Exam 2 Flashcards
Psychosis
Alterations in mental state
Schizophrenia Clinical Picture
Affects 1% of adults
Characterized by psychosis
Develops gradually, presenting at 15 to 25 years
Child-onset and late-onset are more rare
DSM-V Criteria for Schizophrenia
Two or more of the following for a significant portion of time in one month:
Delusions, hallucinations, disorganized speech, gross disorganization or catatonia, negative symptoms (not showing emotions)
Continuous disturbance for at least 6 months
Epidemiology of Schizophrenia
1 in 40,000 children
No difference related to race, social status, culture
More frequently diagnosed among males and in urban areas
Comorbidities of Schizophrenia
Substance abuse disorders
Anxiety, depression, risk for suicide
Physical health or illness
Polydipsia
Etiology of Schizophrenia
Biological factors: Genetics
Neurobiological: dopamine therapy, neurochemical hypotheses
Brain structure abnormalities
Prenatal stressors, psychological stressors, environmental stressors, prognostic considerations
Phases of Schizophrenia
Prodromal: onset, mild changes
Acute: exacerbation of psychotic symptoms
Stabilization: symptoms diminishing, movement toward previous level of functioning
Maintenance or Residual: new baseline is established
Assessment During Prodromal Phase of Schizophrenia
Positive symptoms: present but not actually present
Negative symptoms: absence of something that should be there
Cognitive symptoms: symptoms that impair thinking or memory
Affective symptoms: involve our emotions
Positive Symptoms of Schizophrenia
Alterations in reality testing
Delusions, alterations in speech, concrete thinking (inability to think abstractly)
Alterations in Speech with Schizophrenia
Associative looseness (word salad, jumble of words meaningless to listener)
Clang association (words chosen based on sound)
Neologisms (meaning for the patient only)
Echolalia (pathological repetition of another’s words)
Circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech
Distortions of Thought with Schizophrenia
Thought blocking: reduction or stoppage of thought; hallucinations may cause this
Thought insertion: belief that someone else has inserted thoughts into their brains
Thought deletion: belief that thoughts have been taken or are missing
Magical thinking: believing that thoughts affect others’ consequences
Paranoia
Alterations in Perception with Schizophrenia
Depersonalization: feeling of being unreal or having lost identity
Derealization: feeling that the environment has changed
Hallucinations
Illusions: misperceptions or misinterpretations of a real experience
Alterations in Behavior with Schizophrenia
Catatonia Motor retardation Motor agitation Stereotyped behaviors Waxy flexibility Echopraxia Negativism Impaired impulse control Gesturing or posturing Boundary impairment
Negative Symptoms with Schizophrenia
Absence of essential human qualities
Anhedonia: lack of pleasure
Avolition: lack of motivation
Asociality: don’t want to interact with anyone
Affective blunting: no affect, no expressions, monotone
Apathy: lack of interest
Alogia: poverty of speech
Cognitive Symptoms of Schizophrenia
Concrete thinking
Impaired memory
Impaired information processing
Impaired executive functioning
Affective Symptoms of Schizophrenia
Assessment for depression is crucial (may herald impending relapse, increases substance abuse, increases suicide risk, further impairs functioning)
Self-Assessment with Schizophrenia
Anosognosia: inability to recognize illness
Assessment Guidelines with Schizophrenia
Any medical problems
Drug/alcohol use disorders
Mental status examination
Cognitive assessment
Assess for hallucinations, delusions, suicide risk
Assess ability to ensure personal safety
Assess prescribed meds
Potential Nursing Diagnoses for Schizophrenia
Positive Symptoms: disturbed sensory perception, risk for self-directed or other-directed violence, impaired verbal communication
Negative Symptoms: social isolation, chronic low self-esteem
Outcomes Identification for Schizophrenia
Phase I-Acute: patient safety and medical stabilization
Phase II-Stabilization: help patient understand illness/treatment, stabilize medications, control/cope with symptoms
Phase III-Maintenance: maintain achievement, prevent relapse, achieve independence, satisfactory quality of life
Planning for Schizophrenia
Phase I-Acute: best strategies to ensure patient safety and provide symptom stabilization
Phase III-Maintenance: provide patient and family education, relapse prevention skills are vital
Implementation during Acute Phase of Schizophrenia
Psychiatric, medical, and neurological evaluation
Psycopharmalogical treatment
Support, psychoeducation, and guidance
Supervision and limit setting in the milieu
Monitor fluid intake
Working with aggression
Interventions for Stabilization and Maintenance Phases of Schizophrenia
Medication administration/adherence
Relationships with trusted care providers
Community-based therapeutic services
Teamwork and safety
Activities and groups
Counseling and communication techniques
Psychobiological Interventions for Schizophrenia
Antipsychotic medications (1st, 2nd, and 3rd generation)
Injectable antipsychotics (short- and long-acting)
First-Generation Antipsychotics
Dopamine antagonists
Target positive symptoms of schizophrenia
Advantage: less expensive
Disadvantages: extrapyramidal side effects (dystonia, akathisia, pseudoparkinsonism), ACh side effects (dry mouth), tardive dyskinesia (repetitive movements), weight gain, sexual dysfunction, endocrine disturbances
Second-Generation Antipsychotics
Serotonin and dopamine antagonists (clozapine)
Treat both positive and negative symptoms
Minimal to no EPS or tardive dyskinesia
Disadvantage: tendency to cause significant weight gain, risk of metabolic syndrome (increased risk for diabetes)
Third-Generation Antipsychotics
Really a subset of the SGAs
