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Summary NSG 335 Exam 2 Study Guide
- Course
- NSG 335
- Institution
- Marian University
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Exam #2 Study GuideModule 8: Psychosis and Schizophrenia
Identify the defining characteristics of schizophrenia including the common age of
onset
o Delusional disorder: delusions that have lasted 1 month or longer
o Brief psychotic disorder: sudden onset of delusions, hallucinations,
disorganized speech or catatonic, symptoms last longer than one
day but not longer than 1 month
o Schizophreniform disorder: like schizophrenia but symptoms last
less than 6 months
o Schizoaffective disorder: major depressive, manic or mixed episode
concurrent with symptoms, mood and thoughts are altered concurrently,
last 6 months but may lead to schizophrenia¸
o Substance induced psychotic disorder and psychotic disorder due to
another medical condition: illicit drugs, alcohol, medications or toxins
that can induce delusions or hallucinations
o Schizophrenia prodromal phase: 15-25 can develop, child onset:
before 15 years, late onset: 40 years, mild symptoms- diminished school
performance and cognitive ability, have at least one psychotic symptom
(hallucination, delusions or disorganized speech or thought)
First episode develops between the ages of 15-25
Everyone who is diagnosed with schizophrenia has at least one
symptom” hallucination, delusion, disorganized speech, altered
thoughts
Comorbidity: substance use disorders- increased relapse,
incarceration, homelessness, violence, and suicide. People are
often with nicotine as a form of coping cognitive impairment.
Anxiety, depression and suicide can occur frequently, suicide
attempts are more frequent within 3 years. Physical illnesses are
common, risk of premature death 3.5 time greater than general
population, die more than 20 years prematurely.
Risk: poor health maintenance, poor nutrition, victimization,
trauma and reduced ability to recognize or respond of
illnesses.
First episode acute: meeting the diagnostic criteria
First episode partial remission: an improvement after a
previous episode maintained
First episode full remission: period of time after a previous
episode
Multiple episodes acute: two episodes
Continuous: symptoms fulfilling the criteria of the disorder
Polydipsia: happens in 20% of individuals with schizophrenia,
hyponatremia
, Symptoms of hyponatremia: confusion, delirium,
hallucinations, worsening of the psychotic symptoms, dilute
urine, polyuria, and coma
o Psychosis: altered cognitions, perception and or impaired ability to
determine what is real
o Psychotic disorder: result of underlying medical issue
Identify risk factors for the development of schizophrenia
o Genetics: 80%, 50% for identical twins, 15% for fraternal twins
o Neurobiological: antipsychotic drugs block activity of dopamine,
o amphetamines and cocaine- enhance dopamine activity and
psychosis or precipitate schizophrenia
o new antipsychotics: block serotonin and dopamine
o Glutamate can cause psychosis
o GABA calm neurotransmitter is altered in schizophrenia
o Acetylcholine may be affected in psychosis
o Structural abnormalities- atrophy, disrupt communication, occurs in
late adolescence to early adulthood, inflammation or neurotoxic effects
(infections, oxidative stress, or autoimmune dysfunction) can alter brain
structure
How to find the structure: PET (shows blood flow and glucose
metabolism, shows brain activity), CT, MRI
Reduced volume in the right anterior insula, reduced volume and
changes in hippocampus, accelerated age related decline in
cortical thickness, gray matter deficits, reduced connectivity in brain
areas, neuronal overgrowth, widespread white matter
o Prenatal stressors: infections during or after pregnancy increases the
risk of mental illness
o Environmental factors: stress increases cortisol levels that can
precipitate the schizophrenia. Toxins are found in drinking water and can
contribute to schizophrenia, other factors include trauma or abuse,
exposure to psychological trauma, or social defeat. These factors can
cause structural changes
Identify the stages of schizophrenia (ie prodromal, acute, stabilization,
maintenance or residual)
o Prodromal: mild changes in thinking, reality testing, and mood
occurs. Speech and thoughts may be odd and anxiety obsessive
thoughts and compulsive behaviors are present, concentration
deteriorates, symptoms appear in 1-12 months before the full episode
o Acute: ability to function is impaired, hospitalization is required for
stabilization. mild to many and disabling, symptoms include
hallucinations, delusions, apathy, social withdrawal; diminished
affect, anhedonia, disorganized behavior, and impaired judgement
and cognition impairment. The person has difficulty coping, can last
several months
, o Stabilization: symptoms are stabilizing and diminishing and can
return to baseline functioning, can last for months, may receive care
in residential crisis center
o Maintenance or residual: new level of baseline functioning is
established and positive symptoms diminished or absent, but
negative and cognitive symptoms continue. Can be independent with
few or no symptoms
o Relapse is common, some have one or several episodes and none
thereafter, should be managed with treatment
Define the positive, negative, cognitive, and affective symptoms of schizophrenia
o Prodromal phase: assessing the prognosis, reducing risk factors
and reduce the risk of developing schizophrenia.
o Positive symptoms is when the symptoms should not be present,
includes hallucinations, delusions, paranoia, or disorganized or bizarre
thoughts.
It is when the symptoms appear early, precipitates treatment.
One symptom is alterations in reality testing, Reality testing is
the unconscious process is which we determine what is real
and not. Ex: hearing a voice but no one is there, conclusion is that
you are mistaken and was not real. Impaired reality testing
experiences hallucinations or delusions as real
Delusional are false beliefs, no evidence
Associative looseness: results from haphazard and illogical
thinking where concentration is poor and thoughts are loosely
connected. Ex: I like to dance; my feet are wet
Word salad: jumble of words, associative looseness
Clang association: choosing words based on sound and
meaning is used to rhyme or have similar beginning sound
Neologism: meaningful words to patient but nonexistent
meaning for others
Echolalia: repetition of another words or is unable to generate
words of their own
Magical thinking: believing that reality can be changed by
thoughts or unrelated actions
Paranoia: irrational fear
Hallucinations: sensory experience, no source exists: auditory
(hearing voices), visual: seeing things, olfactory: smelling odors,
gustatory: experience tastes, tactile: feeling bodily sensations
o Negative is the absence of qualities that should be present. It can
include the inability to enjoy activities, social discomfort, or lack of goal
oriented behavior
o Cognitive is when there is subtle or obvious impairment in memory,
attention, thinking, disorganized or irrational thoughts, impaired
judgement, impulse control, prioritization, and problem solving
o Affective is when symptoms are involving emotions and their expression
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