Schizophrenia: Symptoms and Characteristics

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Questions and Answers

A patient experiencing neuroleptic malignant syndrome (NMS) secondary to antipsychotic medication administration requires immediate intervention. Which of the following pharmacological interventions directly targets the underlying pathophysiology of NMS?

  • Administration of intravenous lorazepam to manage acute agitation and prevent potential self-harm.
  • Immediate administration of dantrolene and bromocriptine to address muscle rigidity and dopaminergic blockade. (correct)
  • Intramuscular injection of benztropine to counteract extrapyramidal symptoms and restore motor control.
  • Concurrent administration of propranolol and clonazepam to manage tachycardia and anxiety associated with NMS.

A patient diagnosed with schizophrenia presents with persistent auditory hallucinations despite adherence to an antipsychotic regimen. Which advanced neuroimaging technique would be most useful in differentiating between treatment-resistant hallucinations and structural brain abnormalities?

  • Positron emission tomography (PET) scan with glucose metabolic analysis to detect general areas of neural hypo- or hyper-activity.
  • Computed tomography (CT) scan to rule out gross structural abnormalities affecting cerebral perfusion.
  • Functional magnetic resonance imaging (fMRI) to assess real-time brain activity patterns associated with hallucination experiences. (correct)
  • Electroencephalography (EEG) to identify abnormal cortical electrical activity indicative of seizure disorders.

A patient exhibiting catatonic behavior secondary to schizophrenia demonstrates waxy flexibility. Which advanced nursing intervention is most critical to prevent complications associated with prolonged immobility?

  • Initiating a bowel management program with regular stool softeners to prevent impaction from decreased peristalsis.
  • Administering high-dose benzodiazepines to manage acute agitation and prevent potential self-injury.
  • Implementing a strict fluid restriction to prevent potential hyponatremia from psychogenic polydipsia.
  • Conducting passive range-of-motion exercises every two hours to prevent contractures and skin breakdown. (correct)

In a patient with schizophrenia experiencing medication-induced metabolic syndrome, which therapeutic approach is most effective for mitigating cardiovascular risk beyond standard dietary and exercise interventions?

<p>Switching to an antipsychotic with a lower propensity for metabolic side effects while closely monitoring psychiatric stability. (C)</p> Signup and view all the answers

A patient with schizophrenia displays persistent negative symptoms, particularly avolition and anhedonia, despite optimal antipsychotic management. Which adjunctive pharmacological strategy has the most evidence for improving these specific symptoms?

<p>Introducing a dopamine partial agonist such as aripiprazole to selectively enhance dopaminergic activity in the prefrontal cortex. (A)</p> Signup and view all the answers

A patient with a long history of schizophrenia presents with tongue movements and lip smacking. Which intervention is most appropriate?

<p>Discontinue the offending medication and switch to an atypical antipsychotic, if appropriate. (A)</p> Signup and view all the answers

A patient with schizophrenia is prescribed clozapine. Which laboratory value requires ongoing monitoring due to the risk of a potentially life-threatening side effect?

<p>Complete blood count (CBC) with differential for agranulocytosis. (C)</p> Signup and view all the answers

A patient in the acute phase of schizophrenia exhibits disorganized thinking and delusional beliefs. Which nursing intervention is most therapeutic?

<p>Providing simple, direct language and reinforcing reality without arguing with delusions. (C)</p> Signup and view all the answers

Which nursing intervention is most appropriate for a patient experiencing auditory hallucinations?

<p>Acknowledging the hallucinations while presenting reality and encouraging distraction techniques. (B)</p> Signup and view all the answers

A patient diagnosed with schizophrenia is prescribed haloperidol. The nurse should monitor for which of the following side effects?

<p>Sedation and hypotension. (C)</p> Signup and view all the answers

A patient with schizophrenia is being discharged. What is the most important topic to emphasize in patient and family education?

<p>Importance of medication adherence and recognizing early signs of relapse. (B)</p> Signup and view all the answers

Which of the following is an example of a negative symptom of schizophrenia?

<p>Affective flattening. (C)</p> Signup and view all the answers

What is the primary mechanism of action of typical antipsychotic medications?

