Copy of Russell's NUR 361 Test 2 (Schizophrenia section).pdf

NUR 361 Psych Test 2 Review Schizophrenia (17 questions) Predisposing Factors ○ Biological Genetics ○ Biochemical Chemical imbalances ○ Physiological Viral infections Anatomical abnormalities Electrical activity in the brain Physical conditions ○ Psychological Poor parent-child relationships Childho...

NUR 361 Psych Test 2 Review Schizophrenia (17 questions) Predisposing Factors ○ Biological Genetics ○ Biochemical Chemical imbalances ○ Physiological Viral infections Anatomical abnormalities Electrical activity in the brain Physical conditions ○ Psychological Poor parent-child relationships Childhood trauma ○ Environmental Sociocultural factors Stressful life events Cannabis and genetic vulnerability Phases ○ Phase I: The Premorbid Phase- Premorbid signs are those that occur before there is clear evidence of illness and may include distinctive personality traits or behaviors ○ Phase II: The Prodromal Phase- The prodromal phase of schizophrenia begins with a change from premorbid functioning and extends until the onset of frank psychotic symptoms ○ Phase III: Active Psychotic Phase (Acute Schizophrenic Episode)Schizophrenia is a chronic illness that is characterized by acute episodes in which symptoms are more pronounced. During acute episodes, psychotic symptoms are typically prominent. ○ Phase IV: Residual Phase- A residual phase usually follows an active phase of the illness (symptoms described in Phase III). During the residual phase, symptoms of the acute stage are either absent or no longer prominent. Schizophrenia Spectrum and Psychotic Disorders ○ Schizophrenia- Symptoms of delusions, hallucinations, disorganized speech for at least 6 months ○ Delusional Disorder- Characterized by the presence of delusions that have been experienced by the individual for at least 1 month. ○ Brief Psychotic Disorder- Identified by the sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor. These symptoms last at least 1 day but less than 1 month. ○ Substance and Medication Induced Psychotic Disorder- Found to be directly attributable to substance intoxication or withdrawal or after exposure to a medication or toxin. ○ Psychotic Disorder Due To Another Medical Condition- Prominent hallucinations and delusions that can be directly attributed to another medical condition. ○ Catatonic Disorder- Significant motor disturbance that may range from stupor (no motor activity) to excessive motor activity and agitation. Seen in schizophrenia spectrum disorders, MDD, Bipolar Disorder. ○ Schizophreniform Disorder- The essential symptoms are identical to those of schizophrenia, but the duration, including prodromal, active, and residual phases, is at least 1 month but less than 6 months. ○ Schizoaffective Disorder- Manifested by signs and symptoms of schizophrenia, along with a strong element of symptomatology associated with the mood disorders (MDD or Bipolar Disorder). Symptoms ○ Positive symptoms Delusions (Fixed, False Beliefs) Persecutory- belief that one is going to be harmed by other(s) Referential- belief that cues in the environment are specifically referring to them Grandiose- belief that they have exceptional greatness Somatic- beliefs that center on one’s body functioning Bizarre- a delusion that is totally implausible in reality Of reference- Events in the environment are assumed by individuals with delusions of reference to be referring to themselves Of control or influence- Individuals believe that certain objects or persons have control over their behavior Nihilistic- The individual has a false idea that the self, a part of the self, others, or the world is nonexistent Erotomanic- Individuals with erotomanic delusions falsely believe that someone, usually of a higher status, is in love with them Jealous- The content of jealous delusions centers on the idea that the person’s sexual partner is unfaithful Hallucinations (Sensory Perceptions Without External Stimuli) Auditory- false perceptions of sound Visual- false visual perceptions that may consist of formed images, such as of people, or of unformed images, such as flashes of light Tactile- false perceptions of the sense of touch, often of something on or under the skin Olfactory- false perception of taste Gustatory- false perceptions of the sense of smell Disorganized Thinking (Manifested in Speech) Loose associations- characterized by speech in which ideas shift from one unrelated subject to another Neologisms- newly invented words that are meaningless to others but have symbolic meaning to the individual Clang associations- words governed by sounds, often taking the form of rhyming Word salad- a group of words that are put together randomly, without any logical connection Circumstantiality- occurs when the individual delays in reaching the point of a communication because of unnecessary and tedious details Tangentiality- a veering away from the topic of discussion and difficulty maintaining focus and attention Perseveration- occurs when the individual persistently repeats the same word or idea in response to different questions Echolalia- refers to repeating words or phrases spoken by another Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia) Catatonia- ranging from rigid or bizarre posture and decreased responsivity to complete lack of verbal or behavioral response to the environment. Waxy flexibility- describes a condition in which the client with schizophrenia allows body parts to be placed in bizarre or uncomfortable positions. This symptom is associated with catatonia. Posturing- is manifested by the voluntary assumption of inappropriate or bizarre postures. Pacing back and forth and body rocking- a slow, rhythmic, backward-and-forward swaying of the trunk from the hips, usually while sitting. Regression- is the retreat to an earlier level of development. Eye movement abnormalities- may manifest in several ways including difficulty maintaining focus on a stationary object and difficulty with smooth pursuit of a moving object. ○ Negative symptoms Disturbances in affect Inappropriate affect- the individual’s emotional tone is incongruent with the circumstances Blunted affect- the emotional tone is very weak Flat affect- appears to be devoid of emotional tone (or overt expression of feelings) Apathy- an indifference to or uninterest in the environment Avolition- the inability to initiate goal-directed activity Lack of interest or skills in interpersonal interaction Anosognosia- lack awareness of there being any illness or disorder even when symptoms appear obvious to others Anergia- deficiency of energy Anhedonia- inability to experience pleasure Lack of abstract thinking ability- concrete thinking, or literal interpretations of the environment, represents a regression to an earlier level of cognitive development ○ Cognitive symptoms Memory issues Inability to process social cues Impaired sensory perception Nursing Interventions ○ Assessment- assess for hallucinations, delusions ○ Therapeutic communication- acceptance, do not reinforce hallucinations ○ Safety promotion- monitor nutritional intake for catatonic patients ○ Patient and family education- medication adherence Medication Management ○ Typical antipsychotics (1st generation) Drugs: Fluphenazine Haloperidol (Haldol) Treats positive symptoms Increased risk of EPS symptoms- acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome Benztropine is given for EPS symptoms Usually not the first line of treatment ○ Atypical antipsychotics (2nd generation) Drugs: Clozapine (Clozaril) Risperidone (Risperdal)- 1st drug tried Treats positive and negative symptoms Increased risk of metabolic symptoms Usually the first line of treatment (EXCEPT clozapine) Clozapine is used for treatment resistance Needs weekly blood tests Monitor for agranulocytosis and flu-like symptoms ○ Long-Acting Injections (LAI) Used to increase medication compliance Given every 2 weeks to every 3 months depending on medication Medications ending with consta, deconoate, sustenna, maintena, etc. indicate it is a LAI