Card Set Information

2013-03-07 08:27:52
nur210e2 Schizophrenia

Show Answers:

  1. A patient is found in a closet with an empty 2-liter bottle of cola taken from the staff refrigerator. The bottle was full but now is empty. Recently, staff have noticed an increase in this patient’s response to auditory hallucinations and the recent addition of confusion to his symptoms. For the past several days, the patient has been seen drinking from the hallway water cooler and taking items from his peers’ dinner trays. Which response is most appropriate?

    A. Place the patient on every-15-minute checks to identify any further deterioration.
    B.. Attempt to distract the patient from excess fluid intake and other bizarre behavior.
    C. Request an increase in antipsychotic medication, owing to the worsening of his psychosis.
    D. Restrict his access to fluids, and evaluate for water intoxication via daily weights.
    D. Restrict his access to fluids, and evaluate for water intoxication via daily weights.

    The exact reason for polydipsia, the excess intake of fluids, in persons with schizophrenia is not known, but it may be due to endocrine disturbances resulting in an increased sense of thirst. In some cases, the amount of fluid ingested is sufficient to cause hyponatremia or water intoxication. This is indicated by confusion, a worsening of psychosis, the development of delirium, and eventually coma and death. Putting the patient on 15-minute checks does not address the problem of excess fluid intake. However, restricting his fluid will allow excess fluid to be excreted, and daily weights will measure significant weight gain in a short period of time. Distraction might temporarily interfere with the patient’s efforts to consume excess fluids but probably not enough to reduce the problem significantly, given his persistence. Distraction would also not provide any ongoing data for continued assessment of the polydipsia. Although an antipsychotic medication increase might seem logical because his symptoms have worsened, in this case there is a good chance that the worsening of his psychosis is due to his water intoxication, in which case, fluid restriction to normal intake levels is the intervention that best impacts directly on the root cause of his increasing symptoms.
    (this multiple choice question has been scrambled)
  2. Jim is sometimes seen moving his lips silently or murmuring to himself when he does not realize others are watching. Sometimes when he is conversing with others, he suddenly stops, appears distracted for a moment, and then resumes. Based on these observations, Jim most likely is experiencing which symptom(s)? Select all that apply.

    1. Illusions
    2. Paranoia
    3. Delusional thinking
    4. Auditory hallucinations
    5. Impaired reality testing
    6. Stereotyped behaviors

    Illusions are misinterpretations of phenomena which exist in the real world but are misperceived; for example, a patient mistakes a rope for a snake.

    Paranoia is an irrational fearfulness.

    Delusions are irrational beliefs held despite evidence to the contrary.

    None of these symptoms are consistent with Jim’s behavior as described here. However, it is likely that he is experiencing

    auditory hallucinations, which are internally-generated “voices” the patient experiences as if they are coming from a source other than himself. Indications that a person is experiencing auditory hallucinations include verbally responding to the “voices” (often done quietly or even silently, in which case, the patient’s moving lips might be the only clue); being interrupted and/or distracted by the voices (causing the interruption in his conversation); and eye and head tracking movements (wherein the patient moves his eyes or head as if following the source of the voices he hears, just as a listener would normally track the position of the person with whom he is speaking).

    It is also likely that Jim is experiencing

    impaired reality testing. Reality testing is the ability to determine accurately whether or not an experience is based in reality. For example, a student up alone studying late at night thinks she hears a voice and in response, scans the room to see if anyone is there. Seeing no one, the student determines that she was mistaken. The student is testing reality, using her senses and logic to confirm or refute her experience. Persons with psychotic disorders such as schizophrenia often are impaired in their ability to determine whether a phenomenon is based in reality or not; they fail to question or test it and instead assume that it is real.

    Stereotyped behavior is repetitive behavior that does not serve a logical purpose. An example would be repeatedly raising one’s arms overhead when there is no reason to do so. Here it is possible that Jim’s lip movements are stereotyped behaviors, but in the context of the other symptoms that are more associated with auditory hallucinations, the more likely explanation for the lip movement is that he is responding silently to the voices he hears.
  3. Mary, a patient diagnosed with schizophrenia, is encouraged to attend groups but stays in her room instead. Staff and peers encourage her participation, but her hygiene remains poor. She does not seem to care that others wish that she would behave differently. Which is the most likely explanation for Mary’s failure to respond to others’ efforts to help her behave in a more adaptive fashion? Select all that apply.

