Exam #3 Flashcards
what are positive symptoms of schizophrenia?
delusions, hallucinations, disorganized speech, grossly disorganized(hyperactive)
does schizophrenia have periods of remission?
yes
what is the symptom criteria for schizophrenia?
must have delusions, hallucinations, disorganized speech, with catatonic, disorganized, and negative symptoms for at least one month
what are the stages of schizophrenia?
premorbid, prodromal, active psychotic, and residual phase
what happens during the premorbid phase?
symptoms like shy, withdrawn, antisocial, poor school performance
hard to diagnose in this stage
what happens during the prodromal stage?
psychotic symptoms are frank, functional impairment, deterioration in role, social withdraw, sleep disturbance, anxiety, irritability, depression, fatigue, and poor concentration
what happens during the active psychotic phase?
positive and negative symptoms will be present…..delusions, hallucinations, disorganized speech, catatonic behavior….in this stage the patient should be admitted into the psychiatric unit
what are predisposing factors for schizophrenia?
genetics, biochem, viral infections, anatomical abnormalities in the brain, psychological factors, environmental influences, and theoretical integration
how can viral infections cause schizophrenia?
pre natal exposure to the flu virus
how can biochem cause schizophrenia?
too much dopamine activity
what anatomical abnormalities can cause schizophrenia?
reduction in the gray matter and size of hippocampus
what psychological factors can cause schizophrenia?
childhood trauma
what environmental factors can cause schizophrenia?
sociocultural factors, stressful life events, cannabis use in patients who are predisposed
what are the schizophrenic delusional disorders?
grandiose, jealous, persecutory, somatic, and mixed
what does the delusional disorder grandiose mean?
irrational ideas regarding worth, talent, knowledge, and power
what does the delusional disorder jealous mean?
irrational idea that their partner is unfaithful
what does the delusional disorder persecutory mean?
that they are being mistreated or spied on
what does the delusional disorder somatic mean?
irrational belief that he or she has some physical defect, disorder, or disease
what does the delusional disorder mixed mean?
it follows no single theme
what is brief psychotic disorder?
sudden onset of psychotic symptoms that last less than one month
what can cause brief psychotic disorder?
sudden psychosocial stressor or traumatic even
what is the treatment for brief psychotic disorder?
antipsychotics
what is substance and medication induced psychotic behavior?
prominent hallucination and delusions that can attributed to the effects of a drug
what do you to treat substance and medication induced psychotic behavior?
drug screen, give them fluids, and sedate
what is psychotic disorder due to another medical condition?
prominent hallucination and delusions that can attributed to a medical condition
what is the most common population to get medication induced psychotic disorder?
elderly
what can cause medication induced psychotic disorder?
labs being off or UTI
what is schizophreniform disorder?
same symptoms as schizophrenia and lasts between 1 and 6 montsh
what is schizoaffective disorder?
schizophrenia disorder accompanied with a mood disorder like mania, depression, bipolar
what are positive symptoms?
delusions, hallucinations, disorganized thought/speech, and bizarre behaviors
do atypicals treat positive or negative symptoms?
positive symptoms and negative
do typicals treat positive or negative symptoms?
negative symptoms
what are negative symptoms?
flat affect, reduced social interaction, anhedonia, avolition, alogia, catatonia
what are some examples of alterations in thought?
ideas of thought, persecution, grandeur, somatic delusions, jealousy, being controlled, thought broadcasting, thought withdrawal, religiosity, and magical thinking
what does alterations in ideas of thought mean?
misconstrues trivial events and attaches personal significance to them
what does alterations in persecution mean?
feels singled out for harm by others
what does alterations in grandiosity mean?
thinks they are powerful and important
what does alterations in somatic delusions mean?
thinks that their body is changing in an abnormal way…..growing a third arm
what does alterations in jealousy mean?
thinks that their partner is sexually involved with someone
what does alterations in being controlled mean?
that their thoughts are being controlled by someone else
what does thought broadcasting mean?
thinks that their ideas can be heard by others
what does thought withdrawal mean?
