Psych Exam 2 Schizophrenia

A psychosis characterized by abnormalities in perception, context of thought, & thought processes, & extensive withdrawl of one's interest from people & the outside world

• A sx
• A state in which the individual is experiencing hallucinations delusions or disorganized thoughts, speech or behavior

• A mental illness which interferes with a person's ability to:
• Think clearly
• Manage emotions
• Make decisions
• Relate to others

• Lower socioeconomic groups
• Homeless
• Majority 16-25
• Women have later onset than men

• Things that are there but should not be there
• Hallucinations
• Delusions

Perceptual experiences that occur without actual external sensory stimuli. They can include all 5 senses.

• Erroneous fixed beliefs that cannot be changed by reasonable argument
• Grandiose
• Nihilistic
• Persecutory
• Somatic
• Religious
• Referential

Belief that one has exceptional powers, wealth, skills, influence, destiny

Belief that one is dead or a disaster is impending

Belief that one is being watched, plotted against, ridiculed...

• Belief about abnormalities in body fxn or structure
• ex. may have intense fear they are ugly

Has a godly mission, or relationship with God

Tv or radio is talking to them

• Think people can read their minds
• Think people are putting thoughts into their head

• Affective flattening or blunting
• Ambivalence
• Alogia
• Avolition
• Anhedonia

Presence of two opposing forces, leading to inaction (don't do anything), (inability to concentrate)

Brief and lack of content verbal responses (poverty of speech)

Inability to complete projects, assignments, or work

Inability to gain pleasure

Repetition of another's words

Extremely detailed & lengthy talk about a topic

Absence of normal connectedness of thoughts, ideas, & topics

Change in topic that is logical but detours from original topic

Topic of conversation changes repeatedly & rapidly

String of words totally unconnected

Made up words

Suspiciousness that is unrealistic

Belief that neutral stimuli have special meaning

Restricts thinking to the literal & immediate makes no sense to anyone else

Lack of abstract thinking

Purposeless repetition of words/phrases

Use of words interchangeably with similar meanings

• Repetition of words that are similar in sound but in no other way
• ex. I am going to cry, lie, die

Overly & artificial formal language

As if words are being forced out

Behaviors or attitudes that reflect rage

Inability to sit still or attend to others

• Hyperactivity characterized by purposeless activity & abnormal movements
• ex. excessively writing name, or pacing movements

Involuntary imitation of another's movements & gestures

Childlike/immature

Repetitive purposeless movements that are idiosyncratic to the person

• Sustained attention to external stimuli
• ex. fixed and waiting to something to happen (waiting for FBI to come out of woods)

Posture held in fixed position (if you moved their arm up, they would still be "frozen")

• Acute Illness Period
• Stabilization Period
• Maintenance & Recovery Period
• Relapse Period

• Confusing and frightening behaviors
• Subtle progressing to disruptive & bizarre
• Pt is progressively unable to meet basic needs, work and everything deteriorates
• Substance use common
• Generally not violent, unless substance use or not taking meds
• Dependence on family/friends increases
• Cognitive deficits
• High risk for suicide

• Occurs after Dx and initial Tx
• Sx become less acute, but still present (give coping skills)
• Intense med Tx
• Treatable not curable
• Pt and family adjust to life-long/chronic dx reality

• After stablized
• Focus on regaining previous level of fxn
• Meds improve, not cure
• Adherence with meds is vital
• Stress can exacerbate
• *Family support
• *Educate pt and family (NAMI)

• Occurs during Tx and Recovery
• Detremintal to mgt
• Each relapse- longer time to recovery
• Meds + therapy = less relapses

• Medication
• Structured Activities/ Therapy
• Family Support

• Thorazine
• Prolixin
• Mellaril
• Haldol
• Navane
• Stelazine

• Anticholinergic
• Sedation
• EPS
• Hypotension
• Seizure
• Agranulocytosis
• NMS
• TD

• Clozaril
• Zyprexa
• Seroquel
• Respiradol
• Geodone (helps depression too)

• Weight Gain*
• Changes in metabolism including DM and hyperprolacteremia

• Biological: genetic (1 degree relatives), biochemical, physiological
• Psychological
• Environmental: stress (triggers gene)
• Dopamine
• **Still Don't Know

