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N222 - Mental Health/Psychiatric > CH 15: Psychotic Disorders > Flashcards

CH 15: Psychotic Disorders Flashcards

1
Q

Type of Psychotic Disorder

Schizophrenia

A

has psychotic thinking or behavior present for at least 6 months
- areas of functioning, including school or work, self-care, and interpersonal relationship, are significantly impaired.

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2
Q

Type of Psychotic Disorder

Schizotypical Personality Disorder

A

has impariments of personality (self and interpersonal) functioning
- impairment not as severe as with schizophrenia

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3
Q

Type of Pyschotic Disorder

Delusional Disorder

A

experiences delusional thinking for at least 1 month
-self or interpersonal functioning is not markedly impaired

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4
Q

Type of Psychotic Disorder

Brief Psychotic Disorder

A

has psychotic manifestations that last 1 day to 1 month

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5
Q

Type of Psychotic Disorder

Schizophreniform Disorder

A

has manifestations similar to schizophrenia, but duration is 1 to 6 months
- social.occupational dysfuntion might not be present

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6
Q

Type of Psychotic Disorder

Schizoaffective Disorder

A

meets criteria for both schizophrenia and depressive or bipolar disorder

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7
Q

Type of Psychotic Disorder

Substance-Induced Psychotic Disorder

A

experiences psychosis due to substance intoxication or withdrawal
- manifestations are more severn than typically expected

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8
Q

Type of Psychotic Disorder

Psychotic or Catatonic Disorder

not othwise specified

A

exhibits psychotic features (impaired reality testing) or bizarre behavior (psychotic) or significant chand in motor activity behavior (catatonic) but DOES NOT meed criteria for diagnosus with another specific psychotic disorder

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9
Q

Positive symptoms

A

manifestatios of things that are not normally present

most easily identified menifestations

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10
Q

Negative symptoms

A

absence of things that are not normally present

more difficult to treat successfully than positive symptoms

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11
Q

Positive symptoms

of Psychotic Disorders

Expected

A
  • hallucinations
  • delusions
  • alterations in speech
  • bizarre behavior (walking backward constantly)
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12
Q

Negative symptoms

of Psychotic Disorders

Expected

A
  • Affect: blunted and flat
  • Alogia: poverty of thought or speech
  • Anergia: lack of energy
  • Anhedonia: lack of pleasure/joy
  • Avolition: lack of motivation in activites and hygiene
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13
Q

Cognitive findings

of Psychotic Disorders

Expected

A
  • disordered thinking
  • inability to make decisions
  • poor problem-solving
  • difficulty concentration
  • short term memory deficits
  • impaired abstract thinking
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14
Q

Affective findings

of Psychotic Disorders

Expected

A
  • hopelessness
  • suicidal ideation
  • unstable or rapidly changing mood
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15
Q

Alterations in Thought

Delusions

A

false fixed beliefs that cannot be corrected by reasoning and are usually bizarre

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16
Q

Ideas of Reference

Alterations in Thought (Delusions)

A

miscotrues trivial events and attaches personal significance to them

example: believing that others, who are discussing the next meal, are talking about him

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17
Q

Persecution

Alterations in Thought (Delusions)

A

feels singled out for harm by others

example: being hunted down by the FBI

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18
Q

Grandeur

Alterations in Thought (Delusions)

A

believes that they are all powerful and important

like God

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19
Q

Somatic Delusions

Alterations in Thought (Delusions)

A

believes that their body is changing in an unusual way

example: growing a third arm

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20
Q

Jealousy

Alterations in Thought (Delusions)

A

believes their partner is sexually involved with another individual even though there is not any factual basis for this belief

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21
Q

Being controlled

Alterations in Thought (Delusions)

A

believes that a force outside their body is controlling them

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22
Q

Thought Broadcasting

Alterations in Thought (Delusions)

A

believes that their thoughts are heard by others

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23
Q

Thought Insertions

Alterations in Thought (Delusions)

A

believes that others’ thoughs are being inserted into their mind

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24
Q

Thought Withdrawal

Alterations in Thought (Delusions)

A

believes that their thoughts have been removed frpom their mind by an outside agency

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25
Q

Religiosity

Alterations in Thought (Delusions)

A

is obsessed with religious beliefs

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26
Q

Magical Thinking

Alterations in Thought (Delusions)

A

believes their actions and thoughts are able to control a situation or affect others

example: weaing a certain hat that makes them invisible to others

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27
Q

Associative Looseness

Alterations in Speech

A

Unconscious inability to concentrate on a single thought
- can progress to flight of ideas in which the client’s speech moves so rapidly from one thought to another that it is incoherent

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28
Q

Neologisms

Alterations in Speech

A

made-up words that have meaning only to the client

example: “I trangled and flittled.”

