KNOWLEDGE CHECK: PSYCHOLOGICAL DISORDERS NURS 6501

KNOWLEDGE CHECK: PSYCHOLOGICAL DISORDERS NURS 6501

KNOWLEDGE CHECK: PSYCHOLOGICAL DISORDERS NURS 6501

Question 1

4 out of 4 points

Scenario 1: Schizophrenia

A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying.

PMH:  noncontributory

FH: positive for a first cousin who “had mental problems”.

SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.

PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.

DIAGOSIS: schizophrenia.

Questions

1.     What are known characteristics of schizophrenia and relate those to this patient.  

Selected Answer: Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in hallucinations, delusions, and extremely disordered thinking and behavior that impair daily functioning and can be disabling. Schizophrenia involves a range of problems with thinking (cognition), behavior, and emotions. Signs and symptoms of schizophrenia may vary but usually involve delusions, hallucinations, or disorganized speech and reflect an impaired ability to function.

1-  Delusions: These are false beliefs not based on reality. For example, you think that you are being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you, or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.

2- Hallucinations: These usually involve seeing or hearing things that do not exist. Nevertheless, the person with schizophrenia has the full force and impact of a normal experience. Hallucinations can be in any sense, but hearing voices is the most common hallucination.

3- Disorganized thinking (speech): Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that cannot be understood, sometimes known as word salad.

4- Extremely disorganized or abnormal motor behavior: This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, so it is hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.

5- Negative symptoms: This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (does not make eye contact, does not change facial expressions, or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience a pleasure.

Certain factors seem to increase the risk of developing or triggering schizophrenia, including having a family history of schizophrenia; some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development; taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood.

In summary, Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, mind-reading, the delusion of reference, grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion, and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantiality, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyping, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution.

Correct Answer:  

Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, delusion of mind reading, delusion of reference, delusion of grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantially, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyped, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution.

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  • Question 2

4 out of 4 points

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Scenario 1: Schizophrenia

A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying.

PMH:  noncontributory

FH: positive for a first cousin who “had mental problems”.

SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.

PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.

DIAGOSIS: schizophrenia.

Question:

1.     Genetics are sometimes attached to schizophrenia explain this.

Selected Answer: The causes of schizophrenia are not known. There are probably at least two sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. Increased paternal age is associated with a greater risk of schizophrenia. The risk of schizophrenia is elevated in biological relatives of persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins. Genome-wide association studies have identified many candidate genes. However, the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way.
Correct Answer:  

The causes of schizophrenia are not known. There are probably at least 2 sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. Increased paternal age is associated with a greater risk of schizophrenia. The risk of schizophrenia is elevated in biologic relatives of persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins. Genome-wide association studies have identified many candidate genes, but the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way.

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