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schizophrenia psurg Flashcards

1
Q

4 phases in developing schizophrenia

A

Premorbid, prodromal, schizophrenia, residual phase

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2
Q

premorbid phase 1

A

social maladjustment, social withdrawal, irritibility, and antagonistic thoughts and behavior; shyness, family hx, mild s/s, functioning

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3
Q

prodromal phase 2

A

length 2-5 yrs; begins with a change from premorbid and extends until onset of frank pyschotic s/s; substantial functional impairment, sleep disturbance, anxiety, irritability, depressed mood, poor concentration, fatigue, deterioration in role function, social withdrawal; Positive s/s perceptual abnormaliites, ideas of reference, suspiciousness; herald onset of phase 3 schizophrenia; no school, no friends, no sleep

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4
Q

Schizophrenia phase 3

A

Active phase; +/- psychotic s/s prominent; consist of characteristic sypmtoms, social/occupational dysfunction, duration, schizoaffective and mood d/o; substance/GMC, relationship to a pervasive developmental d/o

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5
Q

Residual phase 4

A

(+) s/s of active phase absent; (-) s/s remain

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6
Q

Criteria for Schizophrenia: Characteristic s/s

A

lasting 1 mon, 2+ of s/s: delusions, hallucinations, disorganized speech (frequent derailment or incoherence), grossly disorganized or catatonic behavior, negative psychotic s/s (affective flattening, alogia/no words, or avolition/no drive)

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7
Q

criteria for Schizophrenia: social occupational dysfunction

A

work and self-care markedly below level before onset, or failure to achieve expected level of interpersonal, academic, or occupational achievement

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8
Q

criteria for schizophrenia: duration

A

continuous for at least 6 mon disturbance, with 1 mon of criteria 1

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9
Q

3 characteristics of psychosis

A

disorganization (thought and action not congruent), social functioning, lost contact with reality

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10
Q

Typical onset of pyschosis

A

teens and early 20s

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11
Q

with schizophrenia, rate of suicide is

A

higher

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12
Q

Predisposing factors

A

biological: genetic, neurotransmitter, anatomical and associated dz; Psychological: family (lack of love NOT a cause), stress (precipitate flare up but NOT a cause); Environmental: sociocultural

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13
Q

Major neurotransmitter in psychosis

A

Dopamine D2; then serotonin 5-HT

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14
Q

anatomical & associated dz are

A

flu virus during pregnancy, epilepsy, born with smaller frontal lobe for higher function

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15
Q

Transactional Model for schizophrenia

A

Start with precipitating event stressful/threatening to a weak ego; genetic influence; prenatal viral infx; abn brain structure and epilepsy/Huntington’s dz, brain tumor, Parkisonism, Inadequate Coping Skills; Primary Cognitive Appraisal: perceived threat to self; Secondary Cognitive Appraisal: weak ego, poor coping mechanism so initiate Defense Mechanism: denial, regression, projection, identification, religiosity; Response is Adaptive or Maladaptive; Maladaptive = psychotic episode and exacerbation of s/s (hallucination, delusions, social isolation, violence, inapporpriate affect, bizarre behavior, apathy, autism

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16
Q

Positive s/s of schizophrenia

A

content of thought: delusions, religiosity, paranoia, magical thinking; form of thought associative looseness, neologism, concreate thinking, clang associations, word salad, circumstantiality, tangentiality, mutism, perseveration; sense of self: echolalia, echopraxia, identification and imitation, depersonalization

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17
Q

Negative s/s of schizophrenia

A

Affect: inappropriate affect, bland or flat affect, apathy; Volition: inability to initiate goal-directed activity, emotional ambivalence; Impaired interpersonal functioning and relationship to the external world: autism, deteriorated appearance; Psychomotor Behavior: anergia, waxy flexibility, posturing, pacing and rocking; Associated features: anhedonia, regression

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18
Q

delusion

A

positive: fixed false belief (e.g. persecution from FBI, grandeur of I am Jesus, reference of I must break the code, control or influence of this dental filling controls what I think, somatic of the 70 yo pregnancy, nihilistic of I have no stomach)

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19
Q

religiosity

A

positive: praying all the time, affects functionality; culture appropriate

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20
Q

Paranoia

A

positive: my food has been poisoned

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21
Q

magical thinking

A

positive: it’s raining, the sky is sad.

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22
Q

erotomania

A

positive: Brad Pitt loves me.

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23
Q

associative looseness

A

positive: ideas kinda connect

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24
Q

neologism

A

positive: made up words; RN find the meaning

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25
Q

concreate thinking

A

positive: very literal; RN don’t use abstract thought

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26
Q

clang associations

A

positive: rhyme

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27
Q

word salad

A

positive: random words with no connection between words

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28
Q

circumstantiality

A

positive: so many details, can’t get to the point

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29
Q

tangentiality

A

positive: moves from subject to subject, no point

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30
Q

Mutism

A

positive: inability/refusal to speak

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31
Q

hallucinations

A

positive: false sensory perception; auditory hear voices, visual flashes of light, tactile crawling under skin, gustatory tastes of poop, olfactory smells like burning

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32
Q

Illusion

A

positive: misinterpret object; the real trash can is a dog illusion

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33
Q

echolalia

A

positive: copy what is said

34
Q

echopraxia

A

positive: mimic action

35
Q

Identification

A

positive: unconscious imitation (dress like BFF)

36
Q

Imitation

A

positive: conscious imitation (dress like marilyn monroe)

37
Q

depersonalization

A

positive: beside myself watching things happen to me.