<p>Blocking dopamine receptors (D2). (A)</p> Signup and view all the answers

Which of the following best describes 'word salad' in the context of schizophrenia?

<p>Random words without meaning. (A)</p> Signup and view all the answers

What is the typical age range for the onset of schizophrenia?

<p>15-25 years old. (C)</p> Signup and view all the answers

Which phase of schizophrenia is characterized by a gradual onset of symptoms over months to years?

<p>Prodromal phase. (C)</p> Signup and view all the answers

What does the term 'anhedonia' refer to?

<p>Inability to experience pleasure. (B)</p> Signup and view all the answers

Which of the following is a key nursing consideration when administering antipsychotic medications?

<p>Monitoring for extrapyramidal symptoms. (A)</p> Signup and view all the answers

What is the most appropriate initial nursing intervention when a patient reports hearing voices?

<p>Acknowledging the hallucination and offering reality-based responses. (D)</p> Signup and view all the answers

A patient is prescribed benztropine (Cogentin). Which side effect of antipsychotic medication is this drug used to treat?

<p>Extrapyramidal symptoms (EPS). (C)</p> Signup and view all the answers

Which long acting injectable antipsychotic requires a 3 week overlap with oral antipsychotic?

<p>Risperdal Consta (C)</p> Signup and view all the answers

Which of the following is NOT a risk factor that is related to relapse in schizophrenia?

<p>Adherence to medication regime (B)</p> Signup and view all the answers

A newly admitted patient has a diagnosis of schizoaffective disorder. Which of the following best describes this?

<p>A combination of schizophrenia and a mood disorder, such as depression or mania. (C)</p> Signup and view all the answers

Which of the following statements best describes the difference between hallucinations and delusions?

<p>Hallucinations are sensory experiences without external stimuli, whereas delusions are fixed, false beliefs. (A)</p> Signup and view all the answers

If a patient refuses medication, which of the following is the most appropriate initial nursing action?

<p>Ask the patient about their concerns of refusing the medication (C)</p> Signup and view all the answers

Which of the following is the priority nursing intervention to use when a patient begins to escalate?

<p>Speak to the patient in a calm, direct, and nonthreatening manner (C)</p> Signup and view all the answers

The nurse is caring for a client who takes an antipsychotic medication daily. The nurse assesses the client for symptoms of tardive dyskinesia, knowing that this side effect is characterized by which of the following?

<p>Protruding and rolling of the tongue, chewing movements, and involuntary movements of the body and extremities (C)</p> Signup and view all the answers

A patient with schizophrenia is exhibiting catatonic symptoms. Which assessment finding is most characteristic of catatonia?

<p>Waxy Flexibility (B)</p> Signup and view all the answers

Which of the following interventions is the MOST appropriate to use when communicating with a client experiencing auditory hallucinations?

<p>Focus on reality based topics. (B)</p> Signup and view all the answers

Which of the following is NOT typically included in patient and family teaching regarding antipsychotic medications?

<p>How to adjust medication doses based upon symptoms (C)</p> Signup and view all the answers

A client is taking clozapine 300mg PO TID. Which of the following assessment findings would be of MOST concern to the nurse?

<p>A temperature of 101.5 degrees fahrenheit (D)</p> Signup and view all the answers

One principle of milieu therapy is that manipulation by clients must be addressed in which of the following ways?

<p>By setting limits and being consistent in enforcing the consequences. (B)</p> Signup and view all the answers

Of the following, what is the most common reason that clients with schizophrenia do not adhere to their medication regiment?

<p>Unpleasant side effects (D)</p> Signup and view all the answers

Which of the following defense mechanisms does a patient use when claiming that they are the president - despite not being the president?

<p>Denial (B)</p> Signup and view all the answers

Which of the following is not an action that a nurse would implement for a patient who is experiencing command hallucinations?

<p>Document what the patient is saying to the voices (D)</p> Signup and view all the answers

Which of the following statements would indicate that the patient has a good understanding of relapse prevention?

