Schizophrenia flash cards
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| Age at onset | late adolescence, early adulthood
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| Commons symptoms of psychosis | hallucinations
delusions
difficulty with thought organization
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| Most common cause of psychosis | Schizophrenia
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| Schizophrenia is not characterized by a changing personality, it characterized by... | a deteriorating personality
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| Perceptual disturbance | hallucinations
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| Thought process disturbance | thought derailment
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| Reality testing disturbance | delusions
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| Feeling disturbance | flat or inappropriate affect
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| Behavior disturbance | social withdrawal
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| Attention disturbance | inability to concentrate
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| Motivation disturbance | cannot initiate or persist in goal-directed activities
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| 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
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| Stages of Schizophrenia | Acute phase
Stabilizing phase
Stable phase
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| DSM-IV Subtypes of Schizophrenia | Paranoid
Disorganized
Catatonic
Undifferentiated
Residual
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| DSM-IV Criteria: Paranoid Schizophrenia | Preoccupation with one or more delusions or frequent auditory hallucinations (content frequently persecutory and/or grandiose)
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| DSM-IV Criteria: Disorganized Schizophrenia | * worst prognosis
All of the following are prominent: disorganized speech, disorganized behavior, flat or inappropriate affect
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| 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
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| 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
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| 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
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| Echolalia | the automatic repetition of vocalizations made by another person
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| Echopraxia | the automatic repetition of movements made by another person
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| Positive Symptoms are | the embellishment of normal cognition and perception
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| Negative Symptoms are | an absence or diminution of that which should be
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| Pathoanatomy | decreased cerebral blood flow (CBF)
increased ventricular brain ratios (VBR)s (use MRI and CT)
cerebral atrophy
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| Objective Signs | Alterations in Personal Relationships
Alterations of Activity
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| Objective Signs- Alterations in personal relationships | decreased attention to appearance and social amenities R/T introspection and autism
Inadequate of inappropriate communication
Hostility
Withdrawal
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| Objective Signs- Alterations of activity | psychomotor agitation
catatonic rigidity
echopraxia
sterotypy (repetitive acts or words)
anergia (- energy)
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| Subjective Symptoms | Altered perceptions
Alterations of thought
Altered Consciousness
Alterations of affect
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| Subjective Symptoms- Altered perception | hallucinations (auditory most common *visual could indicate toxicity)
illusions
paranoid thinking
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| Subjective Symptoms- Alterations of thought | loose associations
retardation
blocking
autism
ambivalence
delusions
poverty of speech
ideas of reference
mutism
concrete thinking
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| Subjective Symptoms- Altered Consciousness | confusion
incoherent speech
clouding
sense of "going crazy"
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| Subjective Symptoms- Alterations of affect | inappropriate, blunted, flattened, or labile affect
apathy
ambivalence
overreaction
anhedonia (apathy)
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| Paranoid personality disorder vs. Paranoid delusions | Personality- can be corrected with facts
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| Somatic delusion | After medical tests confirm otherwise, a patient still insists, "I have cancer in my stomach."
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| Grandiose delusion | "I am the president."
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| Religious delusion | "The devil told me to kill my children."
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| Nihilistic delusion | "I am dead."
"If you are dead, how can you talk?"
"I don't know, but I am dead."
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| Delusion of reference | "The TV is talking about me. The guests on Oprah are making fun of me."
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| Delusions of influence | "I can control her with my thoughts."
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| Paranoid delusion | "They all think I'm a homosexual."
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| Schizophrenic overreact to normal events because | they have to in order to overcome mental and social inertia
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| Key objectives for Tx Schizophrenia | work with the family
treat depression (75%)
minimize stressful interactions
treat substance abuse
avoid lengthy, intense verbal interactions
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| Leading cause of premature death for Schizophrenic pts | Suicide
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| 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
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| Psychotherapeutic management is aimed at helping | patients becoming stronger than their symptoms
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| 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
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| Milieu Mgmt- Disruptive Patients | -set limits
-decrease environmental stimuli
-observation
-take away objects that are possible weapons
-restraints-> evaluate for hydration, nutrition, elimination, circulation
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| 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)
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| Milieu Mgmt- Suspicious Patients | -matter-of-fact
-laughter/ whispering
-no touch w/o warning
-consistent
-maintain eye contact
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| Milieu Mgmt- Impaired Communication | -be patient
-dont pressure them to make sense
-provide opportunities for purposeful psychomotor activity
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| 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
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| Milieu Mgmt- Disorganized Patients | -less stimulation
-calm environment
-safe, simple activities
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