Theory Test on Schizophrenia
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| Schizophrenia | Characteristically, disturbances in thought processes, perception, and deterioration of social and occupational functioning.
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| Skhizo | Greek for split
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| Phren | Greek for mind
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| Average age of onset for schizophrenia | 18-25 years
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| Average age of onset for schizophrenia in men | 15-25 years
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| Average age of onset for schizophrenia in women | 25-35 years
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| Is schizophrenia a static or progressive disease? | Progressive. Gets worse with time.
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| Schizophrenia tends to surface when | a person goes through "major major stress"
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| Worst case scenario for schizophrenia (nightmare) | 1 Early onset (child). 2 Male. 3 Strong family history. 4 Paranoid Schizophrenia. 5 Command type voices. "Kill Kill Kill"
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| What percent of the world's population has been diagnosed with schizophrenia? | 1%
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| What is the chance if an identical twin has been diagnosed with schizophrenia that the other twin will also develop schizophrenia? | 50%
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| Best case scenario for schizophrenia | 1 Late onset. 2 Female. 3 No family history of schizophrenia. 4 Paranoid thinking not prominent. 5 No command type voices.
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| Most dangerous type of Schizophrenia | Paranoid. Show minimal signs. Does not or will not talk about it. Afraid of people. May strike or harm others as a preemptively. Unrealistic sense of reality. Crazy ppls.
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| Most scary patients, according to Mr. D, are not the big ones or the strong ones but are the ones that say | "I'm hearing voices." "Why are you doing this to me."
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| Percentage of schizophrenics who will attempt suicide? | 50%
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| What percent of those schizophrenics that attempt suicide will actually succeed? | 15%
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| Why do they attempt suicide? | Stigma, voices, no social life, belief that they are better off dead, no hope of cure, difficulty in finding employment.
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| If both parents have schizophrenia (mom and dad); what are the chances that their children will develop schizophrenia? | 46%
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| What percentage of the schizophrenic population live by themselves (independent)? | 25% (1 out of 4) They only require minor assistance during times of stress.
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| What percentage of the schizophrenic population are homeless? | 6%
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| Should children with schizophrenia be sedated (zombified) with psychotropic drugs? | According to Mr. D, yes, to keep them alive, and to prevent them from being a danger to themselves or danger to others.
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| #1 cause of schizophrenia | Too much dopamine activity.
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| Role of Dopamine | Voluntary decision making, mood, cardiovascular system, motor movement
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| If dopamine levels are too High | Decision making affected, difficulty concentrating, hallucinations, delusions.
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| Role of Serotonin | Mood, appetite, arousal, sleep
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| #2 cause of schizophrenia | Too much serotonin activity.
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| Biochemical influences of schizophrenia might be caused by which of the following: | Abnormal levels of neurotransmitters such as dopamine, serotonin, and norepinephrine
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| #3 cause of schizophrenia | Abnormal levels of Norepinephrine
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| Meth mimics | Norepinephrine
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| Meth works by | allowing you to produce more Norepinephrine, thus triggering a sympathetic response (fight or flight)
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| Meth may produce | a temporary drug induced paranoid schizophrenia
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| Physiological influences of the brain | Viral infection, anatomical abnormalities, and histological changes in the brain.
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| Psychological influences on the brain are not that _________? | prominent
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| Stress does not cause | schizophrenia
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| Stress/Trauma/Abuse at a young age/Prolonged Molestation/ with predisposing factors | may cause/trigger schizophrenia
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| 4 phases of schizophrenia | 1 Premorbid. 2 Prodromal. 3 Active. 4 Residual.
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| 1st phase of schizophrenia | Premorbid Phase.
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| Premorbid Phase | Schizoid personality: The kid in high school that was slightly off, aloof, indifferent, withdrawn, no friends, didn't participate in sports or school events, loner, kept to himself, no care for appearance, not doing well academically. May last a few years
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| Are people with Schizoid Personalities aware that they are going through a premorbid phase? | No. Other people may also not be aware that there is a problem either; that they just might be a loner when they are really going through a Premorbid Phase of Schizophrenia.
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| Are hallucinations present during the premorbid phase? | No
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| 2nd phase of schizophrenia | Prodromal Phase
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| Prodromal Phase | Weirdo. Socially withdrawn, eccentric behavior, neglect in hygiene and grooming, no emotion, disturbed communication, lack initiative, bizarre thinking, magical thinking, and impairment in role function.
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| Magical Thinking | Individual believes that by thinking about a possible occurrence can make it happen. "I can read your mind."
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| Are hallucinations present during the prodromal phase? | Maybe. Might be present during the end of (late) prodromal phase.