    1. She is avolitional.
    2. She is displaying anergia.
    3. She is displaying negativism.
    4. She is exhibiting paranoid delusions.
    5. She is being resistant or oppositional.
    6. She is experiencing social withdrawal.
    7. She is apathetic due to her schizophrenia.

    Avolition is the absence of motivation and is a negative symptom of schizophrenia. Lacking motivation, patients retreat from their usual activities and roles.

    Anergia, another negative symptom of schizophrenia, is a lack of energy that impairs persistence and follow through; this too would likely interfere with Mary’s ability to engage in the activities encouraged of her by staff and peers.

    Negativism is a reluctance to do that which is requested. In this case, Mary is displaying passive negativism in that she is simply failing to respond as requested(active negativism involves doing the opposite of what is requested).

    Paranoid delusions are irrational, fearful beliefs; an example might be a patient’s belief that peers intend to poison him. Although it is possible that paranoia would decrease her comfort around others and could contribute to her reluctance to attend group, there is no information given about the patient’sbeliefs.

    Although anyone can behave oppositionally or resist the wishes of others, there is no information provided here to support that explanation; this choice is included here to illustrate how we may tend to “read into” a person’s behavior and imbue that behavior with meaning that is simply our assumption about the reason for a person’s behavior.

    Social withdrawal and apathy are other negative symptoms of schizophrenia and in this case would tend to cause Mary to avoid others and to see little reason to attend to hygiene or other activities of daily living. It is likely that they are contributing to her avoidance of groups and her impaired hygiene.
  4. You are attempting to interview Mr. Jones, a newly admitted involuntary patient with schizophrenia. Mr. Jones seems evasive and uncomfortable and gives one-word responses that are minimally informative. Which response would be most useful for facilitating the interview?

    A. “Why did you come to the hospital today?”
    B. “It must be difficult to be admitted to a hospital against your will.”
    C. “If you could cooperate for just a few minutes, we could get this done.”
    D. “Did your schizophrenia get worse because you stopped taking your medication?”
    B. “It must be difficult to be admitted to a hospital against your will.”

    Given that the patient has been admitted involuntarily, it is likely that he does not wish to be in the hospital, and it could be that he does not believe he even needs to be in the hospital. As a result, it is likely that he will be resistant.

    Further, patients with schizophrenia may suffer from alogia, or poverty of speech, a symptom wherein speech is minimally productive. Last, in that the patient has just been admitted, it is likely that there has not yet been an opportunity for him to develop trust or rapport with staff.

    Asking a “why” question is not considered therapeutic, because it tends to imply that the patient has done something wrong or that the nurse disagrees or disapproves of his action. Conveying disapproval, even unintentionally, would interfere with building the trust and rapport needed for a successful interview.

    Noting that it must be difficult to be hospitalized against his will is an example of conveying empathy; this sends the message that you appreciate at least somewhat his circumstances and that you are understanding and perhaps supportive. This response is likely to increase the patient’s comfort and cooperation.

    Pointing out that the interview could be finished if only the patient would cooperate for a few minutes would tend to suggest to the patient that you care more about completing the task itself than about the patient; this would interfere with the development of rapport and trust.

    Asking if stopping his medication made his mental illness worse is a closed-ended question, likely to elicit a one-word or yes/no answer, assigns blame, and does not promote the higher-level exchange of information that is desired.
    (this multiple choice question has been scrambled)
  5. A week later, Mr. Jones has begun to take the conventional antipsychotic haloperidol. You approach him with his bedtime dose and notice that he is sitting very stiffly and immobile. When you approach, you notice that he is diaphoretic, and when you ask if he is okay he seems unable to turn towards you or to respond verbally. You also notice that his eyes are aimed sharply upward and he seems frightened. How should the nurse respond? Select all that apply.

    1. Begin to wipe him with a washcloth wet with cold water or alcohol.
    2. Hold his medication, stat page his doctor, and check his temperature.
    3. Administer a medication such as benztropine IM to correct his dystonic reaction.
    4. Reassure him that although there is no treatment for his tardive dyskinesia, it will pass.
    5. Explain that he has anticholinergic toxicity, hold his meds, and give IM physostigmine.
    6. Hold his medication tonight, and consult his doctor after completing medication rounds.
    1, 2

    Muscle rigidity is a component of a number of reactions to typical antipsychotic medications such as haloperidol. However, in a dystonic reaction, the abnormal muscle contraction is limited to one area of the body, usually the head or upper trunk.

