Question | Answer |
Define Schizophrenia | severe, chronic, disabling brain disease, split mind. Usually occurs late adol, early adulthood |
Onset of Sz can show what s/s? | loss of ambition, inability to plan, incr social isolation, altered perception of reality, loss of self-awareness, hallucinations, delusions, disorganized thoughts/speech. |
What is number one early s/s?
What is dangerous s/s of medications? | change in sleep patterns
Polydipsia, can get water intoxicated |
What are positive s/s? | Attention getting behaviors: hallucinations, delusions, ambivalence, looseness of associations, flight of ideas, ideas of reference, echopraxia, perseveration |
What are negative s/s? | Render pt inert and unmotivated: alogia, anhedonia, apathy, blunted affect, catatonia, flat affect, avolition |
What is most common type of hallucinations?
Other types? | auditory
other: visual, olfactory, tactile, gustatory |
Define delusion | False personal beliefs not subj to reason |
types of delusions:
persecutory/paranoid | false beliefs they are being cheated, harassed, poisoned, conspired against, or they or family is focus of persecution |
Grandeur | believes is famous or important person |
somatic | bizarre body phenomena, like losing eyelashes or infested with insects |
Religous
Ideas of reference? | believe occurences are related to them, people on tv are directing special messages to them or their thoughts are being broadcast aloud to others |
types of disorganized thinking:
Tangentiality:
Word Salad
Clang Association | 1. items connect but points are not made
2. words w/o meaning
3. speech wtih rhyming words/sounds |
Loose associations?
Derailing | 1. pt only knows meaning of word
2. doesn't stay on track |
Types of Sz:
Paranoid?
Disorganized? | 1. persecutory or grandiose delusions, hallucinations, hostile, aggerssive beh.
2. Inappropriate or flat affect, loose associations, disorg. beh. incoherence |
Catatonic?
Undifferentiated?
Residual? | 1. motionless or excessive motor, waxy flexibility(can mold into position), stupor, rigidity, posturing
2. delusions and hallucinations, mix
3. continuation of s/s following Sz episode |
what is alogia?
avolition?
anhedonia?
echopraxia?
perseveration? | 1. mute, low speech, blocking
2. apathy in grooming/hygiene, work
3. lack of pleasure, joy to life
4. mimic mvmts
5. get stuck on topic |
Related disorders:
schizoaffective disorder?
schizophreniform?
delusional disorder?
brief psychotic disorder?
Shared psychotic disorder? | 1. both psychotic s/s and criteria for major affective/mood disorder(depr, mania
2. s/s of sz noted < 6 mos
3. nonbizarre delusions |
In new researuch, what drug is being used for toxoplasmosis infections and Sz? | anti-malarial drugs and clindamycin |
Diff. cultural views of Sz
Lower doses of Haldol?
W. Africa?
Native Am.?
Latin America?
china?
N. Africa? | 1. Asians
2. Boufee
3. Ghost sickness- preoccupation w/ death
4. Locura
5. Qi-gong
6. Zar |
First Generation drug therapy and SE?
2nd?
3rd? | 1st: Chlorpromazine(Thorazine)for +, not - s/s
2nd: Haldol, Moban, higher EPS s/s
3rd: clozaine(Clozaril) dopamine and serotonin antagonists |
types of EPS(extrapyramidal s/s):
dytonia?
pseudoparkinsonism?
akathisia? | 1. torticollis(twist neck), oculogyric crisis(eyes roll back in head)
2. shuffle, cog-wheeling, aknesia(slow mvmt)
3. can't sit still |
What drug is best for EPS? | Cogentin, PO or IM
Benedryl
Inderol for akathisia |
Tardive Dyskinesia? | 1. involuntary mvmts, lip smacking, tongue protrusion, grimacing, later in tx and can be permanent |
What are main SE of Clozapine? | seizures
Neuroleptic Malignant Syndrome: fever, muscle rigidity...stop med, give Dantrium
agranulocytosis: have weekly white counts for 1st 6mos of therapy, then q 2wks. If <3500, stop drug.
Diabetes risk |
Three types of thought content:
thought blocking?
thought broadcasting?
thought withdrawal? | 1. pt stop talking mid sentence
2. others can hear thoughts
3. others stealing thoughts |
thought insertion?
tangential thoughts?
flight of ideas? | 1. others insert thoughts against will
2. veering off from topic w/ some thread
3. change subjects w/ no thread |
Preferred outcomes? | prevention of relapse
tx of s/s
independence
success and safety |
Intv for delusions | est trust, assure safety, pursue meaning of delusion, ask for evidence, reflect feeling, decr paranoia wtih distraction, express you don't agree, but pt sees it that way. |
Intv for hallucinations | trust, observe beh, make observations, reflect feelings, help see voices are chemical part of disease, teach coping |
Impaired verbal communication intv | use words pt understands, be congruent with verbal and non-verbal comm, validate meaning of comm, look for themes in comm, set limits for derogatory statements |
SE of meds and intv for
seizures?
Neuroleptic malignant syndrome? | stop med, notify Dr. protect w/ seizures |
Intv and SE for drugs to treat EPS:
Benadryl?
Valium?
Ativan?
Inderal? | 1. observe for sedation, tx dry mouth
2. watch sedation, risk for abuse
3. watch sedation, risk for abuse
4. assess palpitations, dizzy, cold hands/feet |
what is new psychosocial therapy called cognitive enhancement terapy (CET)? | combines computer-based cognitive training wtih group sessions that allow pt to practice adn dev social skills |
Nurse assessment of Sz pt includes | baseline data, age of onset, suicide attempts, support systems, pt perception of problem |
Intv for delusions include? | set expectations/rules, no promises, explain things, recognize delusions as pt perception, 1 to 1 activty, then group, ask if pt sees delusions interfere with life |
Intv for Sz prioritized | safety, trust, clarify feelings |