Hehi Test 1 - Schizophrenia

Front 1

Schizophrenia non-genetic correlates

Back 1

-Families with Expressed Emotion (EE) (?)
- Virus (during 2nd trimester)
- Pregnancy complications
- Birth complications
- Stress vulnerability (inc. genetic vulnerability to developing psychosis when stressed)

Front 2

Percent of population w/ Schiz.

Back 2

1.3%
(of that percentage 8% are sibling of patinet, 45-50% identical twin of patient, 15% paternal twin of patient, 12% child w/ ill parent, 40-45% child w/ 2 ill parents)

Front 3

Dopamine levels & Schizophrenia - explain the correlation

Back 3

Foundation of Schiz is associated with Dopmine receptors in the temporal lobe and basal ganglia - Temporal lobe is accelerating, frontal lobe is slowing down -> the disconnect betwen the 2

Front 4

Associated Neurotransmitters

Back 4

- GABA : loss of GABA -> hyperactivity of dopamine
- Serotonin (5HT)
- Norepinephrine (NE)
(NE and 5HT modulate Dopamine system)
- Glutamate: abnormal neural maturation (mostly seen in young men w/ shiz.)

Front 5

Schizophrenia biological correlations

Back 5

Hypofrontality: frontal lobe shown to have dec. blood flow and glucose metablolism.
Temporal lobe is smaller in size : not seen in all patients -> affects information processing (hypoactivity -> memory difficult b/c cognition impaired)
Bilateral hemisphere - prefrontal and frontal dysfunctions.

Front 6

Positive and Negative Symptoms

-distinguishing characteristics
- types of each

Back 6

- Positive - result of overactivity, acute onset, normal social functioning during remission, favorable response to antipsychotic meds,
hallucinations, delusions, bizarre/ disorganized behav., positive formal thought disorder.
- Negative - result of underactivity; gradual onset, premorbid history of emotional problems, chronic deterioration, atrophy on CT scans, harder to treat, last longer, more severe
- The 5 A's on separate card

Front 7

Hallucinations:

Types of and top 3 most common

Back 7

Image (or sensation) that occurs w/o an external stimulus
- Auditory (75-90%)
- Visual (49%)
-Tactile (20%)
- Olfactory
- Gustatory
Hallucinations can worsen – from commenting to conversations w/ one another. Command hallucinations that tell the person to do things.

Front 8

Delusions:

Types of

Back 8

NOT VALIDATED IN REALITY
A fixed false belief that is contrary to the persons educational and cultural background.
- Persecution (81%)
- Ideas of reference (49%) - things in envirn. are b/c of them -war, bad weather
- Grandeur (39%) - important status "advisor to Al Gore"
- Somatic (28%) -brain is rotting, pregnant w/ 9 babies
- Control (broadcasting, insertion, w/drawl): their thoughts are being controlled, they think people can hear their thoughts (broadcasting), insertion – someone put them their, withdrawl – someone has removed their thoughts b/c they cant think clearly anymore.

Front 9

Difference between bizarre and non bizarre behaviors

Back 9

- Bizarre – could not be possible, “someone stole my kidneys overnight” and have no scars to prove it.
- Non-bizarre – is possible, “FBI is following me”

Front 10

Speech Assessment
- Poverty of speech
- Poverty of content of speech
- POSITIVE FORMAL THOUGHT DISORDER

Back 10

POSITIVE FORMAL THOUGHT DISORDER
- Word Salad: jumble of words that is meaningless
- Flight of Ideas:
- Neologism: making up words
- Clang Association: using words that sound the same
- Echolalia: repeat everything you say

Front 11

The 5 A's of Schizophrenia

(Negative Symptoms)

Back 11

- Affective flattening: lack of facial features, look sad but are not
- Alogia - impoverished thinking and cognition
- Anhedonia: lack of ability to experience pleasure
- Attentional impairment
- Avolition: lack of initiative of energy

Front 12

Cognitive Symptoms of Schiz.

Back 12

Concrete thinking
Loss of Ego boundaries
depersonalization: loss of identity or that part of self is unreal
derealization: false perception that environment has changed

Front 13

Affective Disturbances of Schiz.

Back 13

Restricted/ constricted
Bluted
Flat
Inappropriate
Labile
Aggressive

Front 14

Behavioral Features of Schiz.

Back 14

- Automatism – slow, rigid movement
- Avolition – stay in one place
- Catatonia –absence of movement, unusual postures – keeping arm in the air
- Exhopraxia – mechanic movement
- Negativism - resistance
- Sterotypy – repetitive movement
- Waxy Flexibility – mold the person like wax, put them in positions and they will stay there.

Front 15

Social Changes
Examples of Direct and Indirect

Back 15

Direct
–deterioration of social skills and mistrust
–lossofdrive/motivationloss of drive/motivation
–inability to communicate
–deterioration of personal hygiene
• Indirect
–poor academic/vocational performance
–

Front 16

MSA (Mental Status Assessment) Observations
- Cognitive Changes
- Affective Changes
- Behavioral Changes
- Speech Changes

Back 16

- Cognitive: concrete thinking, thought processes
- Affective: blunted, negative, congruency w/ thought
- Behavioral: appearance, gestures, mannerisms
- Speech: tone, amount, clarity

Front 17

Suicide risk for Schiz
- % that attempt?
- % that succeed?
- highest risk?

Back 17

50% attempt
10-15% at some point succeed
males < 30, college educated, unemployed, recent hospitalization, history of prior depressive episode

Front 18

Peak onset of Schiz for men and women.