    Generalized stiffness is a symptom of the pseudoparkinsonism sometimes caused by this group of medications, but it is a stiffness that inhibits movement rather than the rigidity that is completely preventing movement here.

    The only medication reaction likely to combine muscular rigidity, hyperpyrexia, and sometimes oculogyric crises is neuroleptic malignant syndrome (NMS), a potentially fatal condition that must be treated as a medical emergency. NMS can produce dangerously high fevers, so reducing the body temperature is a key part of treating this reaction. The medication should be held and the doctor contacted immediately for medical orders. Thepatient’s temperature should also be taken to quantify his hyperpyrexia.

    Tardive dyskinesia does not produce rigidity or hyperpyrexia; it involves rhythmic involuntary movements, particularly of the circumoral (area of the face around the mouth) area and extremities.

    Anticholinergic toxicity can produce hyperpyrexia but does not involve motor rigidity or oculogyric crises as seen here. Although holding the medication is desirable, a potentially fatal medical emergency exists, and the doctor’s response is needed immediately, not after medication rounds.
  6. Schizophrenia is best characterized as 

    A. deteriorating personality.
    B. ambivalent personality.
    C. split personality.
    D. multiple personalities.
    A. deteriorating personality.

    The course of the disease is marked by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.
    Text page: 311
    (this multiple choice question has been scrambled)
  7. A descriptor for a subtype of schizophrenia is 

    A. delusional.
    B. dissociated.
    C. disorganized.
    D. developmental.
    C. disorganized.

    Disorganized schizophrenia is a subtype of schizophrenia listed in the DSM-IV-TR and refers to the most regressed and socially impaired of all the schizophrenic disorders. They would have the lowest GAF (Global Assessment of Functioning) score, certainly from among the other schizophrenics. Text page: 788, Other subtypes are:

    (this multiple choice question has been scrambled)
  8. Which of the following would be assessed as a negative symptom of schizophrenia? 

    A. Agitation
    B. Anhedonia
    C. Hostility
    D Hallucinations
    B. Anhedonia

    Negative - something that should be there, but is not.

    Negative symptoms include the crippling symptoms of

    affective flattening
    alogia - poverty of speech/content
    avolition, apathy
    anhedonia, asociality
    attention deficits
    other - reduced ability to "read" others' emotions or intent

    P. 314
    (this multiple choice question has been scrambled)
  9. The type of altered perception most commonly experienced by clients with schizophrenia is

    A. auditory hallucinations.
    B. tactile hallucinations.
    C. illusions.
    D. delusions.
    A. auditory hallucinations.

    Hallucinations, especially auditory hallucinations, are the major example of alterations of perception in schizophrenia. They are experienced by as many as 90% of schizophrenic individuals. Text page: 316
    (this multiple choice question has been scrambled)
  10. What is the most common course of schizophrenia? Initial episode followed by

    A. continuous deterioration.
    B. complete recovery.
    C. recurrent acute exacerbations.
    D. recurrent acute exacerbations and deterioration.
    D. recurrent acute exacerbations and deterioration.

    Schizophrenia is usually a disorder marked by an initial episode followed by recurrent acute exacerbations. With each relapse of psychosis an increase in residual dysfunction and deterioration occurs. Text page: 311
    (this multiple choice question has been scrambled)
  11. The causation of schizophrenia is currently understood to be

    A. a combination of inherited and nongenetic factors.
    B. excessive amounts of the neurotransmitter dopamine.
    C. excessive amounts of the neurotransmitter serotonin.
    D. stress related.
    A. a combination of inherited and nongenetic factors.

    Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme nongenetic factors (such as virus, birth injuries, nutritional factors) that can affect the genes governing the brain or directly injure the brain. Text page: 309
    (this multiple choice question has been scrambled)
  12. Which symptom would not be assessed as a positive symptom of schizophrenia?

