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describes the behavior associated with an individuals feelings or EMOTIONAL TONE
Describe the behavioral manifestations in a person with damage to the frontal lobe
- The person will have changes in their mood and character seen by
Which neurotransmitter is associated with the "fight or flight syndrome"?
What disorders are caused by alterations in norepinephrine?
- decreased amounts=depression
- increased amounts= mania, anxiety, and schizophrenia
Define neuropsychotic symptoms seen with thyroid dysfunction
- increased levels=insomnia, anxiety, emotional lability
- decreased levels=depression, fatigue
Explain what is the prodromal phase of schizophrenia
it is the s/s that preced the characteristic manifestations of the acute fully developed illness.
Can last 2-5 years
S/S of prodromal stage of schizophrenia
- functional impairment and non specific symptoms;
- sleep disturbances, anxiety, irritability, depression, poor concentration, fatigue, behavioral deficits(decrease in role and social withdrawal)
Negative symptoms of schizo
Positive symptoms of the prodromal stage of schizo
- perceptual abnormalities
- ideas of reference
- suspiciousness development
Characteristics of schizo
2 or more of the following for a significant portion of time during a 1 months period:
- disorganized speech (derailment or incoherent)
- grossly disorganized or catatonic behavior
What can decrease the likelihood of schizophrenia?
- limit use of amphetamines (increase dopamine)
- if have a lot of dopamine-take neuroleptics
- get good prenatal care
- wear a helmet and protect the prain
- dont abuse alcohol
What is meant by positive characteristics of schizophrenia
symptoms that are added to a person characteristics
- disorganized thoughts and speech
- bizarre behavior
What is a delusion of reference?
It is irrational thinking that one is being talked about or laughed at by others.
everything going on around them has to do with them.
"someone is trying to get a message to me through the articles in the magazine. I must break the code so I can receive the message"
How do I help a pt manage a delusion?
- Focus on reality-here and now
- help with verbalizations of feelings-anxiety/fear
- focus on the emotional tone of the delusion
- dont argue or deny clients belief
*Use reflective technique and show empathy!!
Very important to remember these when a person is delusional....
- Encourage the client to share their delusions before acting on them.
- Do not argue or try to use logic
- Try to get the patient to see their progress since admission
- voluntary decision making ability
- sleep, arousal states
- pain perception
increased=insomnia, anxiety, emotional lability
increased=mood disorders, psychosis
decreased=depression, apathy, fatigue
increased=depression, anxiety, decreased libido, irritability
decreased=depression, anorexia and increased testosterone
results of increased testosterone
increased sexual behavior and aggressiveness
individuals emotional tones incongruent with the circumstances.
person laughs when told mom is dead
treats extrapyramidal symptoms (EPS) associated with antipsychotic meds, also Parkinsons
when a client hides negative unacceptable thoughts/feelings by expressing positive feelings
Pt. hates mom...but says "I love my mom, she's the best"
bizarre facial and tongue movements, stiff neck and difficulty swallowing
**Adverse rxn to anti psychotic meds
Increased amounts of cortisol =
emotional brain...associated with feelings of fear and anxiety; anger and aggression; love, joy and hope.
Sexuality and social behavior
false sensory perceptions not associated with real external stimuli....can involve any of the 5 senses
a symptom of psychosis in which the patient believes that his or her thoughts are "broadcast" beyond the head so that other people can hear them.
a loss of contact with reality that usually includes:
- false beliefs about what is taking place or who one is(delusion)
- seeing or hearing things that arent there (hallucinations)
false personal beliefs not consistent with a person's intelligence or cultural background.
The individual continues to have the belief in spite of obvious proof that it is false and/or irrational
Ideas of Reference
psychiatry incorrect interpretation of events as having a direct reference to oneself.
ie-a woman rarely leaves her house because she experiences all conversation or laughter she hears as directed at herself
an individual with loose ego boundaries attempting to identify with another person by imitating movements that the other person makes
the parrot like repitition of the words spoken by another person
Positive symptoms of schizo
perceptual disturbances-hallucinations, delusions
disordered thinking-loose associations, perseveration
inability to speak
lack of drive or motivation to pursue meaningful goals
the inability to experience pleasure from activities usually found enjoyable
individual has a false idea abou the functioning of his or her body...
- they smell from any orofus
- infestation of insects on or in skin
- has an internal parasite
- has misshapen or ugly body parts
- dysfunctional body parts
ie-I am 70 years old and will be the oldest person to give birth...the Dr. says I am not prego, but I know I am
sudden cessation of thought in the middle of a sentence
thinking is haphazard, illogical and confused.
