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Psych - Test 2 > Psychotic Disorders > Flashcards

Psychotic Disorders Flashcards

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1
Q

Schizophrenia - Physiological Factors

A

Neurotransmitter dysregulation

  • Dopamine Hypothesis
  • Dopamine and Serotonin Dysregulation (more accepted theory)
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2
Q

Schizophrenia - Onset - Prodromal Symptoms

A 
One year prior to diagnosis
Subtle Changes 
-Behavior
-Thinking
-Relating to others
-Caring for self
-Mounting anxiety
-Emotional blunting
-Loss of interest
-Heightened sensitivity to sound
-Neglect of personal hygiene
-Somatic concerns
-Preoccupied with body parts
-Sense of body distortion
-Self-mutilation
-Starving
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3
Q

Schizophrenia communication -

Tangentiality

A

Digressive or irrelevant manner of speech where central idea is never communicated

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4
Q

Schizophrenia communication -

Circumstantiality

A

Digression into unnecessary details and inappropriate thoughts before communicating central idea

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5
Q

Impaired communication - Bizarre Speech (8)

A
  • Echolalia-
  • Concrete thinking
  • Word salad
  • Loose associations
  • Flight of ideas
  • Thought retardation
  • Thought blocking
  • Neologism - invented words
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6
Q

Schizophrenia - Altered Thought Processes

Delusions (5)

A
  • Persecution
  • Paranoia
  • Reference
    • Referential delusion
    • Ideas of reference
  • Grandeur
  • Somatic
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7
Q

Schizophrenia -

Somatic Delusions

A

Somatic - Thinking that your body is diseased in some way. i.e. The idea that one’s body is completely infested with parasites (clearly untrue).

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8
Q

Schizophrenia -

Nihilistic Delusions

A

Nihilistic - Total rejection of values, extreme skepticism or moral and value judgment

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9
Q

Schizophrenia - Negative Symptoms

Alexithymia

A

Alexithymia - Difficulty naming and describing emotions

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10
Q

Schizophrenia - Negative Symptoms

Asociality

A

Asociality - Few friends ~ preference for solitary activities

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11
Q

Schizophrenia - Negative Symptoms

Anhedonia

A

Anhedonia - Inability to experience pleasure

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12
Q

Schizophrenia - Negative Symptoms

Avolition

A

Avolition - Lack of motivation

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13
Q

Schizophrenia - Negative Symptoms

Apathy

A

Apathy - You don’t care

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14
Q

Schizophrenia - Negative Symptoms

Affect changes

A
  • Flat = no affect

- Blunted = not overly animated

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15
Q

Schizophrenia - Negative Symptoms

Anergia

A

Anergia - no energy

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16
Q

Schizophrenia - Negative Symptoms

Ambivalence

A

Ambivalence - having conflicting ideas, wishes and feelings toward a person, thing or situation.

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17
Q

Schizophrenia - Negative Symptoms

Alogia -

A

Alogia - Decreased productivity of thought and speech

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18
Q

Catatonia - Clinical picture is dominated by three (or more) of the following symptoms (12)

A

Stupor - no psychomotor activity

Catalepsy - passive induction of a posture held against gravity

Waxy flexibility - Slight, even resistance to positioning

Mutism - no or very little verbal response

Negativism- oppositional or no response to instructions

Posturing- spontaneous or active maintenance of a posture held against gravity

Mannerisms- Odd, circumstancial caricature of normal actions

Stereotypy- Repetitive, abnormally frequent, non-goal directed movements

Agitation- Not influenced by external stimuli

Grimacing- scowl

Echolalia- Mimicing another’s speech

Echopraxia- Mimicing another’s movement

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19
Q

Schizoaffective Disorder - Period of illness includes

A

Major mood episode (MDD or Mania)
Concurrent with two or more:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic
  • Negative symptoms
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20
Q

A homeless psychotic patient tells you that they were attacked by insects “all over me”. What is the first thing you would do?

A

Check for bites or any indication of head lice

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21
Q

Nursing Interventions (4)

A
  • Relapse prevention
  • Maintain psychosocial functioning
  • Provide education
  • Improve quality of life
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22
Q

ACT - Assertive Community Treatment

A

“Kendra’s Law”
Intense case management
-Note: Intense case managemetn should be part of discharge plan for client with multiple psychosocial issues (o.e. homelessness) who have multiple hospitalizations

23
Q

Community/Outpatient care - Personalized Recovery Oriented Services (8)

A
  • Improve functioning
  • Reduce inpatient utilization
  • Reduce emergency services
  • Reduce contact with criminal justice system
  • Increase employment
  • Attain higher levels of education
  • Secure preferred housing
  • Mainstream into the community
24
Q

Meeting Patient’s Psychological Needs -

Relapse Prevention Education (8)

A
  • Poor nutrition
  • Lack of sleep
  • Infection
  • Hostile environment
  • Social isolation
  • “Hopeless” attitude
  • Poor social skills
  • Medication issues
    * How will client get meds?
    - Order, finance, pick up
25
Q

Meeting Patient’s Psychological Needs -

Relapse Prevention Education

A
  • Self monitoring
  • Recognition of triggers
    - Events, time, place, stimuli
  • Identify HIGH RISK times
26
Q

Family Needs - Provide Education on the Disease Process

A
  • Need to understand that schizophrenia has many presentation for different clients
  • Should NOT compare client’s symptoms to other schizophrenics in the family, relatives, friends, etc.
27
Q

Strategies for working with Psychotic patients

A

Re-orient to reality
-“I know that you believe you (hear voices) but I want you to know that I do not hear any voices (except yours).”
Acknowledge feelings
-“I believe you are safe here, but it must be very frightening to believe that the CIA is after you.”

