Schizophrenia Flashcards
Risk factors of schiz
- genetics: inherited factors
- physiological: complications in birth/preg, increased paternal age, viral infection, starvation, ACE
- biochemical: stress: cortisol increases dop, loss of hippocampus volume
- enviornmental: cannabis use, minority, immigrants, grew up in dense city, poverty
Positive symptoms of schiz
POSITIVE manifestations: “Added” to distort normal fx. Things that are not typically present
1. Delusions
2. Hallucinations
3. Bizzare behavior (walking backward constantly)
4. Disorganized speech (switches topis or does not make any sense (word salad/incoherence)
Negative symptoms of schiz
NEGATIVE manifestations: “Take away” or reduce a person’s experiences like lack of emotion or motivation. Absence of things that are usually present
1. Alogia: (poverty of speech)slowness in thinking that is observed by how the person speaks, in langage skills
2. Affect: no expression or flat expression doesn’t change
3. Anergia: lack of energy
4. Anhedonia: lack of pleasure or joy
5. Avolition: lack of motivation in activities and hygeine
Idea of reference (alt in thought/delusions)
believing other are talking about him when they are not
Persecution (alt in thought/delusions)
singled out for harm ex. being hunted down by FBI
Grandeur (alt in thought/delusions)
believes they are all powerful and important like a god
Somatic delusions (alt in thought/delusions)
believes their body is changing ex. growing a third arm
Thought broadcasting (alt in thought/delusions)
believes their thoughts are heard by others
Thought insertion (alt in thought/delusions)
believes their thoughts are heard by others
Thought withdrawal (alt in thought/delusions)
believes their thoughts have been removed from their mind by an outside source
Magical thinking (alt in thought/delusions)
believes their action or thoughts are able to control a situation ex. wearing a hat that makes them invisible to others
Automatic obedience (alt in behavior)
responding in a robot like manner
Waxy flexibility (alt in behavior)
being in a specific position for a long time
Stupor (alt in behavior)
motionless long periods of time, coma like
Negativism (alt in behavior)
doing the opposite of what is requested
Echopraxia (alt in behavior)
purposeful imitation of movements made by others
ex: someone yawns, you yawn
Catatonia (alt in behavior)
decrease or increase in the amount of movement ex. muscle rigidity can be so severe the limbs remain in that position
Impaired impulse control (alt in behavior)
reduced ability to resist impulses
Gesturing or posturing (alt in behavior)
Unusual expressions
Boundary impairment (alt in behavior)
ex. client drinks someone else’s drink believing it is his since its in the vicinity
Associative looseness (alt in speech)
unconscious inability to concentrate on a single thought
ex: i like to dance. my feet are wet
Neologisms (alt in speech)
made up words
Echolalia (alt in speech)
client repeats the words spoken to him
Clang association (alt in speech)
meaningless rhyme of words
Word salad (alt in speech)
words jumbled together with little meaning
Building a schiz Therapeutic relationship: 1. Orientation
builds alliance with client, fam, health care team
Establish a collaboration that fosters recovery
Building a schiz Therapeutic relationship: 2. Identification
client is aware of the issues they are facing and see the impact of the disorder
Nurse must consider the phase of psychosis, pos/neg symptoms, keep client SAFE
Building a schiz Therapeutic relationship: 3. Exploitation
client explores interventions and learns how to recognize triggers and express difficulties and need for assistance
setting clear limits on what actions and behaviors are acceptable, explaining what the plan of care includes, work with the client toward recovery and learn to live with mental illness
Building a schiz Therapeutic relationship: 4. Resolution
all requirements of rehab and recovery have been met
Interventions when client is experiencing a delusion or hallucination
- acknowledge the delusion then base it on fact
- call the client by name, and remember not to touch the client
- never argue with a client
- nurse should address the client’s feelings about the episode, and then reorient the client, providing reassurance in an empathetic manner that the environment is safe
Patient education for schiz
- Client and family learning about the disorder and clinical manifestations.
- Recognizing signs of relapse such as sleep disturbances, negative thoughts, challenges with cognitive processing and remembering, being unsure of what is real, hearing voices, and paranoia.
- Assist the patient in formulating an after-discharge relapse prevention plan that includes signs that they are doing worse, who they can reach out to (family, friends, health professionals), crisis line, and emergency phone numbers.
Nursing process for schiz: 1. Assessment
Recognizing cues of schizophrenia spectrum disorder: mood disorder, symptoms of schiz but for a shorter duration (1 month-6 months).
Nursing process for schiz: 2. Analysis
Prioritize care based on the client’s specific health needs.
Nursing process for schiz: 3. Planning/Generate solutions
Establish goals and plan of care addressing most urgent needs first. SMART goals. Evidence based practices to address health concerns
Long term goal: will demonstrate improvement in expressing themselves by stating two activities they would participate in before transitioning to the mental health step-down unit
Nursing process for schiz: 4. Implementation/Take action
Nurse performs interventions and monitors client for improvement. Administers medication and provides education.
Safe enviornment
Reduce noise or excessive activity
Use a calm reassuring approach
Reorient
Create schedule
Encourage socialization
Nursing process for schiz: 5. Evaluation
Interventions have been completed. Assess client outcomes.
