Module 7: Schizophrenia Spectrum Disorders Flashcards
What are different types of delusions?
- Bizarre
- Thought Withdrawal
- Thought Insertion
- Delusions of Control
- Erotomanic
- Grandiose
- Nihilistic
- Persecutory
- Referential
- Religious
- Somatic
Schizophrenia diagnostic criteria?
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
6. Impairment to functioning
If overall course has lasted greater than 6 months then may include periods of prodromal or residual symptoms
What are some interventions for recovery of Schizophrenia?
- Primarily life-long pharmacologic treatment
- Often preference to utilize Long Acting Injectables (LAI) for improved adherence
- Can target comorbidities pharmacologically as well (SUD, anxiety)
- Electroconvulsive Therapy for uncontrolled symptoms
- Psychosocial
- CBT – for psychosis
- Social skills training
- Promote coping skills
- Treat comorbidities such as SUD, anxiety
- Vocational Support
Identify positive symptoms of schizophrenia.
“Additional” or excess experience/perception/function
- Bizarre Behavior
- Delusions
- Hallucinations
- Disorganization
Identify negative symptoms of schizophrenia.
Experiences/perception/function “taken away” or diminished
- Avolition
- Anhedonia
- Attention & cognitive deficits
- Alogia (poverty of speech)
- Blunted/flat affect
- Social Withdrawal
Define referential thinking.
A form of reality distortion that can cause people to believe that events, objects, or interactions with others have a special meaning for them.
Example:
- Believing that people on a bus are talking about you
- Believing that people on TV or radio are talking directly to you
1st and 2nd generation antipsychotics black box?
Not approved for dementia related psychosis.
1st generation antipsychotics adverse effects?
- Neuroendocrine: gynecomastia, menstrual irregularities
- Sedation
- Weight gain
- Extrapyramidal Symptoms (EPS)
- Neuroleptic Malignant Syndrome (NMS)
2nd generation antipsychotics (atypicals) adverse effects?
- Anticholinergic effects
- Agitation, insomnia
- Cardiac Implications
- Hyperprolactinemia
- Sexual dysfunction
- Weight gain/metabolic syndrome
- Weakness, fatigue, sedation
- EPS/NMS (but less likely)
Antipsychotics key adverse effects?
- Anticholinergic side effects
- Extrapyramidal symptoms
- Neuroleptic Malignant Syndrome (NMS)
S/S of Anticholinergic side effects?
- constipation
- decreased sweating
- dilated pupils
- dry mouth
- slowed bowels
- slowed bladder
S/S of Extrapyramidal effects?
- Akathisia: inability to sit still
- Dystonia: involuntary muscle spasms, stiffness
- Pseudoparkinsonism: rigidity, tremor, slowed movement
- Tardive Dyskinesia: later onset, and harder/impossible to reverse
- Uncontrollable facial movement such as lip smacking
Neuroleptic Malignant Syndrome (NMS) symptoms?
- Severe Muscle Rigidity “Lead Pipe”
- Elevated Temperature
- Altered Mental Status
- Autonomic Instability
- HTN, tachycardia, tachypnea, diaphoresis
Neuroleptic Malignant Syndrome (NMS) treatment?
- Stop Medication
- Cool off
- Monitor I/O & Vital Signs
- Expect orders for dopamine agonists (bromocriptine) and/or muscle relaxants (dantrolene or benzodiazepines)
Neuroleptic Malignant Syndrome (NMS) risk factors?
- Dehydration
- First month of treatment
- Genetic Predisposition
- Increasing dose or multiple antipsychotics
What is echolalia?
involuntary repetition of words or phrases spoken by others
- think “echo”
