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72 Cards in this Set
- Front
- Back
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Schizophrenia is the most severe of the mental illnesses and can affect
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all spheres of life, including perception, thought, judgment, mood, drive and ultimately, personality.
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The Three Dimensions of Schizophrenia
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Disorganization dimension
Psychotic dimension The negative dimension |
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DSM-IV-TR
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Must have symptoms for minimum of 6 months and include 1 month of two or more active symptoms
Is defined by characteristics of positive and negative symptoms These symptoms are then placed into the 3 dimensions of psychopathology |
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3 Inescapable Facts about
Schizophrenia |
Clinically apparent in late adolescence early adulthood
Stress plays a role in onset and relapse/Therapeutic efficacy of the neuroleptics |
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Causes of Schizophrenia
Nature vs Nurture |
Viral infections of childhood/
Problems with brain chemistry &brain structure/abnormalities in the fetus/Genetic predisposition Biological theories take the emphasis off of the mom. |
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Disorganization Dimension
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Disorganized speech
Can not process thoughts Incoherent sentences Malfunction in information |
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Disorganization Dimension
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processing
Blocked Accelerated Delayed |
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Disorganization Dimension
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Lack of logical relationship
between thoughts and ideas Demonstrated by Loose Associations- vague, diffuse, unfocused, or incoherent |
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Disorganization Dimension
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Word salad- incoherent words that are totally unrelated
Tangential- clients inability to get the conversation |
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Disorganization Dimension
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Perseveration- repeating oneself
Clanging- sound associations replace conceptual connections Neologisms- made up words that’s meaning is only known to the person |
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Disorganization Dimension
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Echolalia- parrot like repetition, by an individual with loose boundaries of the words spoken by another
Thought blocking- sudden cessation in the train of thought mid sentence(thinking may cease all together |
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Disorganization Dimension
Disorganized behavior- motor or social |
Catatonia- unresponsive to questions or stimuli, mute, immobile, fully conscious
Waxy flexibility-peculiar rigidity, may allow their limbs to be moved but then hold them in the same position for hours |
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Disorganization Dimension
Disorganized behavior- motor or social |
Catatonic excitement- uncontrolled and aimless motor activity( repetitive, rocking, normal movements out of context)
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Disorganization Dimension
Disorganized behavior- motor or social |
Social behavior - isolate themselves
Surroundings become cluttered Refuse to bathe or pickup Pack rats, hoarders Defecate/masturbate |
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Disorganized Dimension affect
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Incongruent affect
Affect expresses feelings or tone (observable) Mood- Climate, sustained emotion |
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Psychotic Dimension
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Delusions-Grandiose,Somatic-
Nihilistic- Religious- Referential- Persecutory- Thought broadcasting thought insertion |
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Psychotic Dimension
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Hallucinations- sensory perceptions with a compelling sense of reality
Auditory Visual Tactile Olfactory Gustatory |
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Positive Type I
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an embellishment of normal cognition and perception
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Positive Schizophrenia Type I
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Symptoms seem like an addition
Prognosis: better No intellectual impairment Recently a new category: Disorganized |
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Negative Schizophrenia Type II
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an absence or diminution of that which should be.
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Negative Schizophrenia Type II
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If assessed early secondary symptoms can be arrested
Therapeutically accessible |
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Positive symptoms- Bizarre behavior/ they over do everything
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Clothing
Social, sexual Aggressive, agitated behavior,Repetitive, stereotyped behavior |
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Positive symptoms (Type I)
Positive formal thought disorder- hyperdopaminergic process |
Derailment,Tangential
Incoherence,Illogicality Circumstantial,Pressured speech,Distractible speech Clanging |
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Positive symptoms-Delusions
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Persecutory,Jealous
Guilt or sin based Grandiose,Religious,Somatic Ideas of reference Delusions of control Delusions of mind reading |
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Positive symptoms/Hallucinations
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Auditory
Voices commenting Voices conversing Somatic-tactile hallucinations Olfactory Visual |
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Negative (Type II) speech symptoms
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Alogia
Poverty of speech Poverty of content of speech Blocking Increased response to latency |
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Negative (Type II)facial symptoms
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Affective flattening or blunting/Unchangeable facial expression/Decreased spontaneous movements/Poor eye contact/Affective non- responsiveness/Lack of vocal inflictions
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Negative Symptoms
Avolition |
Impaired grooming and hygiene
Lack of persistence at work or school Physical anergia |
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Negative Symptoms
Anhedonia |
Few recreational interests or activities/Little sexual interest or activity/Impaired intimacy or closeness/Few relationships with friends or peers/Attention impairment
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Schizophrenia Pattern of Development
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Gradual Deteriorating course
Slowly improve during middle age/Rare occasions with complete spontaneous recovery |
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Course of Illness
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Three overlapping phases
Alternate between acute and stable |
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Acute Phase of Schizophrenia
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Severe psychotic symptoms
Appear abruptly |
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Stabilizing Phase of Schizophrenia
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The patient gets better
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Stable Phase
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May experience hallucinations and delusions, but are not as severe
May be asymptomatic in regard to psychotic symptoms but are anxious and depressed/ depression natural and also a result of the antipsychotics |
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Types of Schizophrenia
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Paranoid
Catatonic Undifferentiated Residual Disorganized |
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Psychosis
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Brief psychotic disorder
Schizophreniform disorder Schizoaffective disorder Delusional disorder |
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Types of Schizophrenia
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Delusional disorder-
Ertomanic Grandiose Jealous Persecutory Somatic Shared Psychotic Disorder |
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Nursing DX for Schizophrenia
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Altered thought process
Sensory perceptual alterations (specify) Impaired verbal communication Altered role performance Self care deficit |
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Nursing DX for Schizophrenia
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Impaired social interaction
Social Isolation Risk for violence, self directed or directed at others Altered family process |
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Schizophrenia Cognitive behavioral therapy
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Distress reduction. Examination of distressing belief. Challenge thinking patterns that cause distress. Promotion of reasoning. Look for alternative choices. Improve mental state.
