Exam 3 Flashcards
How long do schizophrenia sx have to last to be dx with it?
1 month
Name the disorder:
Severe mental condition in which there is disorganization of the personality, deterioration in social functioning, and loss of contact with, or distortion of reality
Involves hallucinations and delusion
Can occur with or without the presence of organic impairment
Psychosis
Name the disorder:
Disabling psychological disorder
Involves: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative sx
Result in a severe deterioration of social and occupational functioning
Schizophrenia
What are the 4 A’s of schizophrenia?
-Affect –> Emotions
-Associative looseness –> Thinking
-Autism –> Reality perception
-Ambivalence –> Vacillation
What are the biochemical factors influencing psychosis?
-Excess dopamine production
-Can also involve other NTs like norepi, serotonin, acetylcholine, GABA, prostaglandins, and endorphins
What prenatal exposures can lead to schizophrenia?
-Influenza
-Ventricular enlargement
-Neural circuit dysfunctions
What are the comorbidities of schizophrenia?
-Substance use disorders
-Nicotine dependence
-Anxiety, depression, suicide
-Physical health or illness
-Polydipsia-psychosis-induced thirst
Name the disorder:
Presence of delusions for at least 1 month
Subtypes of this disorder = erotomanic, grandiose, jealous, persecutory
Delusional disorder
Name the disorder:
Sudden onset of psychotic sx that may or may not be preceded by a severe psychosocial stressor, sx last at least one day but < a month, evidence of impaired reality
Brief Psychotic Disorder
What are 1st gen antipsychotics?
1) Thorazine
2) Prolixine
3) Haldol
What do 1st gen antipsychotics tx?
Positive sx
What are extrapyramidal SEs?
1) Pseudoparkinsonism
2) Acute dystonia
3) Akathisia
4) Tardive Dyskinesia
Name the disorder:
Hallucinations and delusions are attributed to usage of substance, exposure to a substance, or withdrawal from a substance
Substance-Medication Induced Psychotic Disorder
Name the Disorder:
Prominent hallucinations and delusions attributed to another medical condition
Psychotic Disorder d/t another medical condition
What is catatonia?
Motor disturbances from stupor (no motor activity) to excessive motor activity or agitation
Name the disorder:
Sx are identical to schizophrenia, but has only had the condition for < 6 months
Schizophreniform disorder
When does schizophreniform turn into schizophrenia?
When sx persist for > 6 months
Name the disorder:
Schizophrenia in addition to depression or mania
Schizoaffective disorder
What are the 2nd gen antipsychotics?
1) Clozaril
2) Risperidal
3) Zyprexa
4) Seroquel
5) Geodon
What kind of sx do 2nd gen antipsychotics tx?
Positive and negative sx
What is the main side effect of 2nd gen antipsychotics?
Weight gain
True or False:
2nd gen antipsychotics do not cause extrapyrimidal effects
True
What are the phases of schizophrenia?
1) Premorbid
2) Prodromal
3) Active psychotic phase
4) Residual phase
What characteristics are associated with the premorbid phase of schizophrenia?
1) Shy
2) Withdrawn
3) Poor peer relationships
4) Poor performance in school
5) Asocial behavior
What characteristics are associated with the prodromal phase of schizophrenia?
1) Lasts weeks to months, sometimes 2-5 years
2) Significant deterioration in function
3) Depressive sx, signs of cognitive impairment, social withdrawal, sudden onset of OCD behaviors
What characteristics are associated with the active phase of schizophrenia?
-Acute episode where sx are more pronounced
-Psychotic sx are more prominent
What characteristics are associated with the residual phase of schizophrenia?
-Improvement in positive sx but negative sx remain
-Flat affect; impairment in role functioning
What are positive sx of schizophrenia?
1) Delusions
2) Hallucinations
3) Disorganized Thinking
4) Grossly disorganized of abnormal motor behavior
What are negative sx of schizophrenia?
1) Lack of emotional expression
2) Avolition
3) Alogia
4) Associality
5) Diminished ability for abstract thinking
6) Apathy
7) Anergia
8) Anhedonia
Name the vocab:
Decreased or lack of motivation to complete purposeful acitivities
Avolition
Name the vocab:
Decreased verbal communication
Alogia
Name the vocab:
Decreased interest in social interaction and relationship
Associality
Name the vocab:
“The FBI is after me”
Paranoid
Persecutory
Name the vocab:
People on the TV or radio are talking about them
Environmental cues
Referential
Name the vocab:
A celebrity loves them or “I am Jesus Christ”
Power and greatness
Grandiose
Name the vocab:
Thinks something is wrong with an organ or that they are pregnant, centered on personal body function
Somatic
Name the vocab:
Someone of higher status is in love with them
Erotomanic
Name the vocab:
The doctor gave me and shot and now I can communicate with the FBI
Objects/people control them
Control/influence
Name the vocab:
Self/others/world do not exist
Nihilistic
What are positive sx: thought disturbances?