Persons responses dont relate to the question asked, or a paragraph, or sentence or phrase isnt logically connected to those that occur before it
Poverty of speech
brief and empty replies to questions
impairment in the ability to initiate goal-directed activity. Inadequate interest, motivation or ability to choose a logical course of action in a given situation
new words that an individual says that are meaningless to others, but have symbolic meaning to the psychotic person
diathesis stress model
if the combination of the predisposition and the stress exceeds a threshold, the person will develop a disorder
delusions and auditory hallucinations, but normal intellectual functioning and expression of affect.
Delusions are usually about unfair persecution or being some other person who's famous
speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions.
May laugh at changing color of a traffic light
What can disorganized schizo disrupt?
normal activities-showering, dressing and preparing meals
disturbances of movement, can be completely immobile or move all over the place.
May not say anything for hours, or they may repeat anything you say or do senselessly
catatonic schizos are at risk for....
self care deficit....cant take care of themselves
has a little of each schizo...but nothing dominant to label
a past history of at least one episode of schizo, but the person currently has no positive symptoms.
What is it when a person has a transition period between a full blown episode of schizo and complete remission, or it may continue for years without any further psychotic episodes
Differences in individuals brains of those with schizo
- lg ventricles
- enlarged sulci
- cerebellar atrophy
- abnormal cerebral symmetry
- decreased frontal lobe size
schizo symptoms are present for a significant portion of the time within a one month period, but signs of disruption are not present for the full 6 months required for the diagnosis of schizo
What interventions or self help strategies may help clients during an acute phase of hallucinations?
- establish trust
- have client describe what is happening
- care with touch
- assess environmental triggers
- If asked-point out that you are not experiencing the hallucination, but do not deny their experience
a brain illness when a person has a split with reality characterized by remissions and exacerbations
In order to be having active schizoprenia the person must have....
at least 2 of the following symptoms for most of a 1 month period....and lasts for 6 months
- disorganized speech
- disorganized or catatonic behavior
- negative symptoms
Describe what you see in a person with disorganized schizo
- onset before 25
- poor contact with reality
- flat affect or crazy sillines
- facial grimaces and bizarre mannerisms
- incoherent communication
- poor hygiene
Describe what you see in a person with catatonic schizo
- motor behavior abnormalities...no movement to excessive
- waxy flexibility
- catatonic excitement....can be destructive or violent
Describe what you see in a person with paranoid schizo
presence of delusions of persecution or grandeur and auditory hallucinations
tense, suspicious, guarded, argumentative, hostil and aggressive
schizo with depression or mania
- may have suicidal ideation
- euphoria, grandiosity, hyperactivity
presence of one or more non bizarre delusion that lasts for at least 1 month
- erotomanic, grandiose
Erotomanic delusional disorder
individual believes that someone of a higher status is in love with them
Grandiose delusional disorder
the irrational ideas regarding their own worth, talent, knowledge or pwoer. May believe they have a special relationship with a famous person
Persecutory delusional disorder
- most common type
- person believes they are being malevolently treated in some way;
- conspired against, cheted, spied on, followed, poisoned or drugged, harassed
Physical conditions that can cause psychosis
infections like a UTI or upper respiratory infection
Medications that can cause an increase in dopamine...therefor psychosis
- anti depressants
What do you asses in a patient with schizo?
presence of positive or negative symptoms
Nursing process....diagnosis for schizo
- can include;
- impaired verbal comm
- social isolation
- disabled thought process
- bathing hygiene self care deficit
- impaired environment
Nursing process....planning for schizo
- set priorities, select interventions...client will:
- recognize distortions of reality
- perceive environment correctly
- maintain anxiety at a manageable level
- relinquish need for delusions/hallucinations
- perform self care
Nursing process....implementation for schizo
- provide care for client....
- observe for signs of hallucinations
- meet clients needs and keep promises to promote trust
- attend group with client
- TEACH effective communication techniques
- encourage independence with ADL
Nursing process....evaluation for schizo
- reassess to determine if nursing process was successful....
- Is there trust?
- Is anxiety level maintained?
- Is the patient still delusional?
- Is client easily agitated?
- Is verbal communication comprehensible?
I dont need medications, the voice tells me I have been given special protection from God that keeps me safe at all times and gives me power to keep the devil from destroying Los Angeles
Systemized delusion and Religious delusions
There is a code in the newspaper headline about me
Idea of reference
My husband keeps putting thoughts in my head even while I am away from home.
Delusion of control
I cant stay in this room because it has been bugged by the FBI
Delusions of Persecution
Dont look at me, I know you can ready my mind through my eyes
Ive been sick ever since worms got in my brain from sleeping outside without my hat on
I know top secret information that will alter the course of humanity and cure cancer
delusion of grandeur
I am made of chocolate, and chocolate gets eaten