Schizophrenia

A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse? A. "I get upset once in a while, too." B. "I know just how you feel. I'd feel the same way in your situation." C. "I worry, too, when I think people are talking about me." D. "At times, it's normal not to trust anyone."

Correct Answer: A. "I get upset once in a while, too." Sharing a benign, non-threatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse can't know how the client feels. Identify with the client symptoms he experiences when he or she begins to feel anxious around others. Increased anxiety can intensify agitation, aggressiveness, and suspiciousness. If a client is found to be very paranoid, solitary or one-on-one activities that require concentration are appropriate. The client is free to choose his level of interaction; however, concentration can help minimize distressing paranoid thoughts or voices.

A client tells the nurse that people from Mars are going to invade the earth. Which response by the nurse would be most therapeutic? A. "That must be frightening to you. Can you tell me how you feel about it?" B. "There are no people living on Mars." C. "What do you mean when you say they're going to invade the earth?" D. "I know you believe the earth is going to be invaded, but I don't believe that."

Correct Answer: A. "That must be frightening to you. Can you tell me how you feel about it?" This response addresses the client's underlying fears without feeding the delusion. Attempt to understand the significance of these beliefs to the client at the time of their presentation. Important clues to underlying fears and issues can be found in the client's seemingly illogical fantasies.

A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate? A. "Your behavior won't be tolerated. Go to your room immediately." B. "You're just doing this to get back at me for making you come to therapy." C. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes." D. "I'm disappointed in you. You can't control yourself even for a few minutes."

Correct Answer: A. "Your behavior won't be tolerated. Go to your room immediately." The nurse should set limits on client behavior to ensure a comfortable environment for all clients. The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended. Maintain a consistent approach, employ consistent expectations, and provide a structured environment. Clear and consistent limits and expectations minimize the potential for client's manipulation of staff.

Which statement is correct about a 25-year-old client with newly diagnosed schizophrenia? A. Age of onset is typical for schizophrenia. B. Age of onset is later than usual for schizophrenia. C. Age of onset is earlier than usual for schizophrenia. D. Age of onset follows no predictable pattern in schizophrenia.

Correct Answer: A. Age of onset is typical for schizophrenia. The primary age of onset for schizophrenia is late adolescence through young adulthood (ages 17 to 27). Paranoid schizophrenia may sometimes have a later onset. The incidence is also up to ten times greater in children of African and Caribbean migrants compared to Caucasians according to a study conducted in Britain. All of the other options are incorrect.

Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions? A. Antipsychotic-induced akathisia and anxiety. B. The manic phase of bipolar illness as a mood stabilizer. C. Delusions for clients suffering from schizophrenia. D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior.

Correct Answer: A. Antipsychotic-induced akathisia and anxiety Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's used to treat antipsychotic-induced akathisia and anxiety. Off-label use of propranolol includes the use in performance anxiety, which is a subset of a social phobia presenting with tachycardia, sweating, and flushing that occurs secondary to increased activation of the sympathetic nervous system.

A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. He was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed with chronic undifferentiated schizophrenia. The nurse should assign the highest priority to which nursing diagnosis? A. Anxiety B. Impaired verbal communication C. Disturbed thought processes D. Self-care deficit: Dressing/grooming

Correct Answer: A. Anxiety For this client, the highest-priority nursing diagnosis is Anxiety (severe to panic-level), manifested by the client's extreme withdrawal and attempt to protect himself from the environment. The nurse must act immediately to reduce anxiety and protect the client and others from possible injury. Use a non-judgemental, respectful, and neutral approach with the client. Use clear and simple language when communicating with a suspicious client. Be honest and consistent with the client regarding expectations and enforcing rules.

A client tells the nurse that psychotropic medicines are dangerous and refuses to take them. Which intervention should the nurse use first? A. Ask the client about any previous problems with psychotropic medications. B. Ask the client if an injection is preferable. C. Insist that the client takes medication as prescribed. D. Withhold the medication until the client is less suspicious.

Correct Answer: A. Ask the client about any previous problems with psychotropic medications. The nurse needs to clarify the client's previous experience with psychotropic medication in order to understand the meaning of the client's statement. Attempt to understand the significance of these beliefs to the client at the time of their presentation. Important clues to underlying fears and issues can be found in the client's seemingly illogical fantasies. Explain the procedures and try to be sure the client understands the procedures before carrying them out. When the client has full knowledge of procedures, he or she is less likely to feel tricked by the staff.

A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction? A. Dystonia B. Akinesia C. Akathisia D. Tardive dyskinesia

Correct Answer: A. Dystonia Dystonia, a common extrapyramidal reaction to fluphenazine decanoate, manifests as muscle spasms in the tongue, face, neck, back, and sometimes the legs. Dystonia is a dynamic disorder that changes in severity based on the activity and posture. Dystonia may assume a pattern of overextension or over-flexion of the hand, inversion of the foot, lateral flexion or retroflection of the head, torsion of the spine with arching and twisting of the back, forceful closure of the eyes, or a fixed grimace. It may come to an end when the body is in action and during sleep.

Ramsay is diagnosed with schizophrenia paranoid type and is admitted to the psychiatric unit of Nurseslabs Medical Center. Which of the following nursing interventions would be most appropriate? A. Establishing a non-demanding relationship. B. Encouraging involvement in group activities. C. Spending more time with Ramsay. D. Waiting until Ramsay initiates interaction.

