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NUR372 Mental Health > Alterations in Cognition > Flashcards

Alterations in Cognition Flashcards

1
Q

Schizophrenia Overview

A

1 in 100 people, 1% in Canada
any race, culture or SE group

substance abuse disorder occurs in nearly 50% of persons diagnosed

gradually prodromal phase, often mistaken for difficult behaviour

phenomenological picture varies

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2
Q

Epidemiology of Schizophrenia

A

age of onset
- late teens, early twenties (5-45yo)

gender difference
- men early 20s, women late 20s

comorbid conditions
- depression, substance abuse, anxiety, OCD

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3
Q

Etiology of Schizophrenia

A

Biological/biochemical

  • overactive neuronal activity r/t excessive dopamine transmission
  • genetics

Psychosocial

  • coping
  • sensitivity and vulnerability to personal, family and environmental stress
  • risk and protective factors
  • social support
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4
Q

Risk Factors for Schizophrenia

A

perinatal complications

  • traumatic delivery
  • maternal malnutrition
  • exposure to toxins
  • hypoxia
  • in utero exposure to influenza viruses
  • late winter or early spring births
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5
Q

Prodromal phase of early psychosis

A

from onset of unusual behaviour to onset of psychotic symptoms

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6
Q

Schizophrenia Diagnosis

A

a. impaired functioning
- social or occupational below previously achieved level

b. signs of illness persist at least 6 months, 1 month of active symptoms
c. Two out of five symptoms:

Positive - delusions, hallucinations, disorganized speech, abnormal behaviour (excessive dopamine, hyperstimulation of D2 receptors)

Negative - such as impairments, anhedonia, blunted affect

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7
Q

Schizophrenia Subtypes

A

paranoid, disorganized, catatonic, undifferentiated, residual

subtypes are eliminated because they are not stable conditions, no significant clinical utility or scientific validity and reliability

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8
Q

Delusions

A

false belief based on incorrect inference about external reality
firmly held despite objective and contradictory proof

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9
Q

Overvalued idea

A

belief or idea sustained beyond the bounds of reason

held with less intensity or duration than delusions

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10
Q

Preoccupation

A

thought content centred on a particular idea with strong affective tone
- suicidal, homicidal, paranoid trend

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11
Q

Delusions of Reference

A

behaviour of others refers to self

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12
Q

Delusions of Control

A

false belief that one’s will, thoughts or feelings are being controlled by external forces

  • thought insertion
  • thought withdrawal
  • thought broadcasting
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13
Q

Bizarre Delusion

A

false belief that is absurd or fantastic beyond the range of possibility

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14
Q

Alogia

A

poverty of thinking and speech

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15
Q

Affective flattening or blunting

A

lack of emotional expression

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16
Q

Avolition

A

unable to start tasks, lack of motivation

17
Q

Anhedonia

A

unable to experience enjoyment

18
Q

Attentional Impairment

A

social inattentiveness

hypostimulation of D1 receptors

19
Q

Treatment for Schizophrenia

A

a. psychopharmacological
b. training in illness self-management
c. case management (ACT)
d. family psychoeducation
e. supported employment
f. integrated substance abuse treatment
g. ECT
h. brain exercise

20
Q

Interaction Strategies for those with altered realities or disordered thoughts

A
  • accept and make effort to understand
  • decrease stimuli, redirect to quieter areas
  • use focused questions deliberately
  • listen for themes, seek clarification
    • focus on how they feel and not the content
  • avoid arguing or explain
  • be aware of non-verbal communication
  • reorient calmly
21
Q

Dos and Don’ts (with disordered thoughts)

A

Do

  • open, empathic, describe their experience
  • observe for triggers and help reduce
  • ask about feelings
  • focus on reality based thoughts

Don’t

  • react
  • negate their experience
  • underestimate feelings
  • don’t dwell
22
Q

Antipsychotic Medications

A
  1. Conventional
    - typical, first generation
    - more side effects, i.e. EPS
    - dopamine antagonist
  2. Novel
    - atypical, second generation
    - serotonin-dopamine antagonist

efficacy requires:

  • assessment
  • appropriate dosing and duration
  • management of side effects
23
Q

First Generation or Typical Antipsychotics

A

*treats positive symptoms but can cause EPS

Loxapine (loxitane)
Haloperidol (Haldol)
Chlorpromazine (Thorazine)

24
Q

Extrapyramidal Side Effects (EPS)

A
  • tardive dyskinesia
  • pseudoparkinsonian symptoms
    ridigity, mask-like facial expression, stiff gait
  • restlessness, akathisia
  • weakness
  • muscle fatigue
  • slowed movements
  • oculogyric crisis
    prolonged involuntary upward deviation of the eyes
25
Q

Ancillary Medications

A

a. antidepressants
b. benzodiazepines (anxiety or sleep disturbance)
c. antidyskinetics
benztropine (Cogentin)
d. anticonvulsant (mood stabilizer?)
Carbamazapine (Tegratol)
Divolproex (Epival)

26
Q

Second Generation or Atypical Antipsychotics

A

*Relieves both positive and negative symptoms with fewer EPS

Risperidone (Risperdal)
Olanzapine (Zyprexa)
Clozapine (Clozaril)
Aripiprazole (Abilify)
Quetiapine (Seroquel)
27
Q

Neuroleptic Malignant Syndrome (NMS)

A

an extremely serious reaction to neuroleptic drugs and dopamine blockage, at high doses of neuroleptic

onset:

  • elevated temperature
  • labile blood pressured
  • elevated CPK
  • altered LOC
  • rigidity
  • diaphoresis
  • tachycardia

treatment:

  • discontinue medication
  • keep cool
  • hydrate well
28
Q

Schizophreniform Disorder

A

identical to schizophrenia except symptoms lasts at least 1 month but no longer than 6 months, return to baseline functioning after exacerbation

29
Q

Schizoaffective Disorder

A

features of both schizophrenia and mood disorder

  • manic or depressive episode while exhibiting positive symptoms of schizophrenia
  • delusions or hallucination present for 2 weeks without prominent mood symptoms
  • symptoms of mood episode last for substantial portion of the total illness
30
Q

Delusional Disorder

A

delusions are non-bizarre for at least 1 month
never had characteristic symptoms of schizophrenia
disturbances does not markedly impair functioning

  • persecutory
  • grandiose
  • somatic (investigate medical condition)
  • religious (unusual religious experiences)
  • guilt
  • jealous
  • erotomanic
  • mixed
31
Q

Brief Psychotic Disorder

A

duration of 1 day but less than a month with full return to normal functioning

32
Q

Substance Induced Psychotic Disorder

A

Prominent hallucination or delusions

33
Q

Psychotic Disorder NOS (not otherwise specified)

A

when there is not enough information for more specific diagnosis

NUR372 Mental Health (16 decks)

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