Topic 7

What is psychosis?

Loss of contact with reality resulting in impaired reality testing and inability to distinguish what is real from what is not.

What is the hallmark feature of all schizophrenia spectrum disorders?

Psychosis.

What disorders are included in the schizophrenia spectrum?

Delusional disorder, Brief Psychotic Disorder, Schizophreniform Disorder, Schizoaffective Disorder, Schizophrenia, Substance/Medication-Induced Psychotic Disorder, Psychotic Disorder due to a Medical Condition.

How long does Brief Psychotic Disorder last?

1 day to less than 1 month with full recovery.

How long does Schizophreniform Disorder last?

1 to 6 months.

How long must symptoms last for schizophrenia?

At least 6 months with at least 1 month of active symptoms.

What differentiates schizoaffective disorder from schizophrenia?

Schizoaffective disorder includes both psychotic symptoms and a mood disorder, with psychosis occurring for at least 2 weeks without mood symptoms.

Before diagnosing schizophrenia, what must always be ruled out?

Substance use and medical causes of psychosis.

What is the strongest risk factor for schizophrenia?

Genetics and family history.

Approximately what percentage of schizophrenia risk is genetic?

About 80%.

What neurotransmitters are involved in schizophrenia?

Dopamine, serotonin, glutamate, GABA, and acetylcholine.

What is the dopamine hypothesis?

Excess dopamine activity contributes to positive psychotic symptoms.

What structural brain changes occur in schizophrenia?

Reduced hippocampal volume, decreased prefrontal cortex activity, reduced brain connectivity, and abnormal neural pruning.

When does schizophrenia usually begin in males?

15-25 years old.

When does schizophrenia usually begin in females?

25-35 years old.

What factors worsen schizophrenia prognosis?

Late treatment, prolonged untreated illness, slow onset, and severe negative symptoms.

What substance use disorder is common in schizophrenia?

Nicotine dependence.

What percentage of clients with schizophrenia attempt suicide?

About 20%.

What percentage die by suicide?

Approximately 5-10%.

What dangerous fluid disorder may occur in schizophrenia?

Psychogenic polydipsia leading to hyponatremia.

What are the four phases of schizophrenia?

Prodromal, Acute, Stabilization, and Maintenance.

What occurs during the prodromal phase?

Subtle personality changes, social withdrawal, poor hygiene, odd thinking, declining work or school performance.

What occurs during the acute phase?

Active psychosis with hallucinations, delusions, and disorganized behavior.

What occurs during the stabilization phase?

Symptoms begin improving while the client learns coping skills and medication management.

What occurs during the maintenance phase?

Relapse prevention, medication adherence, and community support.

What are positive symptoms?

Abnormal behaviors added to normal functioning.

What are examples of positive symptoms?

Hallucinations, delusions, paranoia, bizarre behavior, catatonia, disorganized speech.

What are negative symptoms?

Normal functions that are absent or reduced.

What are the 6 A's of negative symptoms?

Anhedonia, Avolition, Asociality, Affective blunting, Apathy, Alogia.

What is anhedonia?

Inability to experience pleasure.

What is avolition?

Lack of motivation.

What is asociality?

Social withdrawal.

What is alogia?

Poverty of speech.

What is affective blunting?

Minimal emotional expression.

What is apathy?

Lack of interest or concern.

Which symptoms respond best to antipsychotic medications?

Positive symptoms.

Which symptoms are harder to treat?

Negative symptoms.

What are cognitive symptoms of schizophrenia?

Poor concentration, impaired memory, poor judgment, concrete thinking, impaired problem solving.

What is concrete thinking?

Interpreting information literally rather than abstractly.

What is anosognosia?

Lack of awareness of one's mental illness.

Why is anosognosia important?

It is a major cause of medication nonadherence.

What is the most common type of hallucination?

Auditory hallucinations.

What are command hallucinations?

Voices telling the client to perform actions.

Why are command hallucinations a psychiatric emergency?

They may direct the client to harm themselves or others.

What should the nurse always ask when a client reports hearing voices?

Are the voices telling you to do anything? Are they telling you to hurt yourself or someone else?

What are delusions?

Fixed false beliefs despite evidence to the contrary.

What is a persecutory delusion?

Believing others are trying to harm or kill you.

What is a grandiose delusion?

Believing you have exceptional power, identity, or importance.

What is a referential delusion?

Believing television, radio, or others are sending personal messages.

What is a somatic delusion?

False beliefs involving body function or disease.

What is a control delusion?

Believing outside forces control one's thoughts or actions.