schizophrenia (1) Flashcards
is schizo a split personality disorder?
no
is schizo a source of violence or danger
no
what is the hallmark of schizophrenia
psychosis
what is altered cognition, disorganized thoughts, and altered perception, impaired reality
psychosis
what is the age onset of schizo
late adolesence or early adult (15-25)
what classifies a schizo diagnosis as a childhood onset
before 15
what classifies a schizo diagnosis as a late onset
after 40
what is the prodromal phase of schizo
a “forewarning” phase
which phase of schizo has deteriorating function, social withdraw, functional impairment, sleep disturbance, anxiety, irritability, depression, poor concentration, and fatigue
prodromal
what are the DSM 5 criteria for schizophrenia
1) delusion
2) hallucination
3) disorganized speech
4) grossly disorganized or catatonic behavior
5) negative symptoms
how many of the DSM 5 criteria is needed for a schizo diagnosis, and what do they need to be
need 2 or more of the criteria, but at least one of them needs to be delusion, hallucination, or diorganized speech
how long does the acute phase of schizo last
at least 6 months, with 1 month of symptoms
what do you have to rule out before schizo diagnosis
schizoaffectove mood, substances, meds, conditions, ASD
describe positive schizo sx
add things that the rest of us dont have
examples of positive symptoms
hallucinations adn delusions
describe negative symptoms
miss things typical people have
examples of negative symptoms
lack of pleasure, cant keep goals for themselves
describe cognitive schizo sx
affect ability to think/function
describe affective schizo sx
can’t express emotion well
what kind of sx is a persecutory delusion
positive
what is a persecutory delusion
believe a person is out to get you, constantly scared
what kind of sx is a grandiose delusion
positive
describe grandiose delusion
exaggerated importance, think they are president, jesus, famous
what kind of sx is a referantial delusion
positive
describe referential delusion
everything pertains to you, “newspaper articles are all about me”
describe control or influence delusions
believe someone else has control over you
describe soamtic delusions
body based, patient soaked body in bleach to “get rid of alien eggs”
describe nihilistic delusions
end of the world
describe religiosity delusions
everything is religiously influenced, obsessive
describe erotomantic delusion
think someone loves you, might not even know them
what kind of sx are speech alterations
positive
describe associative looseness
talking all over the place
describe word salad “schizophasia”
real words are jumbled up and person doesn’t realize
describe clang associations
use words based on sound and rhyme
describe neologisms
made up words
describe echolalia
like a parrot, echoes what others say
describe circumstantiality
give lots of details but eventually gets to the point
describe tangentiality
goes on a tangent, never answers questions
describe pressured speech
really fast talking, can’t get a word in, too excited
describe flight of ideas
absolutely does not make sense
describe symbolic speech
think of blood draws as “evil demons doing their mission to suck blood”
what kind of symptom is disorganized thinking
positive
describe cognitive retardation
slowing of thoughts
describe thought blocking
forget what you’re saying int he middle of a sentence
describe thought insertion
believe other people put thoughts into their head (controlled delusion)
describe thought deletion
believe someone took thougts from them
describe magical thinking
they think their thoughts affect others
ex. get mad, wish someine harm, they actually get hurt, believe you caused it
describe depersonalization vs. derealization
depersonalization: something about yourself feels strange, out of body
derealization: reality seems odd
what are the most common hallucinations
auditory
what are command hallucinations?
tells someone to do something or shows them something, DANGEROUS
what are illusions
has a real basis in reality, but is perceived different
(sees a picture, thinks its talking)
what is derealization?
reality seems weird/altered
what is a pronounced increase or severe decrease in movement
catatonia
what is the term for when muscles go rigid in decreased catatonia?
catalepsy
describe waxy flexibility
limbs stay where they are put
what kind of movement is less severe than catatonia - slowed movement
motor retardation
which movement is less severe than catatonic excitement - mild - a tension relieving activity - fidgety - just can’t relax
motor agitation
what are stereotypes behaviors?
seen in ASD, reperitive behavior
what is negativism behavior
very resistant to advice or wishes
what is echopraxia
repeated movement
describe gesturing / posturing
stands or hold body in a weird way
what kind of sx is anhedonia
negative
describe anhedonia
inability to experience pleasure
describe avolition
hard time with motivation, hard to do tasks
what kind of sx is avolition
negative
what kind of sx is alogia
negative
describe alogia
does not use a lot of words
what kind of sx is asociality
negative
descirbe asociality
do not seek out people and connections
what kind of sx is apathy
negative
describe apathy
does not care about anything
describe affective blunting in schizo
a minimal response
-flat affect
-constricted (sad/anger only)
-inappropriate emotional response for situation
-bizarre
is affective blunting positive or negative
negative
is anosognosia a positive or negative symptom
negative
describe anosognosia
do not believe they are sick
describe symptoms of the maintenance phase of schizo compared to the symptoms of the acute and prodromal phase
symptoms of the acute phase are gone, but symptoms of the prodromal phase are the new baseline
how is impairment affected between schizo episodes
impairment increases between each episode
describe affect and impairment in the maintenance phase
flatt affect and role functioning impairment
which neurochemical is strongly linked to schizo
dopamine
which environmental toxins can be linked to schizo
tetracholoroethylene (used to be used in laundry/pipes)
which drug is often a trigger of schizo
marijuana
what prenatal stressors can cause schizo
poor nutrition, hypoxia, infections, substance use / nicotine & marijuana too
describe ventricles in schizo
enlarged lateral cerebral ventricles, 3rd ventricle dilation
which part of the brain will atrophy in schizo
cerebellum
what happens to the fissures in schizo
increase in size
what happens to connectivity of brain region in schizo
reduced connectivity
what are osychological rish factors for schizo?