1) Percusatory
2) Grandiose
3) Reference
4) Control/influence
5) Somatic
6) Nihilistic
7) Erotomatic
8) Jealous
What are positive sx: Perceptual disturbances?
1) Hallucinations (5 senses)
2) Illusions
3) Echopraxia
What is echopraxia?
Imitating movement of others
What are the positive sx: disorganized thinking?
1) Loose associations
2) Neologisms
3) Clang associations
4) Word salad
5) Circumstantiality
6) Tangentiality
7) Perseveration
8) Echolalia
Name the type of disorganized thinking:
Shift of one idea to another without connection of ideas
“The sky is blue and the shoes are worn out”
Loose association
Name the type of disorganized thinking:
Newly invented words that are meaningless to other
“I got a ride on a new telemotor”
Neologisms
Name the type of disorganized thinking:
Using words in a sentence that rhyme
Clang associations
Name the type of disorganized thinking:
Words that are put together without meaning
Word salad
Name the type of disorganized thinking:
Unable to express point of topic d/t unnecessary or tedious details
Tangentiality
Name the type of disorganized thinking:
Speaking same word or idea in response to different questions
The person gets stuck on a particular thought
Perseveration
Name the type of disorganized thinking:
Repeating words or phrases spoken by another
Echolalia
Name the vocab:
Indifference or disinterest in the environment
Apathy
Name the vocab:
Inability to feel/express pleasure; can increase risk for suicide
Anhedonia
Name the phase of planning and implementation of schizophrenia:
-Sx stabilization
-Safety
-Medication
-Communication
-Limit-setting
Phase 1
Name the phase of planning and implementation for phase 1 of schizophrenia:
-Milieu Management (set boundaries and expectations)**
-Activities and groups
-Safety
-Counseling
-Communication techniques
-Associative loosness
-Health teaching/health promotion
Phase II & III
What are contraindications of using antipsychotics?
1) Coma
2) Parkinsons
3) Severe hypotension
4) Older adults with dementia
Name the vocab:
Subjective– Emotion that may have a major influence on a person’s perception of the world
“I’m happy” or “I’m irritated”
Mood
Name the vocab:
Objective– the emotional reaction associated with an experience (how you view a person– can tell if they are happy/sad)
Affect
What are the RFs for Depressive Disorders?
1) Hereditary
2) Over 65
3) NT deficiencies
4) Medical illness
5) PP
6) Trauma
7) Stressful life events
What are the phases of depressive disorders?
1) acute phase
2) Continuation phase
3) Maintenance face
Name the phase of depressive disorders:
Severe clinical findings, tx 6-12 wks, may need hospitalization, reduction of depressive manifestations is the goal, assess suicide risk and implement safety precautions
Acute phase
Name the phase of depressive disorders:
-Increased ability to function
-Tx 4-9 mos
-Relapse prevention
-Med therapy/education
-Psychotherapy
Continuation phase
Name the phase of depressive disorders:
-Remission of manifestations
-Can last for years
-Prevention of future depressive episodes is the tx goal
Maintenance phase
Name the depressive disorder:
frequent temper outbursts that last at least 12 months- and chronic irritability. Not bipolar; dx between ages 6-10 years old
Disruptive mood dysregulation disorder
Name the depressive disorder:
depressed mood, loss of interest for at least 2 weeks. May be “recurrent with a seasonal pattern, seasonal affective disorder (SAD). Must occur almost every day for at least 2 weeks, sleep pattern disturbances, suicidal ideation, anhedonia, weight loss or gain, depressed mood.
MDD
Name the depressive disorder:
more mild form of depression, usually has an early onset, persistent symptoms for 2 years for adults and at least 1 year for children
Persistent depressive disorder
Name the depressive disorder:
occurs in the luteal phase of the menstrual cycle (after ovulation before menstruation)Mood swings, depression, anxiety, overeating, anergic, aching, bloating, weight gain, breast tenderness, excess sleep or insomnia
Premenstrual dysphoric disorder
What other medical conditions can contribute to depressive disorders?
-Electrolyte imbalances
-Thyroid issues
-Vitamin deficiencies
What are the etiology theories of depressive disorders?
1) Serotonin deficiency** (also low norepi & dopamine)
2) Genetics
3) Predisposition & STRESS
What are the main assessment tools for adults to dx depressive disorders?
Hamilton & Beck
What is the most common depression assessment tool used in adults?
Geriatric
What med types are the 1st line tx for MDD?
SSRI/SNRIs
True or False:
TCAs work faster to tx MDD than SSRIs/SNRIs
Flase- SSRIs/SNRIs work faster than TCAs
What kind of effects do you need to watch out for when a pt is taking TCAs?