Correct Answer: A. Establishing a non-demanding relationship A non-threatening, non-demanding relationship helps decrease the mistrust that is common in a client with paranoid schizophrenia. Use a non-judgemental, respectful, and neutral approach with the client. There is less chance for a suspicious client to misinterpret intent or meaning if content is neutral and approach is respectful and non-judgemental.

Nurse Dorothy is evaluating care of a client with schizophrenia; the nurse should keep which point in mind? A. Frequent reassessment is needed and is based on the client's response to treatment B. The family does not need to be included in the care because the client is an adult. C. The client is too ill to learn about his illness. D. Relapse is not an issue for a client with schizophrenia.

Correct Answer: A. Frequent reassessment is needed and is based on the client's response to treatment. Because the client responds to treatment in different ways, the nurse must constantly evaluate the client and his potential. A premorbid adjustment must also be considered. Assess if incoherence in speech is chronic or if it is more sudden, as in an exacerbation of symptoms. Establishing a baseline facilitates the establishment of realistic goals, the foundation for planning effective care.

Positive symptoms of schizophrenia include which of the following?A. Hallucinations, delusions, and disorganized thinking A. Flat affect, avolition, and anhedonia B. Somatic delusions, echolalia, and a flat affect C. Waxy flexibility, alogia, and apathy D. Hallucinations, delusions, and disorganized thinking

Correct Answer: A. Hallucinations, delusions, and disorganized thinking The positive symptoms of schizophrenia are distortions of normal functioning. Option A lists the positive symptoms of schizophrenia. The typical positive symptoms of schizophrenia, such as hallucinatory experiences or fixed delusional beliefs, tend to be very upsetting and disruptive—not a positive experience at all for you or someone you care about who is experiencing them. From the outside, a person with positive symptoms might seem distracted, as if they are listening to something (psychiatrists call this "responding to internal stimuli").

A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that one is: A. Highly important or famous B. Being persecuted C. Connected to events unrelated to oneself D. Responsible for the evil in the world

Correct Answer: A. Highly important or famous. A delusion of grandeur is a false belief that one is highly important or famous. A delusion of grandeur is the false belief in one's own superiority, greatness, or intelligence. People experiencing delusions of grandeur do not just have high self-esteem; instead, they believe in their own greatness and importance even in the face of overwhelming evidence to the contrary. Someone might, for example, believe they are destined to be the leader of the world, despite having no leadership experience and difficulties in interpersonal relationships. Delusions of grandeur are characterized by their persistence. They are not just moments of fantasy or hopes for the future

A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client? A. Ineffective protection related to blood dyscrasias B. Urinary frequency related to adverse effects of antipsychotic medication C. Risk for injury related to a severely decreased level of consciousness D. Risk for injury related to electrolyte disturbances

Correct Answer: A. Ineffective protection related to blood dyscrasias Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias, that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. These medications also have anticholinergic effects, such as urine retention, dry mouth, and constipation. Leukopenia, thrombocytopenia, and blood dyscrasia are rare side effects of treatment with FGAs.

The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's plan of care? A. Meeting all of the client's physical needs. B. Giving the client an opportunity to express concerns. C. Administering lithium carbonate (Lithonate) as prescribed. D. Providing a quiet environment where the client can be alone.

Correct Answer: A. Meeting all of the client's physical needs Because a client with catatonic schizophrenia can't meet physical needs independently, the nurse must provide for all of these needs, including adequate food and fluid intake, exercise, and elimination. The initial management includes supportive measures such as IV fluids and even nasogastric tubes given that patients with catatonia are susceptible to malnutrition, dehydration, pneumonia, etc. The key is early identification of catatonia in a patient with schizophrenia and initiation of treatment.

The nurse is caring for a client with schizophrenia. Which of the following outcomes is the least desirable? A. The client spends more time by himself. B. The client doesn't engage in delusional thinking. C. The client doesn't harm himself or others. D. The client demonstrates the ability to meet his own self-care needs.

Correct Answer: A. The client spends more time by himself. The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the client spend more time by himself wouldn't be a desirable outcome. Rather, a desirable outcome would specify that the client spends more time with other clients and staff on the unit. Delusions are false personal beliefs. Eventually engage other clients and significant others in social interactions and activities with the client (card games, ping pong, sing-a-songs, group sharing activities) at the client's level. Client continues to feel safe and competent in a graduated hierarchy of interactions.

A client with paranoid schizophrenia is admitted to the psychiatric unit of a hospital. Nursing assessment should include careful observation of the client's: A. Thinking, perceiving, and decision-making skills B. Verbal and nonverbal communication processes C. Affect and behavior D. Psychomotor activity

Correct Answer: A. Thinking, perceiving, and decision-making skills Nursing assessment of a psychotic client should include careful inquiry about and observation of the client's thinking, perceiving, symbolizing, and decision-making skills and abilities. Assessment of such a client typically reveals alterations in thought content and process, perception, affect, and psychomotor behavior; changes in personality, coping, and sense of self; lack of self-motivation; presence of psychosocial stressors; and degeneration of adaptive functioning.

A client is admitted to the psychiatric hospital with a diagnosis of catatonic schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. This client is exhibiting: A. Waxy flexibility B. Negativity C. Suggestibility D. Retardation

Correct Answer: A. Waxy flexibility Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them. Catatonic patients may also display "waxy flexibility", meaning that they allow themselves to be moved into new positions, but do not move on their own. Most of the time, this is not an act or a show but rather a genuine and unpremeditated symptom of the illness that patients cannot help.

