Psychotic and Neuro disorders Flashcards
1
Q
Schizophrenia is potentially a devastating brain disorder that affects:
A
Thinking Language Emotions Social behavior Ability to perceive reality accurately
2
Q
when does schizophrenia usually start
A
devastating brain disease that targets young people in their teens and early twenties
3
Q
what is psychosis
A
refers to a total inability to recognize reality (e.g., delusions and hallucinations)
4
Q
what kind of disease is schizophrenia
A
neurological
5
Q
what are the co-occuring illness of schizophrenia
A
- Substance abuse disorders
- Anxiety disorders
- Depression
- OCD
- Panic disorders
- Obesity (probably due to antipsychotic medications); leads to comorbid diabetes and risk of cardiovascular disease
6
Q
what are the theories of causes of schizophrenia
A
- Prenatal infections, environmental toxins, stress, LSD, meth
- Brain structure abnormalities (neuroanatomical)
- Autoimmune?? Brain on Fire
- Neurochemical (brain chemistry)
7
Q
what are the theories of neurochemical causes for schizophrenia
A
dopamine, serotonin, glutamate
8
Q
what kind of prenatal stressors causes risks for schizophrenia
A
Pregnancy and birth complications
9
Q
what kind of psychologic stressors causes risks for schizophrenia
A
Developmental, psychologic, physical, and family stress
10
Q
what kind of environmental stressors creates a risk for schizophrenia
A
- Social adversity, chronic poverty, and growing up in high crime areas or in a foreign culture
- Street drugs in those under 21
11
Q
what are some positive symptoms of schizophrenia
A
Hallucinations Delusions Bizarre behavior Catatonia Formal thought disorder
12
Q
what are some mood symptoms of schizophrenia
A
Depression Anxiety Demoralization Dysphoria Suicidality
13
Q
what are some cognitive symptoms of schizophrenia
A
- Impairment in memory; disruption in social learning
- Inability to reason,
- Solve problems,
- Focus attention
14
Q
what are some negative symptoms of schizophrenia
A
Apathy Lack of motivation Anhedonia Blunted or flat affect Poverty and speech
15
Q
what is the alteration in thinking for impaired reality testing for schizophrenia
A
Absence of ability to correct errors in thinking
16
Q
what is the alteration in thinking of delsuions for schizophrenia
A
False fixed beliefs not corrected by reasoning
- Thought broadcasting
- Thought insertion
- Thought withdrawal
- Delusion of being controlled
17
Q
what is the alteration in thinking of concrete thinking for schizophrenia
A
Impaired ability to think abstractly
18
Q
what are some alterations in speech you will notice in schizophrenia
A
Associative looseness Neologisms Clang association Word salad Echolalia
19
Q
what is Echolalia
A
Pathologic repeating of another’s words
20
Q
what are some alterations in perception you will notice in schizophrenia
A
Depersonalization Hallucinations Illusions Command hallucinations Derealization
21
Q
what are some alterations in behavior you may notice with schizophrenia
A
Bizarre behavior Extreme motor agitation Waxy flexibility Stupor Negativism Automatic obedience Stereotyped behaviors Catatonia Echopraxia
22
Q
Loss of impulse control may result in
A
agitated behaviors
23
Q
Malignant catatonia is an ________ crisis
A
emergency
24
Q
what is caratonia
A
the freezing movement it is moveable but they are stuck for a moment
25
what is Echopraxia
Mimicking the movements of another
26
what are some negative symptoms of schizophrenia
Apathy
Anhedonia
Poor social functioning
Poverty of thought
Flat, blunted, inappropriate, or bizarre affect
Develop insidiously over long period of time
27
after you have rules out medical or substance induced psychosis then assess for...
```
Drug and alcohol use
Command hallucinations
Belief system
Comorbidity
Medication regimen
Family dynamics/support system
```
28
what is the outcomes/treatment for Phase 1 (acute)
- Patient safety
- Medical stabilization
- Refrain from acting on delusions/hallucinations
29
what is the outcome/treatment for Phase 2 (stabilization) and Phase 3 (maintenance)
- Medical adherence, understanding, and compliance
- Continual recovery and functional improvement
- Control and relapse prevention
30
what is the planning for Phase 1 (acute)
- Likely hospitalization (safety, workup, testing)
| - Strategize safely and symptom stabilization
31
what is the planning for Phase 2 (stabilization) and Phase 3 (maintenance)
```
Patient and family education
Skills training (psychosocial)
Relapse prevention skills
Social/vocational/coping skills
Geared toward strengths as well as deficiencies
```
32
what are some therapeutic strategies for schizophrenia
- Lowering the patient’s anxiety
- Decreasing defensive patterns
- Encouraging participation in therapeutic and social events
- Raising feelings of self-worth
- Increasing medication compliance
33
what are the interventions for phase 1 (acute)
- Psychopharmacologic treatment
- Supportive/directive communications
- Limit setting (milieu management and counseling)
- Psychiatric, medical, neurologic evaluation
34
what is the health teaching for phase 2 and phase 3
Disease, medication management
Cognitive and social skills enhancement
Stress and anxiety controls
35
what is the health promotion and maintenance for phase 2 and phase 3
- Improve functional deficits
- Encourage nonthreatening activities
- Encourage family and social interaction
36
Antipsychotic drugs are effective in:
Acute exacerbations of schizophrenia
| Preventing or mitigating a relapse
37
what is the simple purpose of Conventional (first-generation) antipsychotics
Target positive symptoms, BLOCK DOPAMINE
38
what is the simple purpose of Atypical (second-generation) antipsychotics
- Target positive and negative symptoms
- Dopamine, AcH, NE Serotonin
- Atypical agents have fewer side effects.
