Psychosis Flashcards
Pyschotic behavior
An alteration in reality marked by delusions, hallucinations, disorganized speech and disordered behavior
If lab testing is positive for an physiological imbalance then pt has..
Delirium related psychosis
Some causes of delirium
Hypoglycemia Electrolyte Dysfunction Drug intoxication Endocrine Disorder Intracranial Bleeding
S/S of delirium
Rapid Onset
Fluctuating Course
Visual, Tactile, Olfactory Hallucinations
Not oriented to time, person, place
IF lab tests are negative (everything normal)
Consider psychiatric causes
4 Psychiatric Causes
- Schizophrenia
- Acute Mania
- Psychotic Depression
- Dementia
Schizophrenia “”
“Split mind.”
What age do ppl develop shizo
Early 20s
What are positive symptoms of schizophrenia
Schizophrenic has
Non-Schizophrenic does not have
What are negative symptoms of schizophrenia
Non-Schizophrenic has
that Schizophrenic does not have
Who are the only pts we don’t encourage to talk
Acute Mania
Require yes or no
Medications for acute mania
Lithium (Lithobid)
Carbamazepine (Tegretol)
Antidepressants
Antipsychotics
Anticonvolsants
Main factor in lithium toxicity?
Dehydration
Other factors in lithium toxicity
Diuretics
NSAIDS
Hypoatremia
Renal Impairment
Early signs of lithium toxicitiy
Marked tremor
Anorexia
N/V/D
Lethargy
Late Signs of lithium toxicity
Restless
Abd muscle movements and incoordination
Seizures
Tx for lithium toxcitiy
Large volume IV
Hemodialysis
Things to avoid with psychotic depression
Decision Making
Things to encourage with psychotic depression
Expression of decision making
Who is more likely to attempt suicide?
Woman
Who most likely succeeds at suicide
Men
First thing to care for in attempted suicide
Physical injuries
Encourage suicide pt to..
talk about the problems
Ask pt’s with suicide to look for..
alternative coping mechanisms
Dementia is a …
Chronic
Irreversible
Decrease in mental functioning
Near the end of dementia pts can become..
psychotic
What is classic sign of dementia
disorientation to time, place, and person
Dementia pt’s respond well to what during communication
Touch
Face the pt
Adequate lighting Caregiver
What med can be used for dementia
Antispychotics
2 s/s that go with antispychotics
Dystonia
Akasthisa
Dystonia
Disorganized muscle movement
Oculogyric Crisis
Eyes roll in the back of the head
Blepharospasms
Eyelids stay shut
Buccolingual Crisis
Mouth is forced open, tongue may protrude
Opathalmos
Head is arched backwards
Tarticollis
Head takes awkward position to the side
Toripelvic Crisis
Pt’s pelvis constantly moves
Akasthisa
Constant need to move
When can the antipsychotic symptoms occur?
Shortly after the drug is given or even 5 days after the drug is given
OR
Change of dose
MENTAL STATUS UNCHANGED - CAN BE SCARY FOR PT
Tx for dystonia
Quiet/Decreased stimuli room
Benadryl
Antiparkinson drug Benztropine or Artane
Tx for akathisia
Propranolol - dec movement
What disorder with dystonia can you die from?
Neuroleptic Malignant Syndrome
What is Neuroleptic Malignant Syndrome and when can it occur?
Can occur ANY time you are taking the drug - usually when it is hot out.
Lifethreatening reaction to antispychotics
What are the early symptoms of NMS
Starts with confusion and drowsiness
AMS
Muscle Rigidity
Tremors
What are the bad symptoms of NMS
Lead pip rigidity
Tremor
High fever
Autonomic Dysfunction
CAN LEAD TO RHABDO
RENAL FAILURE
What drugs worsen Serotonin Syndrom
More than one SSRI
Opioids
Illicit Drugs
St. John’s Wort
SSRI Syndrome s/s #1
AMS
agitation
anxiety
confusion
SSRI Syndrome s/s #2
Autonomic Instability
tachy
flushing
diaphoresis
SSRI Syndrome s/s #3
Neuromuscular Abnormalities
hyperflexia
clonus
lower extremity rigidty
Tx for NMS and SSRI syndrome
Stop the med Cooling Stabilize vitals Correct hypoxia - vent Reduce muscular rigidity
What is SSRI Syndrome
Too much serotonin in your body
Needed for nerve and brain cells to function
2 Drugs for Tx of NSM and SSRI SYndrome
Bromocriplie (Parlodel)
Dantrolene (Dantrium)
What is panic disorder
Anxiety due to a threat that does not exist
When do symptoms of panic disorders peak
In 10 minutes from onset and subside within 30 minutes (Running from a bear that isn’t there)
OCD usually shows up
childhood/adolescants
What are compulsions
Carrying through with the need
Drive to preform specific
“Checking the lock”
OCD 2 things
Obsession and Compulsion
PTSD usually occurs
3 months after event (can be years later)
Tx for anxiety disorders rx
Benzos
Anixolytics
Antidepressants
What to encourage for anxiety disorders
Feeling - Verbalize Concerns
Signs of abuse for the caregiver giving the abuse
Hostile Mad at themselves No guilt/remorse Focuses on child behavior instead of injuries Refuse to leave child alone Display anger towards child
Behavioral Signs of abuse in a child
Low Self Esteem Attention Seeking Fearful of abuser Anxious when other children cry Does not turn to care giver for solace
Signs of emotional abuse
Withdrawal Eating Disorders Head Banging Suicidal Self-destructive Rocking Learning difficulties Enuresis
Enuresis
Wetting bed when it is no longer appropraite
Crescent shaped bruises are from
Pinching
Oval shaped bruises are from
Biting
Canine molars of an adult is..
1-1.6 inches
Suspicious fractures of children
Humerus Sternum Fingers Spinous Process Scapula Posterior Ribs
Accidental burn
Child with thrash and have uneven burn
Suspicious burn locations
lips, tongue
rectum, perineum
dorsum of hand
A suspicious burn related to clothing coverage
Burns that are on areas that are normally covered by clothing are suspicious
Abusive Brain Injury
Shaken Baby Syndrome
3 Classic Triad of Shaken Baby Sydrome
Subdural Hemorrhage
Retinal Hemorrhage
Decreased LOC
What is Munchausen Syndrome
PT that enjoys seeking medical care - but it is proxying onto someone else
