N129 Chapter 12 - Schizophrenia

When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be

"You are safe here. This is a locked unit, and no one can get in." - gives global reassurance "I do not believe I understand the word volmers. Tell me more about them." - encourages elaboration about the delusion "Why do you think someone or something is going to harm you?" - asks for info the client will likely be unable to answer "It must be frightening to think something is going to harm you." - This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience.

Persecutory Delusions - most common + grandiose delusions

1) Persecutory Delusions. a) Most common type of delusion (along with grandiose delusions). b) A delusion in which the central theme is that one (or someone to whom one is close) is being attacked, harassed, cheated, persecuted, or conspired against

Four Bleuler's Signs of Schizophrenia

Affect - flat, blunted, inappropriate, bizarre, libel Associative Looseness - Disorganized Thinking Autism - delusions, hallucinations, illusions, neologisms Ambivalence - contradictory emotions, attitudes, ideas, or desires with respect to a particular object, or situation.

Negative Symptoms of Schizophrenia

Affect Flattening/Incongruence Alogia Avolition Apathy Anhedonia - Asociality:

Ambivalence

Ambivalence The coexistence of contradictory emotions, attitudes, ideas, or desires with respect to a particular object, or situation. Ordinarily, the ambivalence is not fully conscious & suggests psychopathology only when present in an extreme form.

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has been diagnosed with schizophrenia is early detection of tardive dyskinesia

An AIMS assessment should be performed periodically on clients who are being treated with antipsychotic medication known to cause tardive dyskinesia.

A client, who has been receiving antipsychotic medication for 6 weeks, tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the client reports flulike symptoms including a fever and a very sore throat, the nurse should arrange for the client to have blood drawn for a white blood cell count. Correct

Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms.

Associative Looseness

Associative Looseness Disorganized thinking, manifested as jumbled & illogical speech. Impaired reasoning is displayed. A disturbance of thinking shown by speech in which ideas shift from one subject to another that is unrelated or minimally related to the first Statements that lack a meaningful relationship in which speech may shift suddenly from one frame of reference to another. The speaker gives no indication of being aware of the disconnectedness, contradictions or illogicality of speech.

Autism

Autism Thinking is not bound to reality but reflects the private perceptual world of the individual. Delusions: A false belief held & maintained as true regardless to the contrary. Hallucinations: Involve perceiving a sensory experience for which no external stimulus exists. Illusions: Are misperceptions or misinterpretations of a real experience. Neologisms: A word a person makes up that has meaning only for that person. Part of a delusional system - seen in schizophrenia & organic mental disorders.

A desired outcome for a client diagnosed with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will ask for validation of reality.

Beginning to question his or her own altered perceptions by seeking input from staff is highly desirable.

Boundary Impairment

Boundary Impairment: Is an impaired ability to sense where one's body ends & another bodies begin.

A nursing intervention designed to help a schizophrenic client manage relapse is to...teach the client and family about behaviors associated with relapse.

By knowing what behaviors signal impending relapse, interventions can be quickly invoked when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted.

Catatonic behavior: Marked motor abnormalities including motoric immobility (i.e. catalepsy or stupor).

Catalepsy: Waxy flexibility - rigid maintenance of a body position over an extended period of time.

Disorganized Thinking - Circumstantiality.

Circumstantiality. 1) Pattern of speech that is indirect & delayed in reaching it's goal. 2) Has excessive or irrelevant detail. 3) Has parenthetical remarks. 4) The speaker does NOT lose the point - as seen with loose associations 5) Clauses remain logically connected. 6) For the listener, it seems that the end will never be reached.

.Disorganized Speech - Clang Association:

Clang Association: The choice of words bases on their sounds rather than meaning.

Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)? clinical

Clinical epidemiology represents a broad field that addresses what happens to people with illnesses who are seen by providers of clinical care. Studies use traditional epidemiological methods and are conducted in groups that are usually defined by illness or symptoms or by diagnostic procedures or treatments given for the illness or symptoms.

Disorganized Thinking - Concrete Thinking.

Concrete Thinking. 1) Thinking characterized by immediate experience. 2) Thinking not characterized by abstractions. 3) There is an over-emphasis on the specific detail as opposed to general & abstract concepts. 4) It may occur as a primary, developmental defect or it may develop secondary to schizophrenia or organic brain disease. 5) Example: a) Nurse - "What brought you to the hospital?" b) Patient - "An ambulance". c) Instead of an attempted overdose of medications.

Control Delusions.

Control Delusions. Believing that another person, group of people or external force controls thoughts, feelings, impulses or behavior. For example: The patient wears a tin-foil hat so radiation will not enter their brain.

