1. define psychosis
    break from reality, alteration in perceotion, includes delusions, hallucinations, disorganized speech or behavior
  2. gender differences of schizophrenia
    • affected equally but onset differs
    • men between 18-25 are more affected by negative symptoms
    • women between 25 and 45 have better social functioning before the diagnosis
  3. genetic theory of schizophrenia etiology
    • a predisposition for schizophrenia is inherited and something triggers it
    • you are 10 times more likely to be diagnosed with schizophrenia if a first degree relative also has it
    • estimate that maybe 80% of cases have this predisposition
  4. brain anatomy etiology of schizophrenia
    • 4 consistant changes that occur in the brains of patients with schizophrenia
    • done using post mortem studies
  5. dopamine hypothesis of schizophrenia etiology
    • most relied on theory
    • positive symptoms are caused by dopamine hyperactivity in the mesolimbic tract
    • associated with excessive dopamine transmission- most meds are dopamine blockers and they are able to reduce the positive symptoms
  6. social theory of schizophrenia etiology
    • one theory is the expressed emotion theory
    • schizophrenia is more prevalent where the family environment is more hostile, highly critical, higher expressed emotions, overinvolved families
  7. comorbidity with schizophrenia
    • increased risk of medical problems- as high as 80%
    • they dont receive adequate medical care- many medical problems go undiagnosed
    • depression and suicide- voices telling them to commit suicide, shame of having the disease
    • substance abuse: 40% of patients have substance issues- may self medicate
    • cigarette smoking- pts may smoke more b/c it is thought to reduce effectiveness of meds, also reduces anxiety
  8. diagnostic criteria for schizophrenia
    5 symptoms that must be present
    • must have 2 of the 5 for at least 6 months for diagnosis
    • delusions
    • hallucinations
    • disorganized speech
    • grossly disorganized or catatonic behavior
    • negative symptoms
  9. positive symptoms
    hallucinations: auditory, visual, tactile, olfactory, gustatory
  10. persecutory delusions
    others intend to hard of persecute the patient
  11. ideas of reference
    events within environment pertain to an individual- the patient thinks the tv or radio is talking directly to them
  12. grandiose delusions
    • exaggerated feeling of importance, power, knowledge or identity
    • thinking they can do anything, they have great ideas that no one else can understand
  13. nihilistic delusions
    • patient thinks self, part of self, others or world doesn't exist
    • " i'll never die" "i have no head"
  14. somatic delusions
    false idea about body function
  15. religious delusions
    excessive demonstration of or obsession with religious ideas/behavior
  16. substitution delusions
    belief that an individual is someone else
  17. thought disorder: loose associations
    ideas shift from one unrelated topic to another
  18. thought disorder: word salad
    • group or random unconnected words that the patient puts together in a sentence
    • " purple tree table rainbow"
  19. thought disorder: clang associations
    choosing words based on the sounds, rhyming
  20. thought disorder: echolalia
    repeating words or phrases said by another person
  21. thought disorder: perseveration
    repetition of same word or idea in response to different questions
  22. catatonic excitement
    extreme motor agitation- unusual movements
  23. waxy flexibility
    • maintains rigid position, moveable
    • if you move patient they will stay in that position, wont move on their own, even in painful positions
  24. catatonic posturing
    • voluntary assumption of bizarre position
    • will stay like that for a very long time but no reason for why they are in that position
  25. catatonic stupor
    seemingly unaware of surroundings- lack of movements all together but not paralysis
  26. echopraxia
    pathological imitation of body movements of another person
  27. negative symptoms: affective blunting
    reduced range of emotional expression
  28. anhedonia
    inability to experience pleasure
  29. avolition
    • inability to pursue and persist in goal-directed behavior or activities
    • lack of desire, drive or motivation
  30. alogia
    • reduced fluency and production of language and thought
    • poverty of speech
  31. apathy
    feelings of indifference
  32. acute phase of schizophrenia
    • florid positive symptoms, suicidality, violence, can be very frightening
    • this is when hospitalizations occur, the pts are no longer able to care for themselves
    • pt may not remember psychotic periods after they happen
  33. stabilization phase of schizophrenia
    • symptoms are still present but less evident
    • this is when medication adjustment would occur
  34. maintenance phase of schizophrenia
    • acute symptoms have decreased, may even remit completely
    • family is involved at this point, figuring out how to prevent relapse
    • medication non-compliance is largest cause of relapse
  35. paranoid schizophrenia
    • prominent delusions and/or hallucinations
    • most common, best known subtype
    • hallucinations may not be paranoid
    • delusions and hallucinations may be linked but they dont have to be
