Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Mental Health Nursing > Lecture 11 - Schizophrenia & Psychotic Disorders > Flashcards

Lecture 11 - Schizophrenia & Psychotic Disorders Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Mental Health flashcards Nursing Management of Care flashcards NCLEX-PN® flashcards NCLEX-RN® flashcards Nursing Fundamentals flashcards Nursing Pediatrics flashcards Nursing Safety & Infection flashcards Nursing Pharmacology flashcards Nursing Maternity flashcards Family Nurse Practitioner (FNP) flashcards
1
Q

At what age is schizophrenia usually diagnosed?

A

Men: 18-25
Women: 25-35

Males are more likely to develop it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is late onset schizophrenia?

A

Diagnosis of schizophrenia after age of 45 - characterized by increased positive symptoms
–> Women disproportionately affected (perhaps d/t protective factor of estrogen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the four major dopamine reliant pathways in the brain and what are their roles?

A

Mesocortical tract
–> Cognition, motivation, emotional responses

mesolimbic
–> Associated with reward and desire

Nigrostriatal
–> movement initiation

tuberoinfundibular tracts
–> Linked to pituitary and hormonal release of FSH, TSH, LH, and prolactin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the four phases of schizophrenia development?

A

1 - Premorbid
2 - Prodromal
3 - Acute
4 - Residual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is waxy flexibility?

A

When a person appears catatonic but can be passively moved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are two common affective changes in schizophrenia?

A

Lability and incongruence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a state of psychosis?

A

A state in which the individual is experiencing positive symptoms
–> Hallucinations, delusions, or disorganized thoughts, speech, or beheaviour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the three phases of the acute phase of schizophrenia?

A

Acute psychosis
Stabilization
Maintenance & Recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What occurs during the acute psychosis phase of acute schizophrenia?
What are the therapeutic goals during this time?

A

Abrupt onset of positive symptoms following prodromal phase - perhaps due to overcompensation for loss of dopamine, especially in mesolimbic tract
–> Disruptive to social functioning
–> Often coupled with substance use
–> Risk of harm to self/others

Therapeutic Goals: Ensure safety Alleviate positive symptoms, normalize sleep and intake, address substance use.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What occurs during the stabilization phase of acute schizophrenia?

What are the therapeutic goals during this time?

A

Establish a diagnosis, symptoms may be mostly negative and less acute. Substance use is eliminated/reduced.
Requires an adjustment period for families and patients.
Socialization with others and recovery begins

Therapeutic Goals:
Stabilization of symptoms is focus - may use LAI
Psychosocial education starts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What occurs during the maintenance and recovery phase of acute schizophrenia?

What are the therapeutic goals during this time?

A

Schizophrenia a a chronic illness, recovery includes periods of symptom exacerbation

Therapeutic Goals:
Medication adherence is priority
Stress management - stress can lead to decompensation
Continued education for patient and family

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is recovery time from a psychotic episode affected by previous relapses?

A

With each relapse, there is a longer recovery time
–> For this reason, early diagnosis and treatment is very important

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What factors can encourage recovery in the maintenance and recovery phase of acute schizophrenia?

A

Early Detection with short duration of untreated psychosis

Optimal treatment which includes not just medications, but also social support network, a stable living environment, access to meaningful activity and companionship, attention to physical health, and use of CBT or other psychotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should should the focus be during CBT for those with schizophrenia?

A

Address cognitive distortions related to living with auditory hallucinations and delusional content

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the different types of schizophrenia?

A

Paranoid, disorganized, catatonic, undifferentiated, residual type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What comorbidities are commonly seen in schizophrenia?

A

There is an association between diabetes and schizophrenia medications - metabolic syndrome

Disordered water/electrolyte imbalances d/t excessive drinking

Substance use + Cigarette smoking

Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Milieu therapy for schizophrenia should be focused on what?

A

Social functioning to provide security and dignity through structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Behavioural therapy with which focus can be helpful for people with disorganized schizophrenia?

A

Reinforcing certain desired behaviours can be helpful for disorganized patterns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What should we focus on during an interpersonal functioning assessment with schizophrenia?

A

Social isolation, emotional detachment, appearance, self-esteem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is echopraxia?

