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119 Cards in this Set
- Front
- Back
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What are considered first rank symptoms of schizophrenia
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psychotic delusion and hallucinations
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What are considered second rank symptoms of schizophrenia
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any other experiences or behaviors associated with schizophrenia that aren't delusions or hallucinations
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What population is the only group that it is thought to experience improvement from schizophrenia
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the elderly
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When are patients with schizophrenia at highest risk for suicide?
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during the acute phases
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what are the focus of initial treatment for schizophrenia
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initiation of medications, dec risk of suicide, normalizing sleep and reducing substance use
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Wha is the focus of the stabilization period of treatment for schizophrenia
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medication regimens are established and the families are adjusted to the idea of having a family member with schizophrenia. Ideally substance use is eliminated.
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What is the focus of the maintenance and recovery period of treatment for schizophrenia?
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Regaining previous level of functioning and quality of life.
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What is a major reason for relapses of schizophrenia patients
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Noncompliance with the medication regimen which may be a stressor for causing a severe and rapid relapse.
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What happens with each successive relapse that a schizophrenia patient experiences?
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There is a longer period of time to recover.
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Aside from medication compliance, what factors have been implicated in schizophrenic relapses?
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The degree of cognitive impairment, the degree of coping skills, the accessibility of community resources, income supports, and responsiveness of friends, family and supportive others.
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How long must symptoms of schizophrenia be present in order to be diagnosed?
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they must experience symptoms most days of a month with continuous disturbances for at least 6 months
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______ symptoms are considered symptoms that are present but shouldn't be, like delusions or hallucinations.
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Positive
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______ symptoms are considered symptoms that aren't present that should be, like a flat affect instead of a full range affect
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negative
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_____symptoms reflect an excess or distortion of normal functions, including delusion and hallucinations
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positive
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______symptoms reflect a lessening or loss of functions, such as restrictions in the range and intensity of emotion, reduced fluency and productivity of thought or speech, withdrawal and inability to initiate and persist in goal-directed activity, and inability to experience pleasure.
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Negative
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_____symptoms reflect a lessing or loss of functions, such as restrictions in the range and intensity of emotion, reduced fluency and productivity of thought or speech, withdrawal and inability to initiate and persist in goal-directed activity and inability to experience pleasure.
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Negative
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_____ type Schizophrenia is characterized by delusions or auditory hallucinations, disorganized speech, disorganized or catatonic behavior without an inappropriate or flat affect
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paranoid type
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______ type Schizophrenia is characterized by disorganized speech, behavior, and a flat or inappropriate affect.
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Disorganized type
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_______ type Schizophrenia is characterized by at least two of the following: motor instability/stupor, excessive purposeless motor activity extreme negativism, posturing/prominent grimaces or mannerisms, echolalia or exhopraxia
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catatonic type
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_______ type schizophrenia is characterized by an absence of prominent hallucinations or delusions, but the patient has odd beliefs or unusual perceptual experiences
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residual type
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_____ are erroneous fixed, false beliefs that cannot be changed by a reasonable argument that are usually a misinterpreted experience.
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delusions
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Delusion are the belief that one have exceptional powers, wealth, skills, influences or destiny.
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grandiose
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_____delusions are the belief that one is dead or a calamity is impending
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nihilistic
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_____Delusions are the belief that one is being watched, ridiculed, harmed, or plotted against
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persecutory
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_____ Delusions are the belief about abnormalities in body functions or structure
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somatic
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What type of hallucinations are most common with Schizophrenia
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auditory
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______ is a negative symptom of Schizophrenia defined as a concurrent experience of equally strong opposing feeling so that it is impossible to make a decision
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ambivalence
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_______ is a negative symptom of Schizophrenia that is characterized by an inability to enjoy activities
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anhedonia
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what happens to the ventricular system of the brain in patients with Schizophrenia
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it enlarges
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what happens to the brain cortex in patients with Schizophrenia
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the sulci becomes more prominent
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what happens to the hippocampus and temporal lobe of the brain in patients with Schizophrenia
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they become smaller
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what happens to the basal ganglia in pts with Schizophrenia
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it enlarges
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how do neurocognitive dysfunctions typically manifest themselves in patients with Schizophrenia
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as disorganized behaviors
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_____ is the repetition of another's words that is parrot-like and inappropriate
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echolalia
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_____ is a speech pattern that is extremely detailed and lengthy discourse about a topic
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circumstantiality
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_____ is defined as the abesnce of the normal connectedness of thoughts, ideas, and topics; sudden shifts without apparent relationships to the proceeding topics
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loss associations
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____ is when the topic of conversation is changed to an entirely different topic that is a logical progression but causes a permanent detour from the original focus
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tangentiality
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____ is the term for when the topic of conversation changes repeatedly and rapidly, generally after just one sentence or phrase
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flight of ideas
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____ Is a string of words that aren't connected in any way
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word salad
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____ are words that are made up that have no common meaning and aren't recognized
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neologisms
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____ Is the belief that neutral stimuli have special meaning to the individual, such as the television commentator speaking directly to the individual
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referential thinking
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____ is the term to describe thinking that is restricted to the literal and immediate so that the individual has private rules of logic and reasoning that make no sense to anyone else
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autistic thinking
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____ is the term for a lack of abstraction in thinking, an inability to understand punch lines, metaphors, and analogies
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concrete thinking
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____ is the purposeless repetition of words of phrases
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verbigeration
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_____ is the use of words interchangeably with similar meanings
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metonymic speech
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_____ is the repetition of words or phrases that are similar in sound but in no other way, for example light, right, might, sights?