<p>&quot;It is important that I call my doctor if I start hearing voices again or feel anxious&quot; (D)</p> Signup and view all the answers

Flashcards

Schizophrenia Definition

Derived from Greek words meaning "split mind," first identified by Dr. Bleuler in 1911.

Schizophrenia Epidemiology

Typically occurs between 15-25 years old, Affects 1% of the population, More common in men than women, High rates of unemployment, homelessness, incarceration, and suicide, Leading cause of disability among 15-44-year-olds.

Delusions

False beliefs (paranoia, grandiosity, somatic)

Hallucinations

Sensory experiences without external stimuli (auditory, visual, tactile, gustatory, olfactory).

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Disorganized Thinking

Associative looseness, neologisms (made-up words), clang associations (rhyming words), word salad (random words without meaning).

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Abnormal Motor Behavior

Catatonia, bizarre posturing, waxy flexibility.

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Affective Flattening

Reduced emotional expression.

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Avolition

Lack of motivation.

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Anhedonia

Inability to experience pleasure.

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Alogia

Reduced speech output.

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Social Withdrawal

Poor social functioning.

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Premorbid Schizophrenia Phase

Social withdrawal, poor relationships.

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Prodromal Schizophrenia Phase

Gradual onset of symptoms over months to years.

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Active Schizophrenia Phase

Psychotic symptoms dominate.

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Residual Schizophrenia Phase

Symptoms lessen but may persist.

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Nursing: Hallucinations

Acknowledge, but do not reinforce hallucinations; Provide reality-based responses; Minimize stimuli; Encourage distraction techniques.

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Nursing: Delusions

Do not challenge beliefs; Reinforce reality; Establish trust and consistency.

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Nursing: Communication

Use simple, direct language; Provide structure and routine.

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Nursing: Safety First

Suicide precautions if necessary; Monitor for self-harm or aggression; Ensure medication adherence.

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Typical Antipsychotics Mechanism

Blocks dopamine receptors (D2).

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Typical Antipsychotics Side Effects

Extrapyramidal Symptoms (EPS), Tardive Dyskinesia, Neuroleptic Malignant Syndrome (NMS).

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Atypical Antipsychotics Mechanism

Blocks dopamine and serotonin receptors.

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Atypical Antipsychotics Side Effects

Weight gain & metabolic syndrome, Hyperglycemia, Less risk of EPS.

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Nursing: Medications

Monitor vital signs (BP, HR); Assess for EPS (akathisia, dystonia, tardive dyskinesia); Monitor CBC & WBC (especially with Clozapine); Educate on medication adherence and potential side effects.

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WBC Count significance

monitor for agranulocytosis (Clozapine)

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Glucose (Fasting) significance

Hyperglycemia risk with atypicals

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Lipid Panel significance

Monitor for metabolic syndrome

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Liver Function significance

Monitor for hepatotoxicity

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Electrolytes significance

Monitor for imbalances

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Extrapyramidal Symptoms

EPS (Extrapyramidal Symptoms): Tremors, rigidity, akathisia, dystonia

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Neuroleptic Malignant Syndrome

Neuroleptic Malignant Syndrome (NMS): Fever, rigidity, altered mental status

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Psychosocial Interventions

Cognitive Behavioral Therapy (CBT)

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Study Notes

  • Schizophrenia comes from Greek words that mean "split mind"
  • Dr. Bleuler first identified Schizophrenia in 1911

Epidemiology & Characteristics

  • Schizophrenia diagnoses typically occur between ages 15 and 25
  • Schizophrenia affects 1% of the population
  • Schizophrenia is more common in men than women
  • Schizophrenia is correlated with high rates of unemployment, homelessness, incarceration, and suicide
  • Schizophrenia is a leading cause of disability among 15-44 year olds

Signs and Symptoms

  • Positive Symptoms are excesses or distortions of normal functions
  • Delusions are false beliefs (paranoia, grandiosity, somatic)
  • Hallucinations are sensory experiences without external stimuli (auditory, visual, tactile, gustatory, olfactory)

Disorganized Thinking examples

  • Associative Looseness
  • Neologisms (made-up words)
  • Clang Associations (rhyming words)
  • Word Salad (random words without meaning)