Disorganized Thinking - Thought Blocking.

D. Thought Blocking. 1) Blocking: A sudden obstruction or interruption in spontaneous thinking or speaking. b) Perceived as an absence or deprivation of thought.

Positive Symptoms of Schizophrenia

Delusions Hallucinations Boundary Impairment Disorganized Speech Disorganized Thinking Disorganized Behavior Catatonic Behavior

Disorganized Speech - Incoherence

Disorganized Speech. - Incoherence: 1) Speech or thinking is incomprehensible to others. 2) Words or phases are joined together without a logical or meaningful connection. 3) Not due to aphasia. a) Aphasia: Impairment in the understanding or transmission of ideas by language in any of it's forms - reading, writing, or speaking - due to injury or disease of the brain centers involved in language. b) Example seen with patients with head injuries, CVA, etc.

Disorganized behavior - Automatism:

Disorganized behavior - Automatism 1) Automatic & apparently undirected nonpurposeful behavior that is not consciously controlled. 2) Posturing 3) Waxy Flexibility. 4) Catatonic Behavior

6. Disorganized behavior. A. Bizarre Behavior:

Disorganized behavior - Bizarre Behavior: 1) Inappropriate clothing - especially for weather) 2) Inappropriate appearance - grooming & hygiene). 3) Inappropriate social behavior. 4) Inappropriate sexual behavior.

Disorganized thinking - Loose Associations

Disorganized thinking. - Loose Associations. 1) A pattern of thinking that is: a) Haphazard b) Illogical c) Confuse 2) Thinking in which connections in thought are interrupted.

Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years and Tara at 31 years. Based on your knowledge of early and late onset of schizophrenia, which of the following is true? Tara has a better chance for positive outcomes because of later onset.

Female patients diagnosed with schizophrenia between the ages of 25 and 35 years have better outcomes than do their male counterparts diagnosed earlier. These two patients do not have the same expectation of a poor prognosis. There is no evidence suggesting that Tara will have more positive signs of schizophrenia. It is actually more unlikely that Aaron will be able to live a productive life because of his earlier onset, which has a poorer prognosis.

According to Rogers, a synonym for genuineness is . congruence

Genuineness refers to self-awareness of one's feelings as they arise within the relationship and the ability to communicate them when appropriate. It is the ability to meet others person-to-person without hiding behind roles. Rogers uses the word congruence to signify genuineness.

Grandiose Delusions. - most common + persecutory

Grandiose Delusions. a) Most common type of delusion -along with persecutory delusions b) Believing that one is a very powerful or important person. c) Grandiosity: An inflated appraisal of one's worth, power, knowledge, importance, or identity. When extreme, grandiosity may be of delusional proportions.

Ideas of Reference Delusions.

Ideas of Reference Delusions. A delusion whose theme is that events , objects, or other person's in one immediate environment have a particular & unusual significance. Giving persons significance to trivial events. Perceiving events as related to you when they are not.

Jealous Delusions.

Jealous Delusions The delusion that one's sexual partner is unfaithful Erotomanic Delusions. Believing that another person desires you romantically.

v. Labile Affect:

Labile Affect: An affect type that indicates abnormal sudden rapid shifts in XGB DX CXaffect.

Disorganized thinking

Loose Associations Tangentiality Circumstantiality Thought Blocking Concrete Thinking

Mixed Delusions

Mixed Delusions. A combination of any of the other delusions discussed.

Negative Symptom - Anhedonia - Asociality - no pleasure

Negative Symptom - Anhedonia- Asociality: • Inability to experience pleasure in activities that usually produce. • Poor eye contact. • Few recreational interests or activities. • Decreased sexual interest or closeness. • Decreased mirthfulness or joy. • Few relationships with friends or peers.

Negative Symptoms of Schizophrenia Affect Flattening/Incongruence Alogia Avolition Apathy Anhedonia - Asociality:

Negative Symptoms - Affect Flattening /Incongruence: • Blunted Affect. • Flat Affect. • Inappropriate Affect. • Bizarre Affect.

Negative Symptoms - Alogia - poverty of speech & content of speech

Negative Symptoms - Alogia: • Poverty of speech. • Poverty of content of speech. • Speech conveys little information because of vagueness or superficiality. • Sparse productivity of thought.

Negative Symptom - Avolition: lack of motivation Apathy: indifference

Negative symptom - Avolition/Apathy: • Avolition: Lack of goal directed activity. Lack of motivation. • Apathy: A state of indifference. • Reduced motivation. • Inability to initiate tasks. o Social contacts. o Hygiene & grooming (ADLs). • Decreased spontaneous movement & behavior. • Inattention to grooming & hygiene. • Reduced task completion: o At work. o At Home. o At school. o Physical lack of energy.

