Exam 4

Question 1

What are the effects of first generation medications for schizophrenia? Common side effects? Examples?

Answer 1

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

Question 2

What are the effects of second generation schizophrenia medications? Common side effects? Examples?

Answer 2

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

Question 3

What are the types of affect seen in schizophrenic patients?

Answer 3

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

Question 4

What type of hallucinations do schizophrenic patients experience?

Answer 4

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

Question 5

What are delusions?

Answer 5

false beliefs held despite a lack of evidence to support them

Question 6

What type of delusions can schizophrenic patients experience?

Answer 6

persecutory: someone’s out to get you

grandiose: think highly of self

religious: think god is talking to you, very common

Question 7

What are positive symptoms that schizophrenic patients may experience? Examples?

Answer 7

those that are there that should not be, are noticeable, appear early, and elicit treatment sooner and

hallucinations, delusions, paranoia, bizarre speech/behavior/thoughts

Question 8

What are negative symptoms that schizophrenic patients may experience? Examples?

Answer 8

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)

Question 9

What is anhedonia?

Answer 9

reduced ability or inability to experience pleasure

Question 10

What is avolition?

Answer 10

reduced motivation or goal-directed behavior; difficulty beginning and sustaining goal-directed activities

Question 11

What is affective blunting?

Answer 11

reduced or constricted affect

Question 12

What is alogia?

Answer 12

reduction in speech, sometimes called poverty of speech

Question 13

What are risks that come along with a diagnosis of schizophrenia?

Answer 13

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

Question 14

What are the treatment plans for schizophrenia?

Answer 14

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

Question 15

What are some pt and family teachings for schizophrenia?

Answer 15

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

Question 16

What are the phases of bipolar disease?

Answer 16

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

Question 17

What are symptoms of bipolar disease?

Answer 17

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

Question 18

What is rapid cycling?

Answer 18

seen with bipolar I or II

at least 4 mood episodes in 12 months, associated with more severe symptoms

Question 19

How is bipolar disease assessed?

Answer 19

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

Question 20

What are the speech patterns of schizophrenic patients?

Answer 20

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

Question 21

What types of delusions can schizophrenic patients experience?

Answer 21

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

Question 22

What type of agitation medications can be given for schizophrenic patients?

Answer 22

divalproex
olanzapine
risperidone
lithium

Question 23

What are the uses of lithium? Side effects? Nursing education?

Answer 23

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)

Question 24

What are types of anticonvulsants that schizophrenic patients may take? Uses? Side effects?

Answer 24

valporic acid, divalproex

treating and preventing mania

nausea, weakness, indigestion, diarrhea, dizziness, black box warning, teratogenic, hepatotoxicity, low platelets, pancreatitis

Question 25

What are second generation antipsychotics and antidepressives that schizophrenic patients may have? Uses? Nursing education?

Answer 25

venlafaxine

acute mania, insomnia, mood stabilization

must always combine antidepressant with a mood stabilizer to prevent manic episodes or rapid cycling

Question 26

What are benzodiazepines used for? Examples?

Answer 26

insomnia and anxiety, short term d/t highly addictive

lorazepam, alprazolam

Question 27

What are some teaching points for those with schizophrenia?

Answer 27

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

Question 28

What is persistent depressive disorder? Who is it more common in? Treatment?

Answer 28

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

Question 29

What other conditions may induce depression?

Answer 29

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

Question 30

What is seasonal affective disorder? Who is it more common in? Treatment?

Answer 30

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)

Question 31

What are the phases of treatment for depression? Their goals?

Answer 31

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

Question 32

What is the goal of pharmacotherapy for depression? How does treatment with them typically go?

Answer 32

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

Question 33

What are the classes of pharmacotherapy drugs used for depression? Examples?

Answer 33

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

Question 34

What are other integrative treatments used for depression?

Answer 34

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

Question 35

What are some teaching points for those with depression?

Answer 35

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