Schizophrenia Flashcards
What is a common long term side effect of anti-psychotic meds?
Metabolic syndrome:
Hyperglycemia
Hypertriglycerides
HTN
Obesity
What is the difference between schizophrenia and schizophreniform disorder?
Schizophreniform looks exactly the same as schizophrenia EXCEPT short duration (1-6 months)
What is schizoaffective disorder?
The combo of a mood disorder and schizophrenia.
Signs of depression or mania or mix of both and symptoms of schizophrenia
What is the difference between a schizotypal PD and schizophrenia?
Schizotypal PD can develop into schizophrenia.
Schizotypal PD is considered to be “on the spectrum” of schizophrenia.
Schizotypal PD usually DONT experience the psychosis.
What is delusional disorder?
Non-bizzare delusions
(These things could actually happen)
Persecution, someone being in love with them, being followed, etc.
Behavior is not obviously odd.
What are the benefits of catching schizophrenia early?
Why is it important for nurse to recognize prodromal stage?
The better the chance of recovery if treated early.
Every relapse and period of psychosis does damage and makes it more difficult to completely recover.
Greatly improves prognosis.
What are the 4 phases of schizophrenia?
Prodromal
Acute (psychotic break)
Stabilization (psychosis disappearing)
Maintenance (remission, but may have mild persistent symptoms)
What are s/sx of prodromal stage of schizophrenia?
Social withdrawal
Depressed mood
Decreased functioning
Disturbed perceptions
Magical thinking
Peculiar behavior
Self care diminished
Sleeping/eating patterns off
Work/school performance tanks
What are some bio neuro changes in schizophrenia?
Dopamine dysregulation (too high)
Serotonin low
Inappropriate synaptic pruning that occurs in teen years
Gray and white matter decreased
What are some positive symptoms of schizophrenia?
Hallucinations
Delusions
Bizarre behavior
Catatonia (odd movements and body shape)
Thought and speech disorders
What are some negative symptoms of schizophrenia?
Flat affect
Alogia (little to no speech)
Avolition (no motivation to do anything or follow through)
Anergia (no energy)
Anhedonia (can’t feel pleasure)
Asocial
What is circumstantiality?
A positive symptom of schizophrenia
Excessively detailed speech. Can’t separate relevant from irrelevant details
What is neologism?
Made up words
Positive sign of schizo
What is tangentiality?
Type of speech that can’t stay on subject
Wanders off in train of thought
What is associative looseness?
Postive symptom of schizo
Thinking is haphazard, illogical and confused
Example: “ I like to dance, all monkeys have tails.”
What is echolalia?
Repeating
What is echopraxia?
Mimicking anothers movements
What is clang association?
Rhyming meaningless words
Why are command hallucinations a med emergency?
Because the “command” is usually dangerous to themselves or others
What is the term “impairment of insight” in schizo?
This is hallmark of schizophrenia
It means that don’t understand or recognize their illness and don’t adhere to treatment
What are cognitive symptoms of schizophrenia?
Memory impairment
Inability to reason, problem solve, focus, make decisions
What is catatonia?
Positive symptom of schizophrenia
Two categories:
Extreme or abnormal motor behavior:
Run around the room
Robot like
Bizarre posture
Waxy flexibility
Stereotyped movement (like vacuuming floor but with no vacuum)
Does the opposite of instructions
AND/OR:
Extreme psychomotor retardation:
Stupor (still for long periods of time)
Coma like
Slow speech
What does treatment focus on in acute phase of schizophrenia?
Safety
Crisis intervention
Symptom stabilization
Medication
Evaluation
Rule out medical cause
Therapeutic millieu
Support to patient and family
What is treatment focused on in stabilization phase of schizophrenia?
Teaching patient understanding and acceptance of illness
Developing strategy for tx
Medication education
Relapse prevention
Connecting them to support system
What is one danger in treatment after relapse?
Takes longer to achieve remission after med re-start
Meds can become ineffective and patient can become unresponsive to treatment
Two categories of antipsychotic meds
First gen or typical antipsychotics
These are dopamine antagonists
Second gen or atypical antipsychotics
These are dopamine and serotonin antagonists
Who are NEVER given antipsychotics?
Geriatrics WITH dementia
What is main difference between 1st gen and 2nd gen antipsychotics ?
Equal efficacy
SGAs (2nd gen) are better tolerated and have fewer SEs like extrapyramidal symptoms and anticholinergic effects.
–The exception is clozapine–
Antipsychotic meds are ___ depressants.
CNS
–They cause sedation–
How long do antipsychotics usually take to start working?
2–4 weeks
What is the advantage of a “depot” IM form of antipsychotics?
Last longer
Don’t need a pill every day
Most last 1-4 weeks
Invega Trinza lasts 3 months
Side effects of antipsychotics?
Sedation
Orthostatic hypotension
Lower seizure threshold
Cardiac dysrhythmias
Hormonal dysregulation
Sexual dysfunction
Weight gain
Metabolic syndrome
EPS
Anticholinergic
What is clozapine useful for?
What is the danger?
Negative symptoms of schizophrenia
The danger is increased risk of agranulocytosis.
Also increases risk of seizures and myocarditis.
It is only used today for treatment-refractory patients
What is agranulocytosis?
WBCs <3.5
Clinical s/sx of agranulocytosis?
Fever
Chills
Sore throat
Mouth ulcers
Bleeding gums
Weakness
What are extrapyramidal symptoms?
Side effect of antipsychotics
Tardive dyskinesia
Acute dystonia
Akathisia
Pseudoparkinsonism
What is tardive dyskinesia?
A type of extrapyramidal symptom that appears after long treatment. Can be permanent if not treated promptly
Involuntary muscle movements of face and jaw.
Tongue, lip smacking, biting, chewing, sucking motions
What is acute dystonia?
Muscle spasms of tongue, head, neck.
Fixed upward eye gaze
Back spasms that make back arch forward
–Type of EPS–
What is akathisia?
Fidgeting and restlessness
–Type of EPS–
What is pseudoparkinsonism?
Stiff muscles
Salivation
Shuffling gait
Tremor
Slow movements (bradykinesia)
–Type of EPS–
What meds are used to treat EPS (extrapyramidal symptoms)?
Trihexyphenidyl (Artane)
Benztropine mesylate (Cogentin)
Benadryl
Biperiden (Akineton)
Amantadine hydrochloride (Symmetrel)
–All these are used to treat Parkinsons, except Benadryl–
What is neuroleptic malignant syndrome?
Rare side effect of antipsychotics
Acronym for s/sx is FEVER
F=Fever
E=Elevated CPK/WBC
V=Vital sign instability (BP up and down, tachycardia, diaphoresis, salivation, tremors, incontinence)
E=Encephalopathy (change in LOC)
R=Rigidity (muscle)
What are the 1st gen antipsychotics?
Haloperidol (Haldol)
Trifluoperazine (Stelazine)
Fluphenazine
Loxapin
Chlorpromazine (Thorazine)
Thioridazine (Mellaril)
What are some common 2nd gen antipsychotics?
Clozapine (Clozaril)
Aripiprazole (Abilify)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Resperidone (Risperdal)
Many end in these suffixes:
—peridone
—piprazole
