Psychosis

Question 1

Positive symptoms

Answer 1

something that’s not suppose to be there that’s added on – hallucinations, delusions, thought disturbances, illusions

Question 2

Negative symptoms

Answer 2

something that’s taken away, anhedonia, avolition, catatonia, affective flattening

Question 3

Schizophrenia Stages

Answer 3

Acute
Stabilization
Maintenance

Acute phase: working on managing ADLs, education, reduce substance use
Untreated symposm just endure and carry forward

Question 4

Prodromal

Answer 4

a process of changes or deterioration in heterogeneous subjective and behavioral symptoms that precede the onset of clinical psychotic symptoms

can mimic depression. Positive symptoms tend to happen in more subtle ways

Question 5

Auditory Hallucinations

Answer 5

Can be sounds rather than voices
Voices can be self-derogatory
Antipsychotic medications do not always completely eradicate auditory hallucinations
Many people do learn to manage life even with hearing voices which are disruptive
Not everyone who hears voices has psychosis
Aim to understand the person’s experience (do not interpret)

Question 6

Stage of Hallucinations

Answer 6

Comforting
Condemning
Controlling or Command

Start comforting move to condemning then into command.
As anxiety rises the voices might get more condemning. They might start making meaning out of the voices and start listening.
As they start listening it can become more difficult to control their awareness. Worry that if their around others that others will hear the voices too. This helps to isolate the person.
Each level correlates with increased anxiety

Question 7

Interventions for Hallucinations

Answer 7

The first step is always to establish a therapeutic relationship, show acceptance and listen.
Look and listen for cues or symptoms of the hallucination and ask client their perspectives.
Observe patterns in hallucinations.
How does the person meet their needs/goals?

Question 8

Interventions for Negative Symptoms

Answer 8

Listen, engage and accept
Ask about depth of feelings (excitement, joy, sorrow)
Assess for the specific stage of lack of motivation
Encourage completion of ADL’s as much as possible
Short, frequent check-in’s helpful

Question 8

Schizoaffective Disorder

Answer 8

Schizoaffective Disorder has all the component of schizpophrenia but also has a mood component tacked in (mania, hyupomania or depression taked on)

Info: your symptoms can be effected by the mood state your in,
Explore the persons understanding. Their own self-stigma. What they think about the diagnosis, their assumptions etc. Maybe they think their now a terrible person etc. so understand what the diagnosis means to them

Question 9

Types of delusions
Persecutory/paranoid
Referential
Grandiose
Erotomanic
Nihilistic
Somatic
Religious
Jealous
Bizarre
Magical thinking

Answer 9

Delusion: false fixed belief that doesn’t change when presented with dif evidence
Persecutory/paranoid – most common type of delusion. People think their being harassed, followed, spyed on
Referential – every day gestures are for you (walk by and the street light turns off so it has specific meaning to me). More related to a thing happening to a person. It’s there for me
Grandiose– person has exceptional ideas, fame fortune, money (need to confirm that the information is false)
Erotomanic – false belief that another person is in love with them. Often a celebrity
Nihilistic – false idea that part of the self is missing/aspects of the word are destroyed. I’m fading away, I’m dead/decomposing
Somatic – associated. scorpion in brain with headache.
Religious – false fixed belief that has religious implications. Believe their Jesus
Jealous – 48min
Bizarre – something that’s not possible within our reality (aliens)
Magical thinking – belief that our thoughts/actions/words can prevent things from happening. ”I’m sad so it’s raining. My sadness caused the rain”. Person causes something to happen

Question 10

Interventions of Delusional Thought Content

Answer 10

Use reasonable doubt
Agree to disagree
What to share with others/what not to share
Understanding the emotion
Assist to identify specific problems caused by delusion and problem-solve
*Reality testing

Question 10

Typical Antipsychotic Medication

Answer 10

chlorpromazine (Thorazine),
haloperidol (Haldol),
methotrimeprazine (Nozinan),
zuclopenthixol dihydrochloride (Clopixol)

cause EPS

Question 11

EPS include

Answer 11

Akathisia
Akinesia
Pseudoparkinsonism
Dystonias
And Tardive Dyskinesia

Question 12

Akathisia

Answer 12

inability to stand still

Question 13

Akinesia

Answer 13

absence of movemet

Question 14

Atypical Antipsychotic Medication

Answer 14

risperidone (Risperidal),
paliperidone (Invega),
ziprasidone (Zeldox ),
quetiapine (Seroquel),
olanzapine (Zyprexa) &
aripiprazole (Abilify)

More likely to cause metabolic side effects

Question 15

Clozapine (clozaril)

Answer 15

used for treatment resistant schizophrenia
Risk agranulocytosis

Clozapine – need to monitor blood work, a whole protocal that goes along with it. Agranulocytosis is not common at all. What is very common is constipated and it can be deadly if you become systemically septic

Question 16

Neuroleptic Malignant Syndrome

Answer 16

Extrapyramidal side effects (muscle rigidity)
Increased body temperature (diaphoresis)
Change in consciousness (delirium, confusion, coma)
Fluctuating BP, Tachycardia, decrease respirations
Elevated CK and myoglobin (causes damage to the liver and kidneys)
Tremor
Progresses over days to weeks if untreated

Question 17

Rapid Tranquillization

Answer 17

Most common Haldol 5 mg and Lorazepam 2 mg IM for agitation
Olanzapine and chlorpromazine also used
Clopixal acuphase – Long acting – 72 hours

Question 18

Depot Medication

Answer 18

All depot medication should be administered as a deep Intramuscular injection
Gluteal sites are the preferred sites for injection (unless the package indicates differently ex Risperidone - deltoid)
Most common Abilify Maintenia and Risperidone LA