A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms? A. benztropine (Cogentin) B. dantrolene (Dantrium) C. clonazepam (Klonopin) D. diazepam (Valium)

Correct Answer: A. benztropine (Cogentin) Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Thus, benztropine blocks the cholinergic muscarinic receptor in the central nervous system. Therefore, it reduces the cholinergic effects significantly during Parkinson's disease which becomes more pronounced in the nigrostriatal tract because of reduced dopamine concentrations.

A client with schizophrenia is referred for psychosocial rehabilitation. Which of the following are typical of this type of program? Select all that apply. A. Analyzing family issues and past problems B. Developing social skills and supports C. Learning how to live independently in a community D. Learning job skills for employment E. Treating family members affected by the illness F. Participating in in-depth psychoanalytical counseling

Correct Answer: B, C, D The goal of psychosocial rehabilitation as a treatment method is to help the client develop the skills and supports necessary for successful living, learning, and working in the community. Analysis of family issues and past problems and treatment of family members are not commonly part of this type of program. The emphasis of psychosocial rehabilitation is on the client's development of skills in the here and now; consequently, psychoanalytic counseling is not part of the approach.

Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)? A. The absence of anticholinergic effects. B. A lower incidence of extrapyramidal effects. C. Photosensitivity and sedation. D. No incidence of neuroleptic malignant syndrome.

Correct Answer: B. A lower incidence of extrapyramidal effects Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. SGAs have loose binding to D2 receptors and can quickly dissociate from the receptor, potentially accounting for the lower likelihood of causing extrapyramidal symptoms (EPS). Moreover, SGAs have agonism at the 5HT1A receptor. Serotonin and norepinephrine reuptake inhibition are potential mechanisms by which risperidone is postulated to produce antidepressant effects. The improvement of positive symptoms is thought to be accomplished through the blockade of D2 receptors specifically in the mesolimbic pathway.

A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response? A. Say, "You know it's your medicine." B. Allow him to open the individual wrappers of the medication. C. Say, "Don't worry about what is in the pills. It's what is ordered." D. Ignore the comment because it's probably a joke.

Correct Answer: B. Allow him to open the individual wrappers of the medication. This is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Talk openly with the client about their beliefs and thoughts, showing empathy and support. Help build trust and rapport with clients. Paranoid clients may be more reluctant to trust anyone, but open communication generally offers more cooperation. Explain all procedures clearly and carefully, and their purpose, before starting them. Prevents aggressive behavior and suspicion. Promotes cooperation and compliance. Helps develop trust.

Nurse Winona educates the family about symptom management for when the schizophrenic client becomes upset or anxious. Which of the following would Nurse Winona state be helpful? A. Call the therapist to request a medication change. B. Encourage the use of learned relaxation techniques. C. Request that the client be hospitalized until the crisis is over. D. Wait before the anxiety worsens before intervening.

Correct Answer: B. Encourage the use of learned relaxation techniques. The client with schizophrenia can learn relaxation techniques, which help reduce anxiety. The family can be supportive and helpful by encouraging the client to use these techniques. When client is ready, introduce strategies that can minimize anxiety and lower voices and "worrying" thoughts, teach client to do the following: focus on meaningful activities; learn to replace negative thoughts with constructive thoughts; perform deep breathing exercise; use a calming visualization or listen to music; or seek support from staff, family, or other supportive people.

The nurse formulates a nursing diagnosis of Impaired verbal communication for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention is most appropriate? A. Helping the client to participate in social interactions. B. Establishing a one-on-one relationship with the client. C. Establishing alternative forms of communication. D. Allowing the client to decide when he wants to participate in verbal communication with the nurse.

Correct Answer: B. Establishing a one-on-one relationship with the client By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations. Assess if incoherence in speech is chronic or if it is more sudden, as in an exacerbation of symptoms. Establishing a baseline facilitates the establishment of realistic goals, the foundation for planning effective care.

Cersei is diagnosed as having disorganized schizophrenia. Which behaviors would Nurse Sansa most likely assess in the client? A. Absence of acute symptoms impaired role function. B. Extreme social withdrawal, odd mannerisms, and behavior. C. Psychomotor immobility; presence of waxy flexibility. D. Suspiciousness toward others increased hostility.

Correct Answer: B. Extreme social withdrawal, odd mannerisms, and behavior Disorganized schizophrenia is characterized by regressive behavior with extreme social withdrawal and frequently odd mannerisms. In the most general sense, disorganized schizophrenia refers to the disorganization of thought processes, behavior, and affect regulation (emotions). The DSM-IV included five subtypes of schizophrenia, including disorganized, paranoid, catatonic, undifferentiated, and residual. The subtypes were removed from the current version of the DSM (DSM-5, released in 2013), as it was determined that they were not helpful when treating the disorder

Which of the following client behaviors documented in Gio's chart would validate the nursing diagnosis of Risk for other-directed violence? A. Gio's description of being endowed with superpowers. B. Frequent angry outburst noted toward peers and staff. C. Refusal to eat cafeteria food. D. Refusal to join in group activities.

Correct Answer: B. Frequent angry outburst noted toward peers and staff Anger is an important factor that indicates the potential for acting out. Because the client is angry with both peers and staff, any acting out would probably be directed toward others. Frequently assess client's behavior for signs of increased agitation and hyperactivity. Early detection and intervention of escalating mania will prevent the possibility of harm to self or others, and decrease the need for seclusions.

