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152 Cards in this Set

  • Front
  • Back
Schizophrenia causes distorted and bizarre _____, ______, ______, _____and _____.
thoughts (know)
perceptions (know)
emotions
movements
behavior
Schizophrenia cannot be defined as a _____ illness; but is thought of as a syndrome or disease process with many different varieties and symptoms, much like varieties of cancer.
single
Schizophrenia is usually diagnosed in _____ adolescence and ____ adulthood.
early
late
Schizophrenia is usually diagnosed from ages ____ to ____ years for men and ____ to ____ for women
15 to 25

25 to 35
Prevalence is ___% of total population, or ___ million in U.S.
1%
3 million
What are the hard, or positive symptoms amenable to antipsychotic medications?
delusions
hallucinations
grossly disorganized
thinking, speech, and
behavior
What are the soft, or negative symptoms which persist over time and are somewhat amenable to atypical antipsychotics?
Negative symptoms may or may not persist even when the positive symptoms have abated and represent a major barrier to recovery.
flat affect
lack of volition
social withdrawal or
discomfort
apathy
alogia
Term for a positive symptom which means holding seemingly contradictory beliefs or feelings about the same person, event, or situation?
ambivalence
Term for a negative or soft symptom which means an absence of will, ambition, or drive to to take action or accomplish tasks?
lack of volition
Term for a positive or hard symptom which means false impressions that external events have special meaning for the person?
ideas of reference
Term for a soft symptom which means a tendency to speak very little or to convey little substances of meaning (poverty of content)
alogia
A hard symptom which means continuous flow of verbalization in which the person jumps rapidly from one topic to another?
flight of ideas
A soft symptom which means feelings of indifference toward people, activities, and events?
apathy
A positive symptom of false sensory perceptions or perceptual experiences that do not exist in reality?
hallucinations
Soft symptoms which mean an absence of any facial expression that would indicate emotions or mood.
flat affect
Hard symptom that means fragmented or poorly related thoughts and ideas.
associative looseness
Negative symptom meaning feeling no joy or pleasure from life or any activities or relationships?
anhedonia
Positive symptom meaning fixed false beliefs that have no basis in reality?
delusions
Negative symptoms meaning psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless, as if in a trance?
catatonia
Positive symptoms which mean imitation of the movements and gestures of another person whom the client is observing?
echopraxia
A negative symptom which means restricted range of emotional feeling, tone, or mood?
blunted affect
A positive symptom which means a persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic?
perseveration
One of the five types of schizophrenia that is characterized by marked psychomotor disturbance, either motionless or excessive motor activity?
catatonic
One of the 5 types of schizophrenia characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior?
undifferentiated
One of 5 types of schizophrenia characterized by at least one previous, though not a current episode; social withdrawal; flat affect; and looseness of associations.
residual
One of 5 types of schizophrenia characterized by persecutory (feeling victimized or spied on) or grandiose delusions, hallucinations;, and occasionally, excessive religiosity (delusional religious focus) or hostile and aggressive behavior.
paranoid (know)
One of 5 types of schizophrenia characterized by grossly inappropriate or flat effect, incoherence, loose associations, and extremely _______ behavior.
disorganized
Although the symptoms of schizophrenia are always severe, the long-term course does not always involve ______ deterioration.
progressive
A psychosis is disordered ______.
thinking
The onset of schizophrenia may be _____ or _____, but most clients slowly and gradually develop the signs.
abrupt
insiduous
Diagnosis is usually made with negative or positive symptoms?
positive
Most clients experience a _____ and ____ onset of symptoms.
slow and gradual
The younger age of onset is associated with _____ outcomes.
poorer
In first years after diagnosis, client may have relatively _____ periods between psychotic episodes or fairly ______ psychosis with some shift in severity of symptoms.
symptom-free
continuous
Over the long term, psychotic symptoms _____ for most clients and are managed more easily.
diminish
Many years of dysfunction are rarely ____.
overcome
Onset may be ______ or ____, but most clients slowly and gradually develop signs and symptoms.
abrupt
insiduous
The diagnosis usually is made when the person begins to display more actively ______ symptoms.
positive
Younger age of onset is associated with _____ outcomes.
poorer
Most clients experience a ____ and _____ onset of symptoms.
slow
gradual
In the first years after diagnosis, client may have relatively ______ periods between psychotic episodes or fairly _____ psychosis with some shift in severity of symptoms.
symptom-free
continuous
Over the long term, psychotic symptoms ______ for most clients and are managed more easily.
diminish
Younger clients display a poorer _____ adjustment, more prominent negative signs, and greater cognitive impairment than do older clients.
premorbid
Those who experience a gradual onset of the disease (about 50%) tend to have both a _____ immediate and long-term course than those who experience an acute and sudden onset.
poorer
Many years of dysfunction are _____ overcome.
rarely
Approximately what percentage of clients relapse within 1 year of an acute episode; this figure doubles by the end of the second year.
30%
Term for one hallmark symptom of schizophrenia which is a false sensory perceptions, or perceptual experiences that do not exist in reality?