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29
Q

Echolalia

Alterations in Speech

A

client repeats the words spoken to him

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30
Q

Clang Association

Alterations in Speech

A

meaningless rhyming of words

often forceful

example: “Oh fox, box, and lox.”

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31
Q

Word Salad

Alterations in Speech

A

words jumbles together with little meaning or sugnificance to the listener

example: “Hip hooray, the flip is cast and wide-sprinting in the forest.”

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32
Q

Alterations in Perception

Hallucinations

A

sensory perceptions that do not have any apparent external stimulus

33
Q

Auditory

Alterations in Perceptions (Hallucinations)

A

hearing voices or sounds

34
Q

Auditiory Command

Alterations in Perceptions (Hallucinations)

A

voice instructs the client to perform an action

(to hurt self or others)

35
Q

Visual

Alterations in Perceptions (Hallucinations)

A

seeing persons or things

36
Q

Olfactory

Alterations in Perceptions (Hallucinations)

A

smelling odors

37
Q

Gustatory

Alterations in Perceptions (Hallucinations)

A

experiencing tastes

38
Q

Tactile

Alterations in Perceptions (Hallucinations)

A

feeling bodily sensations

39
Q

Personal Boundary Difficulties

A

disebfranchisement with one’s own body, identity, and perceptions

40
Q

Depersonalization

Personal Boundary Difficulties

A

nonspecific feeling that a client has lost their identity

self is different ot unreal

41
Q

Derealization

Personal Boundary Difficulties

A

perception that the environment has changed

example: believing that objects in their environment are shrinking

42
Q

Illusions

Personal Boundary Difficulties

A

misperceptions or misinterpretations of a real experience

43
Q

Extreme agitation

Alterations in Behavior

A

pacing and rocking

44
Q

Stereotyped Behaviors

Alterations in Behavior

A

motor patterns that had meaning to client but nit are mechanical and lack purpose

(sweeping the floor)

45
Q

Automatic Obedience

Alterations in Behavior

A

responding in a robot-linke manner

46
Q

Waxy Flexibility

Alterations in Behavior

A

maintaining a specific position for an extended period of time

47
Q

Stupor

Alterations in Behavior

A

motionless for long periods of time

coma-like

48
Q

Negativism

Alterations in Behavior

A

doing the opposite of what is requested

49
Q

Echopraxia

Alterations in Behavior

A

purposeful imitation of movements made by others

50
Q

Catatonia

Alterations in Behavior

A

pronounced decrease or increas in the amoung of movement
- may be so severe that limbs remain in whatever position they are placed

51
Q

Motor Retardation

Alterations in Behavior

A

pronounced slowing of movement

52
Q

Impaired Impulse Control

Alterations in Behavior

A

reduced ability to resist impulse

53
Q

Gesturing or Posturing

Alterations in Behavior

A

assuming unusual and illogical expressions

54
Q

Boundary Impairment

Alterations in Behavior

A

impaired ability to see where one person’s body ends and another begins

55
Q

Abnormal Involuntary Movement Scale

(AIMS)

Standardized Screening Tool

A

used to monitor involuntary movemnets and tardive duyskinesia in clients who take antipsychotic medication

56
Q

World Health Organization Diability Assessment Schedule

(WHODAS)

Standardized Screening Tool

A

helps to determine the client’s level if global functioning

57
Q

What therapy is used for clients who have a psychotic disorder?

(used both in acute and community facilities)

A

Milieu therapy
- provides structure, safe environment to decrease anxiety and constant thinking about hallucinations

58
Q

Manifestation Management techniques include:

A
  • using music to distract from “voices”
  • attending activities
  • waling
  • talking to a trusted person when hallucinations are most bothersome
  • interacting with an auditory or visual hallucination by telling them to stop or go away

used to cope with deptessive finding and anxiety

59
Q

Client education

for Psychotic Disorders

A
  • develop social skills and friendships
  • participate in group work and psychoeducations
  • comply with the medication
60
Q

Haloperidol
Loxapine
Chlorpromazine
Fluphenazine

1st Generation/Conventional Antipsychotic

A

used to treat mainly positive psychotic symptoms; reduces dopamine
- Nursing actions: monitor for EPS, including dystonia, akathisia, pseudoparkinsonism, and tardive dyskinesia
- Client education: chew sugarless gum, eat food high in fiber, 2-3L of fluids/day
- Postural hypotension: lightheadedness and dizziness (sit or lie down)

