Altered Thought Processes Flashcards
what is psychosis
A syndrome of neurocognitive symptoms that impairs cognitive capacity,
leading to deficits of perception, functioning, and social relatedness
what are the 5 symptomatic domains of psychosis
Delusions
Hallucinations
Disorganized thought
Disorganized or abnormal motor behavior
Negative symptoms
what is primary psychosis
A psychiatric cause, i.e. schizophrenia, schizoaffective DO
Psychobiological origin (genetic & neural pathways) makes future episodes
more likely to occur
what is secondary psychosis
Contributing cause, i.e. substance intoxication, delirium, or dementia
Have a greater chance to recover
what can psychosis do
Unregulated neural circuits release inflammatory markers that degrade
the circuit
can cause dementia
is there a genetic link btwn scizophrenia
yes
neurobio of scizo
Dopamine hypothesis (associated
with positive symptoms)
* Increased dopamine production
* Increased release of dopamine
* Increased receptor sensitivity
* Increased dopamine receptors
other nts involved in scizo
norepinephrine, serotonin, acetylcholine, GABA, and glutamate, loss of grey matter, ventricular enlargement
excess or not enough serotonin in scizo
excess
what do glutamate levels do
Increase during stress
First episode of psychosis
precipitated by stress
Hippocampus becomes
hypermetabolic then atrophies
Common finding in schizophrenia –
research to identify new biomarkers
to signal early illness, prevention, &
treatment
positive symptopns of scizo
overt symptoms that should not be present
hallucinations
delusions
disorganized thoughts
negative symtpoms of scizo
does not refer to attitude, but instead a lack of characteristics that should be present
reduced speech
lack of emotional and facial expression
diminished abiligt to begin and sustain activities
decreased ability to find pleasure in everyday
social w/draw
cognitive deficits
difficilties w/ following aspects of cognition can make it hard to live a normal life or earn a living
memory
attention
planning
decision making
what are delusions
Fixed false personal belief that does not
change when confronted with conflicting evidence
what are persecutory delusions
paranoid
what are grandiose delusions
exaggerated feeling of importance
somatic delusions
body function
erotomanic delusions
in love with him or her
jealous delusions
irrational w/out cause
reference delusions
Events in environment refer to him
or her, i.e. radio is talking to them
what is paranoia
Extreme suspiciousness of others
what is magical thinking
Ideas that one’s thoughts or
behaviors have control over specific situations
wha is loose associaion
Shift of ideas from one unrelated topic to another
what are neologisms
Made-up words that have meaning only to the person who invents them
what is concrete thinking
Literal interpretations of the environment
what are clang associations
Choice of words is governed by sound (often rhyming)
what is word salad`
Group of words put together in a random fashion
what is circumstantiality
Delay in reaching the point of a communication because of unnecessary
and tedious details
what is tangentiality
Inability to get to the point of communication due to introduction of many new
topics
what is perseveration
Persistent repetition of the same word or idea in response to different
questions
what hallucination is most common in scizo
auditory
what are illusions
misperceptions of real external stimuli
what is echolalia
repeating words that are heard
what is echopraxia
repeating movements that are observed
what is apathy
disinterest in the enviornment
what is avolition
Impairment in the ability to
initiate goal-directed activity
what is emotional ambivalence
Coexistence of
opposite emotions toward same
object, person, or situation
what is associality
Impaired interpersonal functioning and relationship external world
what is anergia
deficiency of energy
what is anosognosia
Impairment of a person’s ability to
understand and perceive their illness
what is waxy flexibilty
Passive yielding of all movable parts of the body to any effort
made at placing them in certain positions
what is posturing
voluntary assumption of inappropriate or bizarre postures
what is catatonia
Significant motor disturbance that may range from stupor (no motor
activity) to excessive motor activity and agitation
FGA/Typical antipsychotics moa
block postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla
address positive symptoms
loxapine
fga/typical antipsychotics
haloperidol
fga/typical antipsychotics
PIMOZIDINE
fga/typical antipsychotics
cholpromazine
fga/typical antipsychotics
fluphenazine
fga/typical antipsychotics
mesoridazine
fga/typical antipsychotics
perphenazine
fga/typical antipsychotics
prochlorperazine
fga/typical antipsychotics
sg2/atypical antipsychoitcs moa
weaker dopamine receptor antagonists than FGAs
but are more potent antagonists of the serotonin 5HT2A receptors
clozapine
SGA/Atypical antipsychotics
risperodone
SGA/Atypical antipsychotics
paliperidone
SGA/Atypical antipsychotics
olanzapine
SGA/Atypical antipsychotics
quetiapine
SGA/Atypical antipsychotics
ziprasidone
SGA/Atypical antipsychotics
aripiprazole
SGA/Atypical antipsychotics
clozapine
SGA/Atypical antipsychotics
risk for infection
lais
Historically used for treating clients with schizophrenia who relapse due to nonadherence.
Now clients may be treated with LAI if it is their preference without demonstrating a history
of nonadherence
Injections administered every 2 or 4 weeks
antipsychotic side effects
Metabolic Syndrome
* Extrapyramidal symptoms (EPS)
dyskinesia
* Neuroleptic malignant syndrome
* Agranulocytosis (clozapine):
* Anticholinergic effects
* Hormonal effects (prolactin)
* EKG changes (QT prolongation)
* Sedation
* Orthostatic hypotension
* Nausea; gastrointestinal upset
* Skin rash
* Photosensitivity
* Increased risk of mortality in elderly clients with dementia
symptoms of neroleptic malignant syndrome
fever, confusion, muscle rigidity, diaphoresis, and tachycardia. Life threatening
monitoring for agranilocytosis
monitor CBC with Diff/ANC (absolute neutrophil count)
what labs to look at with metabolic syndrome
↑weight, ↑cholesterol/lipids, ↑BG, ↑BP, ↑waist circumference
extrapyramidal symptoms
akathisia, pseudoparkonsonism, dystonia, tardive
what is dystonia
uncontrolled muscular spasm
s+s of eps
dystonia
pseudoparkinsonism
akathisia
tardive dyskinesia
what is pseudoparkinsonism
tremor/bradykinesia
what is akathisia
restlessness
what is tardive dyskinesia
abnormal involuntary movements
treatment for dystonic reaction
im/iv diphenhydramine
most dystonic reactions occur where
neck and above
which drugs mostly cause eps
1st gen antipsychoics
what is used to treat eps
benzotropine and diphenhydramine
benzotropine
anticholinergic
what to know about fga
Positive symptoms
- Risk for TD
- EPS
- Low risk of cardiometabolic side effects
- Cheap
what to know about sgas
Positive Symptoms and some benefit with negative symptoms,
- Very low risk of TD
- Lower risk of EPS
- Risk of cardiometabolic side effects
- Clozapine is oldest SGA and has additional monitoring due to risk of agranulocytosis
what is aripiprazole tablet with sensor used to treat
scizo
bipolar 1
mdd
monitoring for clozapine
weekly bloodwork
report s/s of infection
