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Psych Exam 2 > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

overview

A

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

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2
Q

risk factors

A

genetic

^ dopamine, some serotonin

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3
Q

onset of schizophrenia

A

combo of genetics, brain trauma, toxin exposure, interaction w/ environment

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4
Q

substance use

A

street drugs can increase dopamine which increases symptoms

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5
Q

positive symptoms

A 
disorganized thought process
concrete thinking
paranoid 
hallucinations, delusions
diminished attention/concentration
impaired insight - do not believe they are ill
impaired judgement
altered personality
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6
Q

positive symptoms - alterations in behavior

A 
impulsive
cataonia - lots or no motor activity
stupor - no rxn to environment
posture - weird gestures/distortions
waxy flexibility
ritualistic behaviors
echopraxia
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7
Q

positive symptoms - disorganized speech

A 
loose associations
flight of ideas
tangential thinking
circumstantial thinking
neologism
word salad - random words w/o sentences
clang associations - speak in rhymes
echolalia 
mutism
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8
Q

negative symptoms

A 
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
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9
Q

phases of schizophrenia

A

prodromal phase
acute schizophrenia
chronic schizophrenia

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10
Q

prodromal phase

A

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withdrawn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
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11
Q

acute schizophrenia

A

pt begins to experience psychosis:
danger to self/others
often requires hospitalization

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12
Q

chronic schizophrenia

A

symptoms decrease
can usually return to less restrictive environment
may still have residual symptoms

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13
Q

interventions: disturbed thought processes

A 
frequent brief contact
brief promises
do not argue about delusions
do not reinforce delusions
eye contact may be threatening
constant observation
DO NOT TOUCH
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14
Q

interventions: disturbed sensory perception

A 
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
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15
Q

interventions: defensive coping/paranoia

A

neutral approach
honest & consistent regarding rules
use clear, simple language
do not laugh, whisper, etc.

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16
Q

interventions: social interaction

A

spend short, frequent periods w/ pt
one-on-one activity safely adding others
teach social skills when ready
provide corrective feedback

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17
Q

atypical antipsychotics - action

A

block post-synaptic dopamine receptors in basal ganglia, hypothalamus, limbic system, brainstem, & medulla

may also affect serotonin levels

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18
Q

atypical antipsychotics - intended effects

A

tx of hallucinations & delusions
tx of NEGATIVE symptoms of schizo
decrease in aggressive behavior
augmentation of antidepressant & antimanic meds

19
Q

typical & atypical antipsychotic side effects

A 
EPS
sedation
anticholinergic effects
weight gain
photosensitivity
decrease seizure threshold
orthostatic hypotension
gallactorrhea/amenorrhea
sexual dysfunction
20
Q

typical & atypical antipsychotic contraindications

A

CNS depressants - > depressant effects
cigarettes - < plasma concentration of med
beta blockers - severe hypotension
antidepressants - > blood concentratino of antidepressant
SSRIs - sudden onset of EPS

21
Q

atypical antipsychotics - teaching

A

regular admin of meds can prevent psychosis exacerbations

clozapine - monitor blood count - may cause bone marrow toxicity

risperdal - available in depo form

22
Q

atypical antipsychotics - toxic effects

A

NMS

23
Q

commonly used atypical antipsychotics

A 
clozipine
resperidone
olanzipine
quetiapine
ziprasidone
ariprazole
24
Q

typical antipsychotics - action

A

blocks post-synaptic dopamine-2 receptors in the basal ganglia, hypothalamus, limbic system, brainstem, & medulla

25
Q

typical antipsychotics - intended effects

A

tx of hallucinations & delusions
tx of tics, vomiting, hiccoughs
decrease in aggresive behavior

not very helpful w/ negative symptoms

26
Q

typical antipsychotics teaching

A

taking meds regularly will prevent reoccurance of psychotic & other symptoms
doses should be lowered for the elderly
haldol & prolixin are available as depot injections

27
Q

commonly used typical antipsychotics

A 
haldol
prolixin
perphenazine
trifluoperazine
thiothixene
chlorpromazine
28
Q

reversible EPS side effects

A

acute dystonic reaction
akathasia
pseudoparkinsonism

29
Q

acute dystonic reaction

A

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

30
Q

acute dystonic reaction - treatment

A

IM Benadryl

31
Q

akathasia

A

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

32
Q

akathasia treatment

A

anti-parkinsonian meds:
cogentin
artane

33
Q

pseudoparkinsonism

A

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
34
Q

pseudoparkinsonism treatment

A

anti-parkinsonian meds:
cogentin
artane

35
Q

irreversible EPS side effects

A

tardive diskenesia

neuroleptic malignant syndrome

36
Q

tardive dyskinesia

A

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

37
Q

neuroleptic malignant syndrome

A

occurs because dopamine levels drop sharply

**fever is first symptom - an EMERGENCY
diaphoresis
htn
tachycardia
cardiac irregularities
muscle rigidity
incontinence
unconsciousness - coma - death
38
Q

neuroleptic malignant syndrome tx

A 
IV fluids 
cooling blankets
cardiac meds
anti-epileptic meds
anti-hypertensive meds
39
Q

types of schizophrenia

A

paranoid
disorganized
catatoni
schizoaffective disorder

40
Q

paranoid schizophrenia

A

most common
positive symptoms
predmoninant symptoms - paraoid delusion that someone is trying to harm them

41
Q

disorganized schizophrenia

A 
early age of onset
negative symptoms
inappropriate affect, inappropriate giggling
extremely poor contact w/ reality
regressed
42
Q

catatonic schizophrenia

A

characterized by alterations in behavior

extreme motr excitement or retardation (mute)

43
Q

schizoaffective disorder

A

pts have a predominant schizophrenic illness w/ an affective continuum disorder - MDD, mania, bioplar

Psych Exam 2 (6 decks)

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