(know that its a distortion in sensory perception, may vary from stress to a persistent experience that just will not stop and that brings them to the hospital; when voices are talking to a patient...the patient thinks voices are talking to them.
hallucinations (know)
Term used for fixed, false beliefs with no basis in reality and found in psychotic phase of illness?
delusions (know)
In the years immediately after onset of psychotic symptoms, there are how many typical clinical patterns emerging?
two
In one pattern, the client experiences on-going psychosis and never fully ____, although symptoms may shift in severity over time.
recovers
In a second pattern, the client experiences episodes of psychotic symptoms that alternate with episodes of relative ______ recovery from the psychosis.
complete
_____ ____ play a crucial role in the course of the disease and individual outcomes.
antipsychotic medications
Antipsychotic meds do not ____ the disorder; however, they are crucial to its successful management
cure
_______ is one of 5 types of schizophrenia characterized by persecutory (feeling victimized or spied on) or grandiose delusions, hallucinations;, and occasionally, excessive religiosity (delusional religious focus) or hostile and aggressive behavior.
Paranoia (know)
"A person thinks someone is trying to poison him is a type of?"
persecutory example of paranoia (know)
"The president has picked me to go with him to the ball and dance with him this evening."
grandiose example of paranoia
(know)
A woman who's hallucinations and delusions occupy Jesus and religion.
accepted religiosity is an example of paranoia (know)
Term for a disorder for which someone who exhibits symptoms of schizophrenia but for less than 6 months necessary to meet the diagnostic criteria for schizophrenia. Social or occupational functioning may or may not be impaired.
schizophreniform disorder
Term for a disorder in which two people sharing a similar delusion. The person with this diagnosis develops this delusion in the context of a close relationship with someone who has psychotic delusions. A person may be diagnosed with schizophrenia and maybe a friend is not, but they can share it...a madness shared...used example of a restaurant by that name.
shared psychotic disorder (folie a deux) (know)
Term for a disorder in which the client has one or more nonbizarre delusions - that is, the focus of the delusion is believable. Psychosocial functioning is not markedly impaired, and behavior is not obviously odd or bizarre.
delusional
Term for a disorder in which a client exhibits the symptoms of psychosis and, at the same time, all features of a mood disorder, either depression or mania.
schizoaffective
Term for a disorder for which the client experiences the sudden onset of at least one psychotic symptom, such as delusions, hallucinations, or disorganized speech or behavior, which lasts from 1 day to 1 month. The episode may or may not have an identifiable stressor or may follow childbirth.
brief psychotic
Do not confuse _____ personality disorder and _____ personality disorder with schizophrenia or related disorders even though they sound alike.
schizoid
schizotypal
Schizophrenics have trouble with and are slower at image storing to short-term memory, long-term memory, or processing information that gets to short-term memory because?.
because of frontal lobe having to do with metabolism...may be too much serotonin or dopamine (know)
Four current etiologic theories which focus on biologic theories of schizophrenia are?
genetic factors
neuroanatomic theories
neurochemical theories
immunovirologic factors
An etiologic theory which includes exposure to a virus (such as flu) or the body's response to a virus that alters brain pathology. Can involve cytokines as they play a role in signaling the brain to produce behavioral and neurochemical changes needed in the face of physical or psychological stress to maintain homeostasis. Another is infection in pregnant women which may cause schizophrenia.
(1 of 4)
immunovirologic factors
An etiologic theory based on research showing that persons with schizophrenia have less brain tissue, enlarged ventricles in the brain, cortical atrophy, and diminished oxygen and glucose metabolism. (1 of 4)
neuroanatomic theories
An etiologic theory which indicates identical twins have a concordance rate of 50% for schizophrenia, fraternal twins havea a 15% concordance rate. One biologic parent with schizophrenia results in a 15% risk for a child; having two parents with schizophrenia carries a 35% risk. (1 of 4)
genetic factors
One of 4 etiologic theories which is a postulate that excess dopamine is a causative factor. Drugs that block dopamine receptors reduce psychotic (positive)symptoms. Excessive serotonin may also play a role in schizophrenia, causing many of the negative symptoms.
neurochemical theories
A neuroimaging tool which shows the brains of people with schizophrenia to differ in structure and function from the brains of control subjects.
computed tomography
People with schizophrenia have relatively less brain tissue and 1______ fluid than people who do not have schizophrenia.
1. cerebrospinal
Research consistently shows decreased brain volume and abnormal brain function in which two lobes of the brain?
frontal (negative signs, example is lack of volition or motivation and anhedonia)
temporal (positive signs, example is psychosis)
There is a theory that suggests which neurotransmitter modulates and helps to control excess dopamine?
serotonin
Clozapine (Clozaril) is one of the newer antipsychotics which can dramatically reduce psychotic symptoms and ameliorate the negative signs of schizophrenia by balancing which two neurotransmitters?
dopamine
serotonin
It's possible that schizophrenia has 3 separate symptom complexes or syndromes which are?
hallucinations/delusions
disorganization of thought
and behavior
negative symptoms

