Psych Exam 2 Schizophrenia

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allison06
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67869
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Psych Exam 2 Schizophrenia
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2011-02-27 00:26:39
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Nursing Psych
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Schizophrenia
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  1. Define Schizophrenia
    A psychosis characterized by abnormalities in perception, context of thought, & thought processes, & extensive withdrawl of one's interest from people & the outside world
  2. Define Psychosis
    • A sx
    • A state in which the individual is experiencing hallucinations delusions or disorganized thoughts, speech or behavior
  3. Define Schizophrenia
    • A mental illness which interferes with a person's ability to:
    • Think clearly
    • Manage emotions
    • Make decisions
    • Relate to others
  4. Discuss epidemiology in Schizophrenia
    • Lower socioeconomic groups
    • Homeless
    • Majority 16-25
    • Women have later onset than men
  5. What are positive symptoms?
    • Things that are there but should not be there
    • Hallucinations
    • Delusions
  6. Define Hallucinations
    Perceptual experiences that occur without actual external sensory stimuli. They can include all 5 senses.
  7. Define Delusions
    • Erroneous fixed beliefs that cannot be changed by reasonable argument
    • Grandiose
    • Nihilistic
    • Persecutory
    • Somatic
    • Religious
    • Referential
  8. Define the delusion Grandiose
    Belief that one has exceptional powers, wealth, skills, influence, destiny
  9. Define the delusion Nihilistic
    Belief that one is dead or a disaster is impending
  10. Define the delusion Persecutory
    Belief that one is being watched, plotted against, ridiculed...
  11. Define the delusion Somatic
    • Belief about abnormalities in body fxn or structure
    • ex. may have intense fear they are ugly
  12. Define the delusion Religious
    Has a godly mission, or relationship with God
  13. Define the delusion Referential
    Tv or radio is talking to them
  14. Discuss Thought Broadcasting and Thought Insertion
    • Think people can read their minds
    • Think people are putting thoughts into their head
  15. List Negative Symptoms
    • Affective flattening or blunting
    • Ambivalence
    • Alogia
    • Avolition
    • Anhedonia
  16. Define negative sx Ambivalence
    Presence of two opposing forces, leading to inaction (don't do anything), (inability to concentrate)
  17. Define negative sx Alogia
    Brief and lack of content verbal responses (poverty of speech)
  18. Define negative sx Avolition
    Inability to complete projects, assignments, or work
  19. Define negative sx Anhedonia
    Inability to gain pleasure
  20. Define disorganized speech Echolalia
    Repetition of another's words
  21. Define disorganized speech Circumstantiality
    Extremely detailed & lengthy talk about a topic
  22. Define disorganized speech Loose Associations
    Absence of normal connectedness of thoughts, ideas, & topics
  23. Define disorganized speech Tangentiality
    Change in topic that is logical but detours from original topic
  24. Define disorganized speech Flight of Ideas
    Topic of conversation changes repeatedly & rapidly
  25. Define disorganized speech Word Salad
    String of words totally unconnected
  26. Define disorganized speech Neologisms
    Made up words
  27. Define disorganized speech Paranoia
    Suspiciousness that is unrealistic
  28. Define disorganized speech Referential Thinking
    Belief that neutral stimuli have special meaning
  29. Define disorganized speech Autisitic Thinking
    Restricts thinking to the literal & immediate makes no sense to anyone else
  30. Define disorganized speech Concrete Thinking
    Lack of abstract thinking
  31. Define disorganized speech Verbigeration
    Purposeless repetition of words/phrases
  32. Define disorganized speech Metonymic Speeech
    Use of words interchangeably with similar meanings
  33. Define disorganized speech Clang Association
    • Repetition of words that are similar in sound but in no other way
    • ex. I am going to cry, lie, die
  34. Define disorganized speech Stilted Language
