Exam 4 Flashcards
What are the effects of first generation medications for schizophrenia? Common side effects? Examples?
decreases positive symptoms with little effect on negative
extrapyramidal, sedation, weight gain (especially in abdomen), hyperglycemia, anticholinergic, orthostatic, sexual dysfunction, risk of CV disease (dyslipidemia) and DM
Haloperidol, chlorpromazine, thioridazine
What are the effects of second generation schizophrenia medications? Common side effects? Examples?
treats positive and negative symptoms, used when there is comorbid major depression or bipolar disease
extrapyrmidal, sedation, weight gain, hyperglycemia, anticholinergic, orthostatic hypotension, risk of metabolic syndrome and increased risk of suicide (especially in adolescents)
Clozapine, resperidone, Quetiapine
What are the types of affect seen in schizophrenic patients?
Flat: Immobile or blank facial expression
Blunted: Reduced or minimal emotional response
Constricted: Reduced in range or intensity (e.g., shows sadness or anger but no other moods)
Inappropriate: Incongruent with the actual emotional state or situation (e.g., laughing in response to a tragedy)
Bizarre: Odd, illogical, inappropriate, or unfounded; includes grimacing
What type of hallucinations do schizophrenic patients experience?
auditory: common, can be single or multiple sounds or voices, often it is god speaking to them, often it is conversation or comments, pt might be seen with lips moving silently or cocking their head to one side as if listening, may develop delusions to explain the voices
command: pt is directed to take action by god, the devil, or another person, this is a red warning as they may actually do some type of harmful behavior
visual: the second most common, see individuals and animals that do not exist
What are delusions?
false beliefs held despite a lack of evidence to support them
What type of delusions can schizophrenic patients experience?
persecutory: someone’s out to get you
grandiose: think highly of self
religious: think god is talking to you, very common
What are positive symptoms that schizophrenic patients may experience? Examples?
those that are there that should not be, are noticeable, appear early, and elicit treatment sooner and
hallucinations, delusions, paranoia, bizarre speech/behavior/thoughts
What are negative symptoms that schizophrenic patients may experience? Examples?
absence of qualities that should be present, and are serious because the pt is missing important human qualities and can be harder to treat than positive symptoms, they contribute to withdrawal and poor social functioning
ability to enjoy activities, goal directed behaviro like work/school, comfort in social situations, the A’s (anhedonia, avolition, asociality, affective blunting, apathy, alogia)
What is anhedonia?
reduced ability or inability to experience pleasure
What is avolition?
reduced motivation or goal-directed behavior; difficulty beginning and sustaining goal-directed activities
What is affective blunting?
reduced or constricted affect
What is alogia?
reduction in speech, sometimes called poverty of speech
What are risks that come along with a diagnosis of schizophrenia?
poor health maintenance, decreased access and quality health care d/t stigma
impaired ability to express needs
poor nutrition
substance use (trying to self-medicate)
poverty (inability to hold job)
victimization
trauma
sterotyping
unable to recognize and respond to symptoms of illness
What are the treatment plans for schizophrenia?
after acute hospitalization, the pt might transition to partial hospitalization program for weeks to months as weeks to months as they continue to improve: day programs keeping the pt in a safe environment and decrease withdrawl, increase motivation, and offer socalization
as the pt and family is educated about the disease, they need to know what community resources may be helpful: teach about illness, expectations of what will come next, ways to cope, meds and side effects, relapse prevention
What are some pt and family teachings for schizophrenia?
have regular contact with supportive individuals
take care of one’s diet, health, and hygiene keeps you healthy
minimize tobacco and caffeine as they may make your medications less effective
maintain a stable weight
maintain a regular sleep pattern
keep active
nurture yourself and practice stress-reduction activities
joint support groups
What are the phases of bipolar disease?
acute phase: onset of new manic or hypomanic episode, goal during this phase is symptom reduction and eventually remission, tend to teach patients basic needs
continuation phase: is about treatment, pt is often ambivalent about treatment and don’t believe they need it, they enjoy the energy and euphoric feelings and don’t see a problem, dont want to give that up, still working towards remission of symptoms
maintenance: goal is to prevent relapse, symptoms are controlled as well as possible, tasks are education, support, working on problem-solving skills, awareness of risks of relapse, importance of attending group therapy, identifying new coping skills
What are symptoms of bipolar disease?
bipolar I: more severe, shifts in mood and behavior, at least one manic episode, euphoric, energized, eat little, sleep little (classic sign), feeling important and powerful, may take risky chances, initial euphoria turns into agitation and irritability, distractible, decreased concentration, eventually exhaustion then depression occurs
bipolar II: most common form, at least one hypomanic episode, psychosis is never present, depression may be severe with a risk of suicide, often under diagnosed and mistaken for personality disorder or depressive disorder
What is rapid cycling?
seen with bipolar I or II
at least 4 mood episodes in 12 months, associated with more severe symptoms
How is bipolar disease assessed?
mood: people spend more time in depressed state than manic state, can quickly change to anger and irrtation when frustrated, often seek out social events, spend lots of monty they may not have, have sex indiscriminately, make grandiose plans, euphoria is unstable (continuous stream of talk, often overly familiar, have boundless enthusiasm and lots of self-confidence)
distractibility: hallmark symptom of mania, results in few tasks being completed
appearance: may dress gaudy or bizarre, lack of attention to grooming and hygiene
What are the speech patterns of schizophrenic patients?