Ariprazole, brexpiprazole, calprazine
Dopamine system stabilizers
May improve positive and negative symptoms and cognitive function
Little risk of EPS or tardive dyskinesia
Potentially Dangerous Responses to Antipsychotics
ACh toxicity
Neuroleptic malignant syndrome
Agranulocytosis
Prolongation of QT interval
Liver impairment
Advanced Practice Interventions for Schizophrenia
Individual and group therapy
Psychoeducation
Medication prescription and monitoring
Basic health assessment
Cognitive remediation
Family therapy
Anxiety
Apprehension, uneasiness, uncertainty, or dread from real or perceived threat
Normal anxiety is necessary for survival
Fear
Reaction to a specific danger
Mild Anxiety
Everyday problem-solving leverage
Grasps more information effectively
Moderate Anxiety
Selective inattention
Clear thinking hampered
Problem-solving not optimal
Sympathetic nervous system symptoms begin
Severe Anxiety
Perceptual field greatly reduced
Difficulty concentrating on environment
Confused and automatic behavior
Somatic symptoms increase
Panic
Markedly disturbed behavior–running, shouting, screaming, pacing
Unable to process reality; impulsivity
Defense Against Anxiety
Automatic coping styles
Protect people from anxiety
Maintain self-image by blocking feelings, conflicts, memories
Can be healthy or unhealthy
Separation Anxiety Disorder
Developmentally inappropriate levels of concern over being away from a significant other
Panic Disorder
Panic attacks
Unpredictable, self-limiting
Typically last 10min or longer
May have palpitations, tremors, SOB, feeling of smothering, chest pain, nausea, abdominal pain, dizziness, paresthesia
All other medical issues have been ruled out if given this diagnosis
Agoraphobia
Excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing
Social Anxiety Disorder
Severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others
Generalized Anxiety Disorder
Excessive worry that lasts for months
Easily fatigued, difficulty concentrating, muscle tension, sleep disturbance, difficulty functioning due to worry
Other Anxiety Disorders
Substance-induced anxiety disorders
Anxiety due to medical condition (COPD)
Obsessions
Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind
Compulsions
Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety
Obsessive-Compulsive Disorders
Obsessive-compulsive disorder
Body dysmorphic disorder
Hoarding disorder
Hair pulling and skin picking disorders
Epidemiology of Anxiety Disorders
Decreased levels of serotonin and dopamine
Assessment of Anxiety Disorders
Sound physical and neurological exam
Determine source of anxiety (primary vs. secondary)
Determine current level of anxiety
Assess for potential self-harm
Complete psychosocial assessment (ask patent about causes they can identify)
Self-assessment
Nursing Diagnoses and Outcome Identification for Anxiety
Anxiety (self-monitors intensity, uses reduction techniques)
Ineffective coping (identifies ineffective and effective patterns)
Planning with Anxiety
Patients do not usually require inpatient admission
Planning involves selecting community-based interventions
Encourage active participation in planning to increase positive outcomes
Patient experiencing severe levels may not be able to participate in planning
Implementation for Anxiety
Identify their anxiety
Counseling
Teamwork and safety
Promotion of self-care activities
Pharmacological interventions (antidepressants, anti-anxiety drugs, other classes)
Psychobiological interventions
Integrative therapy
Health teaching
Concepts Central to Addictive Use Disorders
Addiction
Intoxication
Tolerance
Withdrawal
Comorbidities with Substance Abuse Disorders
Psychiatric comorbidities (schizophrenia, anxiety)
Medical comorbidities (diabetes, hepatitis C, psoriasis)
Etiology of Substance Abuse Disorders
Neurobiological factors
Psychological factors
Sociocultural factors
Caffeine
Most widely used psychoactive substance in the world
Can result in intoxication and withdrawal
Cannabis
Most widely used illicit drug in the world
Fourth most commonly used psychoactive drug in the United States after caffeine, alcohol, and nicotine
Hallucinogens
Cause a profound disturbance in reality
Inhalants
Solvents for glues and adhesives
Propellants
Thinners
Fuels
Opioids
Heroin and prescription drugs
Pharmacologic treatment: methadone, buprenorphine, and naltrexone
Withdrawal symptoms start within 6-8 hours and peak within 2-3 days
Withdrawal symptoms: bone pain, insomnia, hostility, aggression, vomiting, diarrhea
Sedative, Hypnotic, and Antianxiety Medications
Benzodiazepines, benzodiazepine-like drugs, carbamates, barbiturates, barbiturate-like hypnotics
CNS depressants–drowsiness, low BP, slow breathing
Withdrawal symptoms include insomnia, anxiety, tremors, sweating, increased HR and BP, seizures
NG tube and gastric lavage for overdose
Stimulants
Amphetamine-type, cocaine, or other stimulants
Second only to cannabis as the most widely used illicit substances in the United States
Systemic Effects of Alcoholism
Peripheral neuropathy
Alcoholic myopathy and cardiomyopathy
Esophagitis, gastritis, and pancreatitis
Alcoholic hepatitis
Cirrhosis of the liver
Leukopenia
Thrombocytopenia
Cancer of the head and neck
Screening Tools
SBIRT: Screening, Brief Intervention, Referral to Treatment
AUDIT: Alcohol Use Disorders Identification Test
CAGE: 4 questions to identify alcohol abuse
CAGE-AID: same questions as CAGE but adds drug use to alcohol
T-ACE: Tolerance, Annoyance, Cut down, Eye opener
Implementation for Substance Abuse Disorders
Promote safety and sleep (first-line interventions)
Reintroduce good nutrition and hydration
Support for self-care
Explore harmful thoughts and spiritual distress
Care Continuum for Substance Abuse
Detoxification Rehabilitation Halfway houses Other housing Partial hospitalization Intensive outpatient treatment Outpatient treatment Alcoholics Anonymous Relapse Prevention
