Psychotic Disorders Flashcards
What are the positive symptoms of schizophrenia?
hallucinations, delusions, and disorganized thought (first-generation good for these symptoms)
What are the negative symptoms of schizophrenia?
lack of interest, motivation, or pleasure in activities
What is the the biggest concern with pharmacological treatment with schizophrenia?
compliance!!!!
Not only do medications have bad side effects and take a long time to start working (so they could have bad side effects before the medication even starts taking effect) but the nature of the disease itself can become an issue for compliance
What is the priority outcome of treating schizophrenia?
suppressing acute episodes
preventing recurrence
maintain highest level of functioning
What is the therapeutic outcome of typical antipsychotics (first generation or conventional)?
blocks positive symptoms (by blocking ACh, norepinephrine, histamine, dopamine)
What are the main adverse effects of typical antipsychotics called? Describe acute dystonia.
Extrapyramidal effects (EPS):
5 hours to 5 days - acute dystonia - severe spasms of tongue, face, neck, back.. this is an emergency and needs immediate treatment (airway) - anticholinergics (benzotropine (Cogentin)) , diphenhydramine (antihistamine)
How are EPS symptoms classified?
Using the abnormal involuntary movement scale (AIMS)
Describe parkinsonism (EPS).
Within a month - bradykinesia, rigidity, shuffling gait, drooling, tremors
treatment - lowering dose can help… same treatment as acute dystonia but amantadine (Symmetrel) is added.
Describe Akathisia (EPS).
within 2 months - continual pacing, restlessness, agitation
treatment - benzodiazepines (agitation), beta-blockers (decrease agitation, restlessness), anticholinergics
Describe tardive dyskinesia (EPS).
Months - years - involuntary movements of tongue, face, arms, legs, pill rolling in hands, and lip-smacking
treatment - change medication or lower dose
MAY BE PERMANENT
What are some other side effects of typical antipsychotics?
neuroleptic malignant syndrome (rare: can happen within a few weeks) - High fever, blood pressure changes, muscle rigidity, dysrhythmias, mental status changes LIFE THREATENING
anticholinergic symptoms - dry mouth, constipation, tachycardia, urinary retention, blurred vision, photophobia
neuroendocrine effects - gynecomastia and menstrual irregularities
Photosensitivity - protect skin from sunlight
seizures - especially if past history
orthostatic hypotension
sedation
sexual dysfunction - compliance issue
agranulocytosis
What are some nursing considerations for typical antipsychotics?
neuroleptic malignant syndrome - stop medication, give antipyretics, cooling blankets, monitor vitals, increase fluids (hemodynamics), ** give dantrolene (Dantrium) to relieve muscle spasms **, administer benzodiazepines to control anxiety
mane anticholinergic symptoms - report palpitations or inability to urinate
protect skin from sunlight - photosensitivity
tolerance to orthostatic hypotension with develop with time
sedative effects will improve with time
sexual dysfunction may be a compliance issue
monitor WBC and look for signs of infection (fever, sore throat) - agranulocytosis
What are some patient teaching points for typical antipsychotics?
report EPS symptoms (especially acute dystonia on discharge (5 hours - 5 days) life threatening)
manage anticholinergic effects - report urinary retention and palpitations (emergent)
rise from sitting/lying slowly (will get better with time)
take at bedtime (sedative effects) (will get better with time)
avoid other CNS depressants, be careful driving, etc…
report sexual side effects
take as directed (2-4 weeks for initial effect and months for full effect)
avoid/ protect yourself from sunlight
monitor and report signs of infection (fever, sore throat)
If compliance is an issue, there are long-acting IM injections (depot preparations)
What are the main differences of atypical antipsychotics (second generation) from typical antipsychotics (first generation)?
atypical -
less EPS symptoms (usually just mild tremors)
weight gain is common (not common for typical)
new onset of diabetes or increased BG in diabetics (not common for typical)
Hypercholesterolemia (increased risk for cardiovascular disease
OUTCOMES ARE THE SAME FOR BOTH MEDICATIONS
What are some key patient teaching points that are specific to atypical antipsychotics?
Monitor Blood glucose
Can also be given IM to increase compliance
clozapine (Clozaril) can cause agranulocytosis
