What are some risk factors for developing schizophrenia
ID twins with one having it the other has 50% chance
children born from father 60 yrs or older have higher risk
What are the pathophys hypothesis for schizo
dopamine hypo
What is the dopamine pathway
too much dopamine in the mesolimbic, mesocortical, tubero-hypophyseal or nigrostriatal pathway
What is an abnormal anatomy finding of schizo pats
larger brain ventricles than normal
What are some physiological/physical factors could contribute to schizophrenia
epilepsy huntingtons dis birth trauma head injury in adulthood alc abuse cerebral tumor or accident
What are some of the psychosocial factors that could contribute to schizophrenia
poor brain dev from poor nutrition of pregnant mothers
prenatal viral infection
Toxoplasmosis Gondii exposure to prego
What is schizoprenia
a syndrome that causes abnormal thinking with possible positive, negative or cognitive symptoms
What are examples of positive symptoms and what is positive symptom def
positive symptoms dont have a physiological counterpart like a heart beat to tachycardia ex: delusions hallucinations disorganized speech disorganized behavior catatonic behavior
What are delusions and give example
false beliefs that the person feels very strongly about and are inconsistent with their culture like thinking someone is controlling them, trying to harm them or talking to them when they clearly arent like seeing only their first name in the newpaper
What are hallucinations and give example
any sensation that isnt there
like hearing voices
What is catatonic behavior
abnormal movements, posture or responsiveness to stimuli
like refusing to move, or being in a stupor, negativism
What are negative symptoms
the loss or reduction of a normal process like a decrease in the ability to convey emotions or a loss of interest in things that they would normally find interesting
What are 6 negative symptoms and give examples
avolition- decrease motivaiton to accomplish goals
Affect or Flat affect- inappropriate reaction to something like being calm when you see an aligator in the house
Alogia- lack in content in their speech like responding with just a “yes” to a question that would normal start a full conversation
attention - poor
anhedonia - absense of pleasure
Apathy- emotionless
What are cognitive symptoms
difficulty with cognitive funcitons like learning, memory, and understanding
What is required to diagnose schizophrenia
must have two of the following and one of them must be one of the first three, must have these symptoms for at least 6mo, and other health probs cant be the cause hallucinations delusions disorganized speech disorganized behavior catatonic behavior negative symptoms
What are the phases of schizophrenia
premorbid
prodromal
schizophrenic (active) episode
residual
What types of symptoms are seen in premorbid phase
antisocial behavior like
shyness
withdrawn
poor relationships
What symptoms are seen in predromal phase
isolation
anx
poor acedemic performance
what symps are seen in the residual phases
negative symptoms of the active phase or signs of premorbid/predromal
rarely psychosis
What are some factors that are assoc. with good prognosis with schizo
caught during the premorbid onset later in life female gender caused by abrupt stress rather than disease short active phase/min residual symps not structural abnormalities
What are some conditions/delusions that are used to describe a pats thought content of positive symps
delusions like
persecution
ideas of reference- believes things that are referring to them when they aren’t
grandeur thoughts
somantic delusions like believing they have a third leg
paranoia
magical thinking
being controlled
thought broadcasting- think others can hear their thoughts
religiosity- obsessed w/ religion
thought insertion- thinking their thoughts have been extracted forcefully
What are some thought processes of positive symps and give ex
associative looseness- shifting from unrelated topics
neologism- making up words that only mean something to them
concrete thinking- literal interpretations like asking them to write a sentence on the paper and they write “a sentence” on it
clang association- chooses based on sound and rhyme
mutism- inability or refusal to talk
echolalia - repeating words that was
echopraxia - copying movements
What are some conditions to describe the appearance/mood/affect of a schizo pat
inappropriate affect- incongruent with the circumstances
bland affect- weak emotional tone
flat affect- void of emotions
apathy- disinterested
What are some psychomotor behavior descriptors
anergia- energy deficiency
waxy flexibility- resistant to all movements
posturing- voluntary inappropriate or bizzare postures
pacing and rocking- like it soulnd s
What are some things that are related to self violence and schizo pats
extreme supiciousness panic anx catatonic excitement rage rx's command hallucinations
What might the diagnosis of impaired verbal comm be related to
panic anx
withdrawal
disordered unrealistic thinking
What might the diagnosis of self care deficit be related to
withdrawal
regression
panic anx
inability to trust
What screening tool is used in DSM 4
global assessment function (GAF)
What screening tool is used in DSM 5
WHODAS
What scale is used on pats taking first gen antipsychs and what does it test for
abnormal involuntary movement scale
for tardive dyskinesia
What are the steps of the AIM scale
- ask pat if they have anything in mouth and remove if they do
- ask pat about the condition of their teeth, and if dentures or something is bothering them now
- ask pat if they have any movement of face, mouth, hands, or feet- have them describe them if so and how much it bothers them
- Have pat sit with hands on knee’s, legs slightly apart and feet flat on ground then observe the entire body for any invol movements
- Ask pat to sit with hands hanging between legs, observe for invol moves
- ask pat to open mouth and observe tongue for invol movements, repeat twice
- ask pat to protrude tongue, mon for invol tongue moves, repeat twice
- ask pat to tap thumb to other fingers as rapidily as poss for 10-15 secs, first right hand then left, observe invol movements in face and legs
- flex and extend arms one at a time
- have pat stand, observe entire bod for invol moves
- ask pat to extend both arms in front of them palm down, observe trunk, legs, and mouth
- have pat walk a few paces turn and walk back to chair, observe hands and gait, repeat twice
is there any symptom that is unique to schizo
no
Care for schizo pats
ask directly about hallucinations
if they have command halluc’s, provide safety for dangerous commands
assess for paranoid delusions
focus conversations on reality based subjects
ID triggers like loud noises
assess abilities to do ADL and teach them if struggling
encourage med compliance
What type of route for med admin is helping with compliance
injection
What is a common addiction that schizo pats have and why
smoking bec the nicotine increases acetylcholine which helps they relax and counteract the effects of antipsych’s
What are some discharge teaching for schizo’s
teach about disease they have
teach to see doctor ev 3mo bec meds can cause probs like diabetes
get organizer for pills
need to support groups and refrain from using abusive substances
log feelings and changes in behavior
What are some guidelines for responding to a pats delusions
don’t argue against or agree to them
focus on pats feelings
try to offer a reasonable explanation like ‘I can’t imagine that the president of US would have a reason to kill a citizen, but it must be frightening for you to believe that.”
What was the first med to treat schizo
chlorpromazine
When is a schizo pat more likely to commit suicide
residual phase after the hallucinations go away
How often does a mental health asssessment need to be done in psych nursing
ev 8 hours
What is the difference between mood and affect
mood is what you ask them and what they respond with, scaling them is a good idea
affect is the outward expression of their emotional state