38
Q

Inappropriate affect

A

negative: emotional tone incongruent with situation

39
Q

Bland/blunted or flat affect

A

negative: bland is emotional tone is weak; flat is void of emotional tone (masking)

40
Q

apathy

A

negative: indifference or disinterest

41
Q

Impaired volition: goal directed activity

A

negative: can’t start goal directed activity; RN give step-by-step

42
Q

Impaired volition: emotional ambivalence

A

negative: need-fear dilemma for intimacy; back and forth between room and community room

43
Q

autism

A

negative: retreat to own private world

44
Q

deteriorated appearance

A

negative: neglected hygiene, grooming, self-care

45
Q

anergia

A

negative: no energy

46
Q

waxy flexibility

A

negative: leave arm out of BP, even if uncomfortable

47
Q

posturing

A

negative: voluntary bizarre position; resist unposturing

48
Q

pacing and rocking

A

negative: purposeless, rhythmic swaying of trunk from hips when sitting

49
Q

anhedonia

A

negative: no pleasure; suicide risk

50
Q

regression

A

negative: retreat to earlier level of development.

51
Q

types of schizophrenia

A

disorganized, catatonic, paranoid, undifferentiated

52
Q

disorganized schizophrenia

A

hebephrenic schizophrenia: onset before 25, chronic, regressive, poor reality testing, flat affect then silly; facial grimace bizarre, personal appearance neglected, social impairment extreme

53
Q

Catatonic stupor schizophrenia

A

mutism, waxy flexibility, posturing

54
Q

catatonic excitement schizophrenia

A

frenzied, spastic, incoherent shouting, die from exhaustion; RN give meds or mechanical restraints

55
Q

paranoid schizophrenia

A

persecutory/gradeur delusion, auditory hallucination r/t FBI, suspicious gaurded, argumentative, aggressive; onset late 20s-30s; can be minimal social/occupational/living impairment

56
Q

Undifferentiated schizophrenia

A

don’t fit criteria for schizophrenia perfectly

57
Q

Residual schizophrenia

A

1 schizophrenic event; evidence of illness; no psychotic s/s

58
Q

Schizoaffective d/o

A

pyschosis + mood d/o (depressed or manic); this is more complicated

59
Q

Brief psychotic d/o

A

sudden onset, later age, precipitating event, duration < 1 mon

60
Q

Schizophreniform d/o

A

meets schizophrenia criteria, but not yet 6 mon of s/s

61
Q

Shared psychotic d/o

A

folie a deux; alpha in relationship imposes delusions on passive partner (women); occurs in long-term relationships, socially isolated

62
Q

list 5 delusional d/o

A

eromatic, grandiose, jealous type, persecutory, somatic

63
Q

psychotic d/o d/t GMC

A

head injury, PTSD, brain tumor, lupus, AIDS; NOT in delirium/chronic progressive dementia

64
Q

substance-induced psychotic d/o

A

meth + no reality testing (if with reality testing, dx substance-related d/o)

65
Q

Phases of tx

A

active, maintenance, rehabilitation

66
Q

active phase of tx

A

establish trust, promote safety, alleviate s/s

67
Q

Maintenance phase of tx

A

improve quality of life; teach coping strategy

68
Q

rehabilitation phase

A

restore to highest capacity

69
Q

Nursing Dx for schizophrenia

A

risk for violence: self/other directed, altered thought process, disturbed sensory perception, social isolation, impaired verbal communication, self-care deficit, disabled familiy coping, ineffective health maintenance

70
Q

Attitude tx

A

be calm so pt calm; ask what’s your plan for the day, in appropriate tone, body language

71
Q

Teaching r/t schizophrenia

A

nature of illness: illness progression, s/s, ways for family to respond to behaviors; management of illness: connection of s/s to times of stress, medication management, importance of not stopping meds, when to contact MD, relaxation tips, social skills training, daily living skills training; support services: financial assistance, legal assistance, caregiver, support groups, respite care so caregiver as day off, home health care

72
Q

Treatment modalities

A

pyschopharmacology with neuroleptics (typical and atypical); social treatment with millieu and family tx; psychological with group tx, social skills training, behavior tx

73
Q

Prognosis of schizophrenia

A

unfavorable course

74
Q

millieu tx

A

aka therapeautic community, therapeautic environment; manipulate environment so pt experience is therapeautic to improve psychological health and functioning; this is why staff wears neutral colors.

75
Q

family tx

A

reduces likelihood of relapse or emergence of mental illness to previously nonaffected family member; reduce family anger/guilt; set limits; increase for family to anticipate and solve problems

76
Q

social skill training

A

focus on role-play; emphasis on ADLs

77
Q

group tx

A

for inpatient not good because it adds stimuli; for outpatient it offers a supportive environment, social interaction, identification, and reality testing

78
Q

behavior tx

A

reduce frequency of bizarre, disturbing, and deviant behaviors, and increasing appropriate behaviors; RN simple concrete instruction, attach positive/negative/aversive to adaptive/maladaptive behavior; clearly defined goals and how they are measured.

79
Q

psychotherapy

A

reality oriented; decrease anxiety and increase trust (do not be overly warm/professional; it looks fake); exploration of behavior within relationships; improve interpersonal communication, emotional expression, and frustration tolerance; teach how to react appropriately to real vs. perceived danger.

80
Q

lithium interacts with which 4 drugs

A

NSAID, haldol, diuretic, carbamazepine

Psurg (15 decks)

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