schizophrenia Flashcards
1
Q
defining schizophrenia
A
- extremely complex mental disorders
- disorder characterized by delusions, hallucinations, disturbances in thinking and communication and withdrawal from social activity
- serious, treatable brain disorder which affects a persons ability to know what is reality and what is not
- neurological illness
- psychosis is one element of the illness
2
Q
epidemiology
A
- halter states:
- – lifetime prevalence of schizophrenia is 1% worldwide
- – no difference related no
- —- race
- —- social status
- —- culture
- critical perspective: some compelling evidence that practitioner bias leads to systemic class/cultural bias against racial and ethnic minorities
- more common in males and among persons growing up in urban areas
- ages of onset; 18-25 is typical of males, with later onset of 25-35 more common in females and associated with better outcomes
3
Q
co-morbidity
A
- substance use disorders
- – nicotine, dependence
- anxiety, depression, and suicide
- physical illness
- polydipsia
4
Q
social realities
A
- family and caregiver stress
- stigma and community isolation
- homelessness
5
Q
psychological realities
A
- difficulties in relating, decision making
- affective blunting
- decrease stress response and coping
- self concept changes
- self stigma
6
Q
tortured artist
A
- creative people have a 90% higher chance of being diagnosed with schizophrenia
7
Q
schizophrenia and the brain
A
- dopamine pathways relevant to schizophrenia symptoms
- – mesolimbic and mesocortical dopaminergic system are thought to play an important role in motivation, cognition; significant to stimuli
- – overactivity of the mesolimbic pathway leads to positive symptoms
- – mesocortical pathway dysfunction leads to negative and cognitive symptoms
8
Q
too much or too little dopamine in different regions of the brain
A
- mesolimbic:
- – high levels of D2 dopamine receptors-impaired grasp of reality, emotional dysregulation
- prefrontal cortex:
- – reduction in dopamine can cause decline in neurocognitive fx, memory, attention and problem solving, social traits
9
Q
role of glutamate
A
- activates NMDA- forms connections between brain cells, significant in brain development, learning and memory
- low NMDA thought to lead to schizophrenia later in life
10
Q
theories of etiology
A
all lead to psychosis:
- early causes; genetic, obstetric complications
- vulnerability: neurocognitive impairments, social anxiety, isolation, odd ideas
- abuse of DA drugs
- social stress
11
Q
etiology: stress and infection
A
- the role of emotional and physical stress (infections) can trigger or worsen the symptoms when illness is already present
- immune dysfunction
- vulnerability stress theory
12
Q
link between marijuana and psychosis
A
- people who use marijuana regularly before the age of 16 are 6x more likely to develop a psychosis
- exposure to THC during brain development is an environmental risk for schizophrenia
- the effects of CBD on schizophrenia symptoms have been mixed. some studies have shown CBD antipsychotic potential while others found no therapeutic link
- reality is by grad 12, 50% of students would have used cannabis
13
Q
phases of schizophrenia
A
nursing care depends on the phase
- prodrome
- acute
- – onset or exacerbation of symptoms
- stabilization
- – symptoms diminishing
- – movement toward previous level of functioning
- maintenance
- – at or near baseline functioning
- health promotion
- – improving health outcomes
14
Q
prodromal phase
A
- may arise a year or so before first episode
- most common symptoms based on retrospective studies
- reduced concentration and attention
- reduced drive and motivation
- depression
- sleep disturbances
- anxiety
- social withdrawal
- suspiciousness
- deterioration in role functioning
- irritability
15
Q
positive symptoms
A
- hallucinations (auditory, command, visual)
- delusions (false, fixed belief)
- racing thoughts
- disorganized speech/behaviour
- disturbed/bizarre behaviour
- depersonalization (feeling of being detached from one’s body or mental processes)
- derealization (a mental state where you feel detached from your surroundings)
16
Q
positive symptoms: altered speech
A
- clang associations
- associative looseness
- word salad
- neologisms (creating new words)
- echolalia (meaningless repetition of words)
17
Q
positive symptoms: other disorders of thought or speech
A
- flight of ideas
- thought insertion
- thought broadcasting
- ideas of reference
18
Q
positive symptoms: alterations in behaviour
A
- motor retardation
- motor agitation
- catatonia
- waxy flexibility (retain position moved into)
- echopraxia (meaningless repetition of movement)
- impaired impulse control
- gesturing or posturing
- boundary impairment
19
Q
negative symptoms
A
- avolition: decreased motivation
- affective flattening: decreased emotional expression (affect is blunt, flat, and inappropriate)
- alogia: decreased fluency in thought and language
- anhedonia: decreased willingness to engage in leisure/pleasure
20
Q
affective symptoms
A
- assessment for depression is crucial
- – may herald impending relapse
- – increases substance use
- – increases suicide risk
- – each psychotic break further impairs functioning
21
Q
cognitive symptoms
A
- difficulty with:
- – attention
- – memory
- – information processing
- – cognitive flexibility
- – executive functions
22
Q
expected outcomes
A
- 1/3 of pt with schizophrenia achieve lasting significant improvements (recover-remission)
- 1/3 of pt improve somewhat but have relapses (mild to moderate symptoms)
- 1/3 of pt remain disabled (chronic - 10% commit suicide)
23
Q
early detection
A
- the sooner the symptoms are recognized and diagnosed, the sooner the person will benefit
- once the symptoms and the fear that goes along with symptoms are addressed, recovery begins
- important to R/O other diseases huntington’s disease, wilson’s disease, epilepsy, tumour, encephalitis, meningitis, MS and others
