Schizophrenia (329 E1)

Question 1

schizophrenia definition

Answer 1

a psychosis characterized by abnormalities in perception, content of thought and thought process, and extensive withdrawal of one’s interest from individuals and the outside world
a disconnection to the mind

Question 2

Psychosis definition

Answer 2

a state in which the individual is experiencing hallucinations, delusions or disorganized thoughts, speech or behavior
caused by schizophrenia and mood disorders like bipolar

Question 3

schizophrenia interferes w/ person’s ability to

Answer 3

• think clearly
• manage emotions
• make decisions
• relate to others

Question 4

peak onset of schizophrenia

Answer 4

men: 15-25 years of age
women: 25-35 years of age

Question 5

etiology of schizophrenia

Answer 5

• genetics
• environmental
• brain chemistry (problems w/ neurotransmitter, dopamine & glutamate)
• substance use

Question 6

comorbidity of schizophrenia

Answer 6

• substance use disorder
• nicotine dependence
• anxiety/depression/SI
• DM
• CVD
• obesity
• malignant neoplasm
• HIV/AIDS
• osteoporosis
• Hep C

Question 7

schizophrenia: positive symptoms

Answer 7

can be thought of as sx that exist but should not be there

• alterations in perception (paranoia, delusions, hallucinations)
• altered speech
• alterations in behavior
• alterations in thought

Question 8

paranoia

Answer 8

• an irrational fear, ranging from mild to profound
• deep mistrust or suspicion of others
• may result in dangerous defensive actions
• paranoia can develop into delusional thoughts

Question 9

delusions

Answer 9

false beliefs that are held despite a lack of evidence to support them and aren’t corrected w/ reasoning
feels very real to patient

Question 10

delusions: persecutory

Answer 10

belief that one is being watched, plotted against, ridiculed

Question 11

delusions: referential

Answer 11

belief that events or circumstances that have no connection to you are somehow related to you

Question 12

delusions: grandiose

Answer 12

belief that one is a powerful or important person

Question 13

delusions: erotomanic

Answer 13

believing that another person desires you romantically

Question 14

delusions: nihilistic

Answer 14

the delusion of nonexistence: a fixed belief that the mind, body or the world at large - or parts thereof - no longer exists

Question 15

delusions: somatic

Answer 15

belief that the body is changing in unusual ways

Question 16

delusions: religious

Answer 16

belief that they have a special relationship w/ god or are on a mission for god, or that they are sinners

Question 17

delusions: control

Answer 17

belief that another person, group or external force controls your thoughts, feelings, impulses or behavior

Question 18

intervening w/ delusion

Answer 18

• remain calm, acknowledge and accept the patient’s experience and feelings
• encourage pt to express feelings and convey empathy about the patient’s fearfulness
• provide reassurance about intentions & present reality
• focus on helping the pt feel safe, focus on the fear and not the delusion

Question 19

when communicating w/ the patient having a delusion

Answer 19

build rapport and trust by being open, honest and genuine

• ask pt to describe the delusion
• validate if part of the delusion is real and present reality
• never debate or argue the delusional content
• assess the intensity, frequency and duration
• what triggered

Question 20

can you clarify a delusion for a pt

Answer 20

it is helpful to clarify misinterpretations of the environment and gently suggest, as tolerated, a more reality based perspective

Question 21

documenting delusions

Answer 21

• type of delusion experienced, content/theme, and the characteristics
• use the patient’s own words
• the pt behavior

Question 22

hallucinations

Answer 22

• alterations in perceptions that involve errors in how one interprets perceptions or perceives reality
• occurs when a person perceives a sensory experience for which non external source exists

Question 23

5 senses of hallucinations

Answer 23

• auditory: hearing voices or sounds
• visual: seeing people or things
• olfactory: smelling odors
• gustatory: experiencing tastes
• tactile: feeling body sensations

Question 24

command hallucinations

Answer 24

• auditory hallucinations in the form of commands that instruct a patient to act in a specific way
• the content of the commands can range in seriousness from innocuous (not harmful) to dangerous, including commands to cause harm to self or other

Question 25

intervening w/ hallucinations

Answer 25

- introduce self to pt to gain rapport, trust and to help develop the nurse pt relationship - approach the pt in a non threatening and calm manner - reassure the pt that they are safe - ask direct questions about type and content

Question 26

assessment for hallucinations

Answer 26

- moving eyes back & forth - muttering or talking to self or object - appearing distracted - suddenly stopping conversation as if interrupted - intently watching a vacant area of the room

Question 27

hallucination: documentation

Answer 27

- type experienced, content/theme, & the characteristics - use pt's own words - the pt's behavior prior to assessment for hallucinations and behaviors during the hallucination - any actions taken to help the patient during the hallucination

Question 28

teach pt w/ hallucination to

Answer 28

- manage stress & stim - use other sounds to compete w/ hallucination - find out what is and isn't real - engage in activities that can take your mind off the hallucination - talk - make contact w/ others - develop a plan for how to cope w/ hallucinations

Question 29

alterations in speech: circumstantiality

Answer 29

extremely detailed & lengthy conversation about a topic **but gets eventually to the point**

Question 30

alterations in speech: tangentiality

Answer 30

wandering off topic or going off on tangents and **never reaching the point**

Question 31

alterations in speech: loose associations

Answer 31

absence of normal connectedness of thoughts, ideas & topics ex: my friend talks about french fries but how can you trust the french