• 2 or more of the following during 1 mo, persisting for at least 6 mo:
• delusions
• hallucinations
• disorganized speech
• disorganised or catatonic behavior
• negative sx
• Plus 1 or more major areas of social or occupational functioning below previous level
• And absence of major depression, manic, or mixed episodes with concurrent active sx

• Any type of delusion
• Least functional impairment
• High suicide risk

• Bizarre posture
• In illnesses other than Schizo
• ECT effective
• Need ROM, IVs, Shock Tx

• Inappropriate affect
• Most impaired

• Doesn't fit DSM IV
• Not sure what to call

• Schizo and mood d/o
• Diagnosis: Uninterrupted period manic or mixed major depression with 2 Schizo sx
• Long term better than schizo, but worse than MDD

• Content of thought
• Form of thought
• Perceptions
• Affect
• Sense of self
• Social Fxn
• Hygiene
• Psychomotor

• Family (genetic dx)
• Past
• Current Physical Health
• Level of anxiety
• SI/HI
• Labs (Lithium)
• Meds

• Risk for Safety (#1)
• Disturbed Thought or Sensory
• Social Isolation
• Impaired Verbal
• Self-Care Deficit

• Demonstrates an ability to relate satisfactorily
• Recognizes distorted thinking
• No harm to self or others

• Initiate safety measure for suicide/ aggression
• Intervening with delusions, hallucinations, paranoia
• Reality testing
• Improving social isolation

• Do not feed into delusions
• Safe environment
• Dec stimulation
• Simple statements
• Recognize their reality
• Use distraction

• Rare but Fatal
• Severe muscle rigidity, elevated temp (up to 107)
• Sx: elevated temp, change in LOC, leukocytosis, elevated creatine, elevated liver enzymes

• Stop administration of offending med
• Monitor VS
• Reduce body temp
• Safety, protect muscle
• Supportive measures
• IV fluids
• Cardiac monitoring
• Admin Dopamine agonist

• Potentially life-threatening
• Occurs in pt w/ several meds w/ anticholinergic effects
• Sx: elevated temp, dry mouth, dec salivation, dec bronchial, nasal secretion, widely dilated eyes
• Confusion, hallucinations
• Self-limiting (3 days)

• D/c med
• Physiostigmine 1-2mg IV
• Gastic lavage
• Charcoal, catharsis

• Pseudoparkinsonism: muscle rigidity & absence of movement
• Dystonia: muscles tense and body contorts
• Oculogyric crisis: eye muscles tighten and eyes roll back
• Akathisia: restless, need to keep moving
• Akinesia: absence or loss of voluntary movement

• Benzotropine (Cogentin)
• Trihexphenidyl (Artane)

• Major risk for pts on long-term neuroleptic meds
• Bizarre movements: lip smacking, tongue movements, difficulty swallowing, pill rolling, & gestures
• Tx: D/C meds at onset tongue movements
• May be irreversible

• Dec ability to fight off infection
• Esp. w/ Clozaril
• Monitor WBC weekly first 6 mo
• Reversible if tx early

• Results in: DM/ Hyperglycemia
• Monitor wt and girth
• Initial Glucose tolerance test
• Monitor blood glucose
• Provide nutrition & activity support

• What to expect as illness progresses
• Sx associated w/ illness
• Ways for family to respond to behaviors associated w/ illness
• Outside support

• Connect exacerbation of sx to stress
• Med mgt (guardian)
• Social skills training
• Daily living skills training

• Financial assistance
• Legal assistance (guardian)
• Caregiver support group
• Respite care
• Home Health

Length 1 day, less than 1 mo

Pt has schizo for less than 6 mo

• Psychotic d/o (nonbizarre, stable)
• Delusions w/o mental d/o

• Delusions could be real life (followed, poisoned)
• Somatic delusions- bring to hospital

• Psychosis transmitted to another person (in close proximity)
• When tx psychotic person, other pt resolved

• Not split personality
• Not caused by dysfxn families
• Not caused by poverty (but leads to)
• Not more violent
• IS HOPE