Schizophrenia and Other Thought Disorders – Flashcards

B. A 20 year old man Symptoms of schizophrenia generally appear in late adolescence or early adulthood. Some studies have indicated that symptoms occur earlier in men than in women

D. "There are many potential causes for this disease, and it's etiology is controversial." The etiology of schizophrenia remains unclear. No single theory or hypothesis has been populated that substantiates a clear-cut etiology for this disease. The more research that is conducted, the more evidence is compiled to support the concept of multiple causes in development of schizophrenia. The most current theory seems to be that schizophrenia is a biologically based disease with a genetic component. The onset of the disease also influenced by factors in the internal and external environment.

B. Effective treatment of schizophrenia requires a comprehensive, multidisciplinary effort, including pharmacotherapy and various forms of psychosocial care includes social and living skills training, rehabilitation, and family therapy

15%

50%

B. An excess of dopamine-dependent neuronal activity in the brain. The dopamine hypothesis suggests that schizophrenia may be caused by an excess of dopamine-dependent neuronal activity in the brain. The excess activity may be related to increased production, or release, of the substance at nerve terminals; increased receptor sensitivity; too many dopamine receptors; or a combination of these mechanisms. This etiology cal theory is from a biochemical influence perspective

B. Limited range of emotional experience and expression - high risk. Individuals diagnosed with schizoid personality disorder are indifferent to social relationships and have a very limited range of emotional experience and expression. They do not enjoy close relationships and prefer to be loners. They appear cold and aloof. Not all individuals who demonstrate the characteristics of schizoid personality disorder progress to schizophrenia, but most individuals diagnosed with schizophrenia show evidence of the characteristics of schizoid personality disorder pre morbidly, putting them at high risk for schizophrenia

A. Phase 1 - Schizoid Personality Individuals diagnosed with schizoid personality disorder are typically loners who appear cold and aloof and and are indifferent to social relationships. Not all individuals who demonstrates the characteristics of schizoid personality disorder progress to schizophrenia, but because of a family history of schizophrenia, this client's risk for acquiring the disease increases from 1% in general population to 10%

A. "Have these symptoms followed an active period of schizophrenic behaviors?" It is important for the nurse to know if this client has recently experienced an active phase of schizophrenia to distinguish the symptoms presented as indications of the Prodromal or residual phase of schizophrenia. Schizophrenia is characterized by periods of remission and exacerbation. A residual phase usually follows an active phase of the illness. Symptoms during the residual phase are similar to those of the Prodromal phase, with flat affect and impairment in role function being prominent

A. Markedly regressive, primitive behavior, and extremely poor contact with reality. Affect is flat or grossly inappropriate. Personal appearance is neglected, and social impairment is extreme. When a client exhibits markedly regressive and primitive behavior, and the client's contact with reality is extremely poor, he or she is most likely to be diagnosed with disorganized schizophrenia. In this subcategory, a client's affect is flat or grossly inappropriate. Personal appearance is neglected, and social impairment is extreme

B. Canonic Scizophrenia A client diagnosed with catatonic schizophrenia exhibits marked abnormalities in motor behavior manifested in extreme psychomotor retardation with pronounced decreases in spontaneous movements and activity. Waxy flexibility is exhibited. Waxy flexibility is a type of posturing or voluntary assumption of bizarre positions in which the individual may remain for long periods. Efforts to move the individual may be met with rigid bodily resistance. The client described in the question is exhibiting signs and symptoms of canonic schizophrenia

A, B, D, E The DSM-IV-TR lists the diagnostic criteria for the diagnosis of schizophrenia A. The duration of symptoms is an important finding to assess to determine the diagnosis of schizophrenia. One of the DSM-IV-TR criteria is that symptoms need to be present for a significant amount of time during a 1-month period and last for 6 months. B. The use of a substance may rule out the diagnosis of schizophrenia. One of the DSM-IV-TR criteria for this diagnosis is that presenting symptoms are not due to the direct physiological effects of the use or abuse of a substance or medication D. The presence of mood disorders is an important finding to assess to determine the diagnosis of schizophrenia. Schizoaffective disorder and mood disorder with psychotic features must be ruled out for the client to meet the criteria for the diagnosis. No major depressive, manic, or mixed episodes should have occurred concurrently with the active-phase symptoms. If mood episodes have occurred during the active-phase symptoms, their total duration should have been brief, relative to the duration of the active and residual periods. E. The ability to form relationships is an important finding to assess to determine the diagnosis of schizophrenia. One of the DSM-IV-TR criteria for this diagnosis is a disturbance in one or more major areas of functioning, such as work, interpersonal relationships, or self-care. When the onset is in adolescence, there should be a failure to achieve expected levels of interpersonal or academic functioning

D. The client is receiving medication that could lead to thought disturbances Steroid medications could precipitate the thought disorders experienced by the client and potentially rule out the diagnosis of schizophrenia. According to the DSM-IV-TR criteria for this diagnosis, the thought disturbance cannot be due to the direct physiological effects of a substance

D. The client's signs and symptoms last for 6 months The client's signs and symptoms lasting for 6 months is further evidence for the diagnosis of schizophrenia. Two or more characteristic symptoms must be present for a significant amount of time during a 1-month period and must last for 6 months to meet the criteria for the diagnosis of schizophrenia.

