Schizophrenia Flashcards
overview
mental illness that affects the way the brain receives and interprets info
impacts ability to think, perceive, organize thoughts, relate to others, ability to function
risk factors
genetic
^ dopamine, some serotonin
onset of schizophrenia
combo of genetics, brain trauma, toxin exposure, interaction w/ environment
substance use
street drugs can increase dopamine which increases symptoms
positive symptoms
disorganized thought process concrete thinking paranoid hallucinations, delusions diminished attention/concentration impaired insight - do not believe they are ill impaired judgement altered personality
positive symptoms - alterations in behavior
impulsive cataonia - lots or no motor activity stupor - no rxn to environment posture - weird gestures/distortions waxy flexibility ritualistic behaviors echopraxia
positive symptoms - disorganized speech
loose associations flight of ideas tangential thinking circumstantial thinking neologism word salad - random words w/o sentences clang associations - speak in rhymes echolalia mutism
negative symptoms
autistic - difficulty forming relationships, distant affect - blunted/flat alogia - poverty of speech avolitional - lack of motivation anhedonia - lack of pleasure ambivalence - difficulty making decisions apathy - "who cares" anergia appearance - disheveled
phases of schizophrenia
prodromal phase
acute schizophrenia
chronic schizophrenia
prodromal phase
period just before the 1st psychotic episode
1-12 months before psychotic symptoms: come on slowly dysfunctions in thinking misinterpret environment certain objects have symbolic meaning withdrawn preoccupied
acute schizophrenia
pt begins to experience psychosis:
danger to self/others
often requires hospitalization
chronic schizophrenia
symptoms decrease
can usually return to less restrictive environment
may still have residual symptoms
interventions: disturbed thought processes
frequent brief contact brief promises do not argue about delusions do not reinforce delusions eye contact may be threatening constant observation DO NOT TOUCH
interventions: disturbed sensory perception
ask directly "what are you hearing?" be empathetic stay w/ pt, direct pt to tell voices to go away help ID triggers engage pt in simple physical activities
interventions: defensive coping/paranoia
neutral approach
honest & consistent regarding rules
use clear, simple language
do not laugh, whisper, etc.
interventions: social interaction
spend short, frequent periods w/ pt
one-on-one activity safely adding others
teach social skills when ready
provide corrective feedback
atypical antipsychotics - action
block post-synaptic dopamine receptors in basal ganglia, hypothalamus, limbic system, brainstem, & medulla
may also affect serotonin levels
atypical antipsychotics - intended effects
tx of hallucinations & delusions
tx of NEGATIVE symptoms of schizo
decrease in aggressive behavior
augmentation of antidepressant & antimanic meds
typical & atypical antipsychotic side effects
EPS sedation anticholinergic effects weight gain photosensitivity decrease seizure threshold orthostatic hypotension gallactorrhea/amenorrhea sexual dysfunction
typical & atypical antipsychotic contraindications
CNS depressants - > depressant effects
cigarettes - < plasma concentration of med
beta blockers - severe hypotension
antidepressants - > blood concentratino of antidepressant
SSRIs - sudden onset of EPS
atypical antipsychotics - teaching
regular admin of meds can prevent psychosis exacerbations
clozapine - monitor blood count - may cause bone marrow toxicity
risperdal - available in depo form
atypical antipsychotics - toxic effects
NMS
commonly used atypical antipsychotics
clozipine resperidone olanzipine quetiapine ziprasidone ariprazole
typical antipsychotics - action
blocks post-synaptic dopamine-2 receptors in the basal ganglia, hypothalamus, limbic system, brainstem, & medulla
typical antipsychotics - intended effects
tx of hallucinations & delusions
tx of tics, vomiting, hiccoughs
decrease in aggresive behavior
not very helpful w/ negative symptoms
typical antipsychotics teaching
taking meds regularly will prevent reoccurance of psychotic & other symptoms
doses should be lowered for the elderly
haldol & prolixin are available as depot injections
commonly used typical antipsychotics
haldol prolixin perphenazine trifluoperazine thiothixene chlorpromazine
reversible EPS side effects
acute dystonic reaction
akathasia
pseudoparkinsonism
acute dystonic reaction
occurs 1-5 days after starting of increasing the dose
acute painful muscle spasm of tongue, neck, throat, face, back, jaw
severe upward deviation of eyeballs, neck pulled to one side, difficulty swallowing
acute dystonic reaction - treatment
IM Benadryl
akathasia
occurs within 30-60 days of starting or increasing dose
inner resistance & motor restlessness that causes arms & legs to move
pt says “very uncomfortable”
sometimes misinterpreted as agitation or anxiety & dr may mistakingly increase the med
unrecognized severe cases have lead to suicide
akathasia treatment
anti-parkinsonian meds:
cogentin
artane
pseudoparkinsonism
occurs within 30-60 days of starting of changing dose
hypersalivation/drooling tremor of hands/feet muscle rigidity no spontaneous arm swing w/ walk difficulty initiating movement facial masking/flat affect shuffling gait
pseudoparkinsonism treatment
anti-parkinsonian meds:
cogentin
artane
irreversible EPS side effects
tardive diskenesia
neuroleptic malignant syndrome
tardive dyskinesia
develops gradually over 6 months - 2 years
beginning - slight involuntary muscle contractions of the mouth, tongue, face - very slight, pt may not notice
advanced - snakelike (athetoid) or jerking (choreiform) movements of trunk/hips
neuroleptic malignant syndrome
occurs because dopamine levels drop sharply
**fever is first symptom - an EMERGENCY diaphoresis htn tachycardia cardiac irregularities muscle rigidity incontinence unconsciousness - coma - death
neuroleptic malignant syndrome tx
IV fluids cooling blankets cardiac meds anti-epileptic meds anti-hypertensive meds
types of schizophrenia
paranoid
disorganized
catatoni
schizoaffective disorder
paranoid schizophrenia
most common
positive symptoms
predmoninant symptoms - paraoid delusion that someone is trying to harm them
disorganized schizophrenia
early age of onset negative symptoms inappropriate affect, inappropriate giggling extremely poor contact w/ reality regressed
catatonic schizophrenia
characterized by alterations in behavior
extreme motr excitement or retardation (mute)
schizoaffective disorder
pts have a predominant schizophrenic illness w/ an affective continuum disorder - MDD, mania, bioplar
