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PCC mental health
Chapter 15 - Schizophrenia
26
Nursing
Undergraduate 4
10/27/2012

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Term
Eugen Bleuler’s 4 A’s of Schizophrenia
Definition
Affect, Associative looseness, Autism, Ambivalence
Term
Epidemiology
Definition
Lifetime prevalence of schizophrenia 1% worldwide
No difference related to
Race
Social status
Culture
Term
Comorbidity
Definition
Substance abuse disorders
- Nicotine dependence
Anxiety, depression, and suicide
Physical health or illness
Polydipsia
Term
Etiology
Definition
Biological factors: Genetics
Neurobiological
- Dopamine theory
- Other neurochemical hypotheses
Brain structure abnormalities
Psychological and environmental factors
-Prenatal stressors
-Psychological stressors
-Environmental stressors
Term
Phases of Schizophrenia
Definition
Phase I – Acute
- Onset or exacerbation of symptoms
Phase II – Stabilization
- Symptoms diminishing
- Movement towards previous level of functioning
Phase III – Maintenance
- At or near baseline functioning
Term
Assessment
Definition
During the prepsychotic phase
General assessment
- Positive symptoms
-> Bizarre behavior (p. 312, 313)
- Negative symptoms (something that should be present in pt’s life but is not)
-> Poor thought process, anhedonia (not able to find pleasure)
- Cognitive symptoms (r/t ability to think)
-> Judgment, disorganized
- Affective symptoms
-> Emotions or expressions
Term
Positive Symptoms
Definition
Alterations in thinking
- Delusions are false, fixed beliefs.
- Concrete thinking(Black & White) is an inability to think abstractly.
- Thinking, speech, perception, or behavior

Alterations in speech
- Neologisms (신조어)
- Echolalia (반향언어; 남의 말을 그대로 흉내)
- Echopraxia (반향동작)
- Clang associations (음향연상; cling ring)
- Word salad (단어들이 일관성없이 튀어나옴)

Alterations in perception
- Depersonalization (비인격화)
- Derealization (현실감 상실)
- Hallucinations
-> Auditory hallucinations
-> Command hallucinations
-> Visual hallucinations
- Boundary impairment

Alterations in behavior
- Catatonia
- Motor retardation
- Motor agitation
- Stereotyped behaviors
- Automatic obedience
- Waxy flexibility
- Negativism
- Impaired impulse control
Term
Negative Symptoms
Definition
Affect
- Flat
- Blunted
- Inappropriate
- Bizarre
Term
Cognitive Symptoms
Definition
Difficulty with
- Attention
- Memory
- Information processing
- Cognitive flexibility
- Executive functions
Term
Affective Symptoms
Definition
Assessment for depression crucial
- May herald impending relapse
- Increases substance abuse
- Increases suicide risk
- Further impairs functioning
Term
Assessment Guidelines
Definition
1. Any medical problems
2. Abuse of or dependence on alcohol or drugs
3. Risk to self or others
4. Command hallucinations
5. Belief system
6. Suicide risk
7. Ability to ensure self-safety
8. Co-occurring disorders
9. Medications
10. Presence and severity of positive and negative symptoms
11. Patient’s insight into illness
12. Family’s knowledge of patient’s illness and symptoms
Term
Outcomes Identification
Definition
Phase I - Acute
- Patient safety and medical stabilization
Phase II - Stabilization
- Adhere to treatment
- Stabilize medications
- Control or cope with symptoms
Phase III - Maintenance
- Maintain achievement
- Prevent relapse
- Achieve independence, satisfactory quality of life
Term
Planning
Definition
Phase I – Acute
- Best strategies to ensure patient safety and provide symptom stabilization
Phase II – Stabilization
Phase III – Maintenance
- Provide patient and family education
Relapse prevention skills are vital
Term
Implementation
Definition
Phase 1 – Acute Settings
- Partial hospitalization
- Residential crisis centers
- Halfway houses
- Day treatment programs
Term
Intervention
Definition
Acute Phase
- Psychiatric, medical, and neurological evaluation
- Psychopharmacological treatment
- Support, psychoeducation, and guidance
- Supervision and limit setting in the milieu

Stabilization and Maintenance Phase
- Milieu management
- Activities and groups
- Safety
- Counseling and communication techniques
- Hallucinations
- Delusions
- Associative looseness
- Health teaching and health promotion
Term
Pharmacological Interventions
Definition
Antipsychotic medications
- Conventional (typical) antipsychotics
-> Typical or first-generation
-> Altered to atypical due to High SE in newborns
- Atypical antipsychotics
-> Second-generation
-> Agranulocytosis (WBC becomes reduced)
Term
Atypical Antipsychotics
Definition
- Treat both positive and negative symptoms
- Minimal to no extrapyramidal side effects (EPSs) or tardive dyskinesia
- Disadvantage – tendency to cause significant weight gain
- Examples
Clozapine (Clozaril) – use declining
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Aripiprazole (Abilify)
Term
Conventional Antipsychotics
Definition
Dopamine antagonists (D2 receptor antagonists)
Target positive symptoms of schizophrenia
Advantage
- Less expensive than atypical antipsychotics
Disadvantages
- Do not treat negative symptoms
- Extrapyramidal side effects (EPSs)
- Tardive dyskinesia
- Anticholinergic side effects
- Lower seizure threshold
Term
Extrapyramidal Side Effects
Definition
Acute dystonia
- Tightened neck muscle (not very common)
Akathisia(안절부절 못함)
Pseudoparkinsonism
Tardive dyskinesia – Abnormal Involuntary Movement Scale (AIMS)
Term
Potentially Dangerous Responses to Antipsychotics
Definition
Neuroleptic malignant syndrome (NMS)
- Fever, lvl of consciousness is affected
- Emergency; needs to get help soon
Agranulocytosis
Term
Adjuncts to Antipsychotic Drug Therapy
Definition
Antidepressants
Antimanic agents
Term
Specific Interventions for Catatonia
Definition
Catatonia – Withdrawn Phase
- Communication guidelines
- Self-care needs
- Milieu needs
Catatonia – Excited Phase
- Communication guidelines
- Self-care needs
Term
Specific Interventions for Disorganized Schizophrenia
Definition
Communication guidelines
Self-care needs
Milieu needs
Term
Undifferentiated Schizophrenia
Definition
Active signs of disorder
- Positive symptoms
- Negative symptoms
Individual does not meet criteria for any other subtype
Term
Residual Schizophrenia
Definition
Active-phase symptoms no longer present
Evidence of two or more residual symptoms persists
- Reduced initiative, interests, or energy
- Social withdrawal
- Impaired role function
- Speech deficits
- Odd beliefs
Term
Advanced Practice Interventions
Definition
Psychotherapy
Cognitive-behavioral therapy (CBT)
Group therapy
Medication
Social skills training
Cognitive remediation
Family therapy
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