    A. Delusion of persecution
    B. Auditory hallucinations
    C. Idea of reference
    D. Affective flattening
    D. Affective flattening

    Positive symptoms are the attention-getting symptoms such as

    bizarre behavior

    They are referred to as florid (occurring in fully developed form) symptoms.
    (this multiple choice question has been scrambled)
  13. When a client with schizophrenia hears hallucinated voices saying he is a vile human being, the nurse can correctly assume that the hallucination

    A. is a retained memory fragment.
    B. is a projection of the client's own feelings.
    C. derives from neuronal impulse misfiring.
    D. may signal seizure onset.
    B. is a projection of the client's own feelings.

    One theory about derogatory hallucinations is that the content is a projection of the individual's feelings about self. The derogatory hallucinations are an extension of the strong feelings of rejection and lack of self-respect experienced by the individual during the prodromal (early symptom (or set of symptoms) that might indicate the start of a disease) period. Text page: 316
    (this multiple choice question has been scrambled)
  14. Which side effect of antipsychotic medication has no known treatment?

    A. Anticholinergic effects
    B. Pseudoparkinsonism
    C. Tardive dyskinesia
    D. Dystonic reaction
    C. Tardive dyskinesia

    Tardive dyskinesia (involuntary, repetitive body movements) is not always reversible with discontinuation of the medication and has no proven cure. Options 1, 2, and 3 often appear early in therapy and can be minimized with treatment. Text page: 331
    (this multiple choice question has been scrambled)
  15. A client with residual schizophrenia is uninterested in community activities. He lacks initiative, demonstrates both poverty of content of speech and poverty of speech, and seems unable to follow the schedule for taking his antipsychotic medication. The case manager continues to direct his care with the knowledge that his behavior is most likely prompted by 

    A. dependency needs.
    B. neural dysfunction.
    C. chronic uncooperativeness.
    D. personality conflict.
    B. neural dysfunction.

    Schizophrenia is considered a neurobiological disorder. The course of schizophrenia involves recurrences. With each relapse further deterioration is noted. Residual schizophrenia refers to the disorder when active phase symptoms are no longer present and the individual is left with two or more of the following symptoms:

    lack of initiative
    social withdrawal
    impaired role function
    marked speech deficits
    odd beliefs

    Text page: 309
    (this multiple choice question has been scrambled)
  16. A client with paranoid schizophrenia refuses food. He states the voices are telling him the food is contaminated and will change him from a male to a female. A therapeutic response for the nurse would be

    A. "Other people are eating the food and nothing is happening to them."
    B. "I understand that the voices are very real to you, but I do not hear them."
    C. "The voices are wrong about the hospital food. It is not contaminated."
    D. "You are safe here in the hospital, nothing bad will happen to you."
    B. "I understand that the voices are very real to you, but I do not hear them."

    This reply acknowledges the client's reality but offers the nurse's perception that he or she is not experiencing the same thing. Text page: 323
    (this multiple choice question has been scrambled)
  17. A client with disorganized schizophrenia would have greatest difficulty with the nurse

    A. interacting with a neutral attitude.
    B. giving multistep directions.
    C. providing nutritional supplements.
    D. using concrete language.
    B. giving multistep directions.

    The thought processes of the client with disorganized schizophrenia are severely disordered and severe perceptual problems are present, making it extremely difficult for the client to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times. Text page: 335
    (this multiple choice question has been scrambled)
  18. A nursing intervention designed to help a schizophrenic client manage relapse is to

    A. remind the client of the need to return for periodic blood draws.
    B. teach the client and family about behaviors associated with relapse.
    C. schedule the client to attend group therapy.
    D. help the client and family adapt to the stigma of chronic mental illness.
    B. teach the client and family about behaviors associated with relapse.

    By knowing what behaviors signal impending relapse (avoiding others, trouble sleeping, troubling thoughts), interventions can be quickly invoked when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted. Text page: 325
    (this multiple choice question has been scrambled)
  19. A client with paranoid schizophrenia tells the nurse "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as 

    A. a delusion.
    B. neologism.
    C. clang association.
    D. blocking.
    B. neologism.

    A neologism is a newly coined word that has meaning only for the client. Text page: 315
    (this multiple choice question has been scrambled)
  20. When a client with paranoid schizophrenia tells the nurse "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be

    A. "I do not believe I understand the word volmers. Tell me more about them."
    B. "You are safe here. This is a locked unit and no one can get in."
    C. "It must be frightening to think something is going to harm you."
    D. "Why do you think someone or something is going to harm you?"
    C. "It must be frightening to think something is going to harm you."