28
Q

Pharmacologic Intervention - Long acting injections

A 
Given every 4 weeks
Check for allergy before administering LAI
-Prolixin Decanoate
-Haldol Decanoate
-Risperdal Consta
-Invega Sustenna
-Zyprxa Relprevv
29
Q

Zyprexa Relprevv - Precautions / Implications

A
  • Post injection delirium/sedation syndrome (PDSS)

- Client must stay for 3 hour observation after injection

30
Q

Zyprexa Relprevv - Symptoms (9)

A
  • Sleepy
  • Dizzy
  • Disoriented
  • Stiff
  • Shaky
  • Weak
  • Increased Blood Pressure
  • Seizures
  • Unconsciousness
31
Q

Alternatives to PO Meds

A
  • Orally disintegrating anti-psychotics OR
  • Long Acting Injections

*We need to know alternatives to standard PO meds

32
Q

Orally disintegrating anti-psychotics (3)

A
  • Zyprexa Zydis
  • Risperdol-M Tab
  • Abilify Discmelt
33
Q

Long Acting Injectables (5)

A
  • Prolixin Decanoate
  • Haldol Decanoate
  • Risperdol Consta
  • Invega Sustenna
  • Zyprxa Relprevv
34
Q

Patient Education for Antipsychotic Side Effects

A
  • Photosensitivity - Stay out of the sun or wear sunscreen
  • EPS - Various movement disorders
  • Pregnancy - Risk vs. benefits
  • Avoid antacids
  • Diet teaching
  • Rise slowly - hypotension (orthostatic)
35
Q

Anti-psychotics Adverse Side Effects -

Agranulocytosis

A
  • May occur with any anti-psychotic
  • Most common with CLOZARIL
  • May occur at any time during treatment
36
Q

Anti-psychotics Adverse Side Effects

Agranulocytosis - Symptoms (4)

A
  • Sore throat
  • Mouth sores
  • Increased temperature
  • “Flu Like” symptoms
37
Q

Anti-psychotics Adverse Side Effects

Agranulocytosis - Nursing interventions (4)

A
  • Check WBCs
  • Hold dose of Clozaril
  • Notify health care prescriber
  • Monitor patient for increased and worsening symptoms
38
Q

Clozaril Protocol

A
  • Not for patient who dislikes needles! *

Initially - Weekly WBC.CBC for 6 months

After 6 months - WBC/CBC bi -weekly for next 6 months

After first year - Month for the duration of medication

39
Q

Anti-psychotic Adverse Side Effects

Neuroleptic Malignant Syndrome - AM FM (4)

A
  • Autonomic Instability - Increased BP/P
  • Muscle Symptoms - “lead pipe rigidity”
  • Fever up to 107
  • Mental status changes - confusion to COMA
40
Q

Extrapyramidal Side Effects -

A

KNOW

41
Q

Extrapyramidal Side Effects -

Psuedoparkinsonism

A

“Pill rolling”

42
Q

Extrapyramidal Side Effects -

Akathesia

A

–MOST COMMON SIDE EFFECT–
Extreme restlessness
“Ants in the pants”

43
Q

Extrapyramidal Side Effects -

Dystonia

A

“Neck to the side”

  • Muscular rigidity
  • Stiff or thick tongue
  • Difficulty swallowing
  • Spasms in face/neck
44
Q

Extrapyramidal Side Effects -

Tardive Dyskinesia

A

“Permanent lip smacking”

  • abnormal, involuntary skeletal movements
  • facial grimacing
  • finger movement
  • jaw swinging
  • repetitive chewing
  • tongue thrusting
  • *-IRREVERSIBLE**
45
Q

Extrapyramidal Side Effects -

Bradykinesia

A

“SLOW movement”

46
Q

Extrapyramidal Side Effects -

Akinesia

A

“No movement”

47
Q

Extrapyramidal Side Effect ASSESSMENT

A

Observe and measure involuntary movements

  • Face
  • Trunk
  • Extremities
  • Abnormal, involuntary skeletal movements
48
Q

** Extrapyramidal Side Effects ** (4)

A
  • Pseudo parkinsonism
  • Pill rolling
  • Drooling
  • Shuffling gait
49
Q

Anticholinergics - Indications for use

EPS

A

Used for

  • Dystonias (decrease drooling)
  • Pseudo-parkinsonism (less of a shuffle)
  • Initiate when symptoms arise
  • Use may become unnecessary after several months
  • Some potential for abuse
  • *-DO NOT USE with TARDIVE DYSKINESIA** -WILL MAKE IT WORSE
50
Q

Anticholinergics - ABC (3)

A

Artane (trihexohenidyl)
Benadryl (diphenhydramine)
Cogentin (benzotropine) MOST COMMON

51
Q

Anticholinergic Side Effects

A

Can’t See (blurred vision)
Can’t Pee (urinary retention)
Can’t Spit (dry mouth)
Can’t Shit (constipation)

52
Q

Anticholinergic Syndrome (4)

A

Increased Temp - Hot as a Hare
Dilated Pupils - Blind as a Stone
Agitation - Made as a Hatter
Hot, dry, flushed skin - Dry as a Bone

53
Q

Non-Compliance (6)

A

Find out WHY patient is non-compliant
-Insensitivity to patient’s challenges

Wishes - opposition of idea of taking meds
Complaints - poorly controlled side effects
Ability to buy medications after discharge
Ability to follow up - transportation, insurance

54
Q

Now Do…

A

Mood Disorders!

Psych - Test 2 (4 decks)

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