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What is psychosis? “A severe mental condition in which there is a disorganization of the personality, deterioration in social functioning, and loss of contact with, or distortion of, reality.”
What are some biological factors in Schizophrenia? Genetics- family link Biochemical influences (dopamine) Viral infection- in utero or childhood
What is the "downward drift"? decreased ability to be able to perform ADLs puts them in lower socioeconomic class
What is Phase I in Schizophrenia development? Premorbid phase: Social maladjustment & withdrawal, irritability, antagonistic thoughts & behavior
What is Phase II in Schizophrenia development? Prodromal Substantial functional impairment, sleep disturbance, anxiety, depressed mood, deterioration of role functioning, social withdrawal, positive symptoms
What is Phase III in Schizophrenia development? Schizophrenia: Delusions, hallucinations, disorganized speech, social/occupational dysfunction, disorganized or catatonic behavior, negative symptoms
What is Phase IV in Schizophrenia development? Residual Phase Absent or no longer prominent symptoms of the acute phase, negative symptoms may remain (remission and exacerbation)
What is a positive symptom of schizophrenia? Positive symptoms tend to reflect an excess or distortion of normal functions
What are the six types of delusions? Delusions of grandeur Delusions of persecution Delusions of control Nihilistic delusions Somatic delusion Delusion of reference (positive symptoms)
What is associative looseness form of thought? speech in which ideas shift from one unrelated subject to another. The individual is unaware that the topics are unconnected
What is Neologisms form of thought? Makes up new words
What is Concrete thinking form of thought? literal interpretation of the environment. ("take these pills", pt takes and holds)
What is Clang associations form of thought? choice of words is governed by the sound of the word (not the meaning)
What is Word salad form of thought? Word salad: words put together randomly with no meaning
What is Circumstantiality form of thought? person delays in answering with other responses but associated with response (eventually get pt. across)
What is the Tangentiality form of thought? kind of like circumstantiality, but NEVER gets to the pt.
What is the Mutism form of thought: may maintain eye contact, but no response (non-verbal)
What is the Perseveration form of thought? repeats the same word or idea over and over in response to different questions.
What is the Highest level of thought disturbance? Word salad
What is echolalia? repeats words she/he hears Identifies with the person speaking by trying to reflect back on what you are saying
What is echopraxia? purposely imitates the movements of others
What is the identification and imitation? unconsciously identifies and consciously imitates- defensive mechanisms because of confusion regarding self identity.
What is Depersonalization? feelings of unreality b/c self-identity is unstable (sense of seeing oneself from a distance, feeling extremities have changed)
What are Illusions? misperceptions or misinterpretations of real external stimuli
What are some Hallucinations of the 5 senses? auditory (most common), visual, tactile, gustatory(taste), olfactory(smell) - usually unpleasant senses, smells, tastes
What does stage 1 in level of Hallucinations look like? Comforting (moderate level of anxiety): Inappropriate grinning or laughing Moving lips without making noise Rapid eye movements Slowed verbal responses, as if preoccupied
What does stage 2 in level of Hallucinations look like? Increased autonomic nervous system signs of anxiety (increased HR, BP, RR) Condeming(severe level) Narrowed attention span Preoccupied with sensory experience and losing ability to differentiate hallucination from reality
What does stage 3 in level of Hallucinations look like? Controlling(severe level of anxiety): Directions given by hallucination will be followed rather than objected to Difficulty relating to others Attention span of only a few seconds or minutes symptoms of severe anxiety such as perspiring, tremors.
What does stage 4 in level of Hallucinations look like? Conquering (panic level of anxiety) Terror-stricken behaviors such as panic potential for suicide/homicide activity that reflects content of hallucination ( violence, agitation, withdrawal, or catatonia Unable to respond to complex directions
What are some negative symptoms? Inapprop affect: laugh at bad news, tone weak. flat affect appears be void of emotional tone, bland affect when tone is weak Apathy- an indifference/disinterest environ, Avolition: Emotional ambivalence: has no strong feelings either way (lacks goals)
What are some additional negative symptoms? Impaired interpersonal functioning Autism-condition created by the person with schizophrenia who focuses inward on a fantasy world, while distorting or excluding the external environment Deteriorated appearance: disheveled and untidy
What is anergia? Lack of energy; inactivity
What is posturing and some examples? voluntary assumption of inappropriate or bizarre postures Waxy flexibility: bizarre, uncomfortable positioning Pacing and rocking Faster pacing or more rocking= getting worse
What are some associate features with negative symptoms? Anhedonia: inability to experience joy, pleasure or closeness Regression: primary defense mechanism of schizophrenia, is a dysfunctional attempt to reduce anxiety
Related to negative symptoms associated with schizophrenic client: brief, empty response -poor eye contact
What is Disorganized Schizophrenia? Behavior is markedly regressive and primitive. Contact with reality is extremely poor. Affect is flat or grossly inappropriate, often with periods of silliness and incongruous giggling.
