CH 15: Psychotic Disorders Flashcards
Type of Psychotic Disorder
Schizophrenia
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.
Type of Psychotic Disorder
Schizotypical Personality Disorder
has impariments of personality (self and interpersonal) functioning
- impairment not as severe as with schizophrenia
Type of Pyschotic Disorder
Delusional Disorder
experiences delusional thinking for at least 1 month
-self or interpersonal functioning is not markedly impaired
Type of Psychotic Disorder
Brief Psychotic Disorder
has psychotic manifestations that last 1 day to 1 month
Type of Psychotic Disorder
Schizophreniform Disorder
has manifestations similar to schizophrenia, but duration is 1 to 6 months
- social.occupational dysfuntion might not be present
Type of Psychotic Disorder
Schizoaffective Disorder
meets criteria for both schizophrenia and depressive or bipolar disorder
Type of Psychotic Disorder
Substance-Induced Psychotic Disorder
experiences psychosis due to substance intoxication or withdrawal
- manifestations are more severn than typically expected
Type of Psychotic Disorder
Psychotic or Catatonic Disorder
not othwise specified
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
Positive symptoms
manifestatios of things that are not normally present
most easily identified menifestations
Negative symptoms
absence of things that are not normally present
more difficult to treat successfully than positive symptoms
Positive symptoms
of Psychotic Disorders
Expected
- hallucinations
- delusions
- alterations in speech
- bizarre behavior (walking backward constantly)
Negative symptoms
of Psychotic Disorders
Expected
- 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
Cognitive findings
of Psychotic Disorders
Expected
- disordered thinking
- inability to make decisions
- poor problem-solving
- difficulty concentration
- short term memory deficits
- impaired abstract thinking
Affective findings
of Psychotic Disorders
Expected
- hopelessness
- suicidal ideation
- unstable or rapidly changing mood
Alterations in Thought
Delusions
false fixed beliefs that cannot be corrected by reasoning and are usually bizarre
Ideas of Reference
Alterations in Thought (Delusions)
miscotrues trivial events and attaches personal significance to them
example: believing that others, who are discussing the next meal, are talking about him
Persecution
Alterations in Thought (Delusions)
feels singled out for harm by others
example: being hunted down by the FBI
Grandeur
Alterations in Thought (Delusions)
believes that they are all powerful and important
like God
Somatic Delusions
Alterations in Thought (Delusions)
believes that their body is changing in an unusual way
example: growing a third arm
Jealousy
Alterations in Thought (Delusions)
believes their partner is sexually involved with another individual even though there is not any factual basis for this belief
Being controlled
Alterations in Thought (Delusions)
believes that a force outside their body is controlling them
Thought Broadcasting
Alterations in Thought (Delusions)
believes that their thoughts are heard by others
Thought Insertions
Alterations in Thought (Delusions)
believes that others’ thoughs are being inserted into their mind
Thought Withdrawal
Alterations in Thought (Delusions)
believes that their thoughts have been removed frpom their mind by an outside agency
Religiosity
Alterations in Thought (Delusions)
is obsessed with religious beliefs
Magical Thinking
Alterations in Thought (Delusions)
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
Associative Looseness
Alterations in Speech
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
Neologisms
Alterations in Speech
made-up words that have meaning only to the client
example: “I trangled and flittled.”
Echolalia
Alterations in Speech
client repeats the words spoken to him
Clang Association
Alterations in Speech
meaningless rhyming of words
often forceful
example: “Oh fox, box, and lox.”
Word Salad
Alterations in Speech
words jumbles together with little meaning or sugnificance to the listener
example: “Hip hooray, the flip is cast and wide-sprinting in the forest.”