(part of neuroanatomic and neurochemical factors)
Cultural considerations...ideas which are considered delusional in one culture, may be commonly accepted by other cultures. Three examples are?
beliefs in sorcery or witchcraft...auditory or visual sitings of the Virgin Mary...hearing God's voice
When assessing the affect of what is considered normal in different cultures, assess which 3 things?
eye contact
body language
appropriate emotional
responses
Which two ethnic groups are more likely to experience schizophrenia?
african americans
asians
Which culture has fewer diagnoses than white clients?
Latino
What type of syndromes occur throughout the world and must be considered when working with a client of a different culture?
culture-bound syndromes
Ethnicity affects a client's response to ______, due to rates of ______ of certain drugs.
medications
metabolism
African Americans, Hispanics, and whites all require 1______ doses of antipsychotics to produce similar effects. Asians require much 2____ doses.
Asians have more 3____ _____ if given standard doses.
similar
lower
side effects
Examples of culture-bound psychotic disorders? (5)
Bouffee delirante
Ghost sickness
Locura
Qi-gong psychotic
Zar
Which culture-bound psychotic disorder is an experience of spirits possessing a person. Seen in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies. The afflicted person may laugh, shout, wail, bang head on wall or be apathetic and withdrawn, refusing to eat or carry out daily tasks. Such behavior is not considered pathologic locally.
Zar
Which culture-bound psychotic disorder is a preoccupation with death and the deceased frequently observed among members of some Native American tribes. Symptoms include bad dreams, weakness, feelings of danger, loss of appetite, fainting, dizziness, fear, anxiety, confusion, feelings of futility, and a sense of suffocation.
ghost sickness
Which culture-bound psychotic disorder is a reaction in an acute, time-limited episode characterized by dissociative, paranoid, or other psychotic symptoms that occur after participating in the Chinese folk health-enhancing practice of qi-gong. Especially vulnerable are those who become overly involved in the practice.
Qi-gong
Which culture-bound psychotic disorder refers to a chronic psychosis experienced by Latinos in the United States and Latin America. Symptoms include incoherence, agitation, visual and auditory hallucinations, inability to follow social rules, unpredictability, and possible violence.
Locura
A culture-bound psychotic disorder found in West Africa and Haiti, involves a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. It is sometimes accompanied by visual and auditory hallucinations or paranoid ideation.
Bouffee delirante
The primary medical treatment for schizophrenia is?
psychopharmacology
(all other treatment modalities have become obsolete)
Another name for antipsychotic medications?
neuroleptics
(used to manage, not cure)
The older, or conventional, antipsychotic medications are?
dopamine antagonists
The newer, or ATYPICAL, antipsychotic medications are both? ______ and _____ antagonists?
dopamine and serotonin...dopamine antagonists inhibit serotonin uptake
The conventional (TYPICAL) antipsychotics (dopamine antagonists) target which signs?
Examples: Fluphenazine (Prolixin) and haloperidol (Haldol)
positive..including
delusions
hallucinations
disturbed thinking

