Ch. 14 & 15 Flashcards
Schizophrenia is a disease that affects ______, _____, _____, _____, and ability to perceive _____ accurately.
Thinking, language, emotions, social behavior, reality
Does the prevalence of schizo vary by culture?
No.
What are the 4 subtypes of schizo?
Paranoid, catatonic, disorganized, undifferentitated, residual, schizoaffective.
What is the most common cause of premature death for schizo’s?
Suicide.
What is the most significant health risk to schizo’s?
Smoking. 75-85% smoke, bringing about many comorbidities. It actually helps with akathisia!
What is another common problem for schizo’s?
40-50% ave substance abuse disorders.
What is polydipsia?
Drinking 4-10 L of water a day. Higher incidence with schizo.
Describe the neurobiological factors that influence schizo.
Too much dopamine causes it. Amphetamines, cocaine, Ritalin, Levodopa can increase dopamine and cause symptoms.
Do genetics play a role in schizo?
Yes, but not a 1 gene scenario like Huntington’s. Multiple genes and environment combine to cause this.
What are some non-genetic factors that involved in schizo?
Prenatal toxins, infections, starvation, lack of oxygen, stress.
When is the typical onset for schizo?
Women = start of menses to 35. 25-35 is average. Men = 18-25
Paranoid schizo is pretty self-explanatory, but what is it most common defense mechanism?
Projection. This type has a later onset (20-30( and generally has a good outcome
What is the essential feature of catatonic schizo? Other features?
Motor dysfunction. Can be agitation or retardation. (Catatonic is rare). Bizarre posturing. Waxy flexibility (hold position for a long time), sterotyped behavior (obsessive routines), negativism/sutomatic obedience, echolalia (repeat words of others), echopraxia (mimic movements).
Which type of schizo is the most socially impaired and regressed?
Disorganized.
What are some s/s of disorganized schizo?
Loose associations (friendly-no tight bonds), bizarre mannerisms, inappropriate affect, incoherent speech, hallucinations. Early onset.
What is undifferentiated schizo?
Person has s/s, but doesn’t meet criteria for paranoid, catatonic, or disorganized.
What is residual schizo?
Active s/s go away, but lack of initiative, withdrawal, magical thinking remain.
What is schizoaffective disorder?
Schizophrenia symptoms with mood disorder, like either phase of bipolar.
What happens with each relapse in schizo?
Increase in residual dysfunction.
Name the 3 phases of schizophrenia.
Prodromal, acute, maintenance, stabilization
What are some s/s of the prodromal stage of schizo?
Withdrawal, decrease function, perceptual disturbances, hallucinations, speaking changes, more religious.
What are some s/s of the acute phase of schizo?
Neglect hygiene, hallucinations, apathy, withdrawal, lack of motivation. Florid positive symptoms plus negative symptoms.
What are some s/s of the maintenance phase of schizo?
Acute symptoms decrease in severity, particularly positive ones.
What are some s/s of the stabilization phase of schizo?
Symptoms in remission, although mild ones may persist.
What are some positive signs of schizo?
Hallucinations, word salad, delusions, paranoia, bizarre behavior, taste, smell, touch, ideas of reference.
What are some negative signs of schizo?
All A’s. Affect (flat), apathy (avolition), anhedonia (can’t feel pleasure), alogia (poverty of though, speech), attention deficit
What are the primary goals when treating schizo during the acute phase?
Safety and med stabilization. Least meds with least side effects.
How do you treat schizoaffective disorder?
With anti-psychotics.
What are the goals during the maintenance phase of schizo?
Patient and family education.
What are the goals during the stabilization phase of schizo?
Prevent relapse.
How is implementation done in schizo?
It is geared towards patient strengths and healthy functioning, as well as weaknesses/symptoms.
How do you communicate with a patient experiencing hallucinations or delusions?
Non-threatening/nonjudgmental. Clarify reality that patient is experiencing. Interact with concrete reality.
How do you communicate with a patients that are paranoid?
Honesty/consistency. Only speak when they can hear. Be neutral. Don’t “like” or “dislike” anything.
How do you deal with associative looseness?
Don’t pretend to understand. Emphasize “here and now”
What are the 4 topics that schizo patient/family teaching should include?
