NURS 406 – Psychiatric Mental Health Nursing Exam 2 Study Sheet
Modules 4-5
Module 4: Schizophrenia and Personality Disorders
Schizophrenia:
Schizophrenia: usually diagnosed in late adolescence or early adulthood; usually due to a stressor
• Onset: is 15 to 25 years of age for men; 25 to 35 years of age for women.
• Prevalence: is estimated at about 1% of total population
o United States: nearly 3 million people are, have been, or will be affected by the disease.
• Schizoaffective disorder:
o Client is severely ill.
o Mixture of psychotic (schizophrenic) and mood symptoms
Clinical Course:
• Onset: abrupt or insidious; most with slow, gradual development of signs and symptoms
• Diagnosis usually with more actively positive symptoms of psychosis
• Immediate-term course: two patterns
o Ongoing psychosis, never fully recovering
o Episodes of psychotic symptoms alternating with episodes of relatively complete recovery
• Long-term course: intensity of psychosis diminishes with age; disease becomes less disruptive; clients may live
independently later in life; many have difficulty functioning in the community.
Etiology: Biologic theories
• Genetic factors (genetic risk is polygenic)*
• Neuroanatomic and neurochemical factors (less brain tissue and cerebrospinal fluid; dopamine excess and serotonin
modulation of dopamine)
• Immunovirologic factors (viral exposure; cytokines)
o Researchers focusing on infections in pregnant women as a possible origin
▪ After influenza epidemics
▪ Respiratory ailments
Phase I: Prodromal phase
• Lasts from a few weeks to a few years
• Deterioration in role functioning and social withdrawal
• Sleep disturbance, anxiety, irritability
• Depressed mood, poor concentration, fatigue
• Can be focused on certain topics, such as religion, the government, or a particular public figure.
Phase II: Schizophrenia
• Psychotic symptoms: are prominent
o Delusions
o Hallucinations
o Impairment in work, social relations, and self-care
Phase III: Residual phase
• The more intense symptoms, like hallucinations, start to fade.
• Still have some strange beliefs.
• Likely to withdraw into oneself and talk less
• Trouble concentrating
• May become depressed with increased awareness
• Risk for suicide
Diagnostic Symptoms of Schizophrenia: 2 or more of the following (Delusions Herald Schizophrenic’s Bad News):
• Delusions
• Hallucinations
• Disorganized Speech
• Grossly disorganized or catatonic Behavior
• Negative symptoms
, Positive Symptoms of Schizophrenia: targets of antipsychotic medications
• Delusions
• Distortions
• Disorganized speech
• Disorganized, catatonic or agitated behavior
• Hallucinations
Delusions: Fixed, false beliefs, despite evidence
• Persecutory • Erotomanic
• Referential have reference to the individual i.e. news • Control
• Grandiose • Thought insertion: one’s thoughts are not truly their
• Somatic own; they belong to someone else and have been
• Guilt inserted into their mind
• Religious • Thought broadcasting: their thoughts are being
• Jealousy broadcasting to others
Assessment: Positive symptoms
➢ Content of thought:
• Delusions: false personal beliefs
• Religiosity: excessive demonstration of obsession with religious ideas and behavior
• Paranoia: extreme suspiciousness of others
• Magical thinking: ideas that one’s thoughts or behaviors have control over specific situations
➢ Form of thought:
• Associative looseness: (also called loose association): shift of ideas from one unrelated topic to another
• Neologisms: made-up words that have meaning only to the person who invents them
• Concrete thinking: literal interpretations of the environment (it’s raining cats and dogs)
• Clang associations: choice of words is governed by sound (often rhyming) Click, clack, clutch=
• Word salad: Jumble of words that is meaningless
• Perseveration: persistent repetition of the same word or idea in response to different questions
• Mutism: inability or refusal to speak
• Circumstantiality: delay in reaching the point of a communication because of unnecessary and tedious details
• Tangentially: inability to get to the point of communication due to introduction of many new topics
➢ Perception: interpretation of stimuli through the senses
• Hallucinations: false sensory perceptions not associated with real external stimuli
o Auditory
o Visual
o Tactile
o Gustatory
o Olfactory
• Illusions: misperceptions of real external stimuli (Pt states: <there’s a bat in my room=; RN: <Nah son, that’s a
jacket…=)
➢ Sense of self: The uniqueness and individuality a person feels
• Echolalia: repeating words that are heard
• Echopraxia: repeating movements that are observed
• Identification and imitation: taking on the form of behavior one observes in another
• Depersonalization: you persistently or repeatedly have the feeling that you're observing yourself from outside
your body
Assessment: Negative Symptoms
➢ 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
➢ Volition: impairment in the ability to initiate goal-directed activity
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Modules 4-5
Module 4: Schizophrenia and Personality Disorders
Schizophrenia:
Schizophrenia: usually diagnosed in late adolescence or early adulthood; usually due to a stressor
• Onset: is 15 to 25 years of age for men; 25 to 35 years of age for women.