C. A persecutory delusion A persecutory delusion is a type of delusion in which the individual believes he or she is being malevolently treated in some way. Frequent themes include being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harasses, or obstructed in the pursuit of long-term goals.The situation described in the question reflects this type of delusion

B. Data will need to be gained by reviewing old records and talking with family Background assessment information must be gathered from numerous sources, including family members and old records. A client in an acute episode would be unable to provide accurate and insightful assessment information because of deficits in communication and thought.

D. "Client is experiencing a delusion of influence." A delusion of influence or control occurs when a client believes certain objects or persons have control over his or her behavior. The statement of the client is reflective of a delusion of influence.

C. Magical Thinking Magical thinking occurs when the individual believes that his or her thoughts or behaviors have control over specific situations or people. It is commonly seen during cognitive development in childhood. The statement presented is an example of magical thinking.

A. "The client is experiencing associative looseness." Associative looseness is thinking characterized by speech in which ideas shift from one unrelated subject or another. The client is unaware that the topics are unconnected. The client statement is an example of associative looseness

B. "I read the Bible every hour so that I will know what to do next." The statement "I read the Bible every hour so that I will know what to do next" is evidence of the symptom of religiosity. Religiosity is an excessive demonstration of or obsession with religious ideas and behavior. The client may use religious ideas in an attempt to provide rational meaning and structure to behavior

B. Echolalia, which is an attempt to acquire a sense of self and identity When client's diagnosed with schizophrenia repeat words that they hear, they are exhibiting echolalia. This is an indication of alterations in the client's sense of self. Weak ego boundaries cause these client's to lack feelings of uniqueness. Echolalia is an attempt to identify with the person speaking

D. The client imitates other people's physical movements. When client's imitate other people's physical movements, they are experiencing echopraxia. The behavior of echopraxia is an indication of alterations in the client's sense of self. These client's have been difficulty knowing where their ego boundaries end and others' begin. Weak ego boundaries cause these client's to lack feelings of uniqueness. Echopraxia is an attempt to identify with others.

C. The client exhibits no emotional expression Flat affect is described as affect devoid of emotional tone. Having no emotional expression is an indication of flat affect.

A. A client diagnosed with schizophrenia being followed up in an out-patient clinic. Group therapy for client's diagnosed with thought disorders has been shown to be effective, particularly in an out-patient setting and when combined with medication management.

D. Schizophrenia In the United States, the prevalence of schizophrenia is approximately 1%. It is recorded that 1.7 million American adults are diagnosed with the brain disorder of schizophrenia

D. Imbalanced fluid volume R/T increased serum levels All physiological problems must be corrected before evaluating thought disorders. In this situation, the psychotic symptoms may be related to the critically high sodium level. If the cause is physiological in nature, the nurse's priority is to assist in correcting the physiological problem. If the client's fluid volume imbalance is corrected, the psychotic symptoms, which are due to the medical condition of hyper atresia, would be eliminated, resulting in an improvement in sensory perceptual symptoms. This would improve the client's ability to communicate effectively and decrease the risk of dry mucous membranes.

C. Risk for suicide Risk for suicide is defined as a risk for self-inflicted, life-threatening injury. The negative symptom of anhedonia is defined as the inability to experience pleasure. This is a particularly distressing symptom that generates hopelessness and compels some client's to attempt suicide.

A. Impaired verbal communication Impaired verbal communication is defined as the decreased, delayed, or absent ability to receive, process, transmit, and use a system of symbols. Clang associations are choices of words that are governed by sound. Words often take a form of rhyming. An example of a clang association is "It is cold. I am bold. The gold has been sold." This type of language is an impairment to verbal communication.

D. Self-Care deficit Self-care deficit is defined as the impaired ability to perform or complete activities of daily living. The client's symptoms of body odor, halitosis, and a disheveled appearance are directly related to a self-care deficit problems

B. Interrupted family processes The nursing diagnosis of interrupted family processes is defined as a change in family relationships or functioning or both. This nursing diagnosis is reflected in the family's conflict related to an inability to accept the family member's diagnosis of schizophrenia

B. Risk for Suicide Risk for suicide is defined as the risk for self-inflicted, life-threatening injury. A past history of suicide attempts greatly increases the risk for suicide and makes this an appropriate diagnosis for this client. Because client safety is always the main consideration this diagnosis should be prioritized.

C. The client lives in an unsafe and unclean environment Impaired home maintenance can be related to regression, withdrawal, lack of knowledge or resources, or impaired physical or cognitive functioning in client's experiencing thought disorders. This is evidenced by an unsafe, unclean, disorderly home environment.