Alterations in Perception
Hallucinations
sensory perceptions that do not have any apparent external stimulus
Auditory
Alterations in Perceptions (Hallucinations)
hearing voices or sounds
Auditiory Command
Alterations in Perceptions (Hallucinations)
voice instructs the client to perform an action
(to hurt self or others)
Visual
Alterations in Perceptions (Hallucinations)
seeing persons or things
Olfactory
Alterations in Perceptions (Hallucinations)
smelling odors
Gustatory
Alterations in Perceptions (Hallucinations)
experiencing tastes
Tactile
Alterations in Perceptions (Hallucinations)
feeling bodily sensations
Personal Boundary Difficulties
disebfranchisement with one’s own body, identity, and perceptions
Depersonalization
Personal Boundary Difficulties
nonspecific feeling that a client has lost their identity
self is different ot unreal
Derealization
Personal Boundary Difficulties
perception that the environment has changed
example: believing that objects in their environment are shrinking
Illusions
Personal Boundary Difficulties
misperceptions or misinterpretations of a real experience
Extreme agitation
Alterations in Behavior
pacing and rocking
Stereotyped Behaviors
Alterations in Behavior
motor patterns that had meaning to client but nit are mechanical and lack purpose
(sweeping the floor)
Automatic Obedience
Alterations in Behavior
responding in a robot-linke manner
Waxy Flexibility
Alterations in Behavior
maintaining a specific position for an extended period of time
Stupor
Alterations in Behavior
motionless for long periods of time
coma-like
Negativism
Alterations in Behavior
doing the opposite of what is requested
Echopraxia
Alterations in Behavior
purposeful imitation of movements made by others
Catatonia
Alterations in Behavior
pronounced decrease or increas in the amoung of movement
- may be so severe that limbs remain in whatever position they are placed
Motor Retardation
Alterations in Behavior
pronounced slowing of movement
Impaired Impulse Control
Alterations in Behavior
reduced ability to resist impulse
Gesturing or Posturing
Alterations in Behavior
assuming unusual and illogical expressions
Boundary Impairment
Alterations in Behavior
impaired ability to see where one person’s body ends and another begins
Abnormal Involuntary Movement Scale
(AIMS)
Standardized Screening Tool
used to monitor involuntary movemnets and tardive duyskinesia in clients who take antipsychotic medication
World Health Organization Diability Assessment Schedule
(WHODAS)
Standardized Screening Tool
helps to determine the client’s level if global functioning
What therapy is used for clients who have a psychotic disorder?
(used both in acute and community facilities)
Milieu therapy
- provides structure, safe environment to decrease anxiety and constant thinking about hallucinations
Manifestation Management techniques include:
- 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
Client education
for Psychotic Disorders
- develop social skills and friendships
- participate in group work and psychoeducations
- comply with the medication
Haloperidol
Loxapine
Chlorpromazine
Fluphenazine
1st Generation/Conventional Antipsychotic
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)
Risperidone
Olanzapine
Quetuapine
Ziprasidone
Clozapine
2nd Generation/Atypical Antipsychotic
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
Aripiprazole
3rd Generation Antipsychotic
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
Acute Dystonia
1st Gen Complications: EPS
sustained muscle contraction
- spasm of tongue, face, neck, back
- requires immediate treatment
- occurs within 1-5 days
Akasthisia
1st Gen Complications: EPS
body restlessness
- inability to sit/stand still; pacing; agitation
- occurs within 5 to 60 days
Pseudoparkinsonism
1st Gen Complications: EPS
drooling, facial masking, bardykinetic, flat affect
- tremors, shuffling gait, stooped posture/hump/hunch, pill rolling, muscle rigidity
- occurs withing 5 to 30 days
Tardive Dyskinesia
1st Gen Complications: EPS
unnatural; bizarre
- late onset
- subtle, gets worse
- can’t dress; difficulty eating
- sometimes irreversible
- monitor for 12 months, then every 3 months
Neuroleptic Malignant Syndrome
(NMS)
1st and 2nd Gen Complications
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
Contraindications for 1st Gen Antipsychotics
- liver issues
- parkinson’s
- severe hypotension
- dementia
Haloperidol and Fluphenazine Depot
1st Generation Antipsychotics
IM every 2-4 weeks
Metabolic Syndrome
2nd Gen Complications
new onsent of DM or loss of glucose control in those with DM
Education: healthy, low-calorie diet; regularly exercise; monitor weight
Risperidone
Contraindication
2nd Gen Contraindications
pregnancy risk category C
- depot injection: IM every 2 weeks
Aripiprazole
2nd Gen Side Effects
- headache
- anxiety
- GI upset
- insomnia
- depo injection: monthly
low risk of DM, weight gain, dyslipidemia, OH, & anticholinergic effects
Clozapine
2nd Gen Antipsychotic
- risk for agranulocytosis (monitor WBC)
- notify provide of signs of infection
- hypersalivation
Olanzapine
2nd Gen Antipsychotic
- after ER injection, monitor for 3 hours
Quetiapine
2nd Gen Side Effects
- cataracts
Pre-assaultive Category
Signs of Escalation
Anger Management
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
Steps to handle aggressive behavior
- 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
Following an aggressive/violent episode
- 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