    This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience. Option 1 gives global reassurance. Option 2 encourages elaboration about the delusion. Option 3 asks for information that the client will likely be unable to answer. Text page: 323
    (this multiple choice question has been scrambled)
  21. A desired outcome for a client with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will

    A. ask for validation of reality.
    B. demonstrate a cool, aloof demeanor.
    C. describe content of hallucinations.
    D. identify prodromal symptoms of disorder.
    A. ask for validation of reality.

    Beginning to question his or her own altered perceptions by seeking input from staff is highly desirable. Text page: 321
    (this multiple choice question has been scrambled)
  22. A client has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be

    A. social, vocational, and self-care skills.
    B. safety and crisis intervention.
    C. stress and vulnerability assessment.
    D. acute symptom stabilization.
    A. social, vocational, and self-care skills.

    During the stable plateau phase of schizophrenia, planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community. Text page: 321
    (this multiple choice question has been scrambled)
  23. A client has been receiving antipsychotic medication for 6 weeks. At her clinic appointment she tells the nurse that her hallucinations are nearly gone and that she can concentrate fairly well. She states her only problem is "the flu" that she's had for 2 days. She mentions having a fever and a very sore throat. The nurse should

    A. advise the physician that the client should be admitted to the hospital.
    B. consider recommending a change of antipsychotic medication.
    C. arrange for the client to have blood drawn for a white blood cell count.
    D. suggest that the client take something for her fever and get extra rest.
    C. arrange for the client to have blood drawn for a white blood cell count.

    Antipsychotic medications may cause agranulocytosis (severe and dangerous leukopenia - lowered white blood cell count), the first manifestation of which may be a sore throat and flulike symptoms. Text page: 330
    (this multiple choice question has been scrambled)
  24. The purpose for a nurse periodically performing the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has schizophrenia is early detection of

    A. cholestatic jaundice.
    B. pseudoparkinsonism.
    C. acute dystonia.
    D. tardive dyskinesia.
    D. tardive dyskinesia.

    An AIMS assessment should be performed periodically on clients who are being treated with antipsychotic medication known to cause tardive dyskinesia. Text page: 331
    (this multiple choice question has been scrambled)
  25. What is Anticholinergic Toxicity?
    Potentially life-thgreatening medical emergency

    Antiparkinsonian drugs such as Cogentin, Benadryl and Symmetrel can reduce some of the EPS (extrapyramidal side effects) of conventional antipsychotic drugs such as Thorazine and Haldol, BUT they can cause significant anticholinergic  (ACh) side effects and WORSEN the Ach side effects of Conventional antipsychotics possibly resulting in:

    Anticholinergic toxicity: dry mucous membranes; reduced or absent peristalsis; mydriasis; nonreactive pupils; hot, dry, red skin; hyperpyrexia without diaphoresis; tachycardia; agitation; unstable vital signs; worsening ofpsychotic symptoms; delirium; urinary retention; seizure; repetitive motor movements

    • Nursing Interventions:
    • Consult prescriber immediately.
    • Hold all medications.
    • Implement emergency cooling measures as ordered (coolingblanket, alcohol, or ice bath).
    • Implement urinary catheterization prn.
    • Administer benzodiazepines or other prn sedation as ordered.
    • Physostigmine may be ordered.
  26. Neologisms
    Neologisms are made-up words
  27. Echolalia
    Echolalia is the pathological repeating of another's words and is often seen in catatonia.

    • Nurse: Mary, come get your medication.
    • Mary: Come get your medication.
  28. Echopraxia
    Echopraxia is the mimicking of movements of another. It is also seen in catatonia.
  29. Clang association
    Clang association is the choice of words based on their sound rather than their meaning, often rhyming and sometimes having a similar beginning sound

    "On the track.. .have a Big Mac
  30. Depersonalization
    Depersonalization is a nonspecific feeling that a person has lost his or her identity and that the self is different or unreal. People may feel that body parts do not belong to them or may suddenly sense that their body has drastically changed. For example, a patient may see her fingers as snakes or her arms as rottingwood.
  31. Derealization
    Derealization is a false perception that the environment has changed. For example, everything seems bigger or smaller, or familiar surroundings have become somehow strange and unfamiliar.

