Schizophrenia Chapter 16

______ is used to screen for symptoms of movement disorders. The client is observed in several positions, and the severity of symptoms is rated from 0 to 4.

Abnormal Involuntary Movement Scale (AIMS)

The assessment of affect requires sensitivity to differences in _______, _______, and _______ ; these vary across cultures.

eye contact, body language, and acceptable emotional expression

Negative symptoms/signs include:

flat affect, lack of volition, and social withdrawal or discomfort.

Immediate course

two typical patterns 1. the client experiences psychosis and never fully recovers 2. client experiences psychosis and recovers completely

The theory regarding serotonin suggests that serotonin ______ and ______. Some believe that excess serotonin itself contributes to the development of schizophrenia.

modulates and helps to control excess dopamine.

The research consistently shows decreased brain ______ in the frontal and temporal areas of persons with schizophrenia.

volume and abnormal brain function

Nonneurologic side effects include:

weight gain, sedation, photosensitivity, and anticholinergic symptoms such as dry mouth, blurred vision, constipation, urinary retention, and orthostatic hypotension.

Neuroleptic malignant syndrome (NMS) is a serious and frequently fatal condition seen in those being treated with antipsychotic medications. It is characterized by signs and symptoms:

muscle rigidity, high fever, increased muscle enzymes (particularly creatine phosphokinase), and leukocytosis (increased leukocytes).

In schizophrenia higher relapse rates are associated with:

non-adherence to medication persistent substance use caregiver criticism negative attitude toward treatment

The primary medical treatment for schizophrenia is ______.

psychopharmacology

Tx

psychotic and mood symptom 1st gen- dopamine antagonists: + signs 2nd gen dep and sero antagonist: = and - signs LAIS: 6 shots available 2-4 weeks

schizophrenia causes distorted and bizarre:

thoughts, perceptions, emotions, movements, and behavior.

Clozapine (Clozaril)

atypical antipsychotic acts on both positive and negative signs

replaces usually occurs with in

1 year

The symptoms of schizophrenia are divided into two major categories:

1. Positive or hard symptoms/signs. 2. Negative or soft symptoms/signs.

The peak incidence of schizophrenia onset is ___ to ___ years of age for men and ___ to ___ years of age for women.

15 to 25; 25 to 35

______ medications play a crucial role in the course of the disease and individual outcomes.

Antipsychotic

______ medications, also known as neuroleptics, are prescribed primarily for their efficacy in decreasing psychotic symptoms. They do not cure schizophrenia; rather, they are used to manage the symptoms of the disease.

Antipsychotic

African Americans, white Americans, and Hispanic Americans appear to require comparable therapeutic doses of antipsychotic medications. ______ clients, however, need lower doses of drugs such as haloperidol (Haldol) to obtain the same effects; therefore, they would be likely to experience more severe side effects if given the traditional or usual doses.

Asian

DSM-5 DIAGNOSTIC CRITERIA: Schizophrenia. Continuous signs of the disturbance persist for at least 6 months. This period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

DSM-5

DSM-5 DIAGNOSTIC CRITERIA: Schizophrenia. Two (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated). At least one of these must be (1), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorgranized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional or avolition).

DSM-5 criteria

______ reactions to antipsychotic medications appear early in the course of treatment and are characterized by spasms in discrete muscle groups such as the neck muscles (torticollis) or eye muscles (oculogyric crisis). These spasms also may be accompanied by protrusion of the tongue, dysphagia, and laryngeal and pharyngeal spasms that can compromise the client's airway, causing a medical emergency.

Dystonic

______ also may be a factor in the way a person responds to psychotropic medications. This difference in response is probably the result of the person's genetic makeup. Some people metabolize certain drugs more slowly, so the drug level in the bloodstream is higher than desired.

Ethnicity

Related Disorders

Schizophreniform disorder( acute psychosis >6 months) Catatonia( chartizerized by marked psychomotor disturbance Delusional disorder (believes the delusion is real) Brief psychotic disorder( psychotic symptoms 1 day to 1 month) Shared psychotic disorder ( two people share similar delusions) Schizotypical personality disorder( odd, eccentric behaviors )

______, a late-appearing side effect of antipsychotic medications, is characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet.

Tardive dyskinesia

Seizures may be associated with high doses of the medication. Treatment is:

a lowered dosage or a different antipsychotic medication.