What is Catatonic Schizophrenia? marked abnormalities in motor behavior and may be manifested in the form of stupor or excitement
What is Catatonic stupor? extreme psychomotor retardation. The individual exhibits a pronounced decrease in spontaneous movements and activity. Mutism and negativism (motiveless resistance to attempts to be moved
What is waxy flexibility? voluntary assumption of bizarre positions, which will remain for long periods. (RN puts your arm in a position to take BP and you keep arm that way even after she's done.
What is Catatonic excitement? state of extreme psychomotor agitation. The movements are frenzied and purposeless usually accompanied incoherent verbalizations and shouting. Could become violent (risk to self and others)
What is Paranoid Schizophrenia? the presence of delusions of persecution or grandeur and auditory hallucinations related to a single theme. tense, suspicious, and guarded, and may be argumentative, hostile, and aggressive.
What is Undifferentiated Schizophrenia? Do not meet the criteria for any of the subtypes, or they may meet the criteria for more than one subtype
What is Residual Schizophrenia? With chronic form of disease, follows acute phase but no current psychotic symptoms, may have social isolation, eccentric behavior, inappropriate or blunted affect, impaired personal hygiene, illogical thinking, apathy
What is Schizoaffective disorder? Schizophrenic behaviors with mood disorder symptoms
What is Brief psychotic disorder? Sudden onset of psychotic symptoms that may or may not be preceded by severe psychosocial stress, lasts 1 day to 1 month
What is Schizophreniform disorder? Schizophrenia that lasts 1 month to 6 months
What are the definitions of Erotomanic, Grandiose, and Jealous delusion disorder? Erotomanic (person believes someone, usually famous or of higher status, is in love with them) Grandiose (irrational ideas about own worth, talent, knowledge, or power) Jealous (irrational idea that sexual partner is unfaithful)
What are the definitions of Persecutory and Somatic delusion disorder? Persecutory (most common type,themes of being conspired against,spied on, followed, poisoned Somatic (belief of some physical defect, disorder, or disease; commonly about foul odors, insect or parasite infestation, misshapen or dysfunctional body parts)
Shared psychotic disorder : Delusions that develop in a second person as a result of a close relationship with a person with a psychotic disorder with prominent delusions
What are some nursing diagnosis for psychosis? Anxiety r/t unconscious conflict with reality Disturbed sensory perception Disturbed thought processes r/t inability to trust Impaired verbal communication r/t psychosis, Ineffective coping r/t inadequate support system
What are some outcomes for psychosis tx? Not harm self or others Demonstrate an ability to relate satisfactorily with others Uses appropriate verbal communication in interactions with others Perceive self realistically Recognize distortions of reality minimize anxiety
What are some communication techniques for psychosis? Moral foundations Preparation for interaction Being with the client Non-verbal communication, vocabulary, and timing Emotional regulation Getting things done Talking about symptom
What are behavioral strategies for psychosis? For inability to learn from experience -Review positive & negative experiences Identify what was successful & what was not successful in client achieving desired goal
What are behavioral strategies for psychosis? For problems with cause-and-effect reasoning Analyze experiences to see what went well & what didn’t Help client sequence events leading to outcomes Rehearse or enact an event before it occurs
What are some nursing interventions for psychosis? Observe client for signs of hallucinations and do not reinforce hallucinations Gain the client’s trust by listening to his or her story, 'getting inside their world,' and acknowledging why they hold particular belief
Other interventions? Intervene at first sign of increased anxiety, agitation, or aggression Avoid touching client without warning him or her Maintain an attitude of acceptance Try to distract client from hallucinations Reinforce and focus on reality
More interventions? Offer to be with client during group activities that he or she finds scary Maintain a safe environment Attempt to decode incomprehensible communication patterns by seeking clarification and validation
And more interventions! Orient client to reality as needed- don’t tell them that they are wrong Provide assistance with self-care as needed while encouraging as much independence as possible
In planning to reinforce reality w/ a client dx w/ schizophrenia, which nursing intervention should be included? discuss perceptions and thinking that are in touch with reality
What are the common med class used for psychosis? Typical & atypical antipsychotics Side effects of extrapyramidal symptoms
What are some other therapies ? Individual psychotherapy Group therapy Behavior therapy Social skills training Family therapy
Created by: UARN85
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