• Prevalence: is estimated at about 1% of total population
o United States: nearly 3 million people are, have been, or will be affected by the disease.
• Schizoaffective disorder:
o Client is severely ill.
o Mixture of psychotic (schizophrenic) and mood symptoms
Clinical Course:
• Onset: abrupt or insidious; most with slow, gradual development of signs and symptoms
• Diagnosis usually with more actively positive symptoms of psychosis
• Immediate-term course: two patterns
o Ongoing psychosis, never fully recovering
o Episodes of psychotic symptoms alternating with episodes of relatively complete recovery
• Long-term course: intensity of psychosis diminishes with age; disease becomes less disruptive; clients may live
independently later in life; many have difficulty functioning in the community.
Etiology: Biologic theories
• Genetic factors (genetic risk is polygenic)*
• Neuroanatomic and neurochemical factors (less brain tissue and cerebrospinal fluid; dopamine excess and serotonin
modulation of dopamine)
• Immunovirologic factors (viral exposure; cytokines)
o Researchers focusing on infections in pregnant women as a possible origin
▪ After influenza epidemics
▪ Respiratory ailments
Phase I: Prodromal phase
• Lasts from a few weeks to a few years
• Deterioration in role functioning and social withdrawal
• Sleep disturbance, anxiety, irritability
• Depressed mood, poor concentration, fatigue
• Can be focused on certain topics, such as religion, the government, or a particular public figure.
Phase II: Schizophrenia
• Psychotic symptoms: are prominent
o Delusions
o Hallucinations
o Impairment in work, social relations, and self-care
Phase III: Residual phase
• The more intense symptoms, like hallucinations, start to fade.
• Still have some strange beliefs.
• Likely to withdraw into oneself and talk less
• Trouble concentrating
• May become depressed with increased awareness
• Risk for suicide
Diagnostic Symptoms of Schizophrenia: 2 or more of the following (Delusions Herald Schizophrenic’s Bad News):
• Delusions
• Hallucinations
• Disorganized Speech
• Grossly disorganized or catatonic Behavior
• Negative symptoms
, Positive Symptoms of Schizophrenia: targets of antipsychotic medications
• Delusions
• Distortions
• Disorganized speech
• Disorganized, catatonic or agitated behavior
• Hallucinations
Delusions: Fixed, false beliefs, despite evidence
• Persecutory • Erotomanic
• Referential have reference to the individual i.e. news • Control
• Grandiose • Thought insertion: one’s thoughts are not truly their
• Somatic own; they belong to someone else and have been
• Guilt inserted into their mind
• Religious • Thought broadcasting: their thoughts are being
• Jealousy broadcasting to others
Assessment: Positive symptoms
➢ Content of thought:
• Delusions: false personal beliefs
• Religiosity: excessive demonstration of obsession with religious ideas and behavior
• Paranoia: extreme suspiciousness of others
• Magical thinking: ideas that one’s thoughts or behaviors have control over specific situations
➢ Form of thought:
• Associative looseness: (also called loose association): shift of ideas from one unrelated topic to another
• Neologisms: made-up words that have meaning only to the person who invents them
• Concrete thinking: literal interpretations of the environment (it’s raining cats and dogs)
• Clang associations: choice of words is governed by sound (often rhyming) Click, clack, clutch=
• Word salad: Jumble of words that is meaningless
• Perseveration: persistent repetition of the same word or idea in response to different questions
• Mutism: inability or refusal to speak
• Circumstantiality: delay in reaching the point of a communication because of unnecessary and tedious details
• Tangentially: inability to get to the point of communication due to introduction of many new topics
➢ Perception: interpretation of stimuli through the senses
• Hallucinations: false sensory perceptions not associated with real external stimuli
o Auditory
o Visual
o Tactile
o Gustatory
o Olfactory
• Illusions: misperceptions of real external stimuli (Pt states: <there’s a bat in my room=; RN: <Nah son, that’s a
jacket…=)
➢ Sense of self: The uniqueness and individuality a person feels
• Echolalia: repeating words that are heard
• Echopraxia: repeating movements that are observed
• Identification and imitation: taking on the form of behavior one observes in another
• Depersonalization: you persistently or repeatedly have the feeling that you're observing yourself from outside
your body
Assessment: Negative Symptoms
➢ 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
➢ Volition: impairment in the ability to initiate goal-directed activity
2