The nurse is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as: A. Delusions B. Hallucinations C. Loose associations D. Neologisms

Correct Answer: B. Hallucinations Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality. The word "hallucination" comes from Latin and means "to wander mentally." Hallucinations are defined as the "perception of a nonexistent object or event" and "sensory experiences that are not caused by stimulation of the relevant sensory organs." In layman's terms, hallucinations involve hearing, seeing, feeling, smelling, or even tasting things that are not real. Auditory hallucinations, which involve hearing voices or other sounds that have no physical source, are the most common type.

A client with schizophrenia tells the nurse he hears the voices of his dead parents. To help the client ignore the voices, the nurse should recommend that he: A. Sit in a quiet, dark room and concentrate on the voices. B. Listen to a personal stereo through headphones and sing along with the music. C. Call a friend and discuss the voices and his feelings about them. D. Engage in strenuous exercise.

Correct Answer: B. Listen to a personal stereo through headphones and sing along with the music. Increasing the amount of auditory stimulation, such as by listening to music through headphones, may make it easier for the client to focus on external sounds and ignore internal sounds from auditory hallucinations. Work with the client to find which activities help reduce anxiety and distract the client from a hallucinatory material. Practice new skills with the client. If clients' stress triggers hallucinatory activity, they might be more motivated to find ways to remove themselves from a stressful environment or try distraction techniques.

The nurse is aware that antipsychotic medications may cause which of the following adverse effects? A. Increased production of insulin B. Lower seizure threshold C. Increased coagulation time D. Increased risk of heart failure

Correct Answer: B. Lower seizure threshold Antipsychotic medications exert an effect on brain neurotransmitters that lowers the seizure threshold and can, therefore, increase the risk of seizure activity. First-generation antipsychotics can also lower the seizure threshold, and chlorpromazine and thioridazine are more epileptogenic than others. First-generation antipsychotics are dopamine receptor antagonists (DRA) and are known as typical antipsychotics. They include phenothiazines (trifluoperazine, perphenazine, prochlorperazine, acetophenazine, triflupromazine, mesoridazine), butyrophenones (haloperidol), thioxanthenes (thiothixene, chlorprothixene), dibenzoxazepines (loxapine), dihydroxyindole (molindone), and diphenylbutylpiperidine (pimozide).

A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements of which of the following disorders? A. Personality disorder B. Mood disorder C. Thought disorder D. Amnestic disorder

Correct Answer: B. Mood disorder According to the DSM-IV, schizoaffective disorder refers to clients suffering from schizophrenia with elements of a mood disorder, either mania or depression. The prognosis is generally better than for the other types of schizophrenia, but it's worse than the prognosis for a mood disorder alone. The term schizoaffective disorder first appeared as a subtype of schizophrenia in the first edition of the DSM. It eventually became its own diagnosis despite lack of evidence for unique differences in etiology or pathophysiology. Therefore, there have been no conclusive studies on the etiology of the disorder. However, investigating the potential causes of mood disorders and schizophrenia as individual disorders allows for further discussion.

A client's medication order reads, "Thioridazine (Mellaril) 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n." The nurse should: A. Administer the medication as prescribed. B. Question the physician about the order. C. Administer the order for 200 mg P.O. q.i.d. but not for 100 mg P.O. p.r.n. D. Administer the medication as prescribed but observe the client closely for adverse effects.

Correct Answer: B. Question the physician about the order. The nurse must question this order immediately. Thioridazine (Mellaril) has an absolute dosage ceiling of 800 mg/day. Any dosage above this level places the client at high risk for toxic pigmentary retinopathy, which can't be reversed. As written, the order allows for administering more than the maximum 800 mg/day; it should be corrected immediately before the client's health is jeopardized.

Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)? A. Monthly blood tests will be necessary. B. Report a sore throat or fever to the physician immediately. C. Blood pressure must be monitored for hypertension. D. Stop the medication when symptoms subside.

Correct Answer: B. Report a sore throat or fever to the physician immediately. A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine. The risk of developing agranulocytosis is around 1% in patients who take clozapine, which may be independent of dosing. Most cases occur early in the treatment, within six weeks to six months, and require extensive monitoring of blood absolute neutrophil counts. The definition of neutropenia is an ANC level below 1500/mm, and agranulocytosis is an ANC level below 500/mm.

When teaching the family of a client with schizophrenia, the nurse should provide which information? A. Relapse can be prevented if the client takes the medication. B. Support is available to help family members meet their own needs. C. Improvement should occur if the client has a stimulating environment. D. Stressful family situations can precipitate a relapse in the client.

Correct Answer: B. Support is available to help family members meet their own needs. Because family members of a client with schizophrenia face difficult situations and great stress, the nurse should inform them of support services that can help them cope with such problems. Provide information on client and family community resources for the client and family after discharge: day hospitals, support groups, organizations, psychoeducational programs, community respite centers (small homes), etc. Schizophrenia is an overwhelming disease for both the client and the family. Groups, support groups, and psychoeducational centers can help

Gio told his nurse that the FBI is monitoring and recording his every movement and that microphones have been placed in the unit walls. Which action would be the most therapeutic response? A. Confront the delusional material directly by telling Gio that this simply is not so. B. Tell Gio that this must seem frightening to him but that you believe he is safe here. C. Tell Gio to wait and talk about these beliefs in his one-on-one counseling sessions. D. Isolate Gio when he begins to talk about these beliefs.

Correct Answer: B. Tell Gio that this must seem frightening to him but that you believe he is safe here. The nurse must realize that these perceptions are very real to the client. Acknowledging the client's feelings provides support; explaining how the nurse sees the situation in a different way provides reality orientation. Recognize the client's delusions as the client's perception of the environment. Recognizing the client's perception can help you understand the feelings he or she is experiencing.