    Both depersonalization and derealization can be interpreted as loss of ego boundaries (sometimes called loose ego boundaries).
  32. Affect
    Outward manifestation of a person's feeling and emotions.

    This is an objective nursing assessment.

    In schizophrenia, affect may not always coincide with inner emotions.
  33. Autism
    Thinking is not bound to reality, but reflects the private perceptual world of the individual. Delusions, hallucinations and neologisms are examples of autistic thinking.
  34. DSM Criteria for Schizophrenia
    • A. Characteristic Symptoms
    • Two or more of the following during a 1-month period (or less if successfully treated)
    • 1. Delusions
    • 2. Hallucinations
    • 3. Disorganized speech (e.g., associative looseness)
    • 4. Grossly disorganized or catatonic behavior
    • 5. Negative symptoms (e.g., affective flattening, avolition, alogia) 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 each other
    • Then only one criterion is needed.

    • 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.

    • D.
    • 1. All other mental diseases (e.g., schizoaffective/mood disorder) have been ruled out.
    • 2. All other medical conditions (substance use/medications or general medical conditions) have been ruled out.
    • 3. If history of pervasive developmental disorders, then prominent hallucinations or delusions for 1month are needed to make the diagnosis of schizophrenia.
  35. A nurse is planning care for a hallucinating and delusional client who has been rescued from a suicide attempt. The nurse plans to:

    A. Begin suicide precautions with 30-minute checks.
    B. Initiate one-to-one suicide precautions immediately
    C. Ask the client to report suicidal thoughts immediately.
    D. Check the client's location every 15 minutes.
    B. Initiate one-to-one suicide precautions immediately

    One-to-one suicide precautions are required for theclient rescued from a suicide attempt. In this situation, additional significant information is that the client is delusional and hallucinating. Both of these factors increase the risk of unpredictable behavior, decreased judgment, and the risk of suicide. Options 1, 2, and 4 do not provide the constant supervision necessary for this client.
    (this multiple choice question has been scrambled)
  36. Schizophrenia usually develops during...
    the late teens and early twenties, although onset before age 10 has been reported.
  37. Psychotic disorders other than Schizophrenia:

    Schizophreniform Disorder
    Symptoms of Schizophrenia for more than 1 month but less than 6.
  38. Psychotic disorders other than Schizophrenia:

    Brief Psychotic Disorder
    At least a day, but less than 1 month and precipitated by some extreme stressors and a return to premorbid functioning.
  39. Substance abuse disorderes occur in nearly AA% of persons with schizophrenia.
    A. 50%
  40. 1st generation or AAA antipsychotics block BBB receptors. Standout examples of these drugs are CCC and DDD. These drugs treat the EEE symptoms of schizophrenia.
    • A. Conventional
    • B. Dopamine
    • C. chlorpromazine (Thorazine)
    • D. haliperidol (Haldol)
    • E. Positive
  41. 2nd generation or AAA antipsychotics block BBB receptors. Standout examples of these drugs are CCC and DDD. These drugs treat the EEE symptoms of schizophrenia.
    • A. Atypical
    • B. Dopamin & Serotonin
    • C. olanzapine (Zyprexa)
    • D. risperidone (Risperdal)
    • E. Positive & Negative
  42. An abrupt onset of schizophrenia is usually a AAA prognostic sign, whereas an insidious onbset over 2-3 years is BBB.
    • A. Favorable, and for those with good premorbid social, sexual and occupoational function have a greater chance for good remission or full recovery.
    • B. Ominous - younger onset is associated with a more discouraging prognosis. A childhood history of withdrawn, reclusive, eccentric and tense behavior is an unfavorable diagnostic sign, as is a preponderance of negative symptoms.
  43. Schizophrenia, Phase I
    Phase I—Acute: Onset or exacerbation of florid, disruptive symptoms (e.g., hallucinations, delusions, apathy, withdrawal) with resultant loss offunctional abilities; increased care or hospitalization may be required.

