Mod. 5 ATI ch. 15 & 24 Flashcards
Interventions schizophrenia
- assess safety
- reduce stimuli
- SME
- suicide assessment
- assess command hallucinations and if plan to follow them
How will nurse be able to recognize and assess signs and symptoms of a psychotic disorder?
!!! recognize social withdrawal
!!! notice positive or negative signs
!!! cognitive findings
!!! Affective findings
DSM Review
used for every mental dx
Positive Symptoms
manifestations of things that are not normally present.
- hallucinations
- delusions
- alterations in speech
- bizarre behavior (walking backward constantly)
Negative symptoms (anergia)
absence of things that are normally present. More difficult to treat successfully than positive ones.
- Affect- usually blunted or flat
- Alogia- poverty of thought or speech. May mumble
- Anergia- lack of energy
- Anhedonia- lack of pleasure or joy
- Avolition- lack of motivation
Psychotic Disorders recognized by DSM-5
8
- Schizophrenia
- Schizotypal personality disorder
- Delusional disorder
- Brief psychotic disorder
- Schizophreniform disorder
- Schizoaffective disorder
- Substance- induced psychotic disorder
- Psychotic or catatonic disorder not otherwise specified
Phases of care
Phase 1
Phase 2
Phase 3
Some labs to consider
RPR: r/o for syphillus
HIV
Tox. screen
Halol
tarditive dyskenesia is the big side effect we look out for
Congentin
should be given with halol. to control the EPS
What causes schizophrenia?
possibly results from a combination of;
- genetic
- neurobiological
- non-genetic (injury at birth, viral infection, nutritional factors)
Typical age of onset of Schizophrenia
late teens and early 20s
- can occur in young children
- can occur in late adulthood
Schizophrenia
client has psychotic thinking/ behavior for at least 6 months
significantly impaired areas of functioning; school, work, self-care, relationships
Schizotypal personality disorder
impairments of personality functioning (self and interpersonal)
impairment not as severe as with schizophrenia
Delusional Disorder
experiences delusional thinking for at least 1 month
self or interpersonal functioning is NOT markedly impaired
Brief Psychotic Disorder
psychotic manifestations that last 1 day to 1 month in duration
schizophreniform disorder
manifestations similar to schizophrenia, but duration is 1-6 months and social/ occupational dysfunction might not be apparent.
schizoaffective disorder
disorder meets criteria for both schizophrenia AND depressive OR bipolar disorder.
substance-induced psychotic disorder
experiences psychosis due to substance intoxication or withdrawal
however, psychotic manifestations are more severe than typically expected.
psychotic or catatonic disorder not otherwise specified
PSYCHOTIC features (impaired reality testing) or BIZARRE behavior (psychotic) or a significant change in MOTOR ACTIVITY behavior (catatonic) but does not meet criteria for diagnosis with another specific psychotic disorder.
Assessment: Cognitive Findings for psychotic disorders
- disordered thinking
- inability to make decisions
- poor problem-solving ability
- difficulty concentrating to perform tasks
- short term memory deficits
- impaired abstract thinking
Assessment: Affective findings for psychotic disorders
involving emotions
- hopelessness
- suicidal ideation
- unstable or rapidly changing mood
Assessment: alterations in thought (delusions) for psychotic disorders
- ideas of reference: misconstrutes trivial events and attaches personal significance to them. ex. thinking others are talking about them when they’re just discussing the next meal
- persecution
- Grandeur
- somatic delusions: believes that their body is changing unusually
- jealousy
- being controlled: believes someone outside their body is controlling
- thought broadcasting: believes their thoughts are being heard by others
- thought insertion: believes that others’ thoughts are being inserted into their mind
- thought withdrawal: believes their thoughts have been removed
- religiosity: obsessed w/ religious beliefs
- magical thinking: beliefs their thoughts/ actions can control others or situations
Assessment: psychotic disorders
Alterations in speech
- associative looseness: unconscious inability to concentrate on a single thought. Can progress to a flight of ideas (one thought to another, incoherent)
- neologisms: made-up words w/ meaning only to the client
- echolalia: client repeats words spoken to him
- clang association: meaningless rhyming of words, often forceful
- word salad: words jumbled together with little meaning or significance to listener
Assessment: psychotic disorders
Alterations in Perception
hallucinations are sensory perceptions that don’t have any apparent external stimulus:
- auditory: command:
- visual
- olfactory
- gustatory: experiencing tastes
- tactile: feeling bodily sensations
Assessment: psychotic disorders
Personal boundary difficulties
disenfranchisement w/ one’s own body, identity, and perceptions
- depersonalization- nonspecific feeling that the client has lost their identity. Self is different or unreal
- derealization- perception that the environment has changed, such as client believing that objects in their environment are shrinking
- illusions- misperceptions or misinterpretations of a real experience
Assessment: psychotic disorders
alterations in behavior
> extreme agitation»_space;> pacing and rocking
stereotypical behaviors»_space;> motor patterns that had meaning, are now mechanical and lack purpose
automatic obedience»_space;> responding in a robotic manner
waxy flexibility»_space;> maintaining specific position for a long time
stupor»_space;> coma-like, motionless
negativism»_space;> doing opposite of what’s requested
echopraxia»_space;> purposeful imitation of movements from others
catatonia»_space;> increase/ decrease in amount of movement. Muscular rigidity, catalepsy
motor retardation»_space;>
impaired impulse control»_space;> reduced ability to resist impulse
gesturing or posturing»_space;> assuming unusual/ illogical expressions
boundary impairment»_space;> impaired ability to see where one person’s body ends and another’s begins
Standardized screening tools for psychotic disorders
Abnormal Involuntary Movement Scale (AIMS)- used to monitor involuntary movement and tardive dyskinesia in clients taking antipsychotic medication
World Health Organization Disability Assessment Schedule (WHODAS)-
helps determine client’s level of global functioning.
Nursing Care: psychotic disorders
Milieu therapy
Milieu Therapy: in acute mental health facilities and in community facilities. It is a social environment controlled to help client.
- provide a structured, safe environment (milieu)
- Program of assertive community treatment (PACT): intensive case management and interprofessional team approach to assist clients w/ community-living needs.
Medications for psychotic disorders
- First- generation/ conventional antipsychotics
- Second- generation/ atypical antipsychotics
- Third- generation antipsychotics
- Antidepressants
- Mood stabilizing agents and benzodiazepines