Negative Symptoms

Negative symptoms refer to deficits that characterize schizophrenia. They include the crippling symptoms of affective blunting: lack of facial expression, anergia: lack of energy, anhedonia: inability to experience happiness, avolition: lack of motivation, poverty of content of speech, poverty of speech, and thought blocking.

In order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to...identify his culture's view regarding suicide.

One approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable or unacceptable. In this view, the mentally ill are those who violate social norms and thus threaten (or make anxious) those observing them. For example, traditional Japanese may consider suicide to be an act of honor, and Middle Eastern "suicide bombers" are considered holy warriors or martyrs. Contrast these viewpoints with Western culture, where people who attempt or complete suicides are nearly always considered mentally ill.

Disorganized Speech - Pressured Speech:

Pressured Speech: 1) Speech that is increased in: a) Amount. b) Accelerated c) Difficult to interrupt. d) Impossible to interrupt. 2) Usual loud & emphatic. 3) Patient talks without any social stimulations. 4) Patient may continue to talk even though no one is listening

Religious Delusions.

Religious Delusions. Unrealistic false belief that the person has special spiritual powers or is an important spiritual person.

Schizophrenia is considered a neurobiological disorder. The course of schizophrenia involves recurrences. With each relapse further deterioration is noted.

Residual schizophrenia refers to the disorder when active phase symptoms are no longer present and the individual is left with two or more of the following symptoms: lack of initiative, social withdrawal, impaired role function, marked speech deficits, and odd beliefs.

Types of Disorganized Speech

incoherence word salad pressured speech clang association echolalia

A client has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be... social, vocational, and self-care skills

Schizophrenia stable plateau phase - planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community.

Signs/Symptoms of Auditory & Visual Hallucinations

Signs/Symptoms of Auditory & Visual Hallucinations i. Turns or tilts head to one side. ii. Darting of the eyes. iii. Talks or mumbles to self. iv. Laughs to self. v. Staring at one spot. vi. Suddenly stops talking vii. Suddenly stops & activity moves lips - silently

Somatic Delusions.

Somatic Delusions. Believing that the body is changing in an unusual way.

Disorganized behavior - Stereotyped Movements

Stereotyped Movements: 1) Repetitive, seemingly driven & nonfunctional motor behavior.

Tactile Hallucinations.

Tactile Hallucinations. Involving the perception of being touched or of something being under one's skin. Most common tactile hallucination: Electrical shocks. Sensations of something creping or crawling on/under skin.

Disorganized Thinking - Tangentiality

Tangentiality - Replying to a question in an oblique or irrelevant way. Thinking in which the speaker goes off topic. Speaker does not return to the topic. Impairment in interpersonal communication.

The phase of the nurse-client relationship that may cause anxieties to reappear and past losses to be reviewed is the termination phase. Correct

Termination, a stage in which the client must face the loss or ending of the therapeutic relationship, often reawakens the pain of earlier losses.

Which of the following is true regarding schizophrenia treatment and outcomes? Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability.

Unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and causes varying degrees of dysfunction or disability.

Visual Hallucinations.

Visual Hallucinations. a) Hallucination involving sight: Formed images - people Unformed images - flashes of light-colors b) Occurs more likely in organic disorders: Acute alcohol withdrawal. Dementia.

Disorganized Speech - Word Salad:

Word Salad: 1) A mixture of words & phrases that lack comprehensive meaning or logical coherence. 2) Jumbled words that is meaningless to the listener & perhaps to the speaker as well.

Neologism - Volmers

a newly coined word that has meaning only for the client.

Positive symptoms are those symptoms that should not be present, but are.

hallucinations, delusions, bizarre behavior, and paranoia and are referred to as florid symptoms.

i. Flat Affect:

i. Flat Affect: 1. Immobile or blank facial expression. 2. An affect type that indicates the absence of signs of affective expression.

ii. Blunted Affect:

ii. Blunted Affect: 1. An affect type that represents significant reduction in the intensity of emotional expression.

iii. Inappropriate Affect:

iii. Inappropriate Affect: 1. An affect type that represents an unusual affective expression that does not match the content of what is being said or thought. 2. Example: Patient laughs when they hear news of something really sad.

anhedonia

inability to experience happiness

iv. Bizarre Affect:

iv. Bizarre Affect: 1. Odd, illogical, emotional state that is grossly inappropriate or unfounded. 2. Especially prominent in disorganized schizophrenia. 3. Example: grimacing & giggling.

anergia

lack of energy

affective blunting

lack of facial expression

avolition

lack of motivation