(these meds have no observable effect on negative signs)
The newer, or ATYPICAL, antipsychotic medications (dopamine and serotonin antagonists) diminish positive symptoms and also lessen negative signs of which type? (3)

dopamine
serotonin
1. lack of volition and motivation
2. social withdrawal
3. anhedonia
Another name for the conventional (typical)antipsychotic fluphenazine?
Prolixin in decanoate and enanthate preparations
Another name for the conventional (typical) antipsychotic haloperidol?
Haldol in decanoate
Prolixin and Haldol are available in depot injection form. They are based in ____ ____, which absorbs slowly over time.
sesame oil
Haldol absorbs over ____ weeks.
4
Prolixin absorbs over how many days?
7 to 28
Injections of Haldol and Prolixin are needed every ____ to ____ weeks and are usually prescribed for clients who have difficulty with _____?
1 to 4 weeks
compliance
It may take several weeks of _____therapy of Prolixin and Haldol to reach a stable dosing level before the transition to depot injections can be made.
oral
Haldol and Prolixin are not suitable for the management of ____ episodes of psychosis.
acute
The side effects of antipsychotic medications are significant and can range from ____ discomfort to permanent _____ disorders.
mild
movement
Side effects from antipsychotic drugs are frightening and upsetting to clients, and are frequently cited as the primary reason why clients _____ or _____ the dosage of their medications.
discontinue
reduce
Serious neurologic side effects include _________ side effects.
extrapyramidal
Extrapyramidal side effects (EPS) examples are? (6)
acute dystonic reactions
akathisia
parkinsonism
tardive dyskinesia
(irreversible)
seizures
neuroleptic malignant
syndrome

(can be treated with ANTICHOLINERGIC)
Non-neurologic side effects include of antipsychotics include?
weight gain
sedation
photosensitivity

and anticholinergic symptoms...
these symptoms include dry mouth, blurred vision, constipation, urinary retention, orthostatic hypotension
Examples of anticholinergic symptoms include? (5)
dry mouth
blurred vision
constipation
urinary retention orthostatic hypotension
Define extrapyramidal side effects?
REVERSIBLE movement disorders induced by neuroleptic medication...
includes dystonic reactions, parkinsonism, and akathisia
Which EPS movement disorder in response to antipsychotic meds appears early in the course of treatment and is characterized by spasms in discrete muscle groups such as neck muscles (torticollis) or eye muscles (oculogyric crisis).
dystonic reactions
Term for a stiff neck associated with muscle spasm, classically causing lateral flexion contracture of the cervical spine musculature; may be congenital or acquired
torticollis
Term used for spasms of the eye muscles?
oculogyric crisis
Spasms (torticollis and oculogyric) may be accompanied by? (3)
protrusion of tongue
dysphagia
laryngeal/pharangeal spasm
that can compromise
client's airway

(these may cause a medical emergency)
Dystonic reactions are extremely _______ and _____ for the client.
frightening
painful
Acute treatment of dystonic reactions includes which medications and which route?
(KNOW)
diphenhydramine (Benadryl)
therapeutic class:
allergy, cold, and
cough remedies,
antihistamines,
antitussives
benztropine (Cogentin)
therapeutic class:
antiparkinson agents
pharmacologic class:
anticholinergics

(both are given IM)
Define pseudoparkinsonism or neuroleptic-induced parkinsonsim symptoms? (6)
shuffling gait
masklike facies
muscle stiffness (continuous)
cogwheeling rigidity
(ratchet-like movements
of joints)
drooling
akinesia (slowness and
difficulty initiating
movement)
pseudoparkinsonism or neuroleptic-induced parkinsonism usually appear when?
in the first few days after starting or increasing the dosage of an antipsychotic medication.
What is the term characterized by restless movement, pacing, inability to remain still, and the client's report of inner restlessness.
akathisia
When does akathisia usually develop?
when the antipsychotic is started or when the dose is increased
Clients become uncomfortable when experiencing signs of akathisia and do what?
may stop taking the antipsychotic medication to avoid the side effects.
Which class of drugs and which drug in that class has been most effective in treating akathisia?
beta blocker
propanolol
Which class of drugs have provided SOME success in treating akathisia?
benzodiazepines
The early detection and sucessful treatment of ____
is very important in promoting client compliance with medication.
EPS