thinks their thoughts have been removed from their brain
what does religiosity mean?
obsessed with religious beliefs
what does magical thinking mean?
thinks that their actions can control a situation…wearing a hat makes them invisible
what is associative looseness?
inability to concentrate on a single though
what is noelogisms?
make up words
what is echolalia?
the client repeats specific words that they have heard
what is clang association?
meaningless rhyming of words
what is tangentiality?
inability to get to the point of communication due to the introduction of many new topics
what is word salad?
words jumbled together with little meaning or significance to the listener
what are auditory hallucinations?
hallucinations you can hear
what are visual hallucinations?
hallucinations that you can see
what are tactile hallucinations?
hallucinations that you can feel
what are gustatory hallucinations?
hallucinations that you can tast
what are olfactory hallucinations?
hallucinations that you can smell
illusions???
what is echopraxia?
copying what they observe
what is depersonalization?
feelings of unreality….lost identity
what is derealization?
perception that the environment has changed
what is identification and limitation?
taking on the form of behavior that they observed someone doing….copy cat
what does apathy mean?
lack of interest in their environment
what alteration in behavior do schizophrenics experience?
flat affect, apathy, agitation, pacing, robot like, stupor, catatonia, impaired impulse control, avolition, anhedonia, and deteriorated apperance
what does stupor mean?
motionless coma-like state
what does catatonia mean?
inability to move normal
what does avolition mean?
inability to initiate a plan to reach a goal
what does anhedonia mean?
inability to experience pleasure
how are some things schizophrenics do socially?
isolate, withdraw, not trust
what do you do when your patient is experiencing hallucinations/dellusions?
be accepting but orient back to reality
in regard to violence, what interventions can do for schizophrenics?
low stimulus, removing dangerous objects, intervene when signs appear
in general, what are some goals for schizophrenic patients?`
decrease anxiety, build trust, define reality, interact with others, safety, hygiene, and adaptive family coping
what are SMART goals
Specific, measurable, attainable, realistic, and have a time``
what type of therapies might schizophrenics attend?
individual, group and behavioral
what training might schizophrenics be apart of to help them socially?
social skills training, family therapy, and assertive community treatment
what is social skills training?
use of role play to help the patient understand eye contact, personal space, voice notation, posture etc
what is family therapy for schizophrenics?
helps family members cope and understand the illenss
what is assertive community treatment for schizophrenics?
care team comes to the patient home and does treatment there
what medications are used to treat schizophrenia?
antipsychotics
what are the two kinds of antipsychotics?
typical and atypical
what type of symptoms do typicals treat?
positive symptoms
do typicals or atypicals have more eps symptoms?
typicals
do typicals or atypicals increase the risk of seizures?
typicals
what type of symptoms do atypicals treat?
positive and negative
do typical or atypicals make you gain weight?
atypicals due to the change in your metabolic rate
do typicals or atypicals have a sedative effect?
atypicals
what must you assess before starting your patient on antipsychotics?
NSAIDs, dietary supplement, drug use, smoking, drinking, prescription med
what are the symptoms of antipsychotics? VERIFY
N/V, diarrhea, rash, photosensitivity, orthostatic hypotension, hormone changes, ECG changes, anticholinergic, seizures, hypersalivation, hyperglycemia,
what is agranulocytosis?
failure of bone marrow to produce adequate white blood cells
what medication can cause agranulocytosis?
clozapine
what is the worst outcome of agranulocytosis?
death
what should you do when you notice that your patient has agranulocytosis?
stop the medication and treat the symptoms
what are the symptoms of agranulocytosis?
fever, malaise, sore throat
what is done for patients with agranulocytosis other than stopping the medication?
lab work to monitor wbc
what is the dystonic reaction?
muscle spasms particularly in the neck, eyes, and tongue
what does the patient experience with the dystonic reaction?
pain, fear, dysphagia, and compromised airway
what should be given to a patient with a dystonic reaction?
benztropine and diphenhydramine
what is akathisia?
inability to sit still
what will a patient with akathisia look like?