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| How long does the prodromal phase last? | 2-5 years
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| 3rd phase of schizophrenia | Active Phase
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| Most people are not diagnosed with schizophrenia until which phase? | 3rd phase (Active)
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| Active (3rd) Phase | 1 month of Characteristic Symptoms. Social/Occupational Dysfunction. Continuous signs of disturbance for at least 6 months.
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| Hallucination | + False sensory perception that is not associated with real external stimuli. May involve any of the five senses.
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| 5 types of hallucinations | Auditory, Visual, Tactile, Gustatory, and Olfactory
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| Auditory Hallucination | + Hearing things that aren't there such as voices, sounds, or music. Command voices are the most dangerous. 3 Days Grace: Misery Loves My Company
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| Visual Hallucination | + Seeing things that aren't there such as visions, people, and flashes of light. 6th sense: "I see dead people"
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| Tactile Hallucination | + Feelings things that aren't there such as being touched, or a crawling sensation. Linkin Park: Crawling
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| Gustatory Hallucinations | + Tasting things that aren't really there. Underoath: I don't feel very receptive today
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| Olfactory Hallucinations | + Smelling things that aren't really there. The Showdown: A Monument Encased In Ash
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| 6 Types of Delusions | Persecution, Grandeur, Reference, Control or Influence, Somatic, and Nihilistic
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| Delusion | + Fixed False Belief
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| Delusion of Persecution | + Individual feels threatened and believes that others intend harm toward him.
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| Delusion of Grandeur | + "I have 10 wives."
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| Delusion of Reference | + Everything is about me. "They are looking/laughing/judging me" "Guy on TV is talking to me"
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| Delusion of Control or Influence | + Other people are controlling me from a distance. "Dentist put a filling in my tooth; I now receive transmissions through the filling that control what I think and do."
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| Somatic Delusion | + False idea about the functioning of his/her body. "I'm a virgin, but I'm pregnant!"
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| Nihilistic Delusion | + False idea that self, part of self, others, or the world is nonexistent. "I have no heart" The Matrix movie. Inception movie.
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| Characteristic Symptoms | Delusions, Hallucinations, Disorganized Speech, Grossly Disorganized or Catatonic Behavior, and Negative Symptoms
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| (-) Negative Symptoms | Opposite of positive symptoms. Zapping away life such as: Apathy, Autism, Anergia, Pacing and Rocking, Anhedonia, Avolition, and Regression.
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| Apathy | - Indifference. Flat effect. "I don't care."
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| Autism | - Inward focus on fantasy world.
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| Anergia | - Lack of energy.
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| Pacing and Rocking | - Constant walking. Moving back and forth in chair while seated.
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| Anhedonia | - Can't feel pleasure.
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| Regression | - Acting like a child/kid.
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| Avolition | - No initiative to do anything. No drive. No purpose.
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| (+) Positive Symptoms | Delusions, Paranoia, Associative looseness, Neologisms, Clang associations, word salad, mutism, Hallucinations, Echoalia, and Echopraxia.
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| Paranoia | + Extreme suspicion of others or intentions.
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| Associative Looseness | + When talking, shifting from one subject to another unrelated subject.
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| Neologisms | + Creation of new words. "Complexicated"
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| Clang Associations | + Choice of words governed by sound. Often rhyming. What rappers do. "It is cold, and bold, the gold has been sold."
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| Word Salad | + Group of words that are put together randomly without any logical connection. "Most forward action grows life double plays circle uniform"
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| Echoalia | + Repeating words that were heard.
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| Echopraxia | + Repeating movements made by others.
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| How many characteristic symptoms do you have to have to be considered schizophrenic. | 2 or more.
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| Is it possible to be schizophrenic without hallucinations or delusions? | Yes
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| How long do you need to manifest 2 or more characteristic symptoms to be considered schizophrenic? | A significant portion of time during a 1 month period.
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| Social/Occupational Dysfunction | Role impairment: lost my job, fired, grades downhill.
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| How long do I have to show signs of disturbance? | 6 months.
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| Within that 6 month time period, how long do I have to display characteristic symptoms? | 1 month.
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| Do I need both 1 month of characteristic symptoms and 6 months of disturbance to be considered schizophrenic? | Yes
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| What is considered signs of disturbance? | Premorbid
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| Before we diagnose a person with schizophrenia we must exclude: | Mood disorders (bipolar or autism) and Drug induced psychosis (Meth).
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| 4th phase of schizophrenia | Residual Phase
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| Residual Phase | Periods of remission and exacerbation. Negative symptoms remain. Flat affect and impairment in role function. May or may not have delusions or hallucinations. Teach coping skills to deal with stress.
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| Can Stress trigger a remission of Residual phase to Active phase schizophrenia? | Yes. Mr. D relative example: Guy received $15,000 inheritance, bought drugs, and went psycho.