Disorganized/Abnormal Motor Behavior examples

  • Catatonia
  • Bizarre posturing
  • Waxy flexibility

Negative Symptoms

  • Negative Symptoms are the loss of normal function
  • Affective Flattening is reduced emotional expression
  • Avolition is lack of motivation
  • Anhedonia is the inability to experience pleasure
  • Alogia is reduced speech output
  • Social Withdrawal is poor social functioning

Phases of Schizophrenia

  • Premorbid Phase includes social withdrawal and poor relationships
  • Prodromal Phase includes a gradual onset of symptoms over months or years
  • Active Phase means psychotic symptoms dominate
  • Residual Phase is when symptoms lessen but may persist

Nursing Interventions for Hallucinations

  • Acknowledge hallucinations, but do not reinforce them
  • Provide reality-based responses
  • Minimize stimuli
  • Encourage distraction techniques

Nursing interventions for Delusions

  • Do not challenge beliefs
  • Reinforce reality
  • Establish trust and consistency

Nursing interventions for Communication

  • Use simple, direct language
  • Provide structure and routine

Nursing interventions for Safety Considerations

  • Suicide precautions if necessary
  • Monitor for self-harm or aggression
  • Ensure medication adherence

Antipsychotic Medications

  • Typical (First-Generation) antipsychotics block dopamine receptors (D2)
  • Examples of Typical Antipsychotics: Haloperidol (Haldol), Chlorpromazine (Thorazine), and Fluphenazine (Prolixin)
  • Side Effects of Typical Antipsychotics: Extrapyramidal Symptoms (EPS), Tardive Dyskinesia, and Neuroleptic Malignant Syndrome (NMS)

Atypical (Second-Generation) Antipsychotics

  • Atypical (Second-Generation) antipsychotics block dopamine and serotonin receptors
  • Examples of Atypical Antipsychotics: Clozapine (Clozaril), Risperidone (Risperdal), Olanzapine (Zyprexa), and Aripiprazole (Abilify)
  • Clozapine (Clozaril) requires WBC monitoring for agranulocytosis

Side effects of Atypical Antipsychotics

  • Weight gain and metabolic syndrome
  • Hyperglycemia
  • Less risk of EPS

Nursing Considerations for Medications

  • Monitor vital signs (BP, HR)
  • Assess for EPS (akathisia, dystonia, tardive dyskinesia)
  • Monitor CBC & WBC (especially with Clozapine)
  • Educate on medication adherence and potential side effects

Lab Values to Monitor

  • WBC Count normal range: 4,500 - 11,000/mm³, monitor for agranulocytosis (Clozapine)
  • Glucose (Fasting) normal range: 70 - 100 mg/dL, watch for Hyperglycemia risk with atypicals
  • Lipid Panel normal range: LDL < 100, HDL > 40, Triglycerides < 150, monitor for metabolic syndrome
  • Liver Function normal range: AST (10-40 U/L), ALT (7-56 U/L), monitor for hepatotoxicity
  • Electrolytes normal range: Na+ (135-145), K+ (3.5-5.0), monitor for imbalances

Side Effects & Management

  • EPS (Extrapyramidal Symptoms) include tremors, rigidity, akathisia, dystonia managed with Benztropine (Cogentin) or Diphenhydramine (Benadryl)
  • Tardive Dyskinesia includes involuntary movements and lip smacking managed by discontinuing offending drug, switching to atypical antipsychotic
  • Neuroleptic Malignant Syndrome (NMS) includes fever, rigidity, altered mental status managed by stopping the medication, administer Dantrolene & Bromocriptine
  • Metabolic Syndrome includes weight gain, diabetes, dyslipidemia managed by diet, exercise, blood glucose levels

Psychosocial Interventions

  • Cognitive Behavioral Therapy (CBT)
  • Social Skills Training
  • Family Education & Therapy
  • Assertive Community Treatment (PACT)
  • Milieu Therapy (Therapeutic Environment)

Patient & Family Education

  • Importance of medication adherence
  • Recognizing early signs of relapse
  • Managing stress & coping skills
  • Avoiding substance abuse which can trigger psychotic episodes

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