The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine, and benztropine. Why is benztropine administered? A. To reduce psychotic symptoms. B. To reduce extrapyramidal symptoms. C. To control nausea and vomiting. D. To relieve anxiety.

Correct Answer: B. To reduce extrapyramidal symptoms Benztropine is an anticholinergic medication, administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications. Consequently, it reduces central cholinergic effects by blocking muscarinic receptors that appear to improve the symptoms of Parkinson's disease. Thus, benztropine blocks the cholinergic muscarinic receptor in the central nervous system. Therefore, it reduces the cholinergic effects significantly during Parkinson's disease which becomes more pronounced in the nigrostriatal tract because of reduced dopamine concentrations.

A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia. His physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by mouth four times per day. Before administering the drug, the nurse reviews the client's medication history. Concomitant use of which drug is likely to increase the risk of extrapyramidal effects? A. guanethidine (Ismelin) B. droperidol (Inapsine) C. lithium carbonate (Lithonate) D. Alcohol

Correct Answer: B. droperidol (Inapsine) When administered with any phenothiazine, droperidol may increase the risk of extrapyramidal effects. Despite being a low-potency drug, chlorpromazine can still cause extrapyramidal side effects (EPS) such as acute dystonia, akathisia, parkinsonism, and tardive dyskinesia (TD). The evolution of EPS side effects can occur through hours to days. Acute dystonia refers to muscle stiffness or spasm of the head, neck, and eye muscles that can start hours after starting the medication. Akathisia includes restlessness and fast pacing. Parkinsonism includes bradykinesia, "cogwheel" rigidity, and shuffling gait.

Every day for the past 2 weeks, a client with schizophrenia stands up during group therapy and screams, "Get out of here right now! The elevator bombs are going to explode in 3 minutes!" The next time this happens, how should the nurse respond? A. "Why do you think there is a bomb in the elevator?" B. "That is the same thing you said in yesterday's session." C. "I know you think there are bombs in the elevator, but there aren't." D. "If you have something to say, you must do it according to our group rules."

Correct Answer: C. "I know you think there are bombs in the elevator, but there aren't." This is the most therapeutic response because it orients the client to reality. Identify feelings related to delusions. If a client believes someone is going to harm him/her, the client is experiencing fear. When people believe that they are understood, anxiety might lessen.

A client with borderline personality disorder becomes angry when he is told that today's psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client's anger? A. "If it had been your emergency, I would have made the other client wait." B. "I know it's frustrating to wait. I'm sorry this happened." C. "You had to wait. Can we talk about how this is making you feel right now?" D. "I really care about you and I'll never let this happen again."

Correct Answer: C. "You had to wait. Can we talk about how this is making you feel right now?" This response may diffuse the client's anger by helping to maintain a therapeutic relationship and addressing the client's feelings. Regardless of the clinical setting, the nurse must provide structure and limit setting in the therapeutic relationship; in a clinic setting, this may mean seeing the client for scheduled appointments of a predetermined length rather than whenev

A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing: A. Deeper sleep than CNS depressants. B. Greater sedation than CNS depressants. C. A calming effect from which the client is easily aroused. D. More prolonged sedative effects, making the client more difficult to arouse.

Correct Answer: C. A calming effect from which the client is easily aroused. Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination. The precise mechanism of action exhibited by phenothiazines is not entirely known. Yet, phenothiazines act primarily through inhibiting the dopamine receptor at the mesolimbic pathway with a selective activity at the D2 receptor. This inhibition antagonizes the hyperactivity of dopamine at the synapse and reduces positive symptoms such as delusions and hallucinations associated with schizophrenia.

A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client? A. Take the medication 1 hour before a meal. B. Decrease the dosage if signs of illness decrease. C. Apply sunscreen before being exposed to the sun. D. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.

Correct Answer: C. Apply a sunscreen before being exposed to the sun. Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun. Photosensitivity is an adverse effect of many drugs, characteristically producing skin lesions in the areas exposed to light, which includes the face, "V" area of the neck, extensor surfaces of forearms, and dorsa of hands with sparing of submental and retroauricular areas. Two major mechanisms mediating drug induced photosensitivity reactions are phototoxic and photoallergic responses.

A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior? A. Word salad B. Tangential C. Avolition D. Perseveration

Correct Answer: C. Avolition Avolition refers to impairment in the ability to initiate goal-directed activity. Avolition, a lack of motivation or reduced drive to complete goal-directed activities, is a concerning and common characteristic in people with schizophrenia. It is one of the negative symptoms of schizophrenia. Negative symptoms involve those that cause a decrease or loss in mental functioning and can interfere with daily functioning, including maintaining a job, relationship, or social life.

A woman is admitted to the psychiatric emergency department. Her significant other reports that she has difficulty sleeping, has poor judgment, and is incoherent at times. The client's speech is rapid and loose. She reports being a special messenger from the Messiah. She has a history of depressed mood for which she has been taking an antidepressant. The nurse suspects which diagnosis? A. Schizophrenia B. Paranoid personality C. Bipolar illness D. Obsessive-compulsive disorder (OCD)

Correct Answer: C. Bipolar illness Bipolar illness is characterized by mood swings from profound depression to elation and euphoria. Delusions of grandeur along with pressured speech are common symptoms of mania. The bipolar affective disorder is a chronic and complex disorder of mood that is characterized by a combination of manic (bipolar mania), hypomanic and depressive (bipolar depression) episodes, with substantial subsyndromal symptoms that commonly present between major mood episodes.