stress, childhood trauma, ACE events, downward shift hypothesis
describe the downward shift hypothesis
decreased socioeconomic status, exposed to more bacteria/viruses, worse nutrition, decreased prenatal care, etc.
substance/nicotine use related to antipsychotics
will decrease effectiveness
what are some comorbiditeis with schizo
substance use, anxiety, depression, suicide, physical illness, POLYDIPSIA
what can polydipsia lead to in schizo
water toxicity, hyponatremia, confusuin
what makes up schizoaffective disorder
bipolar + schizophrenia
what is worse, schizophrenia or schizoaffective disorder?
schizophrenia
what disorder is where you have one delusion but no other symptoms of schizo
delusional disorder
which disorder is where you develop a disorder from another person close to you
shared psychotic disorder (folie a deux)
increased levels of which chemical can cause psychotic disprder (related to hepatic system)
ammonia
describe individual psychotherapy for schizo
REALITY ORIENTED, improve compliance, enhance functioning,
discuss group therapy for schizo
discuss real life plans, problems, relationships, decreases social isolation and improves reality testing
what does behavior therapy focus on for schizo
reduce bizarre, disturbing, deviating behavior
what is milieu therapy
therapeutic environment
what kind of meds are used for schizo
antipsychotics (neuroleptics)
what is the main 1st gen antipsychotic given
haloperidol (haldol)
what is the ling acting injectible form of haldol
haloperidol deconate
what are 1st gen antipsychotics good at doing?
removing positive sx
what kind of antipsychotics can help remove negative sx
atypical 2nd gen
what gen antipsychotic is used for bipolar mania
atypical 2nd gen
what is the most important atypical 2nd gen antipsychotic
paliperidone (invega)
which organ are antipsychotics very hard on
liver
which lab shows impaired liver function
LFTs
what med can not be given for myloproliferative disorders if a patient is on antipsychotics?
clozapine
what is the BBW for antipsychotics?
there is an increased incidence of death in elderly with neurocognitive disorders (stroke)
hownwill antipsychotics interact with the heart (EKG effects)
prolonged QT
what kind of cardiac meds should not be given with antipsychs?
other meds that prolong QT
is a patients QTc is greater than 500, what med can they not give?
ziprasidone
why is a high QTc bad?
increased risk of VT / Vfib
what effects come from anticholinergics, and what should you do to prevent them?
they dry everything up, ice chips, fluids, increase fiber
what can anticholinergic toxicity cause?
altered mental status
what are side effects of blocking alpha adrenergic receptors
ortho hypotension, refelx tachycardia, tremors
what side effects do histamine blockades cause
weight gain/sedation
what med should probably not be given to an overweight person
olanzapine (histamine blocker)
whay is important to know for women who take antipsychotics?
they need contraceptives, these meds are teratogenic
what will antipsychotics do to blood counts?
decrease them
what med in specific do we need to watch out for agranulocytosis
clozapine
which gen antipsychotics are antipsychotic side effects worse with?
typicals
what is pseudoparkinsonism
tremors, shuffling, drooling, rigidity
tx of pseudoparkinsonism
antiparkinsons, BENZTROPINE MESYLATE
what is the tx for akinesia (muslce weakness)
carbidopa/levodopa
what is akathisia
countinuous restlessness
What is the sudden sustained contraction of muscles, spasm of face, arms, legs, neck; often in men less than 25 years old
acute dystonesia
What is the anti-semitic rolling back of the eyes and can occur as part of dystonesia
oculogyric crisis
is acute dystonesia an emergency
yes
Is oculogyric crisis and emergency?
yes
what is the treatment of acute dystonia and oculogyric crisis
stop the psych meds, monitor airway, suction ready
What symptoms characterized by bizarre facial and tongue movements, stiff neck, lip smacking or licking, difficulties swallowing
tardive dyskinesia
Is tardive dyskinesia an emergency?
yes
Which rating scale is used for tardive dyskinesia?
AIMS scale
Treatment of tardive dyskinesia
Monitor airway, benadryl, cogentin
What medication is used to prevent extrapyramidal symptoms such as acute dystonia, oculogyric crisis, and tardive dyskinesia
anticholinergics
Which antipsychotic side effect is characterized by:
- severe Parkinsonian Muscle Rigidity
- Hyper pyrexia, high fever
- Tachycardia, tachypnea, blood pressure fluctuations
- Diaphoresis
- Rapid deterioration of mental status
Occurs within hours of starting meds
Neuroleptic malignant syndrome (NMS)
Which meds need to be given for neuroleptic malignant syndrome
Parlodel and dantrium
Which syndrome comes as a side effect from second generation antipsychotics
Metabolic syndrome
Which is important to consider if you are going outside while on antipsychotics
use sunscreen / protect
Which mental health problem is a high risk for people with schizophrenia
suicide
What is the only consistent protective factor fornsuicide woth schizophrenia
Delivery of and adherence to effective treatment
How do you tell if a client is hallucinating?
-listening pose
-laughing/talking to self
-stops mid sentence
-tracks unknown speaker
watches vacant area of room
What should you say to a client if you think they are hallucinating
Are you hearing voices or seeing something
What are ways that schizophrenia can possibly be prevented?
-No malnutrition, substances
-promote resiliency
-Supplemental essential fatty acids
-Early treatment with antipsychotics
