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ch:14 schizo


schizophrenia distorted and bizarre thoughts,mvms,emotions perceptions,behaviors.dx earlier in men
positive(hard) symptoms delusions,hallucinations,grossly disorg thinking,speech and behavior.Can tx with typical meds
negative(soft) symptoms flat affect,lack of volition,social w/d or discomfort.atypical meds tx both (+)(-) s/sx. can persist after (+) have abated and cause barrier to recovery
ambivalence(+) holding seemingly contradicctory bleiefs or feelings about the same person,event, or situation
associative looseness(+) fragmented or poorly related thoughts and ideas
echopraxia(+) imitation of the mvms and gestures of anouther person whom the pt is observing
delusions(+) fixed false beliefs that have no basis in reality
flight of ideas(+) continous flow of verbalization in which the person jumps rapidly from one topic to another
hallucinations(+) false sensory perceptions or perceptual experiences that do not exist in reality
ideas of reference(+) false impressions that external events have special meaning for the person
perserveration(+) persistent adherence to a single idea or topic, verbal repetition of a sentence or word or phrase,resisting to change the topic
alogia(-) tendency to speak very little
anhedonia(-) feeling no joy or pleasure from life
apathy(-) feelings of indiff toward people, activities, events
blunted affect(-) restricted range of emotional feeling,tone,mood
catatonia(-) psychologically induced immobility occasionally marked by periods of agitationor excitement
flat affect(-) absence of any facial expression that would indicate emotions or mood
lack of volition(-) absence of will,ambition, or drive to take action or finish tasks
paranoid schizo persucatory(feel vicitimized)granidose del, halluc,^religiosity, hostile
disorganized schizo inapp or flat affect,loose assoc, extremely disorg behavior
catatonic schizo psychomotor disturbance,motionless or excessive, catalepsy(waxy flex)or stupor ^ activity is purposeless not stimulate by external stimuli
undiff schizo mixed schizo s/sx along with disturbances of thought affect and behavior
residual schizo at least 1 previous though not current episode,social w/d,flat affect,& loose assoc
onset schizo abrupt or insidious, most pts dev s/sx slow suchs as social w/d,unusual behavior, loss in interest of school/work, neglect hygiene
dx schizo made when more acitve (+) s/sx such as delusions,halluc,& disordered thinking(psychosis) appear, ealier in age worse outcome
immediate course 2 patterns- ongoing psychosis & never fully recovers; episodes of psychotic s/sx alternating w/episodes of complete recovery
long term course intensity of psychosis diminishes w/age, most with difficulty functioning, few w/ability to live indep lives
related disorders schizophreniform,delusional,brief psychotic, shared psychotic
etiology schizo genetic factors(partial) neuroanatomic/neurochem-(less brain tissues &CSF,dop)imunnovirologic factors
schizophreniform disorder s/sx schizo but for < 6 months necessary ti neet dx criteria for schizo
delusional disorder 1+ nonbizzare delusions-focus of del is believable
brief psychotic disorder sudeen onset of at least 1 psych s/sx such as del,halluc,or disorg speech or behavior, lasts 1 day-1month. may follow childbirth
shared psychotic disorder(folie a deux) 2 people share a similar del. dev del in the context of a clos r/t with someone who has psych del
cultural considerations del in 1 culture may be accepted by other cultures, aud/vis halluc normal in some,culture bound syndrome
psychopharmacology primary tx,neuroleptics(tx s/sx)
conventional antipsychotics(dopamine agonists) thorazine,haldol,navane,prolixin, target(+)s/sx, no effect on (-)
atypical antipsy (dopamine,serotonin antagonists) clozapine,risperdal,zyprexa geodon, abilify, diminish(+) and lessen(-)
depot injection forms prolixin in decanoate&enanthate preps, haldol in decanoate, risperidal costa(atypical) effects last 2-4 weeks elim daily PO med
EPS acute dystonia,akathisia,parkinsonism,TD(use AIMS),seizures,NMS
Abnormal Involuntary Mvm scale (AIMS) used to screen for s/sx of mvm disorders(TD) observe pt in several positions rate 0-4, done at admit,dc,or every month
non-neuro s/e weight gain, sedation,photosen,antichol,ortho hypo,agranulocytosis(clozaril)
psychosocial tx indiv/group therapy,social skills training(CET),family therapy, family ed
history previous schizo hx, prev suicidal ideation, current support system, pts perception of current situation
gen appearance,motor behavior,speech odd,bizzare,catatonia(restless)echopraxia(imitate mvms)psychomotor retard, word salad,echolalia(repeat)latency response
clang associations ideas that are related to one another based on sound or rhythm, i WILL take a PILL if i go UPHILL not if my name is JILL
neologisms words invented by pt, im afraid of grittiz. are you grittiz?