restless, pacing, fidgeting, leg shaking etc
when does akathasia typically present?
when antipsychotics are started or increased
what should be administered when the patient has akathisia?
benztropine and diphenhydramine
what is pseudoparkinsonism?
shuffling gait, muscle stiffness, mask expression, drooling
can pseudoparkinsonism be fixed?
yes
what should be administered for patients with pseudoparkionism?
benztropine and diphenahydramine
what is tardive dyskinesia?
abnormal involuntary movements typically seen on the face
what is the patient at risk for socially with tardive dyskinesia?
social isolation
is tardive dyskinesia permanent?
yes
what is used to screen for TD?
aims
what should you do if your patient gets TD?
stop the medication
what is neuroleptic malignant syndrome?
characterized be 104-105 temp
what is the patient at risk for if they get malignant syndrome?
death
what medication is administered for malignant syndrome?
dantrolene
what are the antiparkinsonian agents?
xxxxxx
what are the indications for antiparkinsonian agents?
treatment of all forms of parkinsonism and for the relief of drug-induced extrapyramidal reactions.
what is the MOA of antiparkinsonian agents
restores the natural balance of ACH and dopamine
what precautions should taken when give antiparkinsonian agents?
glaucoma, obstructions, BPH, myasthenia gravis
what are the side effects of antiparkinsonian agents?
anticholinergic effects, Neausa, Gi upset, sedation, dizzines, exacerbation of psychosis, orthostatic hypotension, sedation,
what should patients do when going outdoors if on antiparkinsonian agents?
wear sunscreen
what should patients taking antiparkinsonian agents not consume?
alcohol or other medications without dr knowledge
what might the patient need to do weekly when taking antiparkinsonian agents?
lab draw
is anxiety normal?
yes it prepares you for threats and gives motivation
what is GABA?
a neurotransmitter that is responsible for calming you down
is GABA high or low in patients with GAD?
low
what are risk factors for GAD?
genetics, environment, depression, substance abuse
what are some symptoms of GAD?
restless, on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance
how many symptoms and for how long must a patient experience symptoms in order to be diagnosed with GAD?
3 symptoms for 6 months
how can regular anxiety lead to panic attacks?
if your day to day anxiety is not controlled this leads to GAD and if GAD is uncontrolled this can lead to panic attack
do panic attacks have a trigger or is it random?
specific triggering event
does panic disorder have a trigger or is it random?
random
what are the symptoms of a panic attack?
chest pain, feeling of choking, paresthesia, fear of dying, shaking, sweating, trembling, hyperventilation, depersonalization, derealization, increased HR, and sob
what are the symptoms of anxiety?
irritability, disturbed sleep, muscle tension, increased HR, SOB,
what is hyperventilation?
occurs when a patient has a panic attack…characterized by having too high of respirations
what are the symptoms of hyperventilation?
lightheaded, tachycardia, SOB, numbness, tingling, syncope
what is the patient blowing off too much of during hyperventilation?
too much CO2
what should be done if a patient is hyperventilating?
have them breathe into a paper bag
should you give a patient who is hyperventilating oxygen?
no
does a patient who is hyperventilating go into respiratory acidosis or alkalosis?
respiratory alkalosis
what might the patient receive if they have an active hyperventilation episode?
benzo
what is panic disorder?
a recurrent panic attack that is unpredictable
what medications are administered for panic disorder patients?
Benzo, SSRI, Betablockers, Anxiolytics, and SNRI
what benzo is given to panic disorder patients?
alprazolam
what patient ed is given to patients taking benzo?
they are addictive, has to be tapered off, no caffeine, no smoking, no alcohol, PRN only
what SSRI is given to panic disorder patients?
paroxetine
what patient ed is given to patients taking SSRI?
increased SI, sexual dysfunction, weight gain
what beta blocker is given to panic disorder patients
propranolol
what anxiolytic is given to panic disorder patients?
buspirone
what does anxiolytics mimic?
benzo effect without the symptoms
can you take buspirone daily?
yes
what SNRI do panic disorder patients take?
