M3 D3 Flashcards
Detention Order vs Conditional Discharge
Main difference resides in the hospital’s capacity to involuntarily admit the person UST or NCR to the hospital:
- Detention Order: The person is considered ‘detained’, therefore this allows the hospital to involuntarily admit the person to the hospital without having to utilize provisions within provincial MHAs
- Conditional Discharge: The person is considered ‘discharged’, subjected to some conditions, therefore if the hospital desires to involuntarily admit the person, it must utilize Forms 1, 3, 4
- They can have conditional hearings and fight this
biological factors of schizo
Genetic
- 80% of risk derives from genetic factors
- Link between genes and events in life, such as infections, cause schizophrenia.
physiological
- infection
- physical ilness (epilepsy etc)
- anatomic anomalities (hippocampus changes, lower brain volume)
neurobiological
- The dopamine hypothesis (mesocortical, mesolimbic, nigrostriatal & tuberoinfundibular)
- Other drugs support this theory. Notably cocaine causes behavioural symptoms that are similar to paranoid schizophrenia.
- Pharmacological treatment addresses this – reduction of Dopamine.
dopamine tracts regulate:
MesoL, MesoC, Nigro, Tubero
Mesolimbic (responsible for positive symptoms of schizophrenia)
- Emotions
- Motivation
- Reward system
Mesocortical (negative symptoms)
- Cognition
- Executive functioning
Nigrostiatal
- Movement
- Initiation
- responsible for parkinsons
Tuberoinfunduibular
- Control prolactin secretion
Schizo phases
Phase 1 – Premorbid
- Pre-presentation – characterized by some form of maladjustment
Phase 2 – Prodromal
- Signs and symptoms that precede the, fully developed illness
Phase 3 – Acute phase of schizophrenia
- Active phase of the disorder
- Psychotic symptoms
Phase 4 – Residual
- Schizophrenia is characterized by periods of remission and exacerbation.
- Symptoms of the acute stage are either absent or no longer prominent.
Schizophrenia – Acute Phase – S/S
Posoitive, behaviours, negative, affective, cognitive
Positive Symptoms
- Hallucinations, Illusions, Delusions,
- Speech disorganization
Behaviours
- Bizarre behaviours, Disorganized behaviour (poor hygiene, agitation, etc.), Waxy flexibility (if you move them, they will stay in place)
Negative Symptoms
- Blunted affect,
- Alogia (poverty of thought),
- Avolition (low motivation),
- Anhedonia, Social isolation,
Affective
- Dysphoria, suicidality, hopelessness, lability, incongruence
Cognitive
- Inattention, distractibility
- poor problem solving and decision making skills
- impaired thought process
- impaired judgement
- impaired memory
Psychosis
Psychosis: A state in which the individual is experiencing positive symptoms (hallucinations, delusions, or disorganized thoughts, speech, or behaviours)
Psychotic symptoms may occur without a diagnosis of schizophrenia
Three Phases of Acute Schizophrenia
acute, stabilization, maintenance
Acute psychosis
- Abrupt onset of positive symptoms following prodromal phase (Frightening and anxiety provoking for patient and family)
- Disruptive to social functioning – may require hospitalization
- Often coupled with substance use
- goal to aleviate + symptoms w drugs
stabilization
- Symptoms may still be present (mostly negative), but should be less acute
- Substance use is (hopefully) eliminated/reduced
- L/A injections
Maintencance
- Medication adherence and quality of life improvement
- Stress management – stress may exacerbate symptoms - decompensation
why dont we want relapse for schizophrenia
- We dont want them to get worse
- The more we relapse the hearder is is it recover → longer recovery time
- The medication dose must become higher each time to reach an adequate level
5 types of schizo
- Paranoid type : Preoccupied with delusions and/or hallucinations, suspicious
- Disorganized type: Disorganized speech, disorganized behaviour
- Catatonic type: Motor immobility, excessive or purposeless motor activity
- Undifferentiated type: does not meet the criteria for other types;
- Residual type: Absence of prominent delusions, hallucinations, disorganized speech –> Negative symptoms persist.
Antipsychotic Agents - Therapeutics
There are two classes of antipsychotic agents:
- (1st gen) Typical or conventional antipsychotic agents (older drugs)
- (2nd gen) Atypical antipsychotic agents (Newer drugs)
- both the typical and atypical antipsychotics are effective in relieving positive symptoms of schizophrenia – hallucinations, delusions and bizarre ideation
- Atypical antipsychotics seem to be more effective in improving negative symptoms – social withdrawal, lack of interest in activities, lack of motivation, etc.
General adverse effects of receptor blockage of antipsychotics
D2, A1 and GABA
Dopamine (D2) block
- Extrapyramidal side effects
- Increase prolactin (anterior pituitary gland) bromocriptine reduces these side effects
- men: gynecomastia
- women: amenorrhea
- Galactorrhea
Alpha adrenergic (α1) block
- Orthostatic hypotension
- Dizziness
- Failure to ejaculate
- Priapism (α2)
GABA
- Lowers seizure threshold
General adverse effects of receptor blockage of antipsychotics
H1, Muscarinic cholinergic, 5-HT block
Histamine (H1) block
- Sedation
- Weight gain
Muscarinic cholinergic block
- Dry mouth
- Blurred vision
- Urinary retention
- Constipation
- Tachycardia
Serotonin 5-HT
- Weight gain
- Ejaculatory dysfunction
- Hypotension
EPS
what, types and nursing interventions
Extrapyramidal Symptoms (EPS) nigotrsiatal pathway
- typical antipsychotics
types
- Dystonic reaction: involuntary muscle spasm especially in the head and neck
- Akathisia: inability to sit still (cross and uncross legs, continuously pacing) – Increased distress
- Pseudoparkinsonism (Dyskinesias): Rigidity, slowed movements and tremor (usually extremities)
Nursing Interventions:
- Dystonic reaction:, antiparkinsons agents; Cogentin, Benadryl intramuscular
- Akathisia: Antiparkinsonian agent (e.g., Kemadrin), propranolol, benzodiazepines
- Pseudoparkinsonism (Dyskinesias): Antiparkinsonian agents
Tardive Dyskinesia (TD)
what, interventions
- A late-appearing extrapyramidal side effect of antipsychotics
- More likely with the use of typical antipsychotics
Characterized by repetitive involuntary movements of the:
- Face/head: Curling tongue movements; chewing sideways; grimacing, etc.
- Neck/trunk: Difficulty swallowing; irregular twisting, turning of shoulders and hips, etc.
- Limbs: Irregular, jerky movements of hands, arms, fingers, legs and feet; awkward gait.
Typically irreversible
interventions
- Best prevention is through the prescription of the lowest possible dose of anti-psychotics.
Metaboligic syndrome
Metabolic syndrome
- A triad of diabetes, dyslipidemia and hypertension with associated obesity.
- Those at risk show more rapid weight gain in the first weeks of drug treatment.