verbigeration sterotyped repitition of words that may/not have meaning to listener, i want to go home go home...
echolalia pts imitation or repitition of what nurse says
stilted language use of words or phrases that are flowery,excessive-would ou be so kind as rep of florence nightengale, to bring me wee bit of h2o
perseveration persistent adherance to a single idea or topic and verbal repeat of a sentence-
ex persveration n- how have yo been sleeping pt- ithink people have been following me n-where do you live pt- at the place where people have been following me
word salad combo or jumbled words that are disconnected and make no sense- corn,potatoes,jump up
mood/affect flat,blunted, anhedonia(depressed no joy in life)
thought process thought blocking, broadcasting, withdrawl, insertion
sensorium/intellctual process halluc(7 types), depersonalization9 most extereme form of disorientation pt detached from their behavior
auditory halluc most common, involve hearing sounds, most often voices-command halluc- tell pt to take action to harm self or others
visual halluc seeing images that dont exist, lights dead people,distortions like seeing monster and not nurse, 2nd most common
olfactory halluc smell/odors, may be specific scent lilke pee/poo or rotten odor, also seen in pts with dementia,seizures and CVA
tactile halluc sensations like electricity running through body or bugs on skin, often seen in pts with ETOH w/d rare in schizo
gustatory halluc taste lingering in mouth or thatfood tastes like something else- taste may be metallic or bitter
cenesthetic halluc pts report they feel bodily functions that are undetectable- urine formings, impulses in brain
kinesthetic halluc pt is motionless but reports senstaion of body mvm- floating about ground
persuctory/paranoid del believe "others" are planning to harm pt,spy, ridicule,follow. sometimes can define who "others" are- pt food poisioned or room bugged
grandiose del pt claims to associate w/famous people or that they are famous- pt engaged to celebrity, daughter or president, cure for cancer
religious del second coming of chris, prophet,del appear suddenly and notpart of religious beliefs-pt claims to be messiah,prophet from god
somatic del vague&unrealistic beliefs about pts healthor body function,facts or dx tests dont change beliefs- man saing he is preggo, decaying intestines,worms in brain
referential del ideas of ref, involve pts belief that tc broadcasts, music,newspaper have special meaning to pt-presidents speech directed to them
judgement/insight usually impaired,can be severe pt cant protect themselves, fail to wear warm clothes in winter, insight severely impaired early
self concept loss of ego boundries-lack of clear sense of where their body mind and influence end and whre those aspects of other animate/inanimate objects begin, ideas of ref
roles&r/ts social isolation, trust intimacy problems, lack of confidence,feel strange/diff
physiologic and self care considerations inattention to hygiene and grooming, failure to recognize sensations(hunger,thirst) polydipsia(h2o intox)
nursing dx based on (+) s/sx risk for violence,suicide, disturbed thought process,sensory perception, personal identity, impaired verbal comm
nursing dx based on (-) s/sx self care defecits, social isolation,ineffective health maintenance,ineff therapeutic regimen management
outcome identification acute psychosis wiill get tx in an intensive setting, focus is to stabilize thought processes and reality to orientation-ex:not injure self or others,contact w/reality,interact w/others,express thoughts, participate
interventions safety,therapeutic r/t,interventions for del thoughts,interventions for halluc(voice hearer groups),manage inapp behavior, pt/fam ed(s/sx relapse,selfcare,socialskills,meds)
s/sx of relapse impaired cause-effect reasoning, poor nutriton, lack of sleep, lack of exercise,fatigue,poor social skills,mood swings,hopeless,anxiety, ^ negativity, forgetful, neglect looks
elder considerations late oset ^45, psychotic s/sx later in life associtated w/depression or dementia not schizo, 1/4 exp dementia 1/4 reduction in(+) s/sx, remainder mostly unchanged
mental health promo goal of rehab is recovery, accurate id of those at risk, early interventions- improved prodromal s/sx, prevent social stagnation or decline, prevent or dealy progression of psychosis
Created by: 536862996