Spend time with patient. |
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Schizophrenia Cognitive rehabilitation
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Retraining - memory, attention, speed of mental processing and mental abstraction
to improve overall mental functioning |
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Catatonic Schizophrenia
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Abnormalities in motor behavior
"stupor/ excitement stupor waxy flexibility, motor retardation, mutism, negativism |
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Catatonic Schizophrenia
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Excitement- psychomotor agitation, purposeless w/incoherent verbalizations and shouting, physical and medical control needed, collapse from exhaustion
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Paranoid Schizophrenia
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delusions of persecution or grandure and auditory hallucinations to one theme
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Paranoid Schizophrenia
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tense, suspicious, guarded argumentative, hostile, aggressive
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Psychosis
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Brief psychotic disorder
Schizophreniform disorder Schizoaffective disorder Delusional disorder |
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Types of Schizophrenia
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Delusional disorder-
Ertomanic Grandiose Jealous Persecutory Somatic Shared Psychotic Disorder |
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Nursing DX for Schizophrenia
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Altered thought process
Sensory perceptual alterations (specify) Impaired verbal communication Altered role performance Self care deficit |
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Nursing DX for Schizophrenia
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Impaired social interaction
Social Isolation Risk for violence, self directed or directed at others Altered family process |
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Schizophrenia Cognitive behavioral therapy
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Distress reduction. Examination of distressing belief. Challenge thinking patterns that cause distress. Promotion of reasoning. Look for alternative choices. Improve mental state.
Spend time with patient. |
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Schizophrenia Cognitive rehabilitation
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Retraining - memory, attention, speed of mental processing and mental abstraction
to improve overall mental functioning |
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Catatonic Schizophrenia
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Abnormalities in motor behavior
"stupor/ excitement stupor waxy flexibility, motor retardation, mutism, negativism |
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Catatonic Schizophrenia
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Excitement- psychomotor agitation, purposeless w/incoherent verbalizations and shouting, physical and medical control needed, collapse from exhaustion
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Paranoid Schizophrenia
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delusions of persecution or grandure and auditory hallucinations to one theme
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Paranoid Schizophrenia
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tense, suspicious, guarded argumentative, hostile, aggressive
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Paranoid Schizophrenia
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Less aggression of mental faculties/ little social impairment, prognosis- promising
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Undifferented
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do not meet/ do meet more than one subtype
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Residual Schizophrenia
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Hx of at least one previous episode of schizophrenia w/prominent psychotic symptoms
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Residual Schizophrenia
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Occurs in pt. w/ chronic form and is in the stage that follows acute episode. No psychotic symptoms
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Residual Schizophrenia
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social isolation, essentric behavior, bad personal hygiene,
blunted affect, poverty or overly elaborate speech, illogical thinking apathy |
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Schizoaffective
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Manifested by schizo behaviors w/element of mood disorder
may appear depressed w/ motor retard/SI |
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Schizoaffective symptoms may include
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Euphoria
Grandiosity hyperactivity |
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Brief Psychotic
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sudden onset of psychotic symptoms that may /may not be preceded by severe psychosocial stressor
Last 1 day to 1 month |
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Brief Psychotic
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Return to premorbid levels of fx
disorientation w/symptoms like other types of schizo |
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Brief Psychotic
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Succeptible ppl are histrionic, narcissistic, paranoid, schizotypical, borderline personality disorders
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Schizophreniform
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same as schizophrenia but phases prodomal, active, and residual phases
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Schizophreniform
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At least 1 month, but less than 6(provisional)
change to Schizophrenia if last more than 6 months |
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Delusional
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One or more bizarre delusions for at least one month. Hallucinations not prominent
Non- bizarre behavior based on prominent delusions |
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Shared
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Folie a deux/ second person takes on psychosis of other person's disorder
chronic/ more common in women Occurs when they've been isolated from others |
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echolalia
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repeats words/fragments/sentences they hear
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Echopraxia
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purposely imitate movements
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Affective flattening
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Poor eye contact, unchangeable facial expressions
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