  36. disorganized schizophrenia
    • disorganized speech or behavior, flat or inappropriate affect
    • characterized by a regression to disinhibited behavior, have trouble functioning in daily like, trouble dressing, cleaning themselves, show little to no reaction to major life events- they care but they just cant show it
  37. catatonic schizophrenia
    • characterized by extreme psychomotor disruption
    • less common in U.S
  38. undifferentiated schizophrenia
    • cant clearly state that they meet criteria for the first 3 types
    • used when someone has mostly negative symptoms, more relapses or episodes
  39. residual schizophrenia
    • one documented episode, but no prominent positive symptoms
    • can go years without episodes occurring
  40. Schizophreniform Disorder
    • meet criteria A,D and E for schizophrenia
    • A. at least 2 positive and 2 negative symptoms,
    • D. schizoaffective and mood disorders have been ruled out
    • E. substance/ general medical condition has been excluded
    • - at least 1 month, less than 6
    • - usually no impairment in social/ occupational functioning
  41. Schizoaffective disorder
    • uninterrupted period of illness during which there is major depressive, manic, or mixed episode concurrent with 2 criterion A symptoms for schizophrenia (symptoms of schizo and mood disorder at same time)
    • - at risk for suicide (23-40% of pts attempt)
    • - less common than schizophrenia
    • - more common in women
  42. Delusional Disorder
    • stable, well systemized, logical, non-bizarre delusions ( could conceivably occur) that occur in the absence of other psychiatric disorders for at least 1 month
    • - function well in other areas of life not related to delusion
    • - 6 types- erotomanic, jealous, unspecified, grandiose, somatic, persecutory
    • goal is just symptom management, dont respond well to treatment
  43. erotomanic delusional disorder
    • believe someone is in love with them
    • can lead to stalking
  44. jealous delusional disorder
    may think their partner is cheating on them for no reason
  45. Brief Psychotic Disorder
    • one or more criterion A symptoms of schizophrenia present for at least one day but less then 1 month
    • - return to prior level of functioning
    • - may be due to stressful event
    • - rare
  46. shared psychotic disorder
    • folie a deux
    • - two people in a close relationship, second person begins to take on delusion of the one with the original delusion
    • - may believe it completely or only partly
  47. serotonin- dopamine antagonists
    • block serotonin and dopamine receptors
    • newer, atypical are more efficacious and safer- less EPS
    • more effective for negative symptoms, can also use for bipolar
    • - risperidal
    • - Zyprexa
    • - Seroquel
    • - Geodon
    • - Abilify
    • - invega
    • - clozaril
  48. Clozaril precautions
    • second line med- requires patient to have weekly CBC with differential when they start for first 6 months
    • due to high risk of agranulocytosis
    • need to get WBC and complete neutrophil counts
    • can move to q4week monitoring after a year of good blood tests
  49. Dopamine receptor antagonists
    • older, first line, typical drugs- need 60-80% receptor blockade for efficacy
    • EPS occur at 80% receptor blockade
    • thorazine
    • haldol
    • prolixin
    • trilafon
    • moban
    • mellaril
    • Stelazine
    • Navane
  50. anticonvulsants
    • Depakote: thought to reduce episodes of violence
    • tegretol
  51. Benzodiazepines
    • Ativan
    • Klonopin
    • use with caution for patients with substance abuse, can cause dependence and withdrawal issues
  52. non-pharmacologic interventions for schizophrenia
    • ECT: indicated for patients with catatonic schizophrenia or who cant take anti-psychotic meds, not used for maintenance
    • psychosurgery: limited experimental used, infrequently done
  53. parkinsonism
    • type of EPS, due to anti-psychotic medications
    • - uncontrolled hand and finger movements
    • - shuffling walking, lack of arm swinging
  54. Dystonia
    • type of EPS, due to anti-psychotic medications
    • -characterized by sustained muscle contractions that cause twisting and repetitive movements or abnormal postures
  55. akathisia
    • side effect of anti-psychotic meds, EPS
    • - a sensation of restlessness characterized by an inability to sit still or remain motionless
  56. tardive dyskinesia
    • side effect of anti-psychotics, type of EPS
    • - characterized by involuntary, repetitive, purposeless movements
  57. side effects of anti-psychotics
    • sedation
    • weight gain
    • orthostatic hypertension
    • elevated prolactin
    • photosensitivity
    • new-onset diabetes
    • cardiac arrhythmias
  58. nursing assessment for schizophrenia etc
    • mental status
    • changes in role functioning
    • self-care
    • substance abuse
    • past and present health status
    • family health history
    • family issue
    • environmental assessment
  59. nursing diagnoses for schizophrenia etc
    • disturbed thought process
    • disturbed sensory perception
    • risk for violence
    • ineffective coping
    • self-care deficit
    • impaired social interaction
    • ineffective role performance
    • interrupted family processes
Card Set
mid term