Schizophrenia Spectrum Disorders and Other Psychotic Disorders

Comprehensive practice flashcards covering etiology, diagnostic criteria, positive and negative symptoms, nursing communication strategies, and pharmacological treatments for schizophrenia and related psychotic disorders.

From what Greek root words is the term 'schizophrenia' derived, and what are their literal meanings?

It is derived from 'schiz', which means split, and 'phren', which means mind.

What is the worldwide lifetime prevalence of schizophrenia, and how does it vary across demographic factors?

The lifetime prevalence worldwide is $1\%$, with no differences based on race, social status, culture, gender, or environment.

According to diagnostic criteria, what signs are required for a diagnosis of schizophrenia and for what minimum duration must they persist?

Two or more of the following: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms, continuing for $6+$ months.

How is schizophreniform disorder differentiated from schizophrenia in terms of symptom duration?

Schizophreniform disorder presents with similar signs and symptoms to schizophrenia but lasts for a shorter duration of $1\text{ to }6\text{ months}$.

What is the characteristic duration of brief psychotic disorder before a return to normal functioning?

$1\text{ day to }1\text{ month}$.

What defines schizoaffective disorder?

A mood disorder occurring at the same time as active symptoms of schizophrenia.

What are the diagnostic features of delusional disorder?

Nonbizarre delusions present for at least $1\text{ month}$ without overall impairment in functioning.

What are the four phases that describe the clinical course of schizophrenia?

Prodromal (Pre-illness), Acute, Stabilization, and Maintenance.

How are positive symptoms distinguished from negative symptoms in schizophrenia?

Positive symptoms indicate an excess or distortion of normal functioning that often precipitate hospitalization, whereas negative symptoms represent a loss or lack of normal functioning that develops over time and hinders daily roles.

According to Fig. 17.1, what four treatment-relevant symptom dimensions make up the syndrome of schizophrenia?

Positive symptoms, Negative symptoms, Cognitive symptoms, and Mood symptoms.

What are examples of florid positive symptoms in schizophrenia?

Hallucinations, delusions, illusions, concrete thinking, associative looseness, personal boundary difficulties (depersonalization and derealization), and bizarre behaviors.

What are primary negative symptoms observed in schizophrenia?

Apathy, lack of motivation, anhedonia, blunted or flat affect, avolition, poverty of speech, social withdrawal, and thought blocking.

A patient with schizophrenia states, 'There are worms under my skin eating the hair follicles.' How should this finding be classified?

As a positive symptom.

A patient brushes their teeth with scouring powder because the label says 'it brightens everything.' Which clinical term describes this interaction?

Concrete thinking.

What is the overall goal of care during the acute phase of schizophrenia?

Patient safety and medical stabilization.

What are key nursing communication guidelines when interacting with a patient experiencing hallucinations or delusions?

Approach in a nonthreatening and nonjudgmental manner, identify feelings, clarify reality, avoid arguing or attempting to reason with delusions, interact about concrete reality, and distract attention.

What communication techniques are recommended when caring for a patient who is paranoid?

Be honest and consistent, and avoid talking, laughing, or whispering when the patient cannot hear what is being said.

How should a nurse respond when communicating with a patient exhibiting associative looseness?

Do not pretend to understand, inform the patient that you are having difficulty understanding, look for recurring topics or themes, and emphasize the 'here and now'.

What is the primary focus of the Program for Assertive Community Treatment (PACT)?

To prevent relapse, maximize social and vocational functioning, and maintain the individual in the community.

What is the therapeutic goal of Cognitive-Behavioral Therapy (CBT) in schizophrenia?

To help reduce the frequency and intensity of delusions and hallucinations.

What is the pharmacological mechanism of action of atypical (second-generation) antipsychotics?

They act as serotonin and dopamine antagonists.

What serious hematological adverse effect is associated with clozapine, occurring in up to $1\%$ of patients?

Agranulocytosis.

What is the mechanism of action of conventional (first-generation) antipsychotics?

Dopamine antagonism at D2 receptor sites in both the limbic and motor areas of the brain.

What are the four primary extrapyramidal symptoms (EPS) associated with conventional antipsychotics?

Tardive Dyskinesia (TD), Acute Dystonia, Akathisia, and Pseudoparkinsonism.

Which two life-threatening side effects are associated with conventional antipsychotic medications?

Neuroleptic malignant syndrome (NMS) and agranulocytosis.

What assessment tool is used for early recognition of extrapyramidal symptoms (EPS) in patients taking antipsychotics?

The Abnormal Involuntary Movement Scale (AIMS).

Which four clinical indicators must be monitored to evaluate for metabolic syndrome in patients taking antipsychotics?

Weight gain, glucose abnormalities, elevated lipids, and blood pressure.

What effect does tobacco smoking have on antipsychotic drug levels?

Smoking decreases plasma levels of antipsychotic medications.

Why should patients taking antipsychotics avoid caffeine consumption?

Caffeine can decrease the effectiveness of antipsychotic medications.

What are the core components of milieu therapy in the treatment of schizophrenia?

Safety (protecting the patient and others), a structured routine, group therapy, supervised activities, individual counseling, specialized training, and rehabilitation.