    Overly & artificial formal language
  35. Define disorganized speech Pressured Speech
    As if words are being forced out
  36. Define disorganized behavior Aggression
    Behaviors or attitudes that reflect rage
  37. Define disorganized behavior Agitation
    Inability to sit still or attend to others
  38. Define disorganized behavior Catatonic Excitement
    • Hyperactivity characterized by purposeless activity & abnormal movements
    • ex. excessively writing name, or pacing movements
  39. Define disorganized behavior Echopraxia
    Involuntary imitation of another's movements & gestures
  40. Define disorganized behavior Regressed Behavior
    Childlike/immature
  41. Define disorganized behavior Stereotype
    Repetitive purposeless movements that are idiosyncratic to the person
  42. Define disorganized behavior Hypervigilance
    • Sustained attention to external stimuli
    • ex. fixed and waiting to something to happen (waiting for FBI to come out of woods)
  43. Define disorganized behavior Waxy Flexibility
    Posture held in fixed position (if you moved their arm up, they would still be "frozen")
  44. List the 4 Stages of Schizophrenia
    • Acute Illness Period
    • Stabilization Period
    • Maintenance & Recovery Period
    • Relapse Period
  45. Discuss the Acute Illness Period of Schizophrenia
    • Confusing and frightening behaviors
    • Subtle progressing to disruptive & bizarre
    • Pt is progressively unable to meet basic needs, work and everything deteriorates
    • Substance use common
    • Generally not violent, unless substance use or not taking meds
    • Dependence on family/friends increases
    • Cognitive deficits
    • High risk for suicide
  46. Discuss the Stabilization Period of Schizophrenia
    • Occurs after Dx and initial Tx
    • Sx become less acute, but still present (give coping skills)
    • Intense med Tx
    • Treatable not curable
    • Pt and family adjust to life-long/chronic dx reality
  47. Discuss the Maintenance & Recovery Period of Schizophrenia
    • After stablized
    • Focus on regaining previous level of fxn
    • Meds improve, not cure
    • Adherence with meds is vital
    • Stress can exacerbate
    • *Family support
    • *Educate pt and family (NAMI)
  48. Discuss Relapse in Schizophrenia
    • Occurs during Tx and Recovery
    • Detremintal to mgt
    • Each relapse- longer time to recovery
    • Meds + therapy = less relapses
  49. List the 3 parts to tx Schizophrenia
    • Medication
    • Structured Activities/ Therapy
    • Family Support
  50. List Typical Antipsychotics
    • Thorazine
    • Prolixin
    • Mellaril
    • Haldol
    • Navane
    • Stelazine
  51. List Typical Antipsychotics SE
    • Anticholinergic
    • Sedation
    • EPS
    • Hypotension
    • Seizure
    • Agranulocytosis
    • NMS
    • TD
  52. List Atypical Antipsychotics
    • Clozaril
    • Zyprexa
    • Seroquel
    • Respiradol
    • Geodone (helps depression too)
  53. List Atypical Antipsychotics SE
    • Weight Gain*
    • Changes in metabolism including DM and hyperprolacteremia
  54. List Theories/ Predisposing Factors to Schizophrenia
    • Biological: genetic (1 degree relatives), biochemical, physiological
    • Psychological
    • Environmental: stress (triggers gene)
    • Dopamine
    • **Still Don't Know
  55. Discuss Diagnostic Criteria for Schizophrenia (DSM IV)
    • 2 or more of the following during 1 mo, persisting for at least 6 mo:
    • delusions
    • hallucinations
    • disorganized speech
    • disorganised or catatonic behavior
    • negative sx
    • Plus 1 or more major areas of social or occupational functioning below previous level
    • And absence of major depression, manic, or mixed episodes with concurrent active sx
  56. Define Paranoid
    • Any type of delusion
    • Least functional impairment
    • High suicide risk
  57. Define Catatonic
    • Bizarre posture
    • In illnesses other than Schizo
    • ECT effective
    • Need ROM, IVs, Shock Tx
  58. Define Disorganized Schizophrenia
    • Inappropriate affect
    • Most impaired
  59. Define Undifferentiated Schizophrenia
    • Doesn't fit DSM IV
    • Not sure what to call
  60. Define Schizoaffective D/O
    • Schizo and mood d/o
    • Diagnosis: Uninterrupted period manic or mixed major depression with 2 Schizo sx
    • Long term better than schizo, but worse than MDD