- Atypical agents treat anxiety, depression, and decrease suicidal behavior.
39
what is chlorpromazine(thorazine)
| med
1st gen antipsychotic
| low potency
40
what are some medium potency 1st gen antipsychotics
loxapine (Loxitane)
molidone (Moban)
perphenazine (Trilafon)
41
what are some high potency 1st gen antipsychotics
```
trifluoperazine(generic only)
thiothixene (Navane)
fluphenazine (Prolixin)
haloperidol (Haldol)
pimozide (Orap)
```
42
what are some conventional adverse reactions of 1st gen
- Extrapyramidalsymptoms (EPSs) -- (Akathisia, Acute dystonia, Pseudoparkinsonism)
- Tardive dyskinesia (TD)
- Neuroleptic malignantsyndrome (NMS)
- Agranulocytosis (rare)
- Anticholinergic effects
- Orthostasis
- Lowered seizure threshold
43
what is the teaching of Neuroleptic malignantsyndrome (NMS)
it is an EMERGENCY
fatal 10%
occurs at start of treatment
44
what are the ss of Neuroleptic malignantsyndrome (NMS)
- Decreased LOC
- Muscle- increased tone, rigidity
- Fever, Labile HTN, rapid HR, sweating, drooling, rapid respirations
- Treatment with Dantrium, Parlodel, ECT
45
what is akathisia
lower leg shaking their leg is "alive"
46
what is dystonia
a state of abnormal muscle tone resulting in muscular spasm and abnormal posture
47
what is Tardive dyskinesia
movement disorder that causes a range of repetitive muscle movements in the face, neck, arms and legs
48
what is the treatment of Extrapyramidal symptoms
Lowering the dose
| Prescribing antiparkinsonian drugs:
49
what are some Lowering the dose antiparkinsonian meds
```
* trihexyphenidyl (Artane)
• benztropine mesylate (Cogentin)
• diphenhydramine hydrochloride (Benadryl)
• biperiden (Akineton)
• amantadine hydrochloride (Symmetrel)
```
50
what are some atypical 2nd gen meds that target positive or negative symptoms
- aripiprazole (Abilify)
- clozapine (Clozaril) ** last resort, agranulocytosis
- olanzapine (Zyprexa)
- paliperidone (Invega)
- quetiapine (Seroquel)
- risperidone (Risperdal)
- ziprasidone (Geodon)
51
what are the ss metabolic syndrome
Weight gain, dyslipidemia, altered glucose
| Risk of diabetes, hypertension, atherosclerosis, and increase in heart disease
52
what are the disadvantages of atypical 2nd gen
- metabolic syndrome
- More expensive than conventional antipsychotics
- Agranulocytosis (Low WBC) with Clozapine
53
what are the 6 cognitive domains
- Complex attention
- Executive functioning
- Learning and memory
- Language
- Social cognition
- Perceptual and motor ability
54
Neurocognitive Disorders: Three (3) Main Categories
Delirium
Mild neurocognitive disorder
Major neurocognitive disorder
55
does delirium have co-morbities
Always exists secondary to another medical condition or substance use.
56
what are the common co-morbidities of delirum
```
Surgery
Drugs
Infection, hypoglycemia, fever, other homeostatic disruptions
Pain, emotional stress
Pneumonia, cerebrovascular disease
Congestive heart failure (CHF)
```
57
what are the cognitive disturbances seen in delirum
Thinking, memory, disorientation, impairment, and perception
58
what are the attention disturbances seen in delirum
Loss of focus and attention; confusion over situation and environment
59
what is sundown syndrome
Increased confusion in the evening hours
60
what is the clinical pic of delirum
- Disturbances in consciousness occur.
- Change in cognition occurs.
- Develops over a short period.
- Is common in hospitalized patients, especially older adults.
- Is always secondary to another physiologic condition.
- Is a transient disorder.
- If the underlying condition is corrected, then complete recovery should occur.
61
what is the initial presentation of delirum
- Acute onset
- Sudden reduced clarity of environmental awareness
- Impaired ability to focus, sustain, or shift attention and fluctuating course
- Inattention; questions need to be repeated
- Distracted by irrelevant stimuli
- Fluctuating, unpredictable levels of consciousness
- Sundowning: Disorientation worse at night and early morning
62
what are the physical and mood beahviors will you notice in delirum
- Wandering, falling; requires simple environment
- Dramatic fluctuations
- Labile (quick, changing) moods
63
what are the common symptoms noticed in delirum
- Autonomic hyperactivity (increased vital signs)
- Hypervigilance (constantly alert or scanning room)
- Labile mood swings
- Agitation and/or anger
64
what is the outcome goal of delirum
Patient will return to premorbid level of functioning.