C. THe Client will actively participate in unit activities by discharge Actively participating in unit activities by discharge is an outcome for the nursing diagnosis of social isolation. Participation in unit activities indicates interaction with others on the unit, which leads to decreased social isolation.

A. The client will recognize distortions of reality by discharge When a client is hearing and seeing things others do not, the client is experiencing a hallucination, which is altered sensory perception. A hallucination is defined as a false sensory perception not associated with real external stimuli. Hallucinations may involve any of the five senses. Because schizophrenia is a chronic disease, some individuals, even when he compliant with antipsychotic medications, continue, continue to experience hallucinations. Recognizing distortions of reality by discharge is an appropriate outcome for the nursing diagnosis of altered sensory perception.

B. The client will take antipsychotic medications by discharge Taking antipsychotic medications by discharge is an appropriate outcome for this client's problem of no adherence. The outcome is realistic, client centered, and measurable.

C. The client will notify staff members of bothersome hallucinations When the client has the insight to recognize hallucinations and report them to staff members, the client is in better touch with reality and moving toward remission. This is an outcome that relates to the client's problem of altered sensory perception. Reporting to staff members also can assist in preventing the client from following through with the commands given by auditory hallucinations.

A. Check the client for body lice Before assuming that the client is experiencing a somatic delusion, the nurse first must rule out a physical cause for the client's symptoms, such as body lice. A somatic delusion occurs when an individual has an unsubstantiated belief that he or she is experiencing a physical defect, disorder, or disease.

C. "It must be frightening. I realize this is real to you, but I see no headless people." Empathize get with the client about the altered perception encourages trust and promotes further client communication about hallucinations. The nurse must follow this by presenting the reality of the situation. Client's must be assisted in accepting that the perception is unreal to maintain reality orientation.

B. Appreciate that the client has experienced disturbing delusional thinking. When the nurse conveys understanding that the client is experiencing delusional thinking, the nurse is showing empathy for the client's situation and building trust. This should be the first step to address the problem of disturbed thought processes. All further interventions would be based on the relationship's being established by generating trust.

A. Assign consistent staff members Individuals with paranoia have extreme suspicious of others and their actions. It is difficult to establish trust with client's experiencing paranoia. All interventions would be suspect. Only by assigning consistent staff members would there be hope to establish a trusting nurse-client relationship and increase the effectiveness of further nursing interventions

A. Offer self to build a therapeutic relationship with the client The client described in the question is exhibiting signs of paranoia. Client's with this symptom have trouble trusting others. The nurse should use the therapeutic technique of offering self to assist in building a trusting relationship with this client

D. The nurse should establish a relationship the client's dignity Successful interventions may best be achieved with honesty, simple directness, and a manner that respects the client's privacy and human dignity.

B. "Much patience is required during psychotherapy because client's often relapse" The psychotherapist requires much patience when treating client's diagnosed with schizophrenia. Depending on the severity of the illness, psychotherapeutic treatment may continue for many years before client's regain some degree of independent functioning.

B. "Not all client's diagnosed with schizoid personality disorders progress to schizophrenia." Not all individuals who demonstrate the characteristics of schizoid personality disorder progress to schizophrenia. However, most individuals diagnosed with schizophrenia show evidence of having schizoid personality characteristics in the pre morbid state.

B. Attach consequences to adaptive and maladaptive behaviors When the nurse attaches consequences to adaptive or maladaptive behaviors, the nurse is using behavioral therapy approach. Behavior therapy can be a powerful treatment tool for helping clients change undesirable behaviors

D. Emphasize the rules and expectations of social interactions mediated by peer pressure. When the nurse emphasizes the rules and expectations of social interactions mediated by peer pressure, the nurse is using milieu therapy emphasizes group and social interaction. Rules and expectations are mediated by peer pressure for normalization of adaptation.

A, C, E A. Symptoms of schizophrenia generally appear in late adolescence or early adulthood. Onset at a later age is associated with a more positive prognosis C. Abrupt onset of symptoms precipitated by a stressful event, such as rape, is associated with a more positive prognosis. Being female also is associated with a more positive prognosis E. A family history of mood disorder is associated with a more positive prognosis

A, B, C E

D. Onset of psychotic symptoms within 4 weeks of noticeable behavioral change. When a client has little or no interest in work or school activities, the client is exhibiting the negative symptom of apathy. Apathy is indifference to, or disinterest in, the environment. Flat affect is a manifestation of emotional apathy. Because this client is exhibiting a negative symptom, the client has the potential for a poorer prognosis.

B. Research shows that with continuous antipsychotic drug treatment, the relapse rate of clients diagnosed with schizophrenia can be reduced to approximately 30%

D

D

c

C

D

A, B, C

B

C Clozapine (Clozaril), an atypical antipsychotic, is used to treat symptoms of thought disorders, such as, but not limited to, psychoses.