistic thinking (delusions, hallucinations)
- Ambivalence - holding on to opposing positions on a subject or person (love & hate someone)
Two or more of the following symptoms during 1 month is needed for a diagnosis of schizophrenia?
- disorganized speech
- grossly disorganized or catatonic behavior
- negative symptoms (i.e. affective flattening, avolition, alogia)
Criteria needed for a diagnosis of schizophrenia?
- Two or more symptoms during a 1 month period
- One or more major areas are markedly below premorbid functioning
- Signs persist for at least 6 months
- R/O Mental diseases & medical conditions
Phases of Schizophrenia?
- Acute phase
Positive Symptoms of Schizophrenia?
.Persecution, Grandiosity, Control, and Thought broadcasting, insertion and withdrawal are examples of ?
The inability to think abstractly?
made up words that hold meaning to the patient, but not to others?
pathological repeating of ones words?
choice of words base on sound?
meaningless repetition or imitation of the movements of others
a confused or unintelligible mixture of seemingly random words and phrases
perceiving a sensory experience when none exists (i.e. hearing voices)
- person has lost their identify
- may believe a body part does not belong to them
a feeling that one's surroundings are not real
the persistent repetition of an act, especially by an animal, for no obvious purpose.
performance of all simple commands in a robot like manner
patient continues to hold arm that is raised by the nurse, seen in catatonia?
Negative Symptoms of Schizoprenia?
poverty of speech
inability to experience pleasure or joy
loss of motivation
Cognitive Symptoms of Schizo?
Difficulty with attention, memory, and executive functions (i.e., decision making and problem solving
Nursing Assessment for Schizo?
- Determine if patient has had a medical work-up.
- Assess for co-occuring disorders such as drug abuse.
- Assess risk (suicide or harmful to others).
- Assess for positive and negative symptoms.
- Assess medications
Acute Phase Interventions?
Patient safety and medical stabilization
Goal of Phase II Interventions (Stabilization)
adhere to medication regimens, understand schizophenia, & participate in available psychoeducational activities.
Goal of Phase III Interventions (Maintenance )
Target negative symptoms and participation in social, vocational, and skills training
Strategies for communicating with patient who is hallucinating:
- Watch client for cues.
- Ask pt. directly about hallucinations.
- Focus on reality-based diversions and topics.
- Be alert for signs of anxiety.
- Thought stopping and dismissal techniques.
Strategies for delusional patients:
- Be open & honest; respond to suspicions calmly.
- Ask to describe delusions.
- Avoid arguing content.
- Focus on the feelings the delusions generate.
- Focus conversation on reality-based topics.
Conventional (First Generation) Drugs
Newer (Atypical) Drugs
Muscarinic Cholinergic Blocker A/E?
Alpha 1 blocker A/E?
Alpha 2 blocker A/E?
priaprism (persistent and painful erection)
Serotonin Blocker A/E?
Histamine (H1) Blocker A/E?
blockage of D2 dopamine receptor sites in the motor area cause?
Extrapyramidal Side Effects (EPS)
Acute Dystonic reaction:
Oculogyric crisis - looking up
Acute contractions of the tongue, face, neck, and back
spasm of the muscles causing backward arching of the head, neck, and spine
S/S of Pseudoparkinsonism?
- Rigidity all over the body.
- Masked like face.
- Tremors (Pill rolling) in hands & wrists.
- Short shuffling gait.
- Dripping of saliva.
- Monotonous and slurred speech.
- Loss of postural reflexes which leads to fall & injuries especially in the elderly.
Akathisia is characterized by?
- Subjective feelings of restlessness (inner restlessness).
- Inability to sit still.
- Rocking back and forth on feet.
- Crossing and uncrossing legs frequently.
- Inability to relax.
- It is a jerky irregular movement affecting primarily the lower face (tongue, jaw, and lips), extremities and trunk and includes:
- Protrusion of tongue.
- Chewing movement.
- Puffing of checks.
- Smacking movements.
- Limbs: Choriec, rapid, purposeless movements.
- Hip jerks.
General Class Side Effects: Traditional Antipsychotic
- Dry mouth, urinary retention and hesitancy.
- Blurred vision.
- Dry eyes.
- Increased risk for agranulocytosis & seizures.
- Photo sensitivity.
- Inhibition of ejaculation and impotence in men.
- Neuroleptic malignant syndrome (<1%).
- Metabolic effects (i.e. weight gain and DB Type II)
- Produce minimal to no extrapyramidal side effects or tardive dyskinesia.
- Treat both positive and negative symptoms.
- Improve the neurocognitive defects associated with schizophrenia.
- Decrease affective symptoms and suicidal behaviors
Used for early detection of Tardive Dyskinesia?
Abnormal Involuntary Movement Scale (AIMS) exam
AIMS areas of examination are?
-facial and oral movements
- extremity movements
- trunk movement.
S/S of Neuroleptic Malignant Syndrome (NMS)?
- decreased LOC
- autonomic dysfunction including
- hyperpyrexia, tachycardia, diaphoresis, and drooling
Tx of Mild NMS?
Tx of severe NMS?
Dantrolene (Dantrium) (IV), and ECT.
- Is a serious side effect and can be fatal.
- Liver impairment may also occur.
- Symptoms include sore throat, fever. malaise, and mouth sores.
- Mortality is high if the drug is not ceased.