  61. List parts of Mental Status Exam
    • Content of thought
    • Form of thought
    • Perceptions
    • Affect
    • Sense of self
    • Social Fxn
    • Hygiene
    • Psychomotor
  62. List Additional Assessment of Schizophrenia
    • Family (genetic dx)
    • Past
    • Current Physical Health
    • Level of anxiety
    • SI/HI
    • Labs (Lithium)
    • Meds
  63. List common Nsg Dx for Schizophrenia
    • Risk for Safety (#1)
    • Disturbed Thought or Sensory
    • Social Isolation
    • Impaired Verbal
    • Self-Care Deficit
  64. List common Pt Outcomes for Schizophrenia
    • Demonstrates an ability to relate satisfactorily
    • Recognizes distorted thinking
    • No harm to self or others
  65. List common Nsg Interventions for Schizophrenia
    • Initiate safety measure for suicide/ aggression
    • Intervening with delusions, hallucinations, paranoia
    • Reality testing
    • Improving social isolation
  66. List working w/ pts w/ Delusions & Hallucinations
    • Do not feed into delusions
    • Safe environment
    • Dec stimulation
    • Simple statements
    • Recognize their reality
    • Use distraction
  67. Discuss NMS
    • Rare but Fatal
    • Severe muscle rigidity, elevated temp (up to 107)
    • Sx: elevated temp, change in LOC, leukocytosis, elevated creatine, elevated liver enzymes
  68. List Nsg Intervention/ Tx for NMS
    • Stop administration of offending med
    • Monitor VS
    • Reduce body temp
    • Safety, protect muscle
    • Supportive measures
    • IV fluids
    • Cardiac monitoring
    • Admin Dopamine agonist
  69. Discuss Anticholinergic Crisis
    • Potentially life-threatening
    • Occurs in pt w/ several meds w/ anticholinergic effects
    • Sx: elevated temp, dry mouth, dec salivation, dec bronchial, nasal secretion, widely dilated eyes
    • Confusion, hallucinations
    • Self-limiting (3 days)
  70. List Nsg Intervention/ Tx for Anticholinergic Crisis
    • D/c med
    • Physiostigmine 1-2mg IV
    • Gastic lavage
    • Charcoal, catharsis
  71. Discuss EPS
    • Pseudoparkinsonism: muscle rigidity & absence of movement
    • Dystonia: muscles tense and body contorts
    • Oculogyric crisis: eye muscles tighten and eyes roll back
    • Akathisia: restless, need to keep moving
    • Akinesia: absence or loss of voluntary movement
  72. List Nsg Intervention/ Tx for EPS
    • Benzotropine (Cogentin)
    • Trihexphenidyl (Artane)
  73. Discuss TD
    • Major risk for pts on long-term neuroleptic meds
    • Bizarre movements: lip smacking, tongue movements, difficulty swallowing, pill rolling, & gestures
    • Tx: D/C meds at onset tongue movements
    • May be irreversible
  74. Discuss Agranulocytosis
    • Dec ability to fight off infection
    • Esp. w/ Clozaril
    • Monitor WBC weekly first 6 mo
    • Reversible if tx early
  75. Discuss Metabolic Syndrome
    • Results in: DM/ Hyperglycemia
    • Monitor wt and girth
    • Initial Glucose tolerance test
    • Monitor blood glucose
    • Provide nutrition & activity support
  76. Discuss Client/ Family Education: Nature of the Illness
    • What to expect as illness progresses
    • Sx associated w/ illness
    • Ways for family to respond to behaviors associated w/ illness
    • Outside support
  77. Discuss Client/ Family Education: Mgt of Illness
    • Connect exacerbation of sx to stress
    • Med mgt (guardian)
    • Social skills training
    • Daily living skills training
  78. Discuss Client/ Family Education: Support Services
    • Financial assistance
    • Legal assistance (guardian)
    • Caregiver support group
    • Respite care
    • Home Health
  79. State Time Period of Brief Psychotic Episode
    Length 1 day, less than 1 mo
  80. Define Schizophreniform D/O
    Pt has schizo for less than 6 mo
  81. Discuss Delusional D/O
    • Psychotic d/o (nonbizarre, stable)
    • Delusions w/o mental d/o

    • Delusions could be real life (followed, poisoned)
    • Somatic delusions- bring to hospital
  82. Discuss Shared Psychotic D/O (folie'adeux)
    • Psychosis transmitted to another person (in close proximity)
    • When tx psychotic person, other pt resolved
  83. List Common Misconceptions about Schizophrenia
    • Not split personality
    • Not caused by dysfxn families
    • Not caused by poverty (but leads to)
    • Not more violent
    • IS HOPE

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