Pseudoparkinsonism, or neuroleptic-induced parkinsonism, signs and symptoms includes:

a shuffling gait, mask-like facies, muscle stiffness (continuous) or cogwheeling rigidity (ratchet-like movements of joints), drooling, and akinesia (slowness and difficulty initiating movement). These symptoms usually appear in the first few days after starting or increasing the dosage of an antipsychotic medication.

Schizophrenia usually is diagnosed in late ______ or early ______. Rarely does it manifest in ______.

adolescence; adulthood; childhood

The intensity of psychosis tends to diminish with ______.

age

Findings have demonstrated that people with schizophrenia have relatively less ______ and ______ than those who do not have schizophrenia; this could represent a failure in the development or a subsequent loss of tissue.

brain tissue and cerebrospinal fluid

Awareness of ______ differences is important when assessing for symptoms of schizophrenia.

cultural

Psychotic behavior observed in countries other than the United States or among particular ethnic groups has been identified as a "______" syndrome.

culture-bound

Positive or symptoms/signs include:

delusions, hallucinations, and grossly disorganized thinking, speech, and behavior.

Acute treatment consists of ______ given either intramuscularly or intravenously, or ______ given intramuscularly.

diphenhydramine (Benadryl); benztropine (Cogentin)

One prominent theory suggests excess ______ as a cause of schizophrenia.

dopamine

Currently, the most prominent neurochemical theories involve ______ and ______.

dopamine and serotonin

Those who develop the illness ______ show worse outcomes than those who develop it ______.

earlier; later

Guo et al. (2010) found that ______ and ______ of the first psychotic episode with medication and psychosocial interventions were associated with improved outcomes such as lower relapse rates and improved insight, quality of life, and social functioning.

early detection and aggressive treatment

Computed tomography scans have shown ______ in the brain and cortical atrophy. Positron emission tomography studies suggest that glucose metabolism and oxygen are ______ in the frontal cortical structures of the brain.

enlarged ventricles; diminished

Many clients with schizophrenia have difficulty ______ and ______. This is primarily due to persistent negative symptoms, impaired cognition, or treatment-refractory positive symptoms.

functioning in the community, and few lead fully independent lives.

The biologic theories of schizophrenia focus on:

genetic factors, neuroanatomic and neurochemical factors (structure and function of the brain), and immunovirology (the body's response to exposure to a virus).

One hallmark symptom of schizophrenic psychosis is ______ (false sensory perceptions, or perceptual experiences that do not exist in reality).

hallucinations

Hallucinations are distinguished from ______, which are misperceptions of actual environmental stimuli. For example, while walking through the woods, a person believes he sees a snake at the side of the path. On closer examination, however, he discovers it is only a curved stick. Reality or factual information corrected this ______. Hallucinations, however, have no such basis in reality.

illusions

Long term course

intensity of psychosis diminishes with age most with difficulty functioning few with ability to live fully independent lives

schizoaffective disorder

is diagnosed when the client is severely ill and has a mixture of psychotic and mood symptoms

Younger clients display a poorer premorbid adjustment, more prominent ______ signs, and greater cognitive impairment than do older clients.

negative

Alogia, Anhedonia, Apathy, Asociality, Blunted affect, Catatonia, Flat affect, Avolition or lack of volition, and Inattention, and bizarre behaviors BOX 16.1

negative (soft symptoms/signs)

Neurochemical studies have consistently demonstrated alterations in the ______ systems of the brain in people with schizophrenia.

neurotransmitter

Ambivalence, Associative looseness, Delusions, Echopraxia, Flight of ideas, Hallucinations, Perseveration, and Bizarre behavior BOX 16.1

positive (symptoms/signs)

Medication may control the ______ symptoms, but frequently the ______ symptoms persist after positive symptoms have abated. The persistence of these ______ symptoms over time presents a major barrier to recovery and improved functioning in the client's daily life.

positive; negative; negative

The more effective the client's ______ and ______ to his or her medication regimen, the better the client's outcome.

response and adherence

Akathisia is characterized by:

restless movement, pacing, inability to remain still, and the client's report of inner restlessness.

The signs and symptoms of schizophrenia include those of both:

schizophrenia and a mood disorder such as depression or bipolar disorder.

Schizoaffective disorder is diagnosed when the client is:

severely ill and has a mixture of psychotic and mood symptoms.

Any of the antipsychotic medications can cause NMS, which is treated by ______.

stopping the medication

This pathology correlates with the positive signs of schizophrenia (______ lobe), such as psychosis, and the negative signs of schizophrenia (______ lobe), such as lack of volition or motivation and anhedonia.

temporal; frontal