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PSYCH > Schizoaffective Disorder > Flashcards

Schizoaffective Disorder Flashcards

1
Q

Schizoaffective dx

A

chronic dx char by constant sx of schiz like halluc and delus along with constant or intermittend mood dx like mania and dep

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2
Q

Schizoaffective is often misdx as…

A

Bipolar or schiz

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3
Q

Types of Schizoaffective

A
  • bipolar
  • depressive
  • sx can be constant or come and go
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4
Q

Schizoaffective tx

A
  • antipsychotics, mood stabilizers, dep
  • CBT
  • group therapy
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5
Q

Goals for schiz tx

A

improve QoL and psychosocial intervention
- comprehensive approach

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6
Q

Priority problems for schiz

A

safety, violence, self-harm, disturbed thoughts, sensory perception, social w/d, knowledge deficit, tx non-adherence, ineff coping, social iso, hopeless/powerlessness

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7
Q

Potential outcomes for schiz

A

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

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8
Q

Potential interventions for schiz

A
  • use C-SSRS w shift
  • assess for thoughts of harm
  • use coping strats q shift
  • edu
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9
Q

Schiz relapse

A
  • almost all do; each relapse takes longer to recover
  • major reason is nonadherence to meds
  • psychotherapy with meds dec relapse
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10
Q

How long does it take antipsychotic meds to work

A

2-6w

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11
Q

Is monotherapy recc for schix?

A

YES

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12
Q

Are antipsychotics addictive?

A

NO

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13
Q

Disadv of short term meds

A

More SE faster and less easily managed when IM

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14
Q

Long acting meds

A

best for nonadherent
- q2-4w to months
- need transport to and from the clinic to get

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15
Q

Types of EPS

A
  • acute dystonia
  • akathisia
  • pseudoparkinsonism
  • tardive dyskinesia
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16
Q

EPS affect…

A

motor control and coordination

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17
Q

Acute dystonia

A

sudden sustained muscle ctx of muscle groups in head and neck
- doesn’t cause damage unless involve airway muscles (rare)
- anx, scary

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18
Q

When do EPS begin?

A

w/i 3w of new meds or inc the dose

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19
Q

terticollis

A

dystonia with head pulled to the side

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20
Q

oculogyric

A

EPS with eyes rolled back in head

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21
Q

laryngeal dystonia

A

EPS with spasm of throat, impaired breathing and swallowing

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22
Q

Akathisia

A

restless, pacing, walking while seated, shifting
- can be mistaken for anx, agitation
- tardive type can persist despite tx

23
Q

tx for akathisia

A
  • stop med (may take 6M)
  • dec dose
  • anticholinergic
  • short term lam or pam
  • relaxation exercises
24
Q

What anticholienrgic is given to tx akathisia

A

Benzotropine

25
Q

peudoparkinsonism

A

stiff, stooping, shuffling gate, bradykinesia, pill roll, tremor, dysphagia with drooling

26
Q

pseudoparkinsonism tx

A

ID med and slowly stop or dec dose, oral anticholinergic

27
Q

tardive dyskinesia

A

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

28
Q

how is TD assessed

A

with AIMS q3M

29
Q

How is TD treated

A
  • stop or dec dose
  • switch to 2nd gen med (taper down while tapering up new med)
  • valbenazine or deutrabenzaine as last resort
30
Q

What is a risk of treating TD

A

it may not help and it may worsen underlying condition

31
Q

Anticholinergics sx

A

dry, blurry vision, elimination and sedation, tachy, flushed, drowsy, dizzy, confused, halluc, constipated
- can become TOXIC

32
Q

Neuroleptic malignant syndrome

A

early and severe conds including muscle rigidity, AMS, temp over 103, HTN, tachy, incont, diaphoretic

33
Q

Comps of NMS

A

rhabdo, organ fail, AKI, resp fail, sepsis

34
Q

Biggest predictor of mortality with NMS

A

resp fail

35
Q

Tx for NMS

A

immediately stop all antipsychotics
- supportive hydration, watch VS, ICU, cool bod
- IV dantrolene, bromocriptone mesylate, lorazepam for agitation
- hospitalization (10% fatal)

36
Q

What is very important with NMS?

A

detecting early!!!
dx hard

37
Q

metabolic syndrome NC

A

watch weight, initial gluc test, BG monitor, nutrition/activity support

38
Q

Which drugs are typical antipsychotics?

A

chlorpromazine, haloperidol, fluphenazine, thioidazine, perphenazine

39
Q

What sx are typicals best for?

A

Positive

40
Q

adv of typicals

A

cheaper

41
Q

disadv of typicals

A

Worse SE–EPS, antichol, sedate, wt gain, metabolic sx, NMS, sex dysfunction, endocrine, CV prob, orthostate hypotension and arrhythmia, sz

42
Q

Which meds are atypicals?

A

clozapine, risperidone, olanzapine, quetiapine, ziprasidone

43
Q

3rd gen atypicals with dec risk of EPS and TD

A

apriprazole, brexpraprazole, cariprazine

44
Q

What receptors do typicals works on?

A

D2 antagonists

45
Q

What receptors do atypicals work on?

A

5-ht and d2 antagonists

46
Q

What sx do atypicals work on?

A

pos and neg

47
Q

Why are atypicals first line

A

dec TD and EPS, less sz and ortho hypo

48
Q

disadv of atypicals

A

more wt gain and met sx
$$$

49
Q

SE of atypicals

A

sedation, metabolic chx, cardiac dysrhythia

50
Q

Clozapine use

A

dec violence and inc impulse control

51
Q

When is clozapine given

A
  • after 2 failed mono trials for refractory schiz
52
Q

Serious SE of clozapine

A

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

53
Q

Non pharmalogic tx for schiz

A

group, ECT, CBT, social skill training, support and case management

54
Q

Factors of schiz pt that may make them more likely to be inpt longer

A
  • slow onset (over 2-3y)
  • younger onset
  • longer duration of 1st sx and tx
  • longer period untreated
  • more neg sx

PSYCH (15 decks)

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