Chapter 12 Schizophrenia Spectrum DISORDERs

Question 1

This is the most Disruptive & Disabling of psychotic disorders.

Must have atleast 1 psychotic symptom
Hallucinations, Delusion, Disorganized Speech
Unable to function

Answer 1

Schizophrenia

Question 2

Schizophreniform….

Answer 2

Short term Schizophrenia <6 months

Question 3

Depression, mania, mixed Depression, Schizophrenia sx

Describes

Answer 3

Schizoaffective disorder

Question 4

Schizotypical Personality disorder

Describe….

Answer 4

Eccentric / odd

Question 5

Non- bizarre Delusions describes….

Answer 5

Delusional DO

Question 6

Psychotic NED / NOS….

Answer 6

Schizo Sx that don’t fit into other categories

Question 7

Schizophrenia is a biologically based illness

T ir F

Answer 7

T

Question 8

Schizophrenia

Usually onset late teen early 20s

Early onset <15 …..

Late onset >25…..

Answer 8

Early onset <15 Males, More structural brain damage, bad outcomes

Late onset >25 Females, Less Brain Damage, better outcome

Question 9

Smoking marijuana will help with Schizophrenia

T or F

Answer 9

F

Make it worse

Question 10

Autoimmune disorder can cause schizophrenia …

How?

Answer 10

Inflammation

Flower blood flow

Question 11

Why might poverty lead to schizophrenia

Answer 11

Lead in old paint / pipes

Question 12

Father older 35 at conception
Born late winter / early spring

Risk factors for schizophrenia

T or F

Answer 12

T

Question 13

Alogia, Avolition, anhedonia is what type of symptom in schizophrenia

Type of meds to help…

Effectiveness

Answer 13

Negative

Alogia = poverty of thought
Avolition = No motivation
Anhedonia = lack of joy

2nd generation atypical antipsychotics

Not very effective

Question 14

Alterations in speech with schizophrenia

Associative looseness
Clang associations
Word Salad
Neologisms
Echolalia

Answer 14

Know the terms

Question 15

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.

Answer 15

Waxy flexibility

Question 16

Echopraxia

Answer 16

involuntary imitation or repetition of another person’s movements or actions.

Question 17

Anosognosia….

Answer 17

Person is unaware of their own illness or disability.

This isn’t denial, they truly don’t know

Question 18

Audio hallucinations

What do you assess….

Answer 18

What they hear
Ability to recognize that hallucination is not real
Ability to resist command

Question 19

3 phases of schizophrenia

Answer 19

Acute: Safety is concern
Stabilization:
Maintenance

Question 20

When discharging ensure that you refer them with community resources

T or F

Answer 20

F

Connect then with resources. Ensure communication is present between them

Question 21

Assess content of Delusions but quickly move to reality based topics

The focus is on feelings underlying the Delusions

Answer 21

38 $ ph to start

Question 22

How long fir full effect of antipsychotics

Atypical antipsychotics have an increased mortality rate in this population

Answer 22

2 - 6 weeks

Demented Elderly

Question 23

1st generation antipsychotics

Cheaper than 2nd

Disadvantages
Weight gain
Sex dysfunction
Endocrine distrubing

Plus, these important Sx….

Answer 23

EPS
Anticholinergic
Tardive Dyskinesia

Question 24

1st generation

Low Potency/ High Dose =

High Potency/ Low Dose =

Answer 24

Low Potency/ High Dose
Sedation
Anticholinergic
Low EPS
Thorazine

High Potency/ Low Dose =
Low Sedation
Low ACH
High EPS
Haldol

Question 25

Traditional Fluphenazine & Haloperidol Atypical Risperidone, Aripiprazole, Paliperidone, Olanzapine Have this in common

Answer 25

Long acting Antipsychotic Depot Injection LAI Can last several weeks

Question 26

EPS Onset of Pseudoparkisonism Describe.... Treatment

Answer 26

Onset 5 hr - 30 days Mask like face, stooped posture, shuffling Gait, drooling, tremor, pill rolling Artane Trihexyphenidyl - antiparkinsons Benadryl Cogentin

Question 27

EPS Acute dystonia Onset 1 - 5 hrs Sx.... Interventions

Answer 27

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

Question 28

EPS Akathisia uncontrolled racing thoughts & movements. Risk.... Interventions.....

Answer 28

Risk Suicide Interventions: Ativan, Inderal ( Propranolol) Benztropine ( Cogentin ) - Treats Parkinsons

Question 29

TD SS Chores & Athetoid ..... Describe This screening tool.... How often

Answer 29

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

Question 30

Most serious SE of anticholinergic meds Level of concern Name other SE Meds to help

Answer 30

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

Question 31

Physostigmine Use....

Answer 31

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

Question 32

Do antipsychotics cause issues with BP When to hold... Does this issue go away....

Answer 32

Yes, hypotension Hold systolic <80 when standing Subsides 1 - 2 wks

Question 33

Agranulocytosis can happen with any antipsychotics but is most likely with.... Give General parameters when to hold...

Answer 33

Clozapine WBC < 3000 ANC < 1500

Question 34

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

Answer 34

LOL & younger males Pallor Drooling Sweaty EPS Rigidity Hyperpyrexia HTN Tachycardia Incontence Stupor Coma

Question 35

Parlodel / Dantrium Heparin Cooling Treat arrhythmias Used for ....

Answer 35

NMS

Question 36

Fever Encephalopathy (Confusion/ Disorientated) Vital signs unstable Tachycardia/ Fluctuating BP Enzyme elevated CPK Rigidity Describes

Answer 36

NMS

Question 37

Main SE of Atypical antipsychotics Which is the exception

Answer 37

Weight gain. Aripiprazole (abilify)

Question 38

Can antidepressants be used with antipsychotics....

Answer 38

Yes As well as Mood stabilizers & Antianxiety agents

Question 39

Depersonalization vs Derealization

Answer 39

Depersonalization = personal identity changed Derealization = environment has changed

Question 40

Artane: Trihexyphenidyl Maybe prescribed for....

Answer 40

Pseudoparkisonism Also Benadryl & Cogentin

Question 41

Physostigmine salicylate is ....

Answer 41

Anticholinergic toxicity reversal.