(Chapter 12) Schizophrenia Spectrum Disorders

What is psychosis?

it refers to altered cognition, altered, perception, and/or an impaired ability to determine what is or what is not real

What is the prodromal phase?

it is in which milder symptoms of the disorder occur, often months or years before the full disorder becomes manifested

What is cognitive impairment?

it is difficulties with memory, concentration, decision-making, and problem-solving

What are positive symptoms?

they our presence of symptoms that should not be present

• hallucinations

• delusions

• paranoia

• disorder or bizarre thoughts, behavior, or speech

What are negative symptoms?

they are the absence of qualities that should be present

• Inability to enjoy activities (anhedonia)

• social discomfort

• lack of goal directed behavior

What are affective symptoms?

they are symptoms involving emotions and their expression

What is reality testing?

it is the automatic and unconscious process by which we determine what is and is not real

What our delusions?

they are false beliefs that are held despite a lack of evidence to support them

What is associative looseness?

it results from haphazard and illogical thinking where concentration is poor and thoughts are only loosely connected

• also know as looseness of association

What is clang association?

it is choosing words based on their sound rather than their meaning and often involve words that rhyme or have similar beginning sounds

• ex: “On the track … have a Big Mac” or “Click, clack,clutch,close”

What are neologisms?

• they are words that have a meaning for the patient but a different or nonexistent meaning for others

• a patient may use a known word differently than others or create a completely new word that others do not understand

• ex: “His mannerologies are poor”

What is paranoia?

• it is an irrational fear, ranging from mild (being suspicious, weary, guarded) to profound (believing irrationally that other person intends to kill them)

• fear may result in dangerous defensive actions, such as harming another person before that person can harm the patient

What are hallucinations?

they occur when a person perceives a sensory experience for which no external source exists (e.g.,hearing a voice when no one is speaking)

• auditory: hearing voices or sounds

• visual: seeing people or things

• olfactory: smelling odors that are not there

• gustatory: ex experiencing taste that are not there

• tactile: Phil bodily sensations (e.g., ceiling and insect crawling on one’s skin)

What are command hallucinations?

they are particularly concerning symptoms of hallucinations, where in the person is directed to take an action

• ex: the hallucinations may be telling a patient “ jump out the window” or “ hit that nurse”

• these are often frightening and may be a flag warning of a psychiatric emergency

What are illusions?

they are misinterpretations of a real experience

• ex: a man sees a code on a shadowy coat hanger and believes it to be a bear

What is echopraxia?

it is the mimicking of movements of another

What is concrete thinking?

it is an impaired ability to think abstractly, resulting in interpreting or proceeding things in a literal manner

• ex: a nurse might ask what brought the patient to the hospital, and the patient answers “ a cab” rather than “ a suicide attempt”

What is executive functioning?

• it includes difficulty with reasoning, setting priorities, comparing options, placing things in logical, order or groups, anticipating and planning, and in inhibiting, undesirable impulses or actions

• it interferes with problem-solving and contribute to inappropriateness in social situations

What is anosognosia?

it is the inability to realize of one is ill- an inability caused by the illness itself

• it may lead to the patient to resist or stop treatment, making care more challenging and frustrating to others

• It can interfere with requesting or accepting help

What is the recovery model?

it stresses hope, living a full and productive life, and eventual recovery rather than forcing on controlling symptoms and adapting to disability

What are extrapyramidal side effects EPS)?

they refer to a group of drug induced movement disorders that are primarily associated with the use of antipsychotic medication

• dystonia: involuntary muscle contractions that can cause twitching and repetitive movements

• akathisia: a feeling of inner restlessness and an uncontrollable need to be in constant motion

• parkinsonism: symptoms, resembling Parkinson’s disease, such as tremors, rigidity, and bradykinesia (slowness of movement)

• tardive dyskinesia: a specific type of EPS characterized by repetitive, involuntary movements, particularly in the face and mouth, which can develop after long-term use of antipsychotic medications

What are antipsychotic medications?

they are used to treat psychotic disorders, such as schizophrenia

What are long-acting injectable (LAI)?

they are antipsychotic formulations that need to be administered only every 2 to 4 weeks or even months

• The conflict of taking medications is reduced, and adherence is improved

What is acute dystonia?

it is a sudden, sustained contraction of one or several muscle groups, usually of the head and neck

• it can be frightening and uncomfortable, but unless they involve muscles affecting the airway, which is rare, they are not dangerous

• they can cause significant anxiety

What is akathisia?

it is a motor restlessness that causes pacing and/or an inability to stay still or remain in one place

• it can be severe and distressing to patients and can mistaken for anxiety or irritation

What is pseudoparkinsonism?

it is a temporary group of symptoms that resemble Parkinson’s disease: trimmer, reduced accessory movement (e.g., arms swinging when walking), gate impairment, reduce facial expressiveness (mask facies), and slowing of motor behavior (bradykinesia)

What is tardive bradykinesia?

it persistent EPS involving involuntary rhythmic movements

• more common with first generation antipsychotics, usually after prolonged treatment, and usually persists, even after the medication has been discontinued

• smoking , alcohol, and stimulant use may increase the risk of this form of EPS

What is metabolic syndrome?

it includes weight gain (especially in the abdominal area), dyslipidemia, increase blood, glucose, and insulin resistance

What is anticholinergic toxicity?

it is a potentially life-threatening medical emergency caused by antipsychotics or other antiallergic medication, including many antiparkinsonian drugs, and over-the-counter cold/allergy medicines

What is neuroleptic malignant syndrome?

it is caused by excessive dopamine receptor blockage, occurs in about 0.2% to one percent of patients who have taken first generation antipsychotics

• it is characterized by reduced consciousness and responsiveness, increased muscle tone (generalized muscle rigidity), and autonomic dysfunction

What is severe neutropenia?

it is most often associated with clozapine (Clozaril), but is also possible with most other antipsychotics

• Severe neutropenia is a acute condition involving a dangerously low white blood cell count, which increases the risk of serious illness