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| What are the 5 types of schizophrenia? | Disorganized, Catatonic, Paranoid, Undifferentiated, and Residual.
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| Disorganized schizophrenia | Flat or inappropriate affect, bizarre behavior, impaired social interaction, silliness, contact with reality is very poor, and neglected appearance.
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| What is the age of onset for disorganized schizophrenia? | Usually before age 25.
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| Is disorganized schizophrenia more common in men or women? | Men
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| Paranoid schizophrenia | Most dangerous form of schizophrenia. They have paranoid delusions. They think that everyone is out to get them. They can be hostile and aggressive. Suspicious of everyone.
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| The onset of symptoms for paranoid schizophrenia usually happens... | Later in life.
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| Social impairment for paranoid schizophrenics may be... | Minimal. They can act normal. They are very secretive.
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| At which stage is there no impairment in role function in schizophrenia? | Premorbid (1st) phase
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| At which stage is impairment in role function first manifests? | Prodromal (2nd) phase
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| What symptoms are most prominent in the residual phase? | Negative symptoms
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| Schizophreniform | Goes through all 4 phases of schizophrenia in 1-6 months. Returns back to normal.
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| Brief Psychotic Disorder | Goes through all 4 phases of schizophrenia in 1 day - 1 month. Not caused by drugs. Returns back to normal.
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| Should you argue with a patient that has a grandiose delusion of having 10 wives? | No
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| Should you ask the patient questions about how he got his 10 wives? | No. Asking him questions about how he got his 10 wives will only reinforce his delusion of grandeur, which will not be therapeutic. Instead redirect him to reality.
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| Obsession | a consuming thought that causes anxiety or distress
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| Compulsion | unwanted repetitive behavior patterns
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| Schizoaffective Disorder | Manic or Depressed mood disorder patients that also show signs of schizophrenia. Mood disorder more prevalent than signs of schizophrenia. Give mood stabilizer.
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| GABA | Gamma-AminoButyric Acid. #1 inhibitory and mood stabilizer.
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| Nervous Breakdown (Meltdown) | Brief Psychotic Disorder
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| Environmental Influence of schizophrenia | Stress(full life events)
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| Mutism | + Refusal to speak
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| Group therapy for schizophrenia has been most useful ________ | Long term.
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| The educational procedure in social skills training focuses on _________ | Role-play
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| Sue is displaying major social impairment. Her affect is generally flat and she often displays periods of silliness and incongruent giggling. What is her diagnosis? | Disorganized Schizophrenia
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| When developing a treatment plan for someone who has a psychotic disorder, the priority should always be: | To work on symptoms that are incompatible with client's safety.
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| The educational procedure in social skills training focuses on role-play. | True
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| How should you address voices? | Ask "what are the voices telling you?" instead of "what are they trying to tell you?". Objectify the voices, but do not personify the voices.
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| Is it OK to lie to a paranoid schizophrenic? | No. We have to build trust.
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| What type of setting is better for schizophrenic patients for group therapy? | Out-Patient
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| Most milieu therapy emphasizes | group and social interaction
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| Rules and expectations in Milieu therapy are mediated by | peer pressure for normalization of adaption.
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| When patients are viewed as responsible human beings, the patient role becomes | blurred.
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| Milieu therapy stresses a patient's rights to | goals, freedom of movement, and informal staff relationship.
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| Milieu therapy emphasizes | participation and communication
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| In Psych world, last resort is chemical restraint or physical restraint? | Physical restraint. Needs Psychiatrist order.
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| During a paranoid patient interview, where should you sit? | Closest to the door.
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| Patient has signs and symptoms of: delusional thinking and suspiciousness. What is the Nursing Diagnosis? | Nsg Dx: Disturbed thought processes
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| Patient has signs and symptoms of: delusional thinking and suspiciousness. What is the Nursing Action? | Nsg Act: Don't whisper, serve food family style, check mouth for meds, cautious with touch, use same staff, meet client needs and keep promises to promote trust.
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| Patient has signs and symptoms of: delusional thinking and suspiciousness. What is the desired Outcome? | OTC: Ability to trust, discern delusion from reality.
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| Patient has signs and symptoms of: hearing voices and listening pose. What is the Nursing Diagnosis? | Nsg Dx: Disturbed (Auditory)Sensory Perception
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| Patient has signs and symptoms of: hearing voices and listening pose. What is the Nursing Action? | Nsg Act: Look for signs of hallucinations, caution with touch, say "the voices" instead of "they", distract back to reality.
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| Patient has signs and symptoms of: hearing voices and listening pose. What is the desired Outcome? | OTC: Talk about voices with nurse, no more voices or recognize voices as not real.
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