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Ch. 22

PsychExam 2- Schizophrenia

When is schizophrenia usually diagnosed? Late adolescence to early adulthood
Clinical Course: Prodromal period Stage of early changes that are a precursor to the disorder; may begin in early childhood Symptoms:tension and nervousness, lack of interest in eating, difficulty concentrating, disturbed sleep, decreased enjoyment and loss of interest, restlessness.
Clinical Course: Acute illness Usually occur in late adolescence or early adulthood; might be subtle but at some point can become disruptive and bizarre Include episodes of staying up all night for several nights, incoherent conversations, or aggressive acts against oneself or others
Clinical Course: Stabilization Period After the initial diagnosis of schizophrenia and initiation of treatment; this becomes the focus Symptoms become less acute but may be still present;medication regimens are established
Clinical Course: Recovery Period ultimate goal; medication generally diminishes the symptoms and allows the person to work toward recovery, no medication will cure schizophrenia
Clinical Course: Relapses One major reason for relapse is failure to take medication consistently
Positive Symptoms of Schizophrenia excessive or distorted thoughts, hallucinations, delusions
Negative Symptoms of Schizophrenia emotions and behaviors that should be present, but are diminished, alogia, avolition
Neurocognitive Impairment includes memory (short- and long-term); vigilance or sustained attention; verbal fluency or the ability to generate new words; and executive functioning, which includes volition, planning, purposeful action, and self-monitoring behavior.
Echolalia repetition of another’s words that is parrot-like and inappropriate
Circumstantiality extremely detailed and lengthy discourse about a topic
Loose associations absence of the normal connectedness of thoughts, ideas, and topics; sudden shifts without apparent relationship to preceding topics
Tangentiality the topic of conversation is changed to an entirely different topic that is a logical progression but causes a permanent detour from the original focus
Flight of ideas the topic of conversation changes repeatedly and rapidly, generally after just one sentence or phrase
Word Salad stringing together words that are not connected in any way
Neologisms words that are made up that have no common meaning and are not recognizable
Paranoia suspiciousness and guardedness that are unrealistic and often accompanied by grandiosity
Referential Thinking a belief that neutral stimuli have special meaning to the individual, such as a television commentator who is speaking directly to the individual
Autistic thinking restricts thinking to the literal and immediate so that the individual has private rules of logic and reasoning that make no sense to anyone else
Concrete thinking lack of abstraction in thinking; inability to understand punch lines, metaphors, and analogies
Verbigeration purposeless repetition of words or phrases
Metonymic speech use of words with similar meanings interchangeably
Clang association repetition of words or phrases that are similar in sound but in no other way, for example, “right, light, sight, might”
Stilted language overly and inappropriately artificial formal language
Pressured speech speaking as if the words are being forced out, often rapidly
Comorbidity of Schizophrenia Substance abuse, depression, diabetes mellitus and obesity
Biological Theories Neuroanatomic findings Familial patterns Genetic associations Neurodevelopment Neurotransmitters, pathways, and receptors
Interdisciplinary Treatment Pharmacologic management Psychosocial interventions Priority care issues:Suicide assessment, aggression and safety of patient, staff, others, antipsychotic medications
5–30 days Resting tremor, rigidity, bradykinesia or akinesia, mask like face, shuffling gait, decreased arm swing Parkinsonism or pseudoparkinsonism
1–5 days Intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk, and limbs Acute dystonia
1–30 days Obvious motor restlessness evidenced by pacing, rocking, shifting from foot to foot; subjective sense of not being able to sit or be still; these symptoms may occur together or separately Akathisia
Months to years Abnormal dyskinetic movements of the face, mouth, and jaw; choreoathetoid movements of the legs, arms, and trunk Tardive dyskinesia
Months to years Persistent sustained abnormal postures in the face, eyes, tongue, neck, trunk, and limbs Tardive dystonia
Months to years Persistent abating sense of subjective and objective restlessness Tardive akathisia
Neuroleptic Malignant Syndrome (NMS) (Refer to BOX 22.14 for more symptoms) Life-threatening condition; severe muscle rigidity, elevated temperature with a rapidly accelerating cascade of symptoms: Mental status changes,tachycardia,hypertension or hypotension,tachypnea or hypoxia, diaphoresis or sialorrhea
Anticholinergic Crisis Life-threatening condition: overdose or sensitivity to drugs with anticholinergic properties Symptoms: neuropsychiatric signs (confusion,recent memory loss), hallucinations, physical signs (hot , dry, flushed face, tachycardia, dry mucous membranes)
How do you treat someone with Neuroleptic malignant syndrome? Dopamine agonists (bromocriptine); muscle relaxants (dantrolene or benzodiazepine)
Treatment for someone who is in anticholinergic crisis Discontinuation of medication Physostigmine Gastric lavage, charcoal, catharsis for intentional overdoses
Created by: bolenrocks