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Schizophrenia/Miliu
Quiz 3
| Question | Answer |
|---|---|
| For the treatment environment(Milieu) to be effective it must include these 5 elements | Safety, Structure, Norms, Limit setting and Balance. |
| Examples of ineffective nursing care in a theraputic environment: | 1. Rarely leaving nursing station. 2. Excessive T.V. watching by patients. |
| Most common complaints of patients on inpatient psychiatric units: | Boredom and lack of meaningfull activities. |
| Physical safety includes: | 1. Physical aggression from or patients and staff. 2.Staff supervision when using unsafe grooming items (e.g. sharps, glass items, and plastic bags. |
| Psychologogical safety involves the nurses': | 1. active intervention to prohibit verbal abuse, ridicle or harassmnet of patient's 2. Restrict vistors known to disparage patient. 3.dealing with intrusive behavior such as getting into other private space or bullying about personal characteristics. |
| Structure refers to: | physical environment, rules, and daily schedules of treatmnet activities. Essential because w/out itthere is no justification for the patient being in treatment. |
| Norms refer to: | specific expectations of behavior through out treatment enviroment;intended to proote safety and trust thru the anctioning of socially acceptable behaviors and consistence about what is expected. |
| Limit setting should be: | set for things like self-destructive and sexual behavior. It reinforces norms, making rules and expectations clear which encourages the milieu therapy concept of RESPOSIBILTY TO SELF |
| Balance involves: | represents the value of developing expertise in nursing.Process of gradually allowing independent behaviors in a dependent situation. |
| Schizophrenia cuases: | 1.Genetics influenced by enviroment. 2.Brain tissue changes; left ventrical enlarged. 3. Dopamine excess |
| For schizophrenia to become active, | Something must trigger it. |
| Age of one set: | It is almost always late adolescence or early adulthood. |
| Role of stress: | Onset and relapse almost always related to stress. |
| Efficacy of dopamine antagonists: | Drugs that block dopamine receptors are therapeutic |
| Schizophrenia is: | 1.one of the most common causes of psychosis. 2.is NOT characterized by a changing personality, IT IS characterized by a deteriorating personality. |
| Schizophrenia is a diagnostic term used to describe a major psychotic disorder characterized by distrubancs in: | Perception (hallucinations) Thought process (thought derailmnet) Reality testing (delusions) Feelings (flat or inappropriate affect) Behavior (social withdrawl) Attention (not able to concentrate) Motivation (no goal-directed activities) |
| Diagnosis Criteria | Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): Delusions Hallucinations Disorganized Speech Grossly disorganized or catatonic behavior Negative symptoms |
| Positive Symptoms are things that are ADDED to the experience and include: | Hallucinations – a sensory experience without a stimulus trigger. Auditory (most common), visual, olfactory,tactile Delusions – Disorganized speech – Ongoing disjointed or rambling monologues (“Word salads”) |
| Delusions – false, fixed belief that cannot be corrected by feedback and is not accepted as true by others in the culture | Include:Grandeur Ideas of reference:rained becuz flowers need Persecution: parinod Somatic delusions: with in body Thought broadcasting:you can hear my thoughts Thought insertion:you put idea there. Thought withdrawal- took idea from my head |
| Negative symptoms: ABSENCE OF THINGS | Apathy (avolition) Social withdrawal Alogia Flat affect Anhedonia |
| Apathy (avolition): | lack of energy, contentment to just sit and do nothing (unkempt appearance) |
| Social withdrawal | occurs in an attempt to reduce stimulus to the brain. |
| Alogia | – reduced content of speech. Repeat words over and over |
| Flat affect | – lack of nonverbal expression of emotions |
| Anhedonia | – Inability to experience happiness or joy. Used to enjoy going to the movies, but now does not. |
| Schizophrenia, paranoid type | – delusions, auditory hallucinations |
| Schizophrenia, catatonic type | – features stupor, negativism, rigidity, excitement, posturing |
| Schizophrenia, disorganized type | – flat or inappropriate affect, incoherence |
| Schizophrenia, undifferentiated type | – delusions, hallucinations, incoherence, gross disorganization, (does not fit criteria of other types) |