Back 18

men 15-25 yo
women 25-35

Front 19

Dual diagnosis often associated with Schizophrenia

Back 19

- ETOH abuse/ dependence (40-50%)
- 15-25% marijuana abuse
- 5-10% cocaine abuse
- 80-90% nicotine dependence
people w/ dual diagnosis have more pronounced psychotic episodes, less compliant w/ treatment.
Smoking can dec. effects of meds.

Front 20

Phases of Illness

Back 20

1) Prodromal - precedes Active phase by one month to one year. Gradual development of symptoms w/ derterioration of social skills. Avg. time of phase is 6 months, unusual habits or speech may develop
2) Residual
Affective flattening and role impairment, more negative symptoms over time.

Front 21

Characteristic Symptoms of Schizophrenia

Back 21

-delusions
-hallucinations
-disorganized speech
-grossly disorganized or catatonic -behavior
-negative symptoms (5 A's)

*Must have 2 or more present in 1 month period.
*40% will have one accute episode, but then controlled by medication, 40% have frequent episodes, 20% servere, need to be institutionalized

Front 22

Types of Schizophrenia

Back 22

1) Paranoid Type
2) Catatonic Type
3) Disorganized Type
4) Undifferentiated
5) Residual Type

Front 23

Criteria for being diagnosed w/ Schizophrenia

Back 23

1) Characteristic symptoms - 2 ore more present in 1 month period.
2) Dysfunction in major life area - work, school, self care.
3) Duration - 2 or signs then have the prodromal signs (gradual development of symptoms w/ derterioration of social skills. 6 mon. of continuous signs, 1 month of symptoms

*If you are able to function normally w/ symptoms you should TECHNICALLY not be diagnosed w/ mental illness.

Front 24

Paranoid Type Schiz.

- Characteristic symptoms
- Not prominent symptoms

Back 24

Preoccupation with one or more DELUSIONS or frequent AUDITORY hallucinations

*None of the below are prominent
-disorganized speech
- disorganized or catatonic behavior
- flat or inappropriate affect

Onset is later 35-40yo., treatment is more successful. Most common type of schiz.

Front 25

Catatonic Type Schiz.

Back 25

2 of the following are present:
- motor inflexibility
- excessive motor activity
- extreme negativism or mutism
- preculiarities of voluntary mvmt - inappropriate or bizarre postures
- echolalia or echopraxia

Front 26

Disorganized Type Schiz.

Back 26

ALL are prominent
- disorganized speech
- disorganized behavior
- flat or inappropriate affect

Catatonic criteria are not met

Early onset (teens), most impaired, poor outcomes, common to have family hx. of psych illness.

Front 27

Undifferentiated Type Schiz.

Back 27

Characteristic symptoms are met, but cannot be classified into paranoid, disorganized, or catatonic types.

Front 28

Residual Type Schiz.

Back 28

Presence of 2 or more characteristic symptoms & negative symptoms BUT

Absence of positive symptoms - delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior

Front 29

Schizophreniform Disorder

Back 29

Characteristic symptoms present, but episode (includ prodromal, active, and residual) lasts at least 1 month but less then 6 mon.

Front 30

Schizoaffective Disorder:
subtypes:
Criteria:

Back 30

Major depressive, manic, or mixed episode concurrent w/ characteristic symptoms of schiz.

Subtypes: Bipolar (more common in young adults) or depressive type (more common in older adults)

Criteria: at least 2 weeks of delusions or hallucinations in the absence of prominent mood symptoms

Information on prevalence is lacking, more common in women then men.

Front 31

Delusional Disorder:

Age of oneset, prevalence.

Subtypes

Back 31

Non bizarre delusions for at least one month. Function not impaired. Can be chronic or have no recurrence.

Age of onset: middle to late adult. Accounts for 1-2% of inpatient admits.

Subtypes: Erotomanic (believes one is in love w/ them), Grandiose, Jealous, Persecutory, Somatic

Front 32

Treatment focus for phases of Schiz.
-Acute
- Sub-acute
- Maintenance

Back 32

-Acute: Crisis intervention, SAFETY, Symptom stabilization
-Sub Acute: Stress assessment, daily activities, supports, resources
- Maintenance: Understanding and acceptance of illness, Skills (self care, social, vocational), Realistic expectations, Adaptation to deficits

Front 33

Nursing Interventions

-Anxiety
- Mistrust

Back 33

They will test their boundaries. They are trying to establish if they can trust you. Will be seeing if you follow through w/ what you say.
Short brief periods of interaction – that is all they can tolerate.
Need be very aware of what you are doing nonverbally, the patients are watching you – they may perceive as threatening or you are laughing at them.

Front 34

Nursing interventions for LOOSE ASSOCIATIONS

Back 34

If you don’t understand, “I am having difficulty understanding….” Put the focus on your lack not theirs.
Do point out what you understand to enhance the positive.

Front 35

Nursing Interventions for HALLUCINATIONS

Back 35

Hallucinations – “hearing voices”
• What are they saying? (commanding or demanding – need to know for safety)
• Are you frightened by them?
• Don’t reinforce what is not real – “I understand what you believe, but I am not seeing/ hearing that.”
• If not sure how to bring back to reality say something as simple as “I like your shoes” their shoes are real, interrupts and brings back to reality.
• Some will be told to interact w/ their voices – to tell them to STOP! And leave them alone. Be careful where they are instructed to do so.
• Auditory hallucinations can be helped by simply wearing ear plugs, it tell the brain they cant hear – shuts off the voices.

Front 36

Nursing Interventions DELUSIONS

Back 36

Delusions Interventions

Front 37

Nurisng Intervention Social Withdrawl

Back 37

Social Withdrawl

Front 38

Therapy
- Individual focus
- Group benefits

Back 38

- Indiv.: skills training, cognitive rehabilitation, cognitive content
-Group:
Increases: motivation, medication compliance, social competence, self-concept
Decreases: withdrawl, anxiety