A

Repeating other’s movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the six priorities of physiological nursing interventions with schizophrenia?

A
  1. Promotion of self-care activities
  2. Develop routine for hygiene activities (help with motivation and execution)
  3. Activity, exercise, nutrition
  4. Appetite increases with 2nd gen antipsychotics, help with food choices
  5. Thermoregulation
  6. Promotion of normal fluid intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most important psychoeducation factor with schizophrenia?

A

The ability to identify s/s of decompensation and create a relapse prevention plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Therapeutic effects of antipsychotics may take how long? How long is an adequate trial time?

A

Therapeutic effects may take 1-2 weeks
–> Adequate trial period is 6-12 weeks
–> use PRN medications might be necessary during acute phase

Consider need for LAI and identify interventions for antipsychotic side effects.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What differentiates typical and atypical antipsychotics

A

First gen binds in a much stronger way to receptors and have more significant EPS

Second gen are more effective at improving negative symptoms but have increased risk of metabolic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What antipsychotic has an increased risk of increasing prolactin secretion from the anterior pituitary grand?

A

Risperidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the EPS symptoms?

A

Dystonia
–> Involuntary spasms (esp in head + neck)

Akathisia
–> Inability to sit still, increased distress

Pseudoparkinsonism (Dyskinesias)
–> Rigidity, slowed movements, tremor. Can be observed as the loss of spontaneous movements such as arm swing with gait.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is tardive dyskinesia?

A

A late-appearing chronic extrapyramidal side effect of antipsychotics.

Characterized by repetitive involuntary movements of the face/head, neck/trunk, and limbs.

It is typically irreversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

With which kind of antipsychotic will tardive dyskinesia occur more frequently?

A

Typical

29
Q

What is the best prevention for tardive dyskinesia?

A

Starting people onto the lowest effective dose of typical antipsychotics

30
Q

What is metabolic syndrome?

A

A triad of DM, dyslipidemia, HTN.
–> Rapid weight gain and symptoms of DM

31
Q

With which antipsychotic is weight gain of largest concern?

A

Olanzapine

32
Q

Agranulocytosis of most common with which antipsychotic?

A

Clozapine

33
Q

Symptoms agranulocytosis with clozapine usually occur in the first ___ months.

How long does it take granulocytes to return to normal after discontinuation of the drug?

A

6 months

Returns to normal within 2-4 weeks.

34
Q

Why is agranulocytosis potentially life threatening? How often is blood work done?

A

Regular blood work is requires because compromised immune system can result in life threatening infection.

For initial treatment with clozapine, BW 3x a week

35
Q

What is neuroleptic malignant syndrome? What are the symptoms?

A

Potentially fatal adverse effect of antipsychotic medications that occur within 7 days of onset.

–> Rapid cascade of sustained muscle contraction which results in hyperthermia and increased HR and WBCs
–> Sustained muscle contraction can result in muscle damage, release of myoglobin/CPK, which leads to damage to kidneys and liver.

36
Q

If someone has dystonia, what should the nurse do?

A

Dystonia can be a medical emergency, Cogentin should be administered.

37
Q

What nursing assessments must be done for neuroleptic malignant syndrome?

A

VS regularly (temp in particular)

Blood
–> CPK, myoglobin, liver enzymes, WBCs, lytes

38
Q

What nursing interventions should be used for neuroleptic malignant syndrome?

A

Discontinue the administration of any neuroleptic drugs and notify the physician
–> Pt will be transferred to med/ICU unit
–> Acetaminophen + cooling blankets
–> Hydration + electrolytes

39
Q

What is a major risk for people with schizoaffective disorders?

A

Major risk for suicide
–> Mood cycling with pervasive impulsivity

40
Q

What is schizophreniform disorder?

A

Like schizophrenia but lasts between 1-6 monthly only

41
Q

What is the dopamine hypothesis?

A

The theory that schizophrenia is caused by imbalances of dopamine in the brain

42
Q

What role can encephalitis play in schizophrenia?

A

Can be a causative factor for its development

43
Q

Which anatomical anomalies are associated with schizophrenia?