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clang association
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what is the difference between hallucinations and illusions?
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hallucinations are usually an internal, subjective experience? no one else is exposed to the stimuli that triggered it. Iluusions are usually triggered by an external stimulus, like a tv in the room which although off talks to the person
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______ occur when a person misperceives or exaggerates stimuli that is in their environment
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illusions
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what are examples of how disorganized thinking is manifested in patients with Schizophrenia
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by the presence of echolalia,circumstantiallity, loose associations, tangentiality, flight of ideas,word salad, neologisms, paranoia, referntial thinking, autistic thinking, concrete thinking, verbigeration, metonymic speech, clang associations, stilted language and/or pressured speech.
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_____ is a disorganized behavior characterized by hyperactive purposeless motor activity and abnormal movements such as grimacing and posturing
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catatonic excitement
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______ is a disorganized behavior characterized by the involuntary imitation of another person's movements and gestures
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echopraxia
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_____ is a form of disorganized behavior characterized by repetitive, purposeless movements that are idiosyncratic t the individual and to some degree outside the individual's control.
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Waxy flexibility
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What childhood factors have been associated with an increased risk of developing Schizophrenia?
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Development delays, problems with social adjustment, poor academic or cognitive performance
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When does late onset Schizophrenia typically occur and what gender is most affected?
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Onset is usually after age 45 and more women than men are affected.
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How is late onset Schizophrenia different in its presentation from Schizophrenia with an earlier onset?
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It is more likely to present with positive symptoms, particularly persecurtory or paranoid delusion and the person is more likely to have sensory disturbances like hearing or vision losses.
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What are considered risk factors for the development of Schizophrenia?
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Stresses in the perinatal period (like starvation, poor nutrition, infections), obstetrical complications, genetic/familial susceptibility, age of parents, birth in an urban setting, severe instability of early childhood environment and early developmental difficulties
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Men tend to be diagnosed with Schizophrenia btw the ages of ______ women are typically diagnosed btw the ages ___________
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Men: ages 18-25, women: ages 25-35
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What comorbid medical conditions are prevalent among ppl with Schizophrenia
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DM II, vision & dental problems, HTN and STDs
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What F&E imbalance is associated with Schizophrenia, particularly early onset Schizophrenia?
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disordered water balance, usually in the form of water intoxication and its resultant hyponatremia
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What complications can develop in Schizophrenia patients with chronic hyponatremia?
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Renal dysfunction, urinary incontinence, cardiac failure, malnutrition, or permanent brain damage
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What are the signs and symptoms a pt is experiencing acute hyponatremia?
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confusion, muscle twitching, dec serum and urine osmolatity, and urine specific gravity, weakness, seizures, inc urinary volume and coma
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what are signs and symptoms a pt is experiencing chronic hyponatremia
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generalized weakness, giddiness, headache, muscle cramps, irritability, loss of appetite, nausea, restlessness, and slight confusion
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What is hyposthenuria
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a condition characterized by a urine specific gravity below 1.008, typically from water intoxication
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what happens to the globus pallidus in pt with Schizophrenia
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early in the disease, blood flow to the left side of the globus pallidus is decreased
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what happens to the frontal lobes of the brain in patients with Schizophrenia
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during normal functions of the frontal lobe, like working memory tasks, there is less blood flow.