| Schizophrenia, residual type (THINK OF RECOVERING SCHIZOPHRENIA) | – demonstrates the typical signs and symptoms associated with schizophrenia without displaying evidence of gross disorganization, incoherence, delusions, and hallucinations. |
| Course of Disease: | Marked by acute episodes of psychosis alternating with periods of relatively normal function |
| PHASES OF THE DISEASE: | 1.Prodromal phase 2.Prepsychotic phase 3.Acute Phase 4.Residual Phase |
| Prodromal phase-often begins in adolescence and alot of the time the signs are not noticed because might think typical teenage stuff. | Lack energy/motivation and withdrawal Affect blunted,Beliefs/ideas are odd,May dev excessive interest in philosophy/religion,Self-care,personal hygiene ignored, Emotional lability, Speech difficult to follow, complain of mult phys prob.,Magical thinking |
| Prepsychotic phase | Quiet, passive behavior Prefers to be alone Hallucinations and delusions may be present Odd, suspicious, or eccentric behavior patterns Family members report person has changed into “stranger” |
| Acute Phase | S/S vary widely, but disturbances in thought, perception, emotion, and behavior are apparent. Often, the individual loses contact with reality and is unable to function in the most basic ways. |
| Residual Phase | Symptoms similar to Prodromal phase,Followed by a remission period in which the Indiv able to experience some relief of symptoms and to manage some basic activities of life. Prognosis for recovery is fair to poor because of complex issues of this disor |
| Milieu Therapy – | nurse models appropriate behavior, dress, how to act environment is safe and consistent with schedules to follow. Independence is encouraged with reminders from staff |
| Psychosocial Rehabilitation | Goal:assist mentally illadjust to living in community. Starts in hospital,continues into community Strategy:prevent relapse: Learning from exper;explore feelings about meds;lower stress;know resources and have plan; avoid risky sit. keep healthy |
| Psychopharmacology | Cornerstone of treatment Goal is to eliminate or control positive symptoms. Are Typical and Atypical |
| Typical (First-generation) Antipsychotics Typical – antagonize the neurotransmitter dopamine | Phenothiazines Chlorpromazine (Thorazine) Fluphenazine (Prolixin) Perphenazine Prochlorperazine (Compazine) Thioridazine Trifluoperazine Thioxanthenes Thiothixene (Navane) Nonphenothiazines Haloperidol (Haldol) Loxapine (Loxitane) Molindone (Moban |
| Atypical | Aripiprazole (Abilify) Clozapine (Clozaril) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon |
| Atypical | inhibit dopamine receptors,also inhibit serotonin receptors Exact mechanism symptoms is unknown.S timulate/block cholinergic, histaminic, nicotinic, alpha and beta adrenergic neurotrans.receptors varying degrees, reason many of the adverse effects. |
| Adverse Effects****KNOW THESE** | Extrapyramidal Symptoms (EPS) Dystonias abnormal posture Pseudoparkinsonian symptoms Akathisia- suggestive feeling and jitters Tardive dyskinesia-later in treatment Neuroleptic malignant syndrome (NMS) |
| Adverse Effects Continued | Seizures Weight Gain- #1 reasonfor non-compliance!!! Hyperglycemia Dyslipidemia Dysrhythmias |
| Tardive dyskinesia | Tongue rolling, repetitive behavior. The problem is if you stop or lower meds, behavior will get worse. |
| Blocking cholinergic receptors: | explains anticholinergic effects: dry mouth, constipation, sinus tachycardia, blurred vision, urinary retention |
| Blocking histamine-1 receptors causes: | sedation, drowsiness, and appetite stimulation. (Molindone has no histamine-1 blocking effect and therefore does not lead to weight gain) |
| Blocking alpha-1 and alpha-2 adrenergic receptors causes | postural hypotension, sexual dysfunction, reflex tachycardia, and potentiation of antihypertensive agents. |
| Other side effects include: | hepatotoxicity, blood dyscrasias, allergic reactions, endocrine disorders, skin pigmentation, and reversible effects in the eyes. Patients receiving clozapine are particularly susceptible to developing agranulocytosis |
| Schizophreniform Disorder – | Schizophrenic symptoms, but for less than 6 months |
| Schizoaffective Disorder – | Symptoms of psychosis and at the same time all the features of mood disorder (depression or mania) |
| Brief Psychotic Disorder | Person experiences the sudden onset of at least one psychotic symptom (delusions, hallucinations, disorganized speech or behavior), lasts for 1 day to 1 month |
| Shared psychotic Disorder | Two people who have a close relationship have the same delusions |
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