Question 32

alterations in speech: flight of ideas

Answer 32

topic of conversation changes repeatedly & rapidly w/ only superficial associative connections, making it difficult for others to follow ex: a man begins talking about his business but quickly shifts to discussing the economy, the government and other countries

Question 33

alterations in speech: echolalia

Answer 33

repetition of another's words, pathological repetition of another word

Question 34

alterations in speech: clang association

Answer 34

choosing words based on their sound rather than their meaning; often involves a rhyme or similar beginning sounds ex: "i heard the bell. Well hell then i fell"

Question 35

alterations in speech: symbolic speech

Answer 35

using words based on what they symbolize, not what they mean ex: a pt reports "demons are sticking needles in me" when what he means is he is experiencing a sharp pain

Question 36

alterations in speech: pressured speech

Answer 36

urgent or intense speech; reluctance to allow comments from others

Question 37

alterations in speech: world salad

Answer 37

string of words totally unconnected, jumble of words meaningless to a listener ex: agents want strength of policy on a boat reigning supreme

Question 38

alterations in speech: neologisms

Answer 38

made up words, meaning for the patient only ex: "his mannerologies are poor"

Question 39

thought blocking

Answer 39

a reduction or stoppage of thought ex: in the middle of talking about his childhood, the patient abruptly pauses, after which he can't remember what he was saying

Question 40

thought insertion

Answer 40

the belief that someone else has inserted thoughts into the patient's brain ex: the patients repeatedly complains of having disturbingly violent thoughts, which, she claims are being sent to her by satan

Question 41

thought deletion

Answer 41

a belief that thought have been taken or are missing

Question 42

paranoia

Answer 42

an irrational fear, ranging from mild to profound. fear may result in dangerous defensive actions, such as harming another person before that person can harm the pt

Question 43

catatonia

Answer 43

a pronounced increase or decrease in the rate and amount of movement. Excessive motor activity is purposeless

Question 44

echopraxia

Answer 44

involuntary imitation of another's movements & gestures

Question 45

motor retardation

Answer 45

a pronounced slowing of movement

Question 46

motor agitation

Answer 46

excited behavior, such as running or pacing rapidly, often in response to internal or external stimuli

Question 47

negativism

Answer 47

a tendency to resist or oppose the requests or wishes of other

Question 48

negative symptoms

Answer 48

ones that should be there but aren't **harder to treat than positive symptoms** **interfere greatly with function on a daily basis**

Question 49

negative symptoms: affective blunting

Answer 49

reduced or constricted affect ex: face doesn't move, lack of eye contact

Question 50

negative symptoms: apathy

Answer 50

a decreased interest in activities or beliefs that would otherwise be interesting or important or little attention to them ex: no longer interested in favorite sport **results in loss of activities like personal hygiene**

Question 51

negative symptoms: alogia

Answer 51

a reduction in speech ex: hard to get words out

Question 52

negative symptoms: avolition

Answer 52

reduced or loss of motivation or goal directed behavior; difficulty beginning or sustaining goal directed activities ex: hard to go to school **results in loss of activities like personal hygiene**

Question 53

negative symptoms: anhedonia

Answer 53

a reduced ability or inability to experience pleasure or joy

Question 54

negative symptoms: asociality

Answer 54

a decreased desire for social interaction or discomfort while doing it; social withdrawal

Question 55

cognitive symptoms: concrete thinking

Answer 55

impaired ability to think abstractly resulting in interpreting or perceiving things in a literal manner

Question 56

cognitive symptoms: impaired memory

Answer 56

impacts short term memory and the ability to learn

Question 57

cognitive symptoms: impaired information processing

Answer 57

delayed responses, misperceptions or difficulty understanding others

Question 58

cognitive symptoms: impaired executive functioning

Answer 58

difficulty w/ reasoning, setting priorities, comparing options, plannings...

Question 59

cognitive symptoms: anosognosia

Answer 59

inability to realize one is ill; an inability caused by the illness itself; may result in resistance to or cessation of treatment; often combined w/ paranoia so that accepting help is impossible

Question 60

affective symptoms

Answer 60

involve an altered experience and expression of emotions -> mood may be unstable, erratic, labile or incongruent

Question 61

schizoaffective disorder

Answer 61

a chronic mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions and symptoms of a mood disorder such as mania and depression **an uninterrupted period of illness during which at some time there is either a major depressive episode, a manic episode, or a mixed episode w/ symptoms of schizophrenia**

Question 62

affective disorders

Answer 62

mental health conditions that heavily affect a person's mood and feelings

Question 63

bipolar type schizoaffective disorder

Answer 63

individuals experience a combination of symptoms from both schizophrenia and bipolar disorder. typically, this means individuals experience both depressive and manic espisodes alongside their schizophrenia sx

Question 64

depressive type schizoaffective disoder

Answer 64

individuals suffer form the psychotic symptoms of schizophrenia as well as depressed moods that come w/ major depressive disorder. those living w/ depressive type do not experience highs and lows but instead experience long periods of intense depression

Question 65

depresssive sx of schizoaffective disorder

Answer 65

- feelings of lethargy or not wanting to do anything - no longer deriving pleasure from your favorite activities - inability to sleep or sleeping excessively - loss of appetite - a feeling that you will never be happy again

Question 66

schizophrenia sx of schizoaffective disorder

Answer 66

- delusions - hallucinations - difficulty holding work or staying enrolled in school - problems w/ personal hygiene or taking care of yourself - difficulty communicating w/ individuals

Question 67

treatments of schizoaffective disorder

Answer 67

- medications (antipsychotic, mood stabilizing or antidepressant) - cognitive behavioral therapy - group therapy sessions