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what happens tO the temporal lobe of the brain in pts with Schizophrenia
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THE CORTEX becomes thinner
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what happens to the hippocampus in the brain of a pt with Schizophrenia
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the anterior portion becomes smaller
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what happens to the lateral and third ventricles of the brain of a pt with Schizophrenia
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they enlarge and the sulci widen
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what are three neurodevelopmental changes that occur during puberty that may be implicated in the development of Schizophrenia
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Changes in the neurotransmitter system pathways and substrates occur, synaptic pruning and brain growth, and changes in the steroid-hormonal environment occurs
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What does the dopamine hypothesis pose it is the cause of Schizophrenia
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hyperdopaminergic action in the brain is the cause for the positive symptoms of Schizophrenia, particularly in the left side of the brain; especially in the left temporal lobe and globus pallidus
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what is hypofrontality
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reduced cerebral blood flow and glucose metabolism in the prefrontal cortex of the brain along with hyperactivity of the limbic area condition seen w Schizophrenia
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what causes the positive symptoms associated with schizophrenia
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dopamine hyperactivity in the mesolimbic tract, an area of the brain that regulates emotion and memory
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what is thought to cause the dopamine hyperactivity of the mesolimbic tract in the brains of ppl with Schizophrenia
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an overactive modulation of neurotransmission from the nucleus accumbens or hypoactivity of the mesocortical tracts, preventing normal inhibition of the mesolimbic tract
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what causes the negative symptoms associated with Schizophrenia
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hypoactivity of the mesocortical dopaminergic tract, a part of the brain associated with motivation, planning, sequencing, attention and social behaviors
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What is believed to be the site of the extrapyramidal effects of antipsychotic drugs and the site of motor symptoms (like stereotypical behavior) associated with schizophrenia?
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nigrostriatal dopaminergic tract
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What does the social theory of expressed emotion hypothesize
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Certain family communication patterns increase the symptomatology and incidence of relapse in pts with schizophrenia
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What characteristics make up a high EE family in the theory of expressed emotion? What impact does a high EE family have?
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Critical, hostile, and negative about the patient, and emotionally overinvolved in the patient, shown self-sacrificing and being overprotective. These characteristics lead to increased symptoms and incidence of relapse.
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What characteristics make up a low EE family in the theory of expressed emotion? What impact does a low EE family have?
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Few negative comments, not overinvolved in the patient. Less relapse and symptomatology than schizophrenics with high EE families
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What should always been done for a pt experiencing their first psychotic episode from schizophrenia?
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A suicide assessment
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What is the priority of care for a pt during acute times of illness from schizophrenia?
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Trtment with antipsychotic medications
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What are the priorities during the chronic phase of schizophrenia treatment?
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Helping the patient accept their illness, developing expectations that are realistic helpin them avoid social isolation, preventing hopelessness.
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What should a nurse monitor in order to complete fluid balance assessments in pts with schizophrenia?
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Remain alert for s/s of polydipsia, polyuria. If water imblance is suspected, insititue daily weights, urine specific gravity and serum sodium levels as well as observe for behavioral changes
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polydipsia
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excessive thirst
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How can a nurse promote self-care activities for a pt with schizophrenia
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Develop a schedule with the pt for various hygiene activities and emphasize their importance
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WHen should a program to address weight gain be institiuted for a pt with schizophrenia?
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At the earliest sign of weight gain btw 5-10lbs over the desired body weight
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What teaching is improtant for a client with schizophrenia that has a disordered water balance?
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Self-monitoring skills including how to monitor their own urine specific gravity, what their targeted weight is , how to do daily weights and ensure they know a 5-7 lb weight gain in 1-3 hours indicates too much fluid.
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How are pts with severe water imbalances best managed to restrict their water seeking behavior
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One on one observation and management to redirect their behavior
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What is the general action of antipsychotic drugs
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They block the D2 receptors in the brain
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What are the interventions for a pt who has exceeded their target weight established for their chronic water imbalance?
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Prohibit fluid intake, restrict them to their program/residential area, assess their vitals twice every hour and notivy the physician if severe symptoms develop.
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How long does it take for antipsychotic drugs to begin working, and how long typically until they are considered therapeutic?
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Takes about 1-2 weeks for changes in symptoms and about 6-12 weeks to determine their therapeutic effectiveness.
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_____ is an antipsychotic that is typically used only when all other atypical antipsychotics aren't effective.
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Clozapine/clozaril (because of the risks of agranulocytosis)
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Rarely, antipsychotic medications must be stopped. What situations warrant the cessation of a pt's medications.
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They develop neuroleptic malignantsyndrome or they develop tardive dyskinesia.
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What is the boxed warning for risperidone/risperdal
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it is associated with an inceased mortality in elderly pts with dementia-related psychosis.
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What is the boxed warning for clozapine/clozaril?
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It can cause agranulocytosis within 4-10 weeks, seizures, myocarditis or other adverse cardiovascular events.
