Schizoaffective Disorder Flashcards
Schizoaffective dx
chronic dx char by constant sx of schiz like halluc and delus along with constant or intermittend mood dx like mania and dep
Schizoaffective is often misdx as…
Bipolar or schiz
Types of Schizoaffective
- bipolar
- depressive
- sx can be constant or come and go
Schizoaffective tx
- antipsychotics, mood stabilizers, dep
- CBT
- group therapy
Goals for schiz tx
improve QoL and psychosocial intervention
- comprehensive approach
Priority problems for schiz
safety, violence, self-harm, disturbed thoughts, sensory perception, social w/d, knowledge deficit, tx non-adherence, ineff coping, social iso, hopeless/powerlessness
Potential outcomes for schiz
self-harm free to d/c, est coping strats, oriented by d/c, state 1 benefit of taking meds, participate in self-care q shift
Potential interventions for schiz
- use C-SSRS w shift
- assess for thoughts of harm
- use coping strats q shift
- edu
Schiz relapse
- almost all do; each relapse takes longer to recover
- major reason is nonadherence to meds
- psychotherapy with meds dec relapse
How long does it take antipsychotic meds to work
2-6w
Is monotherapy recc for schix?
YES
Are antipsychotics addictive?
NO
Disadv of short term meds
More SE faster and less easily managed when IM
Long acting meds
best for nonadherent
- q2-4w to months
- need transport to and from the clinic to get
Types of EPS
- acute dystonia
- akathisia
- pseudoparkinsonism
- tardive dyskinesia
EPS affect…
motor control and coordination
Acute dystonia
sudden sustained muscle ctx of muscle groups in head and neck
- doesn’t cause damage unless involve airway muscles (rare)
- anx, scary
When do EPS begin?
w/i 3w of new meds or inc the dose
terticollis
dystonia with head pulled to the side
oculogyric
EPS with eyes rolled back in head
laryngeal dystonia
EPS with spasm of throat, impaired breathing and swallowing
Akathisia
restless, pacing, walking while seated, shifting
- can be mistaken for anx, agitation
- tardive type can persist despite tx
tx for akathisia
- stop med (may take 6M)
- dec dose
- anticholinergic
- short term lam or pam
- relaxation exercises
What anticholienrgic is given to tx akathisia
Benzotropine
peudoparkinsonism
stiff, stooping, shuffling gate, bradykinesia, pill roll, tremor, dysphagia with drooling
pseudoparkinsonism tx
ID med and slowly stop or dec dose, oral anticholinergic
tardive dyskinesia
involuntary rhythmic mvt w/ long-term antipsychotics
- varies; often oral/facial and progresses to fingers, toes, neck, trunk, pelvis
- tongue protrude, smack lips, mouth mvt
how is TD assessed
with AIMS q3M
How is TD treated
- stop or dec dose
- switch to 2nd gen med (taper down while tapering up new med)
- valbenazine or deutrabenzaine as last resort
What is a risk of treating TD
it may not help and it may worsen underlying condition
Anticholinergics sx
dry, blurry vision, elimination and sedation, tachy, flushed, drowsy, dizzy, confused, halluc, constipated
- can become TOXIC
Neuroleptic malignant syndrome
early and severe conds including muscle rigidity, AMS, temp over 103, HTN, tachy, incont, diaphoretic
Comps of NMS
rhabdo, organ fail, AKI, resp fail, sepsis
Biggest predictor of mortality with NMS
resp fail
Tx for NMS
immediately stop all antipsychotics
- supportive hydration, watch VS, ICU, cool bod
- IV dantrolene, bromocriptone mesylate, lorazepam for agitation
- hospitalization (10% fatal)
What is very important with NMS?
detecting early!!!
dx hard
metabolic syndrome NC
watch weight, initial gluc test, BG monitor, nutrition/activity support
Which drugs are typical antipsychotics?
chlorpromazine, haloperidol, fluphenazine, thioidazine, perphenazine
What sx are typicals best for?
Positive
adv of typicals
cheaper
disadv of typicals
Worse SE–EPS, antichol, sedate, wt gain, metabolic sx, NMS, sex dysfunction, endocrine, CV prob, orthostate hypotension and arrhythmia, sz
Which meds are atypicals?
clozapine, risperidone, olanzapine, quetiapine, ziprasidone
3rd gen atypicals with dec risk of EPS and TD
apriprazole, brexpraprazole, cariprazine
What receptors do typicals works on?
D2 antagonists
What receptors do atypicals work on?
5-ht and d2 antagonists
What sx do atypicals work on?
pos and neg
Why are atypicals first line
dec TD and EPS, less sz and ortho hypo
disadv of atypicals
more wt gain and met sx
$$$
SE of atypicals
sedation, metabolic chx, cardiac dysrhythia
Clozapine use
dec violence and inc impulse control
When is clozapine given
- after 2 failed mono trials for refractory schiz
Serious SE of clozapine
Agranulocytosis
- dec granulocyte prod and dec circ granulocytes (WBCs dec)
- life threatening
- worse in first months of tx (watch WBC for 1st 18M)
- d/c if pt gets leukopenia or neutropenia
- fixable when tx early
Non pharmalogic tx for schiz
group, ECT, CBT, social skill training, support and case management
Factors of schiz pt that may make them more likely to be inpt longer
- slow onset (over 2-3y)
- younger onset
- longer duration of 1st sx and tx
- longer period untreated
- more neg sx