61
Q

Risperidone
Olanzapine
Quetuapine
Ziprasidone
Clozapine

2nd Generation/Atypical Antipsychotic

A

treat both positive and negative symptoms; preferred choice for psychotic disorders
- Client Education: follow a healthy, low-calorie diet, regularly exercise, and monitor weight (weight gain)
- Adverse effects: agitation, dizziness, sedation, and sleep disruption (report to provider)
- blood tests needed to monitor for agranulocytosis

62
Q

Aripiprazole

3rd Generation Antipsychotic

A

treats both positive and negative symptoms while improving cognitive function
- decreased risk of EPSs or tardive dyskinesia
- lower risk for weight gain and anticholinergic effects

63
Q

Acute Dystonia

1st Gen Complications: EPS

A

sustained muscle contraction
- spasm of tongue, face, neck, back
- requires immediate treatment
- occurs within 1-5 days

64
Q

Akasthisia

1st Gen Complications: EPS

A

body restlessness
- inability to sit/stand still; pacing; agitation
- occurs within 5 to 60 days

65
Q

Pseudoparkinsonism

1st Gen Complications: EPS

A

drooling, facial masking, bardykinetic, flat affect
- tremors, shuffling gait, stooped posture/hump/hunch, pill rolling, muscle rigidity
- occurs withing 5 to 30 days

66
Q

Tardive Dyskinesia

1st Gen Complications: EPS

A

unnatural; bizarre
- late onset
- subtle, gets worse
- can’t dress; difficulty eating
- sometimes irreversible
- monitor for 12 months, then every 3 months

67
Q

Neuroleptic Malignant Syndrome

(NMS)

1st and 2nd Gen Complications

A

Manifestations: sudden high fever, BP fluctuations, diaphoresis, tachycardia, mucle rigidity, decreased LOC, coma
- life-threatening medical emergency
Nursing Actions: 1) stop med, 2) monitor vitals, 3) apply cooling techniques, 4) antipyrectics, 5) increase fluids, 6) admin meds for arrythmias, 7) admin dantrolene for muscle relaxation, 8) transfer to ICU
- wait 2 weeks before resuming therapy

68
Q

Contraindications for 1st Gen Antipsychotics

A
  • liver issues
  • parkinson’s
  • severe hypotension
  • dementia
69
Q

Haloperidol and Fluphenazine Depot

1st Generation Antipsychotics

A

IM every 2-4 weeks

70
Q

Metabolic Syndrome

2nd Gen Complications

A

new onsent of DM or loss of glucose control in those with DM
Education: healthy, low-calorie diet; regularly exercise; monitor weight

71
Q

Risperidone

Contraindication

2nd Gen Contraindications

A

pregnancy risk category C
- depot injection: IM every 2 weeks

72
Q

Aripiprazole

2nd Gen Side Effects

A
  • headache
  • anxiety
  • GI upset
  • insomnia
  • depo injection: monthly

low risk of DM, weight gain, dyslipidemia, OH, & anticholinergic effects

73
Q

Clozapine

2nd Gen Antipsychotic

A
  • risk for agranulocytosis (monitor WBC)
  • notify provide of signs of infection
  • hypersalivation
74
Q

Olanzapine

2nd Gen Antipsychotic

A
  • after ER injection, monitor for 3 hours
75
Q

Quetiapine

2nd Gen Side Effects

A
  • cataracts
76
Q

Pre-assaultive Category

Signs of Escalation

Anger Management

A

client becomes angry and exhibits anxiety, tension, hyperactivity, and verbal abuse
- argumentative, increased profanity
- stone silence, newly isolative
- alcohol or drug intoxication
- possesion of weapons
- pacing, restlessness
- frowning or grimacing
- clenching fists, waving arms
- leaning forward
- loud, rapid talking; yelling and shouting
- rapid breathing

77
Q

Steps to handle aggressive behavior

A
  • respond quickly
  • remain calm/in control
  • encourage client to express feelings
  • give space
  • maintain eye contact
  • avoid accusatory/threatening
  • calmly and directly state what the client must do
  • use physical activity
  • inform consequences of behavior
  • use pharm interventions is pt does not respond to calm limiting-setting
  • plan 4-6 members to be available and insight of client if appropriate
78
Q

Following an aggressive/violent episode

A
  • discuss ways for client to keep control
  • reassess milieu and identify potential and actual stressors that may have contributed
  • encourage client to talk about the incident, what triggered and escalated the aggression
  • debrief staff to evaluate effectiveness
  • document the entire incident (behaviors leading up, behaviors observerd throughout, nursing interventions implemented, and the clients response

N222 - Mental Health/Psychiatric (7 decks)

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