A client is admitted to the psychiatric unit with active psychosis. The physician diagnoses schizophrenia after ruling out several other conditions. Schizophrenia is characterized by: A. Loss of identity and self-esteem. B. Multiple personalities and decreased self-esteem. C. Disturbances in affect, perception, and thought content and form. D. Persistent memory impairment and confusion.

Correct Answer: C. Disturbances in affect, perception, and thought content and form. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, defines schizophrenia as a disturbance in multiple psychological processes that affect thought content and form, perception, affect, sense of self, volition, relationship to the external world, and psychomotor behavior. Traditionally, symptoms have divided into two main categories: positive symptoms which include hallucinations, delusions, and formal thought disorders, and negative symptoms such as anhedonia, poverty of speech, and lack of motivation.

Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do? A. Assume that the client is posturing. B. Tell the client to lie down and relax. C. Evaluate the client for adverse reactions to haloperidol. D. Put the client on the list for the physician to see tomorrow.

Correct Answer: C. Evaluate the client for adverse reactions to haloperidol. An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. The extrapyramidal symptoms are muscular weakness or rigidity, a generalized or localized tremor that may be characterized by the akinetic or agitation types of movements, respectively. Due to the blockade of the dopamine pathway in the brain, typical antipsychotic medications such as haloperidol have correlations with extrapyramidal side effects.

A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction? A. Hepatitis B. Infection C. Granulocytopenia D. Systemic dermatitis

Correct Answer: C. Granulocytopenia Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly. Weekly complete blood count (CBC) to measure ANC levels. ANC levels less than 1500 indicate neutropenia. Levels less than 500 indicate agranulocytosis. A complete blood count should be taken weekly for the first six months, then every other week for the next six months. A national registry is in place to monitor for safe use.

During a group therapy session in the psychiatric unit, a client constantly interrupts with impulsive behavior and exaggerated stories that cast her as a hero or princess. She also manipulates the group with attention-seeking behaviors, such as sexual comments and angry outbursts. The nurse realizes that these behaviors are typical of: A. Paranoid personality disorder B. Avoidant personality disorder C. Histrionic personality disorder D. Borderline personality disorder

Correct Answer: C. Histrionic personality disorder This client's behaviors are typical of histrionic personality disorder, which is marked by excessive emotionality and attention seeking. The client constantly seeks and demands attention, approval, or praise; may be seductive in behavior, appearance, or conversation; and is uncomfortable except when she is the center of attention. Histrionic personality disorder, or dramatic personality disorder, is a psychiatric disorder distinguished by a pattern of exaggerated emotionality and attention-seeking behaviors. Histrionic personality disorder falls within the "Cluster B" of personality disorders.

An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used for this client to treat: A. Dyskinesia B. Dementia C. Psychosis D. Tardive dyskinesia

Correct Answer: C. Psychosis By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation. Haloperidol is a first-generation (typical) antipsychotic medication that is used widely around the world. Food and Drug Administration (FDA) approved the use of haloperidol is for schizophrenia, Tourette syndrome (control of tics and vocal utterances in adults and children), hyperactivity (which may present as impulsivity, difficulty maintaining attention, severe aggressivity, mood instability, and frustration intolerance), severe childhood behavioral problems (such as combative, explosive hyperexcitability), intractable hiccups.

Hormonal effects of the antipsychotic medications include which of the following? A. Polydipsia and dysmenorrhea B. Dysmenorrhea and increased vaginal bleeding C. Retrograde ejaculation and gynecomastia D. Akinesia and dysphasia

Correct Answer: C. Retrograde ejaculation and gynecomastia Decreased libido, retrograde ejaculation, and gynecomastia are all hormonal effects that can occur with antipsychotic medications. Reassure the client that the effects can be reversed or that changing medication may be possible. Among women taking conventional antipsychotics, 26% to 78% experienced amenorrhea; some had galactorrhea. There was some evidence that hyperprolactinemia decreases libido, an effect that could cause nonadherence to treatment. In addition, bone loss appeared to be a secondary drug side effect in some studies. Finally, physician surveys indicated that the prevalence and severity of hyperprolactinemia are underestimated.

The nurse is providing care to a client with a catatonic type of schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should: A. Ask the client which activity he would prefer to do first. B. Negotiate a time when the client will perform activities. C. Tell the client specifically and concisely what needs to be done. D. Prepare the client ahead of time for the activity.

Correct Answer: C. Tell the client specifically and concisely what needs to be done. The client needs to be informed of the activity and when it will be done. Use clear and simple language when communicating with a client. Minimize the opportunity for miscommunication and misconstruing the meaning of the message. Set limits in a clear matter-of-fact way, using a calm tone. Giving threatening remarks to Jeremy is unacceptable. They can talk more about the proper ways of dealing with the client's feelings. A calm and neutral approach may diffuse the escalation of anger. Offer an alternative to verbal abuse by finding appropriate ways to deal with feelings.

Which non-antipsychotic medication is used to treat some clients with schizoaffective disorder?A. phenelzine (Nardil) A. phenelzine (Nardil) B. chlordiazepoxide (Librium) C. lithium carbonate (Lithane) D. imipramine (Tofranil)

Correct Answer: C. lithium carbonate (Lithane) Lithium carbonate, an antimanic drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including manic-like activity. Lithium helps control the affective component of this disorder. Lithium was the first mood stabilizer and is still the first-line treatment option, but is underutilized because it is an older drug. Lithium is a commonly prescribed drug for a manic episode in bipolar disorder as well as maintenance therapy of bipolar disorder in a patient with a history of a manic episode. The primary target symptoms of lithium are mania and unstable mood.