24
Q
schizophrenia prediction instrument (SPI-A)
A
- at least two of nine of the following basic symptoms
- -inability to divide attention
- – thought interference
- – thought blockage
- – disturbance in receptive speech
- – disturbance in expressive speech
- – disturbance of abstract thinking (concretism)
- – unstable ideas of reference (subject centrism)
- – captivation of attention by details of the visual field
25
Q
first episode psychosis
A
- psychosis: 3% of world pop
- up to 1/3 of pt with schizophrenia have just one episode
- important with each acute episode the prognosis worsens (toxic storm)
- the experience is very frightening, confusing, distressing
- psychosis is treatable
26
Q
types of psychosis
A
- schizophrenia
- schizophreniform disorder
- bipolar
- schizoaffective disorder
- depression with psychotic features
- drug induced psychosis
- organic psychosis
- delusional psychosis
27
Q
acute phase interventions
A
- presence of frank psychosis (hallucinations, delusions, formal thought disorder)
- nursing:
- – therapeutic communication
- – provide safety and support
- – managing delusions and hallucinations
- – prioritize care according to need, if not hallucinating (+ve) then focus on self withdrawal (-ve)
- – self care deficit
- – prevention of water intoxication (polydipsia)
- – continual assessment, evaluate responsiveness to tx
28
Q
acute phase interventions: pharmacology
A
- anti psychotics (neuroleptics): act as dopamine antagonists
- antipsychotic medications
- – first generation FGA -typical
- – second generation SGA atypical
- – third generation TGA atypical
29
Q
first generation typical antipsychotics
A
typical (traditional) anti psychotic (major tranquilizer) first gen (older)- thorazine, haloperidol, stelazine, loxipine, chlorpromazine, depot fluphenazine, flupentixol, Haldol, zuclopenthixol
- action dopaminergic lower neurotransmission of four dopamine pathways (D2 antagonists)
- therapeutic effect: window is narrow and unique
- side effects: acute dystonia (EPS) - chronic, akathisia (EPS), pseudo parkinsonism (EPS), tardive dyskinesia (chronic)
- nurses need to respond quickly to side effects
30
Q
second generation antipsychotics (Atypical)
A
- second gen: risperidone, olanzapine, quetiapine, ziprasidone, amisulpride, clozapine (final choice)
- blood monitoring required
- action block both D2 and 5Ht
- treat both positive and negative symptoms
- minimal to no extrapyramidal side effects (EPS) or tardive dyskinesia
- disadvantage: tendency to cause significant weight gain
- side effects: sedation, hyperglycemia, akathisia, dizziness, photosensitivity
31
Q
clozapine (second gen antipsychotic)
A
- first atypical antipsychotic
- first marketed in 1906, came off market bc of agranulocytosis (low WBC production)
- reserved for tx: resistant pts
- requires registration with clozapine monitoring: CSAN#
- requires base line work up: ECG, blood work
- CBC weekly for 6 months, then q2w for 6 months, then q4w for duration of treatment
- give only 7 day supply at first
- must have at least two trials with other antipsychotics before try clozapine
32
Q
clozapine - side effects
A
- agranulocytosis
- myocarditis
- seizures
- sialorrea (drooling)
- weight gain (hyperglycemia-dislipidemia)
- metabolic syndrome (central obesity, high BP, high triglycerides, low HDL cholesterol, insulin resistance)
33
Q
third generation antipsychotics
A
- aripiprazole (abilify)
- dopamine system stabilizer
- improves positive and negative symptoms and cognitive function
- little risk of EPS or tardive dyskinesia (EPS of face)
34
Q
newest atypical antipsychotic meds
A
- iloperidone (fanapt)
- lurasidone (latuda)
- asenapine (saphris)
- paliperidone (invega)
35
Q
potentially dangerous responses to antipsychotics
A
- agranulocytosis
- anticholinergic toxicity
- neuroleptic malignant syndrome (NMS)
36
Q
anticholinergic toxicity (toxidrome)
A
- blind as a bat: blurred vision
- mad as a hatter: confused, decreased LOC, seizures, psychosis, delirium, coma
- red as beet: flushed, vasodilation, tachycardia, dysrhythmias
- dry as a bone: dry skin, membranes
- hot as a hare: hyperthermia
- stuffed as a pipe: urinary/bowel retention
- myoclonus (quick, involuntary muscle jerks)
37
Q
neuroleptic malignant syndrome (NMS) - FARM
A
- Fever
- Autonomic changes (labile, hypertension, tachycardia, tachypnea, diaphoresis, drooling)
- rigidity of muscles
- mental status changes (agitation, confusion, delirium, coma)
38
Q
adjunct to antipsychotic drug therapy
A
- mood stabilizer
- antidepressants
39
Q
interventions
A
- stabilization and maintenance phases
- medication admin/adherence
- community based therapeutic services
- relationships with trusted care provider
- counselling and communication techniques (hallucinations, delusions, associative looseness)
- health teaching and health promotion
40
Q
advanced practice interventions
A
- individual and group therapy
- psycho-education
- med and med monitoring
- basic health assessment
- cognitive remediation
- family therapy
41
Q
interventions: maintenance phase
A
- teaching for client
- teaching for family
- focus on relapse
- relapse fuel deterioration
- cause of relapse
- managing relapse
42
Q
interventions: health promotion phase
A
- psychiatric rehab and recovery
- promoting adherence to the medical regimen
- promoting ADL
- promoting organized behaviour and insight into illness
- promoting social interaction and social skills
- promoting family understanding
43
Q
general health of people with schizophrenia
A
- 2-4x higher rate of diabetes
- 8x higher rate of HIV
- 2x higher asthma
key modifiable risk factors: - hypertension
- overweight/obesity
- dyslipidemia
- hyperglycemia
44
Q
psychological consequences of psychosis
A
- loss of self esteem
- loss of confidence
- developmental stagnation
- addiction
- depression
- PTSD
