RN Nursing · Psychotic Disorders — Schizophrenia · Practice question
A nurse is speaking with the parent of a client who is experiencing manifestations of psychosis. The parent states, "I don't understand how a child can experience psychosis." Which of the following responses should the nurse make?
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"Recreational drugs that block histamine receptors cause manifestations of psychosis."
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"Low levels of acetylcholine in the brain may cause manifestations of psychosis."
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"Norepinephrine is a neurotransmitter that is primarily responsible for psychosis."
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✓
"Psychosis may be experienced when an individual has excessive amounts of glutamate in the brain."
Answer & explanation
Correct: "Psychosis may be experienced when an individual has excessive amounts of glutamate in the brain."
Psychosis has a neurobiological basis involving several neurotransmitter systems. The dopamine hypothesis has long been central to understanding psychosis, but research also implicates glutamate, specifically the N-methyl-D-aspartate (NMDA) receptor system. Excessive glutamate activity, or conversely NMDA receptor hypofunction, disrupts normal neurotransmission and can produce positive and negative symptoms of psychosis. This mechanism explains why psychosis can occur in anyone, including children, whose developing brains may be vulnerable to these dysregulations. Children are not immune to neurobiological changes that produce psychotic symptoms, which is the key teaching point for this parent. The distractor stating that recreational drugs blocking histamine receptors cause psychosis is inaccurate; substances associated with psychosis typically affect dopamine or glutamate pathways, not histamine. The option citing low acetylcholine is more associated with Alzheimer's disease and cognitive decline than with psychosis. Norepinephrine is primarily linked to mood and arousal disorders such as depression and anxiety rather than being the primary neurotransmitter responsible for psychosis. The glutamate explanation is the most scientifically accurate and provides the parent with a clear, evidence-based reason why psychosis can manifest in a child, helping them understand the disorder has a physiological foundation rather than being a behavioral or moral failing.
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