Since admission 4 days ago, a client has refused to take a shower, stating, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate? A. Dismantling the showerhead and showing the client that there is nothing in it. B. Explaining that other clients are complaining about the client's body odor. C. Asking a security officer to assist in giving the client a shower. D. Accepting these fears and allowing the client to take a sponge bath.

Correct Answer: D. Accepting these fears and allowing the client to take a sponge bath By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in another way. Attempt to understand the significance of these beliefs to the client at the time of their presentation. Important clues to underlying fears and issues can be found in the client's seemingly illogical fantasies. Recognize the client's delusions as the client's perception of the environment. Recognizing the client's perception can help you understand the feelings he or she is experiencing.

The family of a schizophrenic client asks the nurse if there is a genetic cause of this disorder. To answer the family, which fact would the nurse cite? A. Conclusive evidence indicates a specific gene transmits the disorder. B. Incidence of this disorder is variable in all families. C. There is a little evidence that genes play a role in transmission. D. Genetic factors can increase the vulnerability for this disorder.

Correct Answer: D. Genetic factors can increase the vulnerability for this disorder. Research shows that family history statistically increases the risk for the development of schizophrenia. Genetics also play a fundamental role - there is a 46% concordance rate in monozygotic twins and a 40% risk of developing schizophrenia if both parents are affected. The gene neuregulin (NGR1) which is involved in glutamate signaling and brain development has been implicated, alongside dysbindin (DTNBP1) which helps glutamate release, and catecholamine O-methyltransferase (COMT) polymorphism, which regulates dopamine function.

Jaime has a diagnosis of schizophrenia with negative symptoms. In planning care for the client, Nurse Brienne would anticipate a problem with: A. Auditory hallucinations B. Bizarre behaviors C. Ideas of reference D. Motivation for activities

Correct Answer: D. Motivation for activities. In a client demonstrating negative symptoms of schizophrenia, avolition, or the lack of motivation for activities, is a common problem. These "negative" symptoms are so-called because they are an absence as much as a presence: inexpressive faces, blank looks, monotone, and monosyllabic speech, few gestures, seeming lack of interest in the world and other people, inability to feel pleasure or act spontaneously. It is important to distinguish between lack of expression and lack of feeling, between lack of will and lack of activity. When questioned, patients with schizophrenia often express a full range of feelings and desires.

Important teaching for a client receiving risperidone (Risperdal) would include advising the client to: A. Double the dose if missed to maintain a therapeutic level. B. Be sure to take the drug with a meal because it's very irritating to the stomach. C. Discontinue the drug if the client reports weight gain. D. Notify the physician if the client notices an increase in bruising.

Correct Answer: D. Notify the physician if the client notices an increase in bruising. Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important. Although there are no mandatory requirements for therapeutic drug monitoring (TDM) with risperidone, monitoring plasma concentrations for this medication is strongly recommended by European guidelines because of data that shows interdependent variability. Therapeutic monitoring can be of benefit to assess compliance and in identifying low drug concentrations that may be low resulting in therapeutic failure. Also, monitoring the drug level can aid in evaluating for potential drug interactions and side effects.

Which factor is associated with increased risk for schizophrenia? A. Alcoholism B. Adolescent pregnancy C. Overcrowded schools D. Poverty

Correct Answer: D. Poverty Low socioeconomic status or poverty is an identified environmental factor associated with an increased incidence of schizophrenia. A criticism of this research field, which is in fact a criticism relevant to much social science research, is that the investigation of socio-environmental factors in the environment invariably focuses on poverty and deprivation to the exclusion of other important variables. One such variable is income inequality. Income inequality is a measure of the 'rich-poor gap' in any given society and therefore it exists at the ecological level.

Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which adverse reaction? A. Hypertension B. Respiratory arrest C. Tourette syndrome D. Retinal pigmentation

Correct Answer: D. Retinal pigmentation Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The development of pigmentary retinopathy is a unique adverse manifestation associated with thioridazine, and not with other antipsychotics. Patients may have nonspecific symptoms while taking thioridazine, such as dry mouth, dry eyes, sedation, weight gain, dizziness, erectile dysfunction, pruritus, photosensitivity, and constipation. Other rare and more unique side effects of thioridazine include irreversible retinal pigmentation, poikilothermia, and agranulocytosis.

How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated?A. Several minutes A. Several minutes B. Several hours C. Several days D. Several weeks

Correct Answer: D. Several weeks Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear. It can take a few days for chlorpromazine to take effect. It's difficult to determine how long one can expect to wait, as the medication affects each person differently. Ideally, the client should stay on an antipsychotic medication for four to six weeks before deciding whether to continue taking it in the long term. This gives the medication a chance to build up in the system and to begin delivering its full effects.

Upon Sam's admission for acute psychiatric hospitalization, Nurse Jona documents the following: Client refuses to bathe or dress, remains in the room most of the day, speaks infrequently to peers or staff. Which nursing diagnosis would be the priority at this time? A. Anxiety B. Decisional conflict C. Self-care deficit D. Social isolation

Correct Answer: D. Social isolation These behaviors indicate the client's withdrawal from others and possible fear or mistrust of relationships. If a client is found to be very paranoid, solitary or one-on-one activities that require concentration are appropriate. The client is free to choose his level of interaction; however, concentration can help minimize distressing paranoid thoughts or voices. If a client is unable to respond verbally or in a coherent manner, spend a frequent, short period with clients. An interested presence can provide a sense of being worthwhile.