Disease process, meds, prevention of relapse, and stress management.
Where can milieu therapy take place?
Hospital, partial hospital (home at night), halfway house. Structure is good!
What is PACT?
Program for assertive community treatment. A 24/day, 7 day/week team approach to care. Aim is to prevent relapse, help adapt, provide support. For poorly functioning patients. Form of psychotherapy.
What are some other forms of psychotherapy for schizos?
Family, CBT (cognitive behavioral therapy), and social skills training.
How long does it take for antipsychotics to take full effect?
6-8 weeks.
Name some first generation antipsychotics?
Haldol, prolixin, thorazine.
Name some atypical antipsychotics?
Clozaril (clozapine), Risperdal (risperidone), zyprexa (olanzapine), seroquel (quetiapine), Geodon (ziprasidone), Abilify (aripiprazole)
What are some advantages of atypicals? Disadvantages?
Advantages = Less EPS symptoms, address negative as well as positive symptoms. Disadvantages = agranulocytosis, weight gain, seizures, high lipids, cost
What are some advantages of conventional antipsychotics? Disadvantages?
Advantages = Cost. Disadvantages = agranulocytosis, NMS, EPS symptoms, only address positive symptoms.
How are conventional antipsychotics given?
Z-track method
What are some adjunct therapies for antipsychotics?
Antidepressants, lithium, benzodiazapines
What is the difference in action between conventional and atypical antipsychotics?
Conventionals are dopamine antagonists and atypicals are dopamine agonists and effect serotonin levels.
What are some s/s of NMS?
Severe EPS symptoms, elevated temperature, HTN, tachycardia, diaphoresis, and incontinence.
What organ does agranulocytosis effect?
Liver.
What scale is used to recognize early EPS symptoms?
AIMS scale.
Which symptoms of schizo, positive or negative, has a worse prognosis?
Negative.
Which symptoms of schizo, positive or negative, respond better to meds?
Positive.
What are the 3 main cognitive disorders?
Delirium, dementia, and amnestic disorders.
Delirium is always _____ to another disease and is _____.
Secondary. Reversible. Comes on quickly and resolves quickly.
How would you describe primary dementia?
No known cause or cure.
What is the most important risk factor for dementia?
Age.
How do genetics effect AD? Ethnicity?
Early onset (30-60) is usually familial, while late onset has no genetic component. No effect.
A common effect of both delirium and dementia, _____ _____ occurs in the evening.
Sundowner’s syndrome.
Is delirium more common in older patients, or younger patients?
Older.
What are some s/s of delirium?
Angry, hyper vigilant, disturbed consciousness (person, place, time), nd labile emotions.
What are some causes of delirium?
Meds, medical conditions, and sometimes unknown.
What are it’s essential features?
Disturbed consciousness with cognitive difficulties.
From a medical perspective, what is done for delirium?
Find cause, short phrases, same staff, keep distractions to a minimum.
What will you assess for on a patient with delirium?
Vitals, LOC, neuro signs, risk for injury, comfort
What is the most common form of dementia, besides school induced cataonia?
Alzheimer’s disease. Long, slow progression, 4th leading cause of death in the US
What are some examples of executive function?
Planning, organizing, abstract thinking, memories, command muscles, and emotions.
What happens in stage 1 of dementia?
Forgetfulness. First short term memory, then long. Not diagnosable in this stage.
What happens in stage 2 of dementia?
Confusion, progressive memory loss, withdrawal, denial, ADLs decline, depression increases, need day-care.
What happens in stage 3 of dementia?
Ambulatory dementia, ADL loss, depression resolves, institutional care.
What happens in stage 4 of dementia?
End stage. Nonambulatory, loses recognition, forgets how to eat, swallow, etc.
What is the first thing you assess for with dementia? Next?
Any medical conditions that may be contributing to it. Suicide/aggression, family knowledge and coping skills.
With dementia, care is based on the patient and families _____ _____.
Immediate needs.
How do cholinesterase inhibitors help with dementia?
They increase available acetylcholine, which is though to help with memory function.
What other meds are used in dementia?
Namenda, Excelon, Arocept, SSRIs, antipsychotics.
How are these meds for dementia prescribed?
With extreme caution. Low and slow.
