Chapter 12 Schizophrenia Spectrum DISORDERs Flashcards
This is the most Disruptive & Disabling of psychotic disorders.
Must have atleast 1 psychotic symptom
Hallucinations, Delusion, Disorganized Speech
Unable to function
Schizophrenia
Schizophreniform….
Short term Schizophrenia <6 months
Depression, mania, mixed Depression, Schizophrenia sx
Describes
Schizoaffective disorder
Schizotypical Personality disorder
Describe….
Eccentric / odd
Non- bizarre Delusions describes….
Delusional DO
Psychotic NED / NOS….
Schizo Sx that don’t fit into other categories
Schizophrenia is a biologically based illness
T ir F
T
Schizophrenia
Usually onset late teen early 20s
Early onset <15 …..
Late onset >25…..
Early onset <15 Males, More structural brain damage, bad outcomes
Late onset >25 Females, Less Brain Damage, better outcome
Smoking marijuana will help with Schizophrenia
T or F
F
Make it worse
Autoimmune disorder can cause schizophrenia …
How?
Inflammation
Flower blood flow
Why might poverty lead to schizophrenia
Lead in old paint / pipes
Father older 35 at conception
Born late winter / early spring
Risk factors for schizophrenia
T or F
T
Alogia, Avolition, anhedonia is what type of symptom in schizophrenia
Type of meds to help…
Effectiveness
Negative
Alogia = poverty of thought
Avolition = No motivation
Anhedonia = lack of joy
2nd generation atypical antipsychotics
Not very effective
Alterations in speech with schizophrenia
Associative looseness
Clang associations
Word Salad
Neologisms
Echolalia
Know the terms
Positive SS of schizophrenia
Limbs or body parts can be moved into a position by someone else, and they will maintain that position for an extended period, even if it is uncomfortable or unnatural.
Waxy flexibility
Echopraxia
involuntary imitation or repetition of another person’s movements or actions.
Anosognosia….
Person is unaware of their own illness or disability.
This isn’t denial, they truly don’t know
Audio hallucinations
What do you assess….
What they hear
Ability to recognize that hallucination is not real
Ability to resist command
3 phases of schizophrenia
Acute: Safety is concern
Stabilization:
Maintenance
When discharging ensure that you refer them with community resources
T or F
F
Connect then with resources. Ensure communication is present between them
Assess content of Delusions but quickly move to reality based topics
The focus is on feelings underlying the Delusions
38 $ ph to start
How long fir full effect of antipsychotics
Atypical antipsychotics have an increased mortality rate in this population
2 - 6 weeks
Demented Elderly
1st generation antipsychotics
Cheaper than 2nd
Disadvantages
Weight gain
Sex dysfunction
Endocrine distrubing
Plus, these important Sx….
EPS
Anticholinergic
Tardive Dyskinesia
1st generation
Low Potency/ High Dose =
High Potency/ Low Dose =
Low Potency/ High Dose
Sedation
Anticholinergic
Low EPS
Thorazine
High Potency/ Low Dose =
Low Sedation
Low ACH
High EPS
Haldol
Traditional
Fluphenazine & Haloperidol
Atypical
Risperidone, Aripiprazole, Paliperidone, Olanzapine
Have this in common
Long acting Antipsychotic Depot Injection LAI
Can last several weeks
EPS
Onset of Pseudoparkisonism
Describe….
Treatment
Onset 5 hr - 30 days
Mask like face, stooped posture, shuffling Gait, drooling, tremor, pill rolling
Artane Trihexyphenidyl - antiparkinsons
Benadryl
Cogentin
EPS
Acute dystonia
Onset 1 - 5 hrs
Sx….
Interventions
Opisthotonos Severe arching of back,head, and neck
Oculogyric crisis: Eye roll in back of head
Laryngeal Dystonia
Cogwheel rigidity:
Muscle stiffness characterized by a ratcheting or jerky resistance felt by an examiner when moving a patient’s limb passively,
Benadryl & Cogentin
EPS
Akathisia uncontrolled racing thoughts & movements.
Risk….
Interventions…..
Risk Suicide
Interventions: Ativan, Inderal ( Propranolol) Benztropine ( Cogentin ) - Treats Parkinsons
TD
SS
Chores & Athetoid ….. Describe
This screening tool…. How often
Choreic: Rapid purposeless irregular movement
Athetoid: Serpentine, writhing
AIMS: assesses the severity of involuntary movements in patients taking neuroleptic medications
Q3months
The AIMS is scored on a scale of 0–4, where 0 means none, 1 means minimal, 2 means mild, 3 means moderate, and 4 means severe. The total score on the AIMS is not reported to the patient
Most serious SE of anticholinergic meds
Level of concern
Name other SE
Meds to help
Urinary Retention
High level of concern
Constipation, Blurred vision, photosentivuty, Sex Dysfunction, non reaction pupils, tachycardia, more psychosis, seizures, repeating motor movements
Meds: BZD / physostigmine
Physostigmine
Use….
Antidote for anticholinergic effects
Also
acetylcholinesterase inhibitor which can enter and stimulate the central nervous system.
Physostigmine is used to treat glaucoma and delayed gastric emptying
Antidote for Datura & Belladonna poisoning
Do antipsychotics cause issues with BP
When to hold…
Does this issue go away….
Yes, hypotension
Hold systolic <80 when standing
Subsides 1 - 2 wks
Agranulocytosis can happen with any antipsychotics but is most likely with….
Give General parameters when to hold…
Clozapine
WBC < 3000
ANC < 1500
NMS can happen due to antipsychotic use.
Whose at most risk
Which are SS
Flushing /Pallor
Drooling / dry mouth
Sweaty / Dry skin
EPS ?
Floppy muscles / Rigidity
Hypopyrexia /Hyperpyrexia
HTN / Hypotension
Tachycardia / Bradycardia
Diarrhea / Incontence
Stupor / Agitation
Coma / Seizures
LOL & younger males
Pallor
Drooling
Sweaty
EPS
Rigidity
Hyperpyrexia
HTN
Tachycardia
Incontence
Stupor
Coma
Parlodel / Dantrium
Heparin
Cooling
Treat arrhythmias
Used for ….
NMS
Fever
Encephalopathy (Confusion/ Disorientated)
Vital signs unstable Tachycardia/ Fluctuating BP
Enzyme elevated CPK
Rigidity
Describes
NMS
Main SE of Atypical antipsychotics
Which is the exception
Weight gain.
Aripiprazole (abilify)
Can antidepressants be used with antipsychotics….
Yes
As well as
Mood stabilizers & Antianxiety agents
Depersonalization vs Derealization
Depersonalization = personal identity changed
Derealization = environment has changed
Artane: Trihexyphenidyl
Maybe prescribed for….
Pseudoparkisonism
Also
Benadryl & Cogentin
Physostigmine salicylate is ….
Anticholinergic toxicity reversal.