    Note: Some clinicians also designate an earlier Prodromal (or Prepsychotic) Phase in which subtle symptoms or deficits associated with schizophrenia are present; such symptoms may or may not herald the onset of schizophrenia.
  44. Schizophrenia, Phase II
    Phase II—Stabilization: Symptoms are diminishing, and there is movement toward one's previous level of functioning (baseline); day hospitalization or care in a residential crisis center or a supervised group home may be needed.
  45. Schizophrenia, Phase III
    Phase III—Maintenance: The patient is at or nearing baseline (or premorbid) functioning; symptoms are absent or diminished; level of functioning allows the patient to live in the community. Ideally, recovery with few or no residual symptoms has occurred. Most persons in this phase live in their own residences.
  46. Notes about the prepsychotic phase of schizophrenia...
    Early detection and treatment of symptoms that may warn of schizophrenia (abnormal social development and cognitive dysfunction) in those at hgih risk (children of schizophrenics) may lessen the risk of developing the disorder or the severity if it does develop.
  47. Four main symptom groups of schizophrenia
    • Positive
    • Negative
    • Cognitive
    • Affective
  48. Positive symptoms of schizophrenia
    • Hallucinations
    • Delusions
    • Disorganized speech (associative looseness)Bizarre behavior
  49. Negative symptoms of schizophrenia
    • Blunted affect
    • Poverty of thought (alogia)
    • Loss of motivation (avolition)
    • Inability to experience pleasure or joy (anhedonia)
  50. Cognitive symptoms of schizophrenia
    • Inattention, easily distracted
    • Impaired memory
    • Poor problem-solving skills
    • Poor decision-making skills
    • Illogical thinking
    • Impaired judgment
  51. Affective symptoms of schizophrenia
    • Dysphoria
    • Suicidality
    • Hopelessness
  52. Delusions summary

    * This does not include sharing unusual beliefs maintained by one's culture or subculture.
    • Control - thoughts, feeling, impulses, or behavior
    • Ideas of Reference - gving personal significance to trivial events - people talking about you.
    • Persecution - others out to harm you.
    • Grandeur - ...
    • Somatic Delusions - body changing in unusual way (Note this is always a "belief", whereas a "Depersonalization" could be manifest as a delusion or a hallucination.)
    • Erotomanic - belief that another person desires you romantically.
    • Jealousy - belief that one's mate is unfaithful.
  53. Types of hallucinations
    • Auditory
    • Visual
    • Olfactory
    • Gustatory - tastes
    • Tactile
  54. Examples for Pts experiencing hallucinations
    Don't negate the Pts experience, but offer your own perceptions. "I don't see the devil standig over there, but I understand hgow upsetting that must be for you."

    "Here-and-Now" diversions such as conversations or simple projects. "The voice you gear is part of your illness; it cannot hirt you. Try to listen to listen to me and others you can see around you."
  55. Schizophrenia, Paranoid
    • Dominant: hallucinations and delusions.
    • No disorganized speech,disorganized behavior, catatonia, or inappropriate affect present.
  56. Schizophrenia, Disorganized
    • Dominant: disorganized speech and disorganized behavior and inappropriate affect.
    • Delusions and hallucinations, if present, are not prominent or fragmented
    • Associated features include grimacing, mannerisms, and other oddities of behavior.
  57. Schizophrenia, Catatonic
    • Motor immobility (waxy flexibility or stupor)
    • Excessive purposeless motor activity (agitation)
    • Extreme negativism or mutism
    • Peculiar voluntary movement:
    • • Posturing
    • • Stereotyped movements
    • • Prominent mannerisms
    • • Prominent grimaces.
    • Echolalia or echopraxis.
  58. Schizoprenia, Residual
    • No longer has active-phase
    • symptoms (e.g., delusions, hallucinations, or disorganized speech and behaviors)
    • However, persistence of some symptoms is noted, e.g.:
    • • Marked social isolation or withdrawal
    • • Marked impairment in role function (wage earner, student,or homemaker)
    • • Markedly eccentric behavior or odd beliefs
    • • Marked impairment in personal hygiene
    • • Marked lack of initiative, interest,or energy
    • • Blunted or inappropriate affect
  59. Schizophrenia, Undifferentiated
    • Has active-phase symptoms (does
    • have hallucinations, delusions, and bizarre behaviors)
    • No one clinical presentation dominates, e.g.:
    • • Paranoid
    • • Disorganized
    • • Catatonic
  60. Capgras Syndrome is
    A delusional disorder that causes patients to believe that their family members, including pets, have been replaced by imposters.