venlafaxine
what teaching can be given to panic disorder patients to decrease the amount of occurrences?
notice when your symptoms begin, breating, imagery,yoga, sleep, exercise, journaling
what are phobias?
an irrational fear of something
what are risk factors for phobias?
learned behavior or traumatic event
what is agoraphobia?
fear of being vulnerable or unable to escape
what is social phobia?
fear of doing something embarrassing
what are the interventions for phobias?
safety, explore their perception of fear, discuss reality of avoiding
what medications groups are used to treat phobias?
benzo, ssri, betablocker, snri
what benzo is used to treat phobias?
alprazolam
What SSRI is used to treat phobias?
paroxetine
what beta-blocker is used to treat phobias?
propanolol
what snri is used to treat phobias?
venlafaxine
what medications are used to treat OCD?
ssri…Fluoxetine
Paroxetine
Sertraline
Fluvoxamine
what is OCD?
an obsession with something that is relieved by compulsions
what is an obsession?
intrusive thoughts that give anxiety
what is a compulsion?
something that is done to relive anxiety around the obsession
what is the OCD cycle?
obsession, anxiety, compulsion, relief
what are interventions for patients with OCD
identify triggers, allow compulsion but slowly limit, replace compulsion with coping skill
what are ocd patients at risk for?
substance abuse
what are the typical antipsychotics?
chlorpromazine, haloperidol, Fluphenazine,
what are the atypical antipsychotics?
Olanzapine, Risperidone, Aripiprazole, Ziprasidone, clozapine
what are the predisposing factors to PTSD?
the experience, the individual, and recovery
what in the experience predisposed someone to getting PTSD?
severity, duration, anticipation, death, control of reoccurrence, location
what individual attributes predisposed someone to get PTSD?
ego strength, coping, MH condition, previous trauma, temperament, demographic
what in the recovery stage might predispose someone to getting PTSD?
social support, close family, societal attitudes, culture
what are potential causes for PTSD?
DV, war, abuse, disasters, accidents, bullying, surgery, robbery, death of a loved one, adoption, separation
how long must you have symptoms after an experience to have PTSD?
1 month
what are the intrusion symptoms of PTSD?
recurrent memories, nightmares, flashbacks, prolonged distress
what are the avoidance symptoms of PTSD?
avoiding trauma related to…..thoughts, feelings, people. places, conversations, activities, objects, situations
what are cognition symptoms of PTSD?
cant recall specific events, negative toward self, survivor guilt, distorted blame, lack of interest, inability to feel positive emotions
what are the dissociative symptoms of PTSD?
altered sense of reality
what are the arousal and reactivity symptoms of PTSD?
irritable, aggression, self destruction, hypervigilance, exaggerated startle, problems sleeping and concentrating
what are co morb for PTSD?
depression, anxiety, and substance abuse
what are the interventions for PTSD?
stay with them, build trust, encourage verbalization, coping skills
what medications are used for PTSD?
SSRI, betablocker, anxiolytics, Benzo
what SSRI is used to treat PTSD?
paroxetine and sertraline
what betablocker is used to treat PTSD?
propranolol
what anxiolytic is used to treat PTSD?
buspirone
what benzo is used to treat PTSD?
alprazolam
what therapies are used for PTSD?
group CBT, exposure therapy, EMDR, digital therapeutics
what is EDMR?
patients talks about an event while their eyes follow a swinging object
who do you not do EDMR with?
active SI, substance abuse, psychosis, and seizure disorder
what is adjustment disorder?
a response to a stressor that lasts 3-6 months
what are the symptoms of adjustment disorder?
depressed mood, anxiety, disturbance of conduct, mixed disturbance???
what black box warning is associated with antipsychotics?
Increased risk of MORTALITY in ELDERLY patients with dementia-related psychosis.
what are the negative symptoms of schizophrenia?
flat affect, anhedonia, alogia, avolition, asociality, catatonia
what does anhedonia mean?
inability to experience pleasure
what does alogia mean?
lack of speech
what does avolition mean?
inability to reach gaols