A

Larger ventricles + low CSF , changes in hippocampus, grey matter deficits, lower brain volume, disruption in communication pathways

Structural changes are most likely linked to developmental factors such as infection and NT deficits.

44
Q

increasingly severe symptoms of schizophrenia are associated with what physiological changes?

A

Larger/more substantial grey matter loss

45
Q

What is the premorbid phase of schizophrenia?

A

Pre-presentation - often characterized by some form of maladjustment

46
Q

What occurs during the prodromal phase of schizophrenia?
–> How long does it last?
–> S/S?

A

S/S that precede the characteristic manifestations of an acute and fully developed illness - decreased dopamine in the mesocortical tract
–> Starts months/years prior to the acute phase
–> Negative symptoms: Reclusiveness, poor hygiene, lack of initiative + interest, anxiety, obsessions, compulsions, phobias

47
Q

What occurs during the residual phase of schizophrenia?
–> S/S?

A

Schizophrenia is characterized by periods of remission and exacerbation - symptoms from acute phase are either absent or no longer prominent

S/S are like the prodromal phase, with flat affect and poor social functioning

48
Q

Dopamine blockers have which side effects?

A

EPS + Increased prolactin

49
Q

Increased prolactin results in what?

A

Gynecomastia, amenorrhea, galactorrea

50
Q

H1 blockers have which side effects?

A

Sedation/weight gain

51
Q

a1 blockers have which side effects?

A

Ortho Hypo + Dizziness
Failure to Ejaculate + Priapism

52
Q

GABA has which effect on the seizure threshold?

A

Lowers seizure threshold

53
Q

Muscarinic cholinergic blockers have which side effects?

A

Dry mouth, blurred vis, urinary retention, constipation, tachycardia

54
Q

5-HT (serotonergic) receptors have which side effects?

A

Weight gain, ejaculatory dysfunction, hypotension

55
Q

How can we treat dystonic reaction with antipsychotics?

A

Antiparkinsonian agents such as Cogentin (benztropine) and Benadryl IM

56
Q

How can we treat akathisia from antipsychotics?

A

Kemadrin (Procyclidine)
Pronanolol
Benzodiazepines

57
Q

How can we treat pseudoparkinsonism dyskinesias with antipsychotics?

A

With an antiparkinsonian agent

58
Q

What psychiatric medications might cause an anticholinergic crisis?

A

TCAs

59
Q

A patient presents with:
Elevated temp, burning, thirst, confusion, tachycardia, urinary retention, seizure, repetitive motor movements and worsening psychotic symptoms.

They are picking at objects around them.

What might be the problem?

A

Anticholinergic crisis

60
Q

What nursing assessments should be done for anticholinergic crisis?

A

Monitor VS regularly

61
Q

What nursing interventions should be done for an anticholinergic crisis?

A

Discontinue drug - should expect improvement within 26-36 hours

Catheterization may be necessary

Instill cooling measures

Benzodiazepines

62
Q

What disorder is characterized by stable, well-systemized, and logical delusions that occur in the absence of other psychiatric disorders?

Are people with this disorder often receiving care in inpatient units?

A

Delusional disorder
–> Often highly psychosocially functioning and therefore rarely admitted

63
Q

Why is delusion disorder difficult to treat?

A

Treatment is ineffective d/t strong fixation of delusions

64
Q

What are the four kinds of delusions seen in delusional disorder?

A

Erotomania
–> Delusions of romantic relationships

Grandiose

Jealous

Somatic

65
Q

What assessments should be done for someone confirmed to have delusional disorder?

A

Assess the significance of the delusion to the patient and whether they pose a risk to themselves or others.

66
Q

What is schizoaffective disorder?

A

An uninterrupted period of psychotic illness during which there is a major depressive, manic, or mixed episode alongside two symptoms of schizophrenia.

Mood disorder in conjunction with psychotic illness where psychotic features do not occur in conjunction with high or low moods.

67
Q

What is shared psychotic disorder?

A

When an otherwise healthy person shared delusional beliefs of someone with a psychotic disorder
–> Frequently seen when a couple is socially isolated

67
Q

What is brief psychotic disorder

A

A psychotic episode that lasts at least 1 day and less than 1 month
–> Symptoms appear following traumatic or stressful event

Mental Health Nursing (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions