Schizophrenia

Symptoms

100

1.  May occur in any sensory modality auditory being most common. A perceptual experience of something that is not real.

What is a hallucination

200

2. Beliefs that conflict with reality.  When a person believes a person, group or organization is mistreating or harming them despite contradictory evidence. 

a. What is a delusion

300

3. This refers to reduced or lack of ability to function normally.  For example, the person may neglect personal hygiene or appear to lack emotion (doesn’t make eye contact, doesn’t change facial expressions or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure. 

     a. What are negative symptoms of schizophrenia

400

Feelings or behaviors that are usually not present, such as: believing that what other people are say is not true(delusions) hearing, seeing, tasting, feeling, or smelling things that others do not experience (hallucinations) disorganized speech and behavior, movement disorders

What are positive symptoms of schizophrenia

Diagnosis/ Assessments

100

• This diagnostic test is considered definitive in diagnosing schizophrenia or predisposition to schizophrenia.

• What is: there is no single definitive diagnostic test for schizophrenia.
• “More than a century since the delineation of dementia praecox by Kraepelin, the etiology, neuropathology and pathophysiology of schizophrenia remain elusive” (Jablensky MD, 2010).  Although historical progenitor disorders that resemble schizophrenia have been documented back to ancient history and there are certain biological markers that have been identified in relation to schizophrenia, a definitive etiology and diagnosis through pathophysiology is still hypothetical.  (Jablensky MD 2010)

200

• When a patient is presenting with symptomatology indicative of schizophrenia, the health care provider will order these diagnostics tests to rule out conditions that could cause similar symptoms.

• What are drug and alcohol screenings, CBC, CMP, BUN/Cr, MRI, and CT scan (Mayo Clinic Staff, 2020).
• While there is not a single definitive diagnostic to diagnose schizophrenia, it is important to use multiple diagnostics to rule out a litany of different chemicals and medical conditions that can cause psychotic symptoms that are seen in schizophrenia.  Section E of the DSM V states that in determining a diagnosis of schizophrenia “The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition” (Impact of the DSM-IV to DSM-5, 2016).  Causes for disturbances that would rule out schizophrenia can include the following: medications, drugs of abuse, toxins, electrolyte imbalances, hormonal imbalances, metabolic conditions, infections, vitamin deficiencies, autoimmune disorders, and renal disease. (Morgan, K. Townsend, M.C., 2021. p. 448, 451)

300

• These are the five symptoms, designated by the DSM-,5 that if present for a significant portion of the time over the course of one month are indicative of schizophrenia. (Impact of the DSM-IV to DSM-5, 2016). 

• What are delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. . (Impact of the DSM-IV to DSM-5, 2016). 

400

• When assessing a potentially schizophrenic patient it is important to draw your assessment data from these.

• What are: multiple sources!
• Due to the nature of cognitive impairment of a schizophrenic patient in the acute phase of the disorder, it is important to draw from multiple sources other than subjective reports from the patient; these sources can include the following: “family members, old medical records, or from other individuals who are able to report on the progression of the patient’s behavior” (Morgan, K. Townsend, M.C., 2021. P. 452).

Treatments

100

This type of therapy is effective in reducing social isolation, increasing the sense of cohesiveness, and improving reality testing for patients with schizophrenia, but should be done later in treatment

Group Therapy

200

This specific type of individual therapy in proven to be successful at reducing the frequency of bizarre, disturbing and deviant behavior and increasing appropriate behavior.

Behavior Therapy

300

This proactive and comprehensive treatment teaches basic life skills, helps clients work with community agencies, and assists clients in developing a social support network. Vocational expectations and supported work settings are an important part of this treatment program.

Assertive Community Treatment

400

This treatment approach focuses on early intervention at the first episode of psychosis and a personal treatment plan is made immediately after.

R.A.I.S.E-Recovery After Initial Schizophrenic Episode

Medications

100

This class of medication is the most effective in treating schizophrenia

Atypical Antipsychotics

200

This is a common side effect of typical medications that is characterized by frightening muscle spasms

Dystonia

300

This is a common side effect of atypical & typical medications that is characterized by a feeling of inner restlessness and an inability to sit still.

Akathisia

400

Atypical medication block these two receptors

D2 Dopamine & 5HT2A Serotonin

Teaching

100

During this, patients are taught in a group setting and tend to have excellent outcomes.

What are psychoeducational groups

200

By building this with a schizophrenic patient, medication adherence increases by up to 40 percent.

What is report

300

There is little to no evidence to support a particular education method as the best way to improve a schizophrenic patients’ quality of life or improve functional ability. Therefore, this may be a suitable alternative for some patients.

What is computer-based patient education

400

By educating the family as well as the patient, these have shown to be greatly increased.

What is medication adherence, patient outcomes, and more effective coping

Stigma

100

Discrimination against an identifiable group of people, a place, or a nation

What is stigma?

200

Public stigma, self stigma, institutional stigma

What are 3 types of stigma?

300

• reduced hope
• lower self-esteem
• increased psychiatric symptoms
• difficulties with social relationships
• reduced likelihood of staying with treatment
• more difficulties at work

what are some negative effects of stigma?

400

Talk openly, educated yourself and others, be conscious of language

What are some examples that we can do to reduce stigma?

Nursing Care Plans

100

A patient newly admitted for schizophrenia who has vertical cuts along their forearms and inner thighs would require this nursing diagnosis.

Risk for suicide

200

 A patient sits still in a chair with eyes down every day. The patient does not make eye contact and has difficulty expressing needs verbally. When people come near him, he appears agitated when too many people are close by or stand too close to him. An appropriate nursing diagnosis would be.

Social isolation

300

A schizophrenic patient refuses to take his medications saying that they are poison and that there is nothing wrong with him. He refuses to eat or drink anything given to him by staff because it is all poison. An appropriate nursing diagnosis for him would be.

Disturbed thought process

400

A nurse is caring for an 18-year-old college student newly diagnosed with schizophrenia. He has stopped attending class, speaking, or getting out of bed. His parents are talking to the nurse and say, “I don’t know why he can’t snap out of it. We already pay tuition; this is so selfish.” An appropriate nursing diagnosis would be.

Interrupted family process

Final Jeopardy

600

The negative symptom of catatonic schizophrenia seen in this video is known as

Waxy flexibility