What is SGA
FIRST LINE TREATMENT for SCHIZ
Risperidone, clozapine, apriprazole ~done and pine
SGA pharm action
Blocks serotonin more than FGA and blocks less of dopamine, norepi, histamine, and acetylcholine
SGA Therapeutic uses
Relief of pos and neg symptoms of schiz, psychosis from levodopa therapy, impulse control disorders, psychotic manifestations from bipolar disorder
SGA Client education
minimize weight gain → healthy/low cal diet, monitor weight, exercise
SGA adverse effects
Metabolic syndrom:
increases risk of heart disease, stroke, type 2
Symptoms: weight gain, increased BP & glucose
Monitor: daily weight, HDL, cholesterol, triglyceride levels
Agitation, dizziness, sedation, sleep disruption → report to provider
- Blood tests needed to monitor agranulocytosis
Clozapine tablet (not first line) interventions
Adverse: agranulocytosis (low WBC)
Baseline & regular monitoring of WBC and RBC weekly
Notify provider of infection (fever, sore throat, mouth lesions)
Low risk of EPS
What is FGA
chlorpromazine, haloperidol, fluphenazine
-Used to control positive symptoms of psychotic disorders
FGA Pharmalogical action
Blocks dopamine more than SGA, acetylcholine, histamine, and norepi receptors in the brain
FGA Contraindication
agranulocytosis (WBC less than 3,000) → observe for infection and notify provider if occurs
FGA Common side effects
anticholinergic- blurred vision, dry mouth, photophobia, urinary retention, conspitaiton, tachycardia
FGA Serious side effects
extrapyramidal adverse effects → monitor EPS
1. Acute dystonia:
severe spasm of tongue, neck, face, back
Intervention: monitor 1-5 days after first dose
Treatment: benztropine
2. Pseudoparkinsonism:
bradykinesia, rigidity, shuffling gait, drooling, tremors
Intervention: monitor first month after first dose & reduce risks of falling
Treatment: benztropine or trihexyphenidyl
3. Akthisia:
inability to sit or stand still, constant pacing and agitation
Intervention: Monitor first 2 months after first dose & increased risk for suicide
Treatment: Beta blockers, lorazepam/diazepam, or benztropine
4. Tardive dyskinesia:
Involuntary lip smacking, tongue movements, arms, legs, trunk
Intervention: lower dosage or switch to SGA & teach client purposeful muscle movement helps to control the involuntary TD
No treatment
5. Neuroendocrine effects:
gynecomastia (male breasts), weight gain, menstrual irregularities
Intervention: monitor weight & notify provider if manifestations occur
6. Neuroleptic malignant syndrome (fatal): sudden high fever, BP fluctuations, diaphoresis, tachycardia, muscle rigidity, decreased LOC, coma
Intervention: can occur within first week of treatment, stop med, monitor vitals, apply cool blanket, increase fluids,
!Immediate transfer to the ICU!
Treatment: dantrolene or bromocriptine to induce muscle relaxation, medication to treat arrhythmias, antipyretics for fever
7. Orthostatic hypotension
Interventions: monitor BP and HR, hold med until provider is notified if there is a significant decrease in BP or increase in HR, increase fluid intake
8. Sedation
Intervention: take med at bedtime to avoid daytime sleepiness, do not drive
9. Seizures
Increased risk in clients who have an existing seizure disorder
Intervention: increase in antiseizure med can be necessary & report seizure activity to provider
10. Severe dysrhythmias
Intervention: obtain baseline ECG and potassium level prior to treatment & throughout
11. Sexual dysfunction
Intervention: lower dosage, report effects to provider
12. Skin effects: photosensitivity (sunburn), contact dermatitis
Education: avoid excessive exposure to sunlight, use sunscreen, and wear protective clothing, avoid direct contact with the med
What neurotransmitters are related to schiz
Increased DOPAMINE, serotonin, norepinephrine
Decreased GABA
Implicated Glutamate
How long do symptoms for schiz must be present for to be diagnosed?
at least 6 months
What do antipsychotic meds do to neurotransmitters?
They block dopamine to help schiz symptoms
Why are SGA used more than FGA?
Less adverse side effects like EPS
Intervention for Acute Stage (early) schiz
Goal: reduce psychotic thoughts and behaviors
Pt experiencing first episodes –> better response to meds so can take a lower dose
Interventions for Stable/Maintenance stage schiz
Goal: prevent relapse
Therapy- improve relationships, reduce stress, minimize drug and alc, support group
Nonpharm treatment for schiz
-Cognitive behavioral therapy, behavioral skills training, employment,
-Coordinated Specialty Care (CSC): recovery program for first episodes of psychosis (early stage schiz)
-Assertive Community Treatment (ACT): pt with schiz who are at risk for repeated hospitalization or homelessness
haloperidol treats
schiz and tourettes
haloperidol normal side effects
neck twitching, dystonia, muscle twitching –> do not report
haloperidol adverse effects
Neuroleptic malignant syndrome
S&S: fever, diaphroesis, change in mental, muscle RIGIDITY, tremors
Interventions: hold med, assess client, notify provider
Clozapine/Risperidone treats
schiz by controlling positive and negative symptoms
Clozapine/Risperidone normal side effects
sedation, anticholinergic, decreased libido
Clozapine/Risperidone adverse effects
weight GAIN & agranulcytosis
S&S: sore throat, fever, flu symptoms –> report
-Do not give to dementia clients!
Methylphenidate/Amphetamine mix treats
ADHD, conduct disorder
Methylphenidate/Amphetamine mix MOA
increases dop and norepi
Methylphenidate/Amphetamine mix monitor for
Monitor BP and weight LOSS
Methylphenidate/Amphetamine mix interventions
Give med no later than 6 pm cuz restlessness, take weekly weight
Treatment: benzo’s lorazepam and alprazolam
Alogia
(poverty of speech)slowness in thinking that is observed by how the person speaks, in langage skills
Anhedonia
lack of pleasure or joy
Avolition
lack of motivation in activities and hygeine
