Question | Answer |
Age at onset | late adolescence, early adulthood |
Commons symptoms of psychosis | hallucinations
delusions
difficulty with thought organization |
Most common cause of psychosis | Schizophrenia |
Schizophrenia is not characterized by a changing personality, it characterized by... | a deteriorating personality |
Perceptual disturbance | hallucinations |
Thought process disturbance | thought derailment |
Reality testing disturbance | delusions |
Feeling disturbance | flat or inappropriate affect |
Behavior disturbance | social withdrawal |
Attention disturbance | inability to concentrate |
Motivation disturbance | cannot initiate or persist in goal-directed activities |
Bleuler's Four A's of Schizophrenia | Affective disturbance: inappropriate, blunted, flat affect
Autism: preoccupation with self, with little concern for external reality
Associative looseness: stringing together of unrelated topics
Ambivalence: Simultaneous opposite feelings |
Stages of Schizophrenia | Acute phase
Stabilizing phase
Stable phase |
DSM-IV Subtypes of Schizophrenia | Paranoid
Disorganized
Catatonic
Undifferentiated
Residual |
DSM-IV Criteria: Paranoid Schizophrenia | Preoccupation with one or more delusions or frequent auditory hallucinations (content frequently persecutory and/or grandiose) |
DSM-IV Criteria: Disorganized Schizophrenia | * worst prognosis
All of the following are prominent: disorganized speech, disorganized behavior, flat or inappropriate affect |
DSM-IV Criteria: Catatonic Schizophrenia | * best prognosis
At least two of the following:
1. motoric immobility, wavy flexibility, or stupor
2. excessive motor activity (purposeless)
3. extreme negativism or mutism
4. peculiar movements, stereotype of movements, prominent mannerisms, or prom |
DSM-IV Criteria: Undifferentiated Schizophrenia | Characteristic symptoms (motoric immobility, wavy flexibility, or stupor) are present but criteria unmet for paranoid, catatonic, or disorganized subtypes not met |
DSM-IV Criteria: Residual Schizophrenia | A. Characteristic symptoms (motoric immobility, wavy flexibility, or stupor) are no longer present; criteria are unmet for paranoid, catatonic, or disorganized subtypes
B. Continuing evidence of disturbance, such as presence of negative symptoms or chara |
Echolalia | the automatic repetition of vocalizations made by another person |
Echopraxia | the automatic repetition of movements made by another person |
Positive Symptoms are | the embellishment of normal cognition and perception |
Negative Symptoms are | an absence or diminution of that which should be |
Pathoanatomy | decreased cerebral blood flow (CBF)
increased ventricular brain ratios (VBR)s (use MRI and CT)
cerebral atrophy |
Objective Signs | Alterations in Personal Relationships
Alterations of Activity |
Objective Signs- Alterations in personal relationships | decreased attention to appearance and social amenities R/T introspection and autism
Inadequate of inappropriate communication
Hostility
Withdrawal |
Objective Signs- Alterations of activity | psychomotor agitation
catatonic rigidity
echopraxia
sterotypy (repetitive acts or words)
anergia (- energy) |
Subjective Symptoms | Altered perceptions
Alterations of thought
Altered Consciousness
Alterations of affect |
Subjective Symptoms- Altered perception | hallucinations (auditory most common *visual could indicate toxicity)
illusions
paranoid thinking |
Subjective Symptoms- Alterations of thought | loose associations
retardation
blocking
autism
ambivalence
delusions
poverty of speech
ideas of reference
mutism
concrete thinking |
Subjective Symptoms- Altered Consciousness | confusion
incoherent speech
clouding
sense of "going crazy" |
Subjective Symptoms- Alterations of affect | inappropriate, blunted, flattened, or labile affect
apathy
ambivalence
overreaction
anhedonia (apathy) |
Paranoid personality disorder vs. Paranoid delusions | Personality- can be corrected with facts |
Somatic delusion | After medical tests confirm otherwise, a patient still insists, "I have cancer in my stomach." |
Grandiose delusion | "I am the president." |
Religious delusion | "The devil told me to kill my children." |
Nihilistic delusion | "I am dead."
"If you are dead, how can you talk?"
"I don't know, but I am dead." |
Delusion of reference | "The TV is talking about me. The guests on Oprah are making fun of me." |
Delusions of influence | "I can control her with my thoughts." |
Paranoid delusion | "They all think I'm a homosexual." |
Schizophrenic overreact to normal events because | they have to in order to overcome mental and social inertia |
Key objectives for Tx Schizophrenia | work with the family
treat depression (75%)
minimize stressful interactions
treat substance abuse
avoid lengthy, intense verbal interactions |
Leading cause of premature death for Schizophrenic pts | Suicide |
Psychosis-Induced Polydipsia | between 4-10 L/day
-hyponatremia
S/S: lightheadedness, weakness, lethargy, muscle cramps, N/V, confusion, convulsions, coma
I: frequent weigh-in
restrict fluid intake
sodium replacement
positive reinforcement |
Psychotherapeutic management is aimed at helping | patients becoming stronger than their symptoms |
Nurse-Patient Relationship | -be calm when talking
-accept patients as they are, but do not accept all behaviors
-keep promises
-be consistent
-be honest
-do not reinforce hallucinations/ delusions
-orient x3
-do not touch w/o warning
-avoid whispering/laughing when pt cannot |
Milieu Mgmt- Disruptive Patients | -set limits
-decrease environmental stimuli
-observation
-take away objects that are possible weapons
-restraints-> evaluate for hydration, nutrition, elimination, circulation |
Milieu Mgmt- Withdrawn Patients | -nonthreatening, physical activities
-arrange furniture to facilitate conversation
-assist decision making
-reinforce grooming/ hygiene
-psychosocial rehab (social skills, community living, health care skills) |
Milieu Mgmt- Suspicious Patients | -matter-of-fact
-laughter/ whispering
-no touch w/o warning
-consistent
-maintain eye contact |
Milieu Mgmt- Impaired Communication | -be patient
-dont pressure them to make sense
-provide opportunities for purposeful psychomotor activity |
Milieu Mgmt- Hallucinations | -provide distracting activities
-discourage conversation about hallucinations with other patients
-monitor tv selection
-monitor for command hallucinations
-have staff available for listening |
Milieu Mgmt- Disorganized Patients | -less stimulation
-calm environment
-safe, simple activities |