Class 4? - Psychosis: Schizophrenia Recovery Model Flashcards
Why is early intervention in psychosis important?
decreases degree of functional impairment
Psychobiology
dysregulation of dopamine transport systems between the limbic system and prefrontal cortex
Psychosis as a Nursing Concept
a syndrome of neurocognitive symptoms that impairs cognitive capacity leading to deficits of perception, functioning, and social relatedness
What is the DSM-5 definition of psychosis?
abnormalities in five different symptomatic domains: delusions, hallucinations, disorganized thoughts/speech, disorganized or abnormal behaviour, negative (and positive) symptoms
Prodromal Phase of Psychosis
-early signs may be subtile and not easily identifiable
-vague changes in thoughts, feelings, perceptions
Recovery Phase of Psychosis
-psychosis is treatable
-medication can help but doesn’t cure
-relapse not guaranteed, but common
Acute Phase of Psychosis
-clear psychotic S&S (hallucinations, delusions)
-functioning deteriorates
-substance abuse is common
-HIGH RISK OF SUICIDE
Consequences of Psychosis
-difficulty processing information
-impaired observation and concentration
-easily distracted
-difficulty initiating and completing tasks
Individual Psychosis Risk Factors
-temperament
-environment
-genetics
Delusions
fixed beliefs that are unlikely to change despite contradictory evidence
Hallucinations
perceptions that occur without an external stimulus
Does psychosis cause brain damage?
yes it can, but depending how long it lasts
Alogia
poverty of speech
Avolition
decreased motivation to undertake self-directed activites
Anhedonia
inability to feel pleasure
Ambivalence
inability to make a decisions
Monotony
lack of variety and interest
Milieu Therapy
form of psychotherapy that involves the use of therapeutic communities
Vocational Therapy
subfield of occupational therapy where work is used as therapy under conditions close to reality
Serial Health Monitoring
regularly scheduled monitoring of side effects and general health
Case Management
team approach to management
What is the first priority in acute interventions?
safety
What are acute phase interventions?
-safety
-trust and rapport
-reinforce reality
-reduce stimulation
-create a regular routine
-support adherence
What are recovery phase interventions?
-show positive regard
-don’t argue about hallucinations/delusions
-focus on positve-goal activities
-model skills for independence
-connect client with community support, vocational opportunities, support, crisis planning
How are first generation antipsychotics administered?
PO or IM
What are the side effects of first gen antipsychotics?
-parkinsonism
-dystonia
-akathisia
-tardive dyskinesia
-neuroleptic malignant syndrome
What type of meds are used to help side effects of first gen antipsychotics?
anticholinergics
Akathisia
inability to remain still
What does EPS stand for?
extrapyrimidal symptoms
Parkinsonism
identical to PD - shuffling gait, tremors, rigidity
Dystonia
-abnormal posture of face, tongue, eyes, neck, trunk, limbs
-stiffness
-distressing
-difficulty swallowing
Tardive Dyskinesia
impaired voluntary movements, constant movement, lip smacking, tongue protrusion, grimacing, blinking
Neuroleptic Malignant Syndrome is a _____________
medical emergency
What is NMS?
a rare, potentially fatal adverse effect occurring within 7 days after starting or increasing oral antipsychotics
What does NMS involve?
-fever
-muscle rigidity
-ALOC
-fluctuating vitals
-diaphoresis
-incontinence
-leukocytosis
-muscle injury
-metabolic acidosis
How are second gen antipsychotics given?
PO or IM
What are the side effects of second gen antipsychotics?
-metabolic syndrome (weight gain, insulin resistance, dyslipidemia, hypertension)
-seizures
-sialorrhea
-agranulocytosis
-sedation
-orthostatic hypotension
-dysrhythmias
Are EPS, TD, and NMS more common in first or second gen antipsychotics?
first gen
Sialorrhea
excessive saliva flow
Dyslipidemia
elevation of plasma cholesterol, triglycerides, HDLs or LDLs
hyperprolactinemia
high prolactin levels (stimulates breast milk production)
Agranulocytosis
life-threatening condition involving low levels of neutrophils (WBCs)
Secondary Psychosis
-toxic psychosis
-dementia
-medical illness
-toxins, drugs, medication
What is the prevalence of schizophrenia?
1%
What is the age of onset for schizophrenia in women?
18-30yrs or after 40yrs
What is the age of onset of schizophrenia for men?
15-25yrs
What is the prodromal phase of schizophrenia?
a process of changes in subjective and behavioural symptoms that precede the onset of psychotic symptoms
What are some myths about schizophrenia?
-it is uncommon
-it is untreatable
-they are violent
-have multiple personalities
-caused by bad parenting
-unable to work or go to school
____ or more of delusions, hallucinations, disorganized speech, behaviour, and negative symptoms are the diagnostic criteria for schizophrenia
2
At least one schizophrenia symptom must be:
delusions, hallucinations, or disorganized speech
For schizophrenia to be diagnosed:
-it must last at least 6 months
-must affect level of functioning
Schizophrenia _____ be attributed to another diagnosis
cannot
Schizophrenia diagnostic criteria involves at least 2 of the primary criteria for schizophrenia plus:
-major mood episode
-delusions or hallucinations for 2+ consecutive weeks without
-mood symptoms
What is the CHIME model?
-connectedness (peer support, community, relationships)
-hope and optimism (belief in recovery, motivation, positive thinking)
-identity (overcoming stigma)
-meaning (meaning in experience, social roles)
-empowerment (personal responsibility, strenghts)
Traditional Biomedical Model
-medical
-assess-diagnose-treat
-promote clinical recovery
-practitioner has control
Recovery Model
-wellbeing
-individual focused
-personal recovery
-share control
What factors enable recovery?
-accessible
-vocational training
-shared decision making
-respect
-spaces for belonging
