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41 Cards in this Set
- Front
- Back
Phase I of Schizophrenia |
Premorbid phase Social maladjustment Antagonistic thoughts and behavior Shy and withdrawn Poor peer relationships Doing poorly in school Antisocial behavior |
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Phase II of Schizophrenia |
Prodromal phase Lasts from a few weeks to a few years Deterioration in role functioning and social withdrawal Substantial functional impairment Sleep disturbance, anxiety, irritability Depressed mood, poor concentration, fatigue Perceptual abnormalities, ideas of reference, and suspiciousness herald onset of psychosis |
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Phase III of Schizophrenia |
Schizophrenia In the active phase of the disorder, psychotic symptoms are prominent Delusions Hallucinations Impairment in work, social relations, and self-care |
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Phase IV of Schizophrenia |
Residual phase
Symptoms similar to those of the prodromal phase
Flat affect and impairment in role functioning are prominent |
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Delusional Disorder |
Characterized by the presence of delusions that have been experienced by the individual for at least 1 month
Types: Grandiose, Jealous, persecutory, somatic |
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Brief Psychotic disorder |
Sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor
lasts less than one month |
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Substance induced psychotic disorder |
The prominent hallucinations and delusions associated with this disorder are found to be directly attributable to substance intoxication or withdrawal or after exposure to a medication or toxin |
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The catatonic features specifier |
Catatonic features may be associated with other psychotic disorders
Stupor and muscle rigidity or excessive, purposeless motor activity
Waxy flexibility, negativism, echolalia, echopraxia |
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Schizophreniform Disorder |
Same symptoms as schizophrenia
duration at least 1 month > 6 months |
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Schizoaffective Disorder |
Schizophrenic symptoms plus mania or depression |
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1. A client is admitted with a diagnosis of brief psychotic disorder, with catatonic features. Which symptoms are associated with the catatonic specifier? a) Strong ego boundaries and abstract thinking b) Ataxia and akinesia c) Stupor, muscle rigidity, and negativism d) Substance abuse and cachexia |
Correct answer: C Symptoms associated with the catatonic specifier include stupor and muscle rigidity or excessive, purposeless motor activity. Waxy flexibility, negativism, echolalia, and echopraxia are also common behaviors. |
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Delusions |
False personal beliefs |
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Religiosity |
Excessive demonstration of obsession with religious ideas and behavior |
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Paranoia |
Extreme suspiciousness of others |
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Magical Thinking |
Ideas that one's thoughts or behaviors have control over specific situations |
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Associative looseness (loose association) |
Shift in ideas from one unrelated topic to another |
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Neologisms |
Made-up words that have meaning only to the person who invents them |
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Concrete thinking |
Literal interpretations of the environment |
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Clang Associations |
Choice of words is governed by sound (often rhyming) |
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Word Salad |
Group of words put together randomly |
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Circumstantiality |
Delay in reaching the point of communication due to unnecessary and tedious details |
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Tangentiality |
Inability to get to the point of communication due to introduction of many new topics |
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Mutism |
Inability or refusal to speak |
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Perseveration |
persistent repetition of the same word or idea in response to different questions |
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2. The client hears the word “match.” The client replies, “A match. I like matches. They are the light of the world. God will light the world. Let your light so shine.” Which communication pattern does the nurse identify? a) Word salad b) Clang association c) Loose association d) Ideas of reference |
Correct answer: C Loose association is characterized by communication in which ideas shift from one unrelated topic to another. The situation in the question represents this communication pattern. |
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Hallucinations |
False sensory perceptions not associated with real external stimuli
Auditory Visual Tactile Gustatory Olfactory |
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Illusions |
Misperceptions of real external stimuli |
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Echolalia |
Repeating words that are heard |
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Echopraxia |
Repeating movements that are observed |
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Identification and imitation |
Taking on the form of behavior one observes in another |
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Depersonalization |
Feelings of unreality |
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Negative Symptoms |
Loss of normal function |
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Affect |
The feeling state or emotional tone
Inappropriate affect: emotions are incongruent with the circumstances Bland: weak emotional tone Flat: appears to be void of emotional tone Apathy: disinterest in the environment |
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Volition |
Impaired ability to initiate goal-directed activity
Emotional ambivalence
Deterioration in appearance |
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Impaired interpersonal functioning |
Impaired social interaction clinging and intruding on the personal space of others exhibiting behaviors that are not culturally and socially acceptable Social isolation Focus inward and exclusion of external environment |
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Psychomotor behavior |
Anergia: deficiency of energy Waxy flexibility Posturing: voluntary assumption of inappropriate or bizarre postures Pacing and rocking
Associated features Anhedonia: inability to experience pleasure Regression: retreat to an earlier level of development |
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4. To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? a) Reinforce the perceptual distortions until the client develops new defenses b) Provide an unstructured environment c) Avoid making connections between anxiety-producing situations and hallucinations d) Distract the client's attention |
Correct answer: D The nurse should first empathize with the client by focusing on feelings generated by the hallucination, present objective reality, and then distract or redirect the client to reality-based activities. |
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5. A client, diagnosed with paranoid schizophrenia, states, “My roommate is plotting to have others kill me.” Which is the appropriate nursing response? a) “I find that hard to believe.” b) “What would make you think such a thing?” c) “I know your roommate. He would do no such thing.” d) “I can see why you feel that way.” |
Correct answer: A This client is experiencing a persecutory delusion. This nursing response is an example of “voicing doubt,” which expresses uncertainty as to the reality of the client’s perceptions. This is an appropriate therapeutic communication technique in dealing with clients who are experiencing delusional thinking. |
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Typical Antipsychotics |
Haldol/Thorazine
Greater EPS SE: tardive dyskanisia, dystonia, ataksia, parkinsonism
EPS reversal: Cogentin and benadryl |
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Atypical Antipsychotics |
Geodon/Seroquel/Clozaril/Risperdal/Zyprexa
Less EPS SE
Treats positive and negative symptoms of Schizophrenia |
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6. A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms (EPS) of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order? a) Paroxetine (Paxil) b) Carbamazepine (Tegretol) c) Benztropine (Cogentin) d) Lorazepam (Ativan) |
Correct answer: C Benztropine is an anticholinergic medication that blocks cholinergic activity in the central nervous system, which is responsible for EPS. Anticholinergics are the drugs of choice to treat extrapyramidal symptoms associated with antipsychotic medications. |