(the nurse is most often the person who will observe symptoms or client will confide in about these symptoms)
What is the standardized rating scale used to describe EPS?
Simpson-Angus for EPS
Which late appearing side effect of antipsychotic medications is characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of limbs and feet?
tardive dyskinesia
The involuntary movements of tardive dyskinesia may cause them to become more?
socially isolated
Tardive dyskinesia is ______ once it has appeared, but decreasing or discontinuing the medication can arrest the progression.
IRREVERSIBLE
Which atypical antipsychotic drug has not been found to cause side effects of tardive dyskinesia while taking conventional antipsychotic drugs?
clozapine (Clozaril)
Which screen is used for symptoms of movement disorders?
AIMS...Abnormal Involuntary Movement Scale
(refer to 14-1)
In screening with AIMS, the client is observed in several positions and the severity of symptoms is rated from _____ to _____.
0 to 4
The AIMS can be administered every ___ to ___ months.
3 to 6
If the nurse detects an 1____ score on the AIMS, indicating increased symptoms of tardive dyskinesia, they should notify the physician so that the dosage or drug can be changed to prevent advancement of tardive dyskinesia.
1. increased
Seizures are an _____ side effect associated with antipsychotic medications.
However, seizures may be associated with high doses of medication. Treatment is a lowered dosage or a different antipsychotic medication.
INFREQUENT
(incidence is 1%....clozapine is noted for having an incidence of only 5%)
Name the conventional typical antipsychotics that are used to treat POSITIVE symptoms only. (6)
refer to table 14-1

chlorpromazine (Thorazine)
"the thorazine shuffle"
fluphenazine (Prolixin)
haloperidol (Haldol)
molindone (Moban)
thioridazine (Mellaril)
trifluoperazine (Stelazine)
Name the ATYPICAL antipsychotics that are used to treat positive AND negative symptoms.
refer to table 14-1

clozapine (Clozaril)
olanzapine (Zyprexa)
quetiapine (Seroquel)
risperidone (Risperdol)
ziprasidone (Geodon)

COQRZ=CZSRG
What is the condition for a serious and frequently fatal condition seen in those being treated with ANY OR ALL antipsychotic medications.
neuroleptic malignant syndrome (NMS)

(STOP the medication...the patient may be able to tolerate another medicaition, it varies)
What are the symptoms of neuroleptic malignant syndrome?
muscle rigidity
high fever
increased muscle enzymes
(particularly CPK which
means creatine phospho-
kinase)
leukocytosis (INCREASED
leukocytes)
What is the estimate of the percentage of clients who may develop NMS while on antipsychotic meds?
0.1% to 1%
What is the condition that is potentially fatal and is defined as failure of the bone marrow to produce adequate white blood cells)
agranulocytosis (DECREASED WBCs)
Which antipsychotic has the potentially fatal side effect of agranulocytosis?
clozapine (Clozaril)
Agranulocytosis develops _____ and is characterized by what symptoms? (4)
(know)

suddenly

fever
malaise
ulcerative sore throat
leukopenia

(FLaT) not finished
The side effects of agranulocytosis may not be manifested immediately but can occur as long as ___ to ___ weeks after the initiation of therapy.
The drug must be discontinued immediately.
18 to 24 (4.5 months to 6 months)
Clients taking clozapine for agranulocytosis must undergo weekly ____ counts?
WBC
Currently, clozapine is dispensed every ___ days only, and must provide evidence of _____ before refills is furnished.
7
WBC
Besides medication, the folowing can be utilized to treat schizophrenia. These include? (5)
individual therapy
group therapy
family therapy
family education
social skills training
Individual and group therapy can be beneficial by focusing on? (3)
medication management
use of community supports
family concerns
Term used for the type of structured psychotherapy that controls the environment of the patient to provide interpersonal contacts that will develop trust, assurance, and personal autonomy.
milieu
The three forms of social skills training are?
basic model
social problem-solving model
cognitive remediation model
What does the basic model involve?
breaking complex social behavior into simpler steps, practicing through role-playing, and applying concepts in community or real-world setting
What does the problem-solving model focus on?
improving impairments in information processing that are assumed to cause deficits in social skills...includes medication and symptom management, recreation, basic conversation, and self-care.
What does the cognitive remediation model focus on?
improving underlying cognitive impairments by emphasizing such things as paying attention and planning
Family education helps to make family members part of the treatment team.
okay