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52 Cards in this Set
- Front
- Back
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Four A's of schizophrenia
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Affect, Associative looseness, Autism, Ambivalence
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Affect
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Outward manifestation of a person's feelings and emotions. Schizophrenia may cause flat, blunted, inappropriate, or bizarre affect
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Associative looseness
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Disorganized thinking,"", manifested as jumbled and illogical speech and impaired reasoning
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Autism
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Thinking is not bound to reality but reflects the private perceptual world of the individual. Ex: delusions, hallucinations, neologisms
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Ambivalence
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Simultaneously holding two opposing emotions, attitudes, ideas, wishes toward the same person, situation, or object.
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DSM Criteria for Schizophrenia:
A. Characteristic Symptoms |
Two or more of the following during a 1-month period (or less if successfully tx): Delusions, Hallucinations, Disorganized speech, grossly disorganized or catatonic behavior, negative symptoms
Only one criterion needed if delusions bizarre or auditory hallucinations and (a) voices keep a running commentary about person's thoughts/behaviors or (b) two or more voices converse with eachother |
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DSM Criteria for Schizophrenia:
B. Social/Occupational Dysfunction |
IF one or more major areas of the person's life are makedly below premorbid functioning -OR- IF childhood or adolescence failure to achieve expected level of interpsonal, academic, or occupational achievement THEN meets cirteria for B
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DSM Criteria for Schizophrenia:
C. Duration |
Continuous signs persist for at least 6 months with at least 1 month that meets criteria of A (active phase) and may include prodromal or residual symptoms
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DSM Criteria for Schizophrenia
D. 1-3 |
1. All other mental diseases have been ruled out
2. All other medical conditions have been ruled out 3. If hx of pervasive developmental disorders, then prominent hallucinations or delusions for 1 month are needed to make dx of schizophrenia |
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Paranoid Schizophrenia
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later onset, develops rapidly, dominant symptoms: one or more delusions of grandeur/persecution and frequent auditory hallucinations/delusions, NO disorganized speech or flat affect
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Most common defense mechanism used in paranoia
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Projection (i.e. when pt feels angry, they project feeling onto others and believe others are angry with them)
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Ideas of reference
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Personalizing unrelated events (pt sees nurse talking to psychiatrist and believe they are talking about him)
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Providing for Self-Care needs for paranoid schizophrenic
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*Nutrition: provide foods in commercially sealed packaging
*May be fearful someone is going to harm them while sleeping |
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Catatonic schizophrenia
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motor immobility, excessive purposeless motor activity, extreme negativisim or mutism, peculiar movement: posturing, prominent mannerisms or grimacing, echolalia or echopraxia
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Providing for Self-Care Needs for Catatonic schizophrenia (withdrawn)
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*Nutrition: hand or tube fed
*Risk for aspiration *Monitor bowel/bladder incontinence/retention *ROM *Dressing and grooming |
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Providing for Self-Care Needs for Catatonic schizophrenia (excited)
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*Risk for exhaustion
*IM INJ of a sedating antipsychotic *Stimulation reduction *Add'l fluids, calories, rest |
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Disorganized Schizophrenia
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Dominant symptoms: disorganized speech/behavior, flat/inappropriate affect and does not meet criteria for Catatonic Type
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Most regressed and socially impaired of all subtypes of Schizophrenia
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disorganized
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Communication guidelines for Disorganized Schizophrenia
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*Clear, concise, and concrete comm.
*Tasks should be broken down, one at a time *Repeated refocusing necessary |
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Providing for Self-Care Needs for Disorganized Schizophrenia
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*Pts neglect grooming
*Dress inappropriately for weather *Need significant direct assistance with ADLs |
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Undifferentiated Schizophrenia
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Has active phase, has delusions, hallucinations, bizzare behavior, but no one clincal presentation dominates. Disability remains fairly stable and persistent over time
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Residual Schizophrenia
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no longer has active phase symptoms, persistance of 2 or more residual symptoms: social isolation/withdrawal, impairement of role function, impairement of personal hygiene, lack of initiative, interest, energy, blunted/inappropriate affect, speech deficits, odd beliefs
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Positive Symptoms
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The presence of something that is not normally present (hallucinations, delusions are false, fixed beliefs, concrete thinking, alterations in speech, perception, and behavior
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Delusions
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false fixed beliefs that cannot be corrected by reasoning
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Concrete thinking
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impaired ability to think abstractly
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Neologisms
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made-up words that have meaning for the pt but a different nonexistent meaning to others
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Echolalia
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pathological repeating of another's words (most often seen in catatonia)
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Echopraxia
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mimicking of movements of other (catatonia)
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Clang association
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choice of words based on their sound rather than their meaning, often rhyming and sometimes having a similar beginning sound
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Word Salad
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jumble of words that are meaningless to the listener
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Depersonalization
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nonspecific feeling that a person has lost identity and that the self is different or unreal (i.e. body parts don't belong to them)
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Derealization
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false perception that the environment has changed
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Hallucinations
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involve perceiving a sensory experience for which no external stimulus exists
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Illusions
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misperceptions or misinterpretations of a real experience
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Types of hallucinations
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Auditory, Visual, Olfactory, Gustatory, Tactile
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command hallucinations
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voices that direct a person to take action
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Outward indications of possible hallucinations
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turning/tilting head as if to listen to someone, suddenly stopping current activity as if interrupted, and moving the lips silently
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Stereotyped behaviors
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repeated motor behaviors that do not presently serve a logical purpose
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Active negativism
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pt does the opposite of what he/she is told to do
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Passive negativism
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failure to do what is requested
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Negative Symptoms
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the absence of something that should be present but is not. Develop slowly and are those that most interfere with a person's adjustment and ability to cope. Blunted/Flat/Inappropriate/Bizzare affect, Alogia, Avolition, Anhedonia
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Affective blunting
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Neg. symptom. A reduction in the expression, range, and intensity of affect
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Anergia
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Neg. symptom. Lack of energy; passivity, lack of persistence at work/school
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Anhedonia
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Neg. symptom. Inability to experience pleasure
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Avolition
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Neg. symptom. Reduced motivation; inability to initiate tasks such as social contacts, grooming, and other ADLs
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Thought blocking
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Neg. symptom. A sudden interruption in the thought process, usually due to internal stimuli
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Alogia
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reduced verbalization
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Assessment questions to ask if pt is experiencing command hallucinations
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1. Do you recognize the voices?
2. Do you believe the voices are real? 3. Do you plan to follow the command? |
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Cognitive symptoms
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abnormalities in how a person thinks: inattention, distracted, impaired memory, poor problem-solving, poor decision-making, illogical thinking, impaired judgment
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Affective symptoms
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symptoms involving emotions and their expressions: dysphoria, suicidality, hopelessness, assessment for depression is crucial
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Four main symptom groups of schizophrenia
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positive, negative, cognitive, affective
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Phases of Schizophrenia
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Phase I- Acute
Phase II- Stabilization Phase III- Maintenance |
