Schizoaffective Disorder

Question 1

Schizoaffective dx

Answer 1

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

Question 2

Schizoaffective is often misdx as…

Answer 2

Bipolar or schiz

Question 3

Types of Schizoaffective

Answer 3

• bipolar
• depressive
• sx can be constant or come and go

Question 4

Schizoaffective tx

Answer 4

• antipsychotics, mood stabilizers, dep
• CBT
• group therapy

Question 5

Goals for schiz tx

Answer 5

improve QoL and psychosocial intervention
- comprehensive approach

Question 6

Priority problems for schiz

Answer 6

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

Question 7

Potential outcomes for schiz

Answer 7

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

Question 8

Potential interventions for schiz

Answer 8

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

Question 9

Schiz relapse

Answer 9

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

Question 10

How long does it take antipsychotic meds to work

Answer 10

2-6w

Question 11

Is monotherapy recc for schix?

Answer 11

YES

Question 12

Are antipsychotics addictive?

Answer 12

NO

Question 13

Disadv of short term meds

Answer 13

More SE faster and less easily managed when IM

Question 14

Long acting meds

Answer 14

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

Question 15

Types of EPS

Answer 15

• acute dystonia
• akathisia
• pseudoparkinsonism
• tardive dyskinesia

Question 16

EPS affect…

Answer 16

motor control and coordination

Question 17

Acute dystonia

Answer 17

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

Question 18

When do EPS begin?

Answer 18

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

Question 19

terticollis

Answer 19

dystonia with head pulled to the side

Question 20

oculogyric

Answer 20

EPS with eyes rolled back in head

Question 21

laryngeal dystonia

Answer 21

EPS with spasm of throat, impaired breathing and swallowing

Question 22

Akathisia

Answer 22

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

Question 23

tx for akathisia

Answer 23

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

Question 24

What anticholienrgic is given to tx akathisia

Answer 24

Benzotropine

Question 25

peudoparkinsonism

Answer 25

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

Question 26

pseudoparkinsonism tx

Answer 26

ID med and slowly stop or dec dose, oral anticholinergic

Question 27

tardive dyskinesia

Answer 27

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

Question 28

how is TD assessed

Answer 28

with AIMS q3M

Question 29

How is TD treated

Answer 29

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

Question 30

What is a risk of treating TD

Answer 30

it may not help and it may worsen underlying condition

Question 31

Anticholinergics sx

Answer 31

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

Question 32

Neuroleptic malignant syndrome

Answer 32

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

Question 33

Comps of NMS

Answer 33

rhabdo, organ fail, AKI, resp fail, sepsis

Question 34

Biggest predictor of mortality with NMS

Answer 34

resp fail

Question 35

Tx for NMS

Answer 35

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

Question 36

What is very important with NMS?

Answer 36

detecting early!!! dx hard

Question 37

metabolic syndrome NC

Answer 37

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

Question 38

Which drugs are typical antipsychotics?

Answer 38

chlorpromazine, haloperidol, fluphenazine, thioidazine, perphenazine

Question 39

What sx are typicals best for?

Answer 39

Positive

Question 40

adv of typicals

Answer 40

cheaper

Question 41

disadv of typicals

Answer 41

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

Question 42

Which meds are atypicals?

Answer 42

clozapine, risperidone, olanzapine, quetiapine, ziprasidone

Question 43

3rd gen atypicals with dec risk of EPS and TD

Answer 43

apriprazole, brexpraprazole, cariprazine

Question 44

What receptors do typicals works on?

Answer 44

D2 antagonists

Question 45

What receptors do atypicals work on?

Answer 45

5-ht and d2 antagonists

Question 46

What sx do atypicals work on?

Answer 46

pos and neg

Question 47

Why are atypicals first line

Answer 47

dec TD and EPS, less sz and ortho hypo

Question 48

disadv of atypicals

Answer 48

more wt gain and met sx $$$

Question 49

SE of atypicals

Answer 49

sedation, metabolic chx, cardiac dysrhythia

Question 50

Clozapine use

Answer 50

dec violence and inc impulse control

Question 51

When is clozapine given

Answer 51

- after 2 failed mono trials for refractory schiz

Question 52

Serious SE of clozapine

Answer 52

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

Question 53

Non pharmalogic tx for schiz

Answer 53

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

Question 54

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

Answer 54

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