sometimes is sexually explicit ranging from inappropriate to vulgar
Pressured: rapid to frenetic, loud, incoherent, nonstop
Circumstantial: adding unnecessary details but eventually gets to the point
Tangential: losing the point they were trying to make and never finding it again
Loose associations: thoughts only loosely connected
Flight of ideas: fast speech with quick change of multiple topics. Incessant talking, jokes, puns, teasing
Clang associations: like sounds or rhyming
What types of delusions can schizophrenic patients experience?
highly inflated self-regard, often ideas resolve around religion, science fiction, or supernatural
persecutory: may revolve around religion believing that god is punishing them or telling them what to do, may be thoughts that someone or an organization is after them or out to get them, sometime scan lead to hallucinations, rarely leads to violence
What type of agitation medications can be given for schizophrenic patients?
divalproex
olanzapine
risperidone
lithium
What are the uses of lithium? Side effects? Nursing education?
mood stabilizer for schizophrenic patients
weight gain, risk of toxicity (nausea, vomiting, diarrhea, thirst, lethargy, sedation, hand tremor, confusion, blurred vision, polyuria, severe can cause: convulsions, oliguria, death)
need to have labs to monitor for toxicity, need to do labs for renal function and thyroxine, may need an ekg, no antidote for toxicity (just d/c med)
What are types of anticonvulsants that schizophrenic patients may take? Uses? Side effects?
valporic acid, divalproex
treating and preventing mania
nausea, weakness, indigestion, diarrhea, dizziness, black box warning, teratogenic, hepatotoxicity, low platelets, pancreatitis
What are second generation antipsychotics and antidepressives that schizophrenic patients may have? Uses? Nursing education?
venlafaxine
acute mania, insomnia, mood stabilization
must always combine antidepressant with a mood stabilizer to prevent manic episodes or rapid cycling
What are benzodiazepines used for? Examples?
insomnia and anxiety, short term d/t highly addictive
lorazepam, alprazolam
What are some teaching points for those with schizophrenia?
Learn warning signs of an impending episode: May have some similarities but can vary to each person, Even a single night of sleep loss could be a warning sign
Meds can cause significant weight gain: Common reason for stopping treatment, Help pt figure out methods that work for them to take meds regularly
Learn to self-manage treatment adherence: Treatment is long-term, may be lifelong
Use of alcohol, drugs and caffeine can cause relapse
Sleep is crucial
Develop coping strategies: Group and individual therapy are beneficial
What is persistent depressive disorder? Who is it more common in? Treatment?
low level depression that occurs most of the day for the majority of days with at least two of the following symptoms: decreased or increased appetite, insomnia or hypersomnia (hallmark sign of depression), low energy, poor self-esteem, difficulty thinking, hopelessness
women
psychotherapy, CBT, SSRI, SNRI, TCA
What other conditions may induce depression?
premenstrual dysphoric disorder: cluster of symptoms occurring 1 week before menstrual period, symptoms similar to pre-menstrual symptoms, ceases with menopause
substance/med-induced depressive disorder: occurs after prolonged use or withdrawal of drus or alcohol
Other conditions: stroke, parkinsons, cushing, alzheimer, arthritis, back pain, metabolic conditions, HIV, DM, infection, cancer, autoimmune disease
What is seasonal affective disorder? Who is it more common in? Treatment?
depression caused by lack of melatonin in the fall/winter
those living in countries farther from the equator, women 18-30
light box to mimic sunlight for 30 to 45 minutes a day (best in AM)
What are the phases of treatment for depression? Their goals?
acute: 6-12 weeks; reduction of symptoms, possible hospitalization, meds, and other treatments
continuation: 4 to 9 months; prevention of relapse using meds, therapy, and education
maintenance: 1 year or more; prevention of further episodes, meds may be phased out or continued, maintain role as functioning community member in continuation and maintenance phase
What is the goal of pharmacotherapy for depression? How does treatment with them typically go?
achieve complete remission of symptoms
first med is not the one that ultimately provides remission, for first depressive episode meds are usually taken for 6 to 9 months after remission
What are the classes of pharmacotherapy drugs used for depression? Examples?
SSRI: usually first line, Fluoxetine, assoicated with serotonin syndrome (rare life-threatening side effect)
SNRI: serotonin norepinephrine reuptake inhibitor, venlafaxine
SARI: serotonin antagonists reuptake inhibitors, trazodone
NDRI: norepinephrine dopamine reuptake inhibitor, bupropion
NaSSA: nonadrenergic and specific serotenergic antidepressant, mirtazapine
TCA: tricyclic antiepresants, amitriptyline
MAOis: monoamine oxidase inhibitors, phenelzine
What are other integrative treatments used for depression?
St. John’s wort: herb that can increase serotonin, norepinephrine, and dopamine
ECT (electrocurrent therapy)
rTMS: magnetic stimulation approved for treatment resistant depression, pt may feel tapping in their head, scalp contraction, or jaw thightening
VNS (vagus nerve stimulation): boosts levels of neurotransmitters resulting in improved mood and enhancing action of antidepressants
DBS (deep brain stimulation): electrode surgically implanted into specific areas of brain to stimulate underactive areas in depression
exercise: increases availability of serotonin
psychological: CBT, interpersonal therapy, behavioral therapy, group therapy
What are some teaching points for those with depression?
Depression is an illness beyond voluntary control
Depression can be managed with meds and lifestyle changes
Chronic disease management means understanding personal symptoms of relapse
People do best long-term with meds and psychotherapy
Learning to cope with stress and relationships with family, friends and work is key
Including family in discharge planning is important