A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom? A. Dystonia B. Akathisia C. Pseudoparkinsonism D. Tardive dyskinesia

Correct Answer: D. Tardive dyskinesia An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that commonly are irreversible and may interfere with speech. Tardive dyskinesia (TD) is a syndrome which includes a group of iatrogenic movement disorders caused due to a blockade of dopamine receptors. The movement disorders include akathisia, dystonia, buccolingual stereotypy, myoclonus, chorea, tics and other abnormal involuntary movements which are commonly caused by the long-term use of typical antipsychotics.

Drogo, who has had auditory hallucinations for many years, tells Nurse Khally that the voices prevent his participation in a social skills training program at the community health center. Which intervention is most appropriate? A. Let Drogo analyze the content of the voices. B. Advise Drogo to participate in the program when the voices cease. C. Advise Drogo to take his medications as prescribed. D. Teach Drogo to use thought-stopping techniques.

Correct Answer: D. Teach Drogo to use thought-stopping techniques. Clients with long-lasting auditory hallucinations can learn to use thought-stopping measures to accomplish tasks. In this technique, when the obsessive or racing thoughts begin, the client says, clearly and distinctly, "Stop!" This then allows the client to substitute a new, healthier thought. Many therapists encourage the client to, at first, yell out the "Stop!" This helps focus the attention on the word and away from the obsessive thought. Later, the client will be able to mentally yell the word to themselves without needing to say it aloud.

A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn't been employed in the last 14 years. Based on Erikson's theories, the nurse should recognize that this client is in which stage of psychosocial development? A. Autonomy versus shame and doubt B. Generativity versus stagnation C. Integrity versus despair D. Trust versus mistrust

Correct Answer: D. Trust versus mistrust This client's paranoid ideation indicates difficulty trusting others. Erikson believed that early patterns of trust help children build a strong base of trust that's crucial for their social and emotional development. If a child successfully develops trust, they will feel safe and secure in the world. You're essentially shaping their personality and determining how they will view the world.

A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect? A. diphenhydramine (Benadryl) B. phenytoin (Dilantin) C. benztropine (Cogentin) D. amantadine (Symmetrel)

Correct Answer: D. amantadine (Symmetrel) An antiparkinsonian agent, such as amantadine, may be used to control pseudoparkinsonism. Amantadine is now used mostly for Parkinson's disease. Clinical trials have shown that amantadine decreases symptoms of bradykinesia, rigidity, and tremor. There is a combined synergistic effect with added levodopa, which is converted to dopamine by striatal enzymes in the CNS. There can be a transient benefit to the drug, so short-term therapy for patients with mild disease is best.

A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client? A. chlorpromazine (Thorazine) B. imipramine (Tofranil) C. lithium carbonate (Lithane) D. fluphenazine decanoate (Prolixin Decanoate)

Correct Answer: D. fluphenazine decanoate (Prolixin Decanoate) Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication noncompliance. Fluphenazine is a typical antipsychotic used for symptomatic management of psychosis in patients with schizophrenia. There is a long-acting fluphenazine decanoate formulation that is used primarily as maintenance therapy for chronic schizophrenia and related psychotic disorders in patients who do not tolerate oral formulations or in patients where medication compliance is of concern.

Important teaching for clients receiving antipsychotic medication such as haloperidol (Haldol) includes which of the following instructions? Select all that apply. A. Use sunscreen because of photosensitivity. B. Take the antipsychotic medication with food. C. Have routine blood tests to determine levels of the medication. D. Abstain from eating aged cheese.

Correct Answers: A & B Photosensitivity is an adverse effect of many drugs, characteristically producing skin lesions in the areas exposed to light, which includes the face, "V" area of the neck, extensor surfaces of forearms, and dorsa of hands with sparing of submental and retroauricular areas. Two major mechanisms mediating drug-induced photosensitivity reactions are phototoxic and photoallergic responses. Antipsychotics should be taken with food to avoid gastric upset.

Nurse Arya assesses for evidence of positive symptoms of schizophrenia in a newly admitted client. Which of the following symptoms are considered positive evidence? Select all that apply. A. Anhedonia B. Delusions C. Flat affect D. Hallucinations E. Loose associations F. Social withdrawal

Correct Answers: B, D, E These are considered positive symptoms of schizophrenia. The typical positive symptoms of schizophrenia, such as hallucinatory experiences or fixed delusional beliefs, tend to be very upsetting and disruptive—not a positive experience at all for you or someone you care about who is experiencing them. From the outside, a person with positive symptoms might seem distracted, as if they are listening to something (psychiatrists call this "responding to internal stimuli"). The phrase "positive symptoms" refers to symptoms that are in ?excess or added to normal mental functioning.

The etiology of schizophrenia is best described by: A. Genetics due to a faulty dopamine receptor. B. Environmental factors and poor parenting. C. Structural and neurobiological factors. D. A combination of biological, psychological, and environmental factors.

orrect Answer: D. A combination of biological, psychological, and environmental factors. A reliable genetic marker hasn't been determined for schizophrenia. However, studies of twins and adopted siblings have strongly implicated a genetic predisposition. Since the mid-19th century, excessive dopamine activity in the brain has also been suggested as a causal factor. Communication and the family system have been studied as contributing factors in the development of schizophrenia. Therefore, a combination of biological, psychological, and environmental factors are thought to cause schizophrenia