65
what is the medical management of delirum
directed toward identifying and treating any underlying cause.
66
what is the nursing implementations of delirum
directed toward patient safety.
67
what is mild cognitive impairment
- Memory impairment = Main symptom
- Does not interfere with general cognitive functioning
- Does not interfere with ADLs and socialization
68
what is demientia
Evidence of “. . . significant decline in previous cognitive abilities (complex attention, executive function, learning and memory, language, perceptual motor, or social cognition).”
irreversable related to primary encephalopathy
69
what are the major risk factors for Alzhiemer or dementia
Age and female gender
70
what is the genetic theory for late onset Alzheimer
```
does not seem to have an obvious inheritance pattern.
Apolipoprotein E (apoE) on chromosome 19 a risk factor in 20%-25% of cases.
```
71
what is the genetic theory for early onset Alzheimer
age 30–60) is rare and is probably inherited.
| Amyloid precursor protein (APP) on chromosome 21; PS-1 on chromosome 14; and gene PS-2 on chromosome 1
72
what is the difference for primary vs secondary dementia
```
primary
Irreversible
Progressive
Not secondary to any other disease
Example: AD
```
secondary
Result of some other pathologic process
Example: Acquired immunodeficiency syndrome (AIDS)–related dementia
73
what are the cultural risk factors for Alzheimer
African American older adults: twice as likely to develop AD as white counterparts.
Hispanic American older adults: 1.5 times as likely to develop AD as white counterparts.
Other correlations: higher incidence with hypertension, CV disease, and diabetes.
74
what is the pathology of Alzheimer
```
Tau protein changes
Neurofibrillary tangles
Cortex shrinking
Hippocampic degeneration
Enlarged ventricles
Beta-amyloid plaques
Granulovascular degeneration
Brain atrophy
```
75
what are the four defense behaviors for Alzheimer
Denial (cover up)
Confabulation (making up answers in unconscious attempt to maintain self-esteem)
Perseveration (repetition of phrases or behavior)
Avoidance of questions
76
what are the 4 A's of Alzheimers
Amnesia
Aphasia
Apraxia
Agnosia
77
what are the cardinal symptoms of alzheimers
Disturbances in executive functioning and the 4 A’s
78
what is amnesia
memory impairment
79
what is aphasia
loss of language ability
80
what is apraxia
loss of purposeful movement in the absence of motor or sensory impairment
81
what is agnosia
loss of sensory ability to recognize objects
82
what is stage 1 of Alzheimer
forgetfulness; possible depression
83
what is stage 2 of Alzheimer
confusion; memory gaps; self-care gaps; apraxia. Labile mood.
84
what is stage 3 of Alzheimer
unable to identify familiar objects or people; advanced agnosia and apraxia
85
what is stage 4 of Alzheimer
agraphia, hyperorality, hypermetamorphosis
86
what is agraphia
reading and writing impaired
87
what is hyperorality
compulsion to put things in mouth
88
what is hypermetamorphosis
need to touch everything in sight
89
People with dementia often show what in communication
```
Have difficulty finding the right words.
Use familiar words repeatedly.
Invent new words to describe things (neologisms).
Lose their train of thought.
Rely on nonverbal gestures.
```
90
what are the communication guidelines for alzheimers
Always identify yourself.
Call the person by his or her name at each meeting.
Speak slowly.
Use short, simple words and phrases.
Maintain face-to-face contact.
Be near the patient when talking, one or two arm lengths’ away.
Do not argue or refute delusions.
91
what is the only drug used for Alzheimer
cholinesterase inhibitors
92
what does the med cholinesterase inhibitors do
for alzheimers
- Delay and prevent symptoms from becoming worse for a limited time.
- Are useful in treating mild-to-moderate AD.
- Prevent breakdown of acetylcholine, and stimulate nicotinic receptors to release more acetylcholine.
93
what are some Ach E inhibitors (prevents destruction of Ach)
| Used for mild to moderate AD med examples
donepezil (Aricept)
rivastigmine (Exelon)
galantamine (Razadyne)
94
what are some NMDA inhibitors (normalizes glutamate)
Used for moderate to severe AD
| memantine (Namenda)
95
what should be considered for alzheimers enviornement safety
Gradually restrict the use of a car.
Remove throw rugs and other objects.
Minimize sensory stimulation.
If verbally upset, give support and change the topic.
Label rooms, drawers, and often-used objects.
Install safety bars in the bathroom.
Supervise the patient when he or she smokes.
History of seizures exists; educate the family on seizure management.
96
what are some interventions you can do for wandering
Place a mattress on the floor, or use a bed monitor.
Provide a MedicAlert bracelet with identification.
Notify the police department with photographs, or alert the neighbors.
If in the hospital, have the patient wear a brightly colored vest with the patient’s identification printed on the back.
Install complex locks on the door and locks at the top of the door.
Explore feasibility of sensor devices or global positioning system (GPS).