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What is the specific patient requirement/education that should be explained to a patient on clozapine/clozaril
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WBC counts must be taken before starting the medication and then done weekly while on the medication for up to 4 weeks after cessation of the drug. Any flu-like symptoms must be reported to the physician.
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What is thought to be the underlying cause of extrapyamidal symptoms from antipsychotic medications?
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D2 receptors in the basal ganglia are blocked, increasing acetylcholine and causing the symptoms.
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How are extrapyramidal symptoms caused by antipsychotic medications typically managed?
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reducing the dosage of the medication or adding an anticholinergic drug like benztropine/cogentin or trihexyphenidy/artane
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Why might a schizophrenic patient be prescribed benztropine or trihexyphenidyl?
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To reduce extrapyramidal side effects of antipsychotic medications (they are both anticholinergic agents)
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What are the withdrawal symptoms that may develop from the abrupt withdrawal of anticholinergic medications?
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Akathisia (restlessness)
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What are the common characteristics of people who are more likely to develop dystonic reactions from antipsychotic medications
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young men
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_____ Is an extrapyramidal side effect of antipsychotic medications that develops rapidly. It is characterized by oculogyric crisis, torticollis, retrocollis, orolarynealphayngeal hypertonus, tense muscles and body contortions
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dystonia/dystonic reactions
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____ is the term for muscles that control eye tense and pull the eyeball up so the person is looking at the ceiling
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oculogyric crisis (a component of dystonia)
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____ is the term to describe a symptom of dystonia where the neck muscles tense and pull the head back
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retrocollis
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_____ is the term to describe a symptom of dystonia where the patient has extreme difficulty in swallowing due to tensed laryngeal and pharyngeal muscles
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orolaryngeal-pharyngeal hypertonus
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How are dystonic rxns from antipsychotic medications treated?
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By an immediate IV or IM administration of benztropine/cogentin (1-2mg) or diphenhydramine/Benadryl (25-50 mg) followed by daily administration of an anticholinergic and possibly a reduction in the antipsychotic dose
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_____is a condition where a patient reports a restless feeling that drives them to keep moving
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akathisia
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How is akatisia caused by antipsychotic medications treated?
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With a reduction in the dose of the antipsychotic if possible, and a beta-adrenergic blocker like propranolol/inderal (20-120mg)
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What antipsychotic medication requires an evaluation for pre-existing cardiac disease?
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Thioridazine/mellaril. Sudden death has been reported with use of this medication
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_____ is a late -appearing side effect of antipsychotic characterized by movements involving the mouth, tongue and jaw including lip smacking, sucking, puckering, tongue protrusion, the bonbon sign, athetoid (worm like movements of the tongue, chewin, as well as eye blinking, grimacing, rocking from the hips, athetoid finger or toes movements, guitar strumming movements and foot tapping
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tardive dyskinesia
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What are the long-term health problems associated with the development of tardive dyskinesia
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choking, compromised respiratory function, and or respiratory alkalosis
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what is thought to be the cause of tardive dyskinesia from antipsychotic medication
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supersensitvity of the dopamine receptors in the basal ganglia
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What are common side effects of typical antipsychotics
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orthostatic hypotension, EPS conditions, weight gain
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What side effects are caused by the blockage of dopamine in the tuberinfundibular tract by antipsychotic medications
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Hyperprolactinemia, gynecomastia, menstrual irregularities, galactorrhea, and sexual side effects. Most common with haloperidol and risperidone
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What are common side effects of atypical antipsychotics
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Weight gain, orthostatic hypotension, new onset diabetes, sedation
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What antipsychotic is the most likely one to prolong a QT interval associated with polymorphic ventricular tachycardia or ventricular fibrillation?
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Ziprasidone/Geodon
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What should initial white blood cells counts be for a patient prior to starting clozapine.
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Abouve 3500 cells per mm3
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When should clozpine be discontinued?
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if the WBC count is below 3500 or if granulocytes drop below 1500
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_____ is a complication of antipsychotic medications characterized by sever muscle rigidity, elevated temperatur, along with any two of the following; HTN, tachycardia, tachypnea, diaphoresis, incontinence, mutism, leukocytosis, changes in LOC, elevated creatinine phosphokinase
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Neuroleptic malignant syndrome (most common with haloperidol)
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What conditions put a pt at high risk for developing neuroleptic malignant syndrome and how should a nurse monitor them?
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Dehydration, agitation and physical exhaustion put a person at risk. The nurse should carefully monitor the pts F&E status and monitor for early signs and symptoms (fever w no apparent cause, fluctuating vital signs and abrupt changes in LOC)
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