Anticholinergic effects
What tips can you give to pts experiencing anticholinergic effects?
1) Increase H2O
2) Increase fiber
3) Sugarless gum
4) Eye drops
5) Walking/exercising
What can happen if someone on MAOIs has high tyramine levels?
Can cause a hypertensive crisis
What are foods with tyramine?
1) Aged cheese
2) Dried meats
3) Chocolate
4) Smoked sausage/fish
5) Cough medicine
6) Wine
What are examples of complementary therapies for depressive disorders?
1) ECT
2) Vagal nerve stimulator
3) Light therapy
4) Transcranial magnetic stimulation
5) Exercise (3-5 days/wk)
6) CBT
Name the complementary therapy:
Inducing a grand maul seizure for patients experiencing severe depression
**NOT 1st line
ECT
Name the complementary therapy for depressive disorders:
Wired thread under the skin that sends stimulating signals to the brainstem & then sends signals to different areas of the brain
Vagal nerve stimulator
Name the complementary therapy of depressive disorder:
Client stares at a light causing retina stimulation that triggers a release of melatonin & increases serotonin
Effective in those that have SAD
Light therapy
What NT does exercise release?
Serotonin
What does CBT do?
Changes negative behaviors and thought patterns
Name the suicidal cue:
“I’m going to kill myself”
Overt – obvious
Name the suicidal cue:
“I don’t know how much more I can take”
Covert – beating around the bush
Name the type of loss:
Part of life cycle
Necessary
Name the type of loss:
A loss of a valued person or item
Actual
Name the type of loss:
A loss defined by the client that may not be obvious to others (Ex: loss of a job)
Perceived
Name the type of loss:
Losses d/t developmental processes of life
Maturational
Name the type of loss:
Unanticipated loss caused by an external event (Ex: car accident or hurricane)
Situational
What is normal grieving?
Incomplicated/achieved by 6 months
May experience somatic sx like: chest/back/stomach pain or HA
Name the type of complicated grief:
Does not demonstrate normal behaviors of loss, can remain in denial stage for months
Ex: Parent w/ child that passed away states “He’s coming home soon”
Delayed or inhibited gried
Name the type of complicated grief:
Someone w/ somatic sx in addition to grief – can be exaggerated
Distorted or exaggerated grief
Name the type of complicated grief:
Clients remain in denial stage and unable to accept the loss, can result in decreased function to complete ADLs
Prolonged or chronic grief
Name the type of complicated grief:
Grief that cannot be shared publicaly or socially
Ex: Suicide, abortion
Disenfranchised
Name the type of BPD:
-The client has at least 1 episode of mania altering with major depression- more common in men
Climb all the way to the top of the mountain and come right back down
BPD I
Name the type of BPD:
-the client has 1 or more hypomanic episodes alternating with major depressive episodes- more common in women
Get halfway to the top of the mountain and come right back down
BPD II
Name the type of BPD:
-the client has at least 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomanic episodes alternating with minor depressive episodes
not an extreme manic state but above baseline
Cyclothymia
What are the comorbidities of BPD?
1) Substance use
2) Anxiety
3) Borderline personality disorder
4) ODD
5) Social phobias
6) SAD
7) ADHD
8) Migraines
9) Metabolic syndromes
What are the characteristics of mania?
1) Labile mood with euphoria (major mood fluctuations)
2) Restlessness
3) Can’t take criticism
4) Increased talking/activity
5) Flight of ideas
6) Grandiose views
7) Impulsive, demanding, manipulative
8) Attention-seeking behaviors
9) Decreased sleep, ability to do ADLs, visual impairements, denial of illness
What stage of mania:
-Hospitalization may be required
-Reduction of sx & safety is goal
-Risk for harm to self or others
-May need 1:1 supervision
Acute
What stage of mania:
-Tx 4-9 mos
-Relapse prevention through education
-Med adherence & psychotherapy = goal
Continuation
Name the stage of mania:
-Tx generally continues through pt’s life
-Prevention of future manic episodes = goal
Maintenance
What are toxic lithium levels?
1.5 - 2.0 (could be lethal > 3.5)
What are signs of lithium toxicity?
1) V/D
2) Slurred speech
3) Weakness
4) Stupor
5) Coma
6) Tremor
7) Seizires
What are therapeutic lithium levels for acute mania?
1.0 - 1.5
What are therapeutic lithium levels for maintence?
0.6 - 1.2
What are the anticonvulsants meds?
1) Valproate (seizures & BPD)
2) Carbamazepine (seizures & BPD)
3) Lamotrigine (depression, but not mania)
What med is used a lot in BPD II that needs to be watched for rashes as a sign of allergic rxn?
Lamotrigine
What benzos are used in BPD?
Clonzaepam
Lorazepam
What 2nd gen atypical antipsychotics are used in BPD?
Zyprexa
Risperidal
