Schizophrenia Flashcards
Schizophrenia is a devastating brain disorder that affects?
Thinking, language, emotions, social behavior. Lost ability to perceive reality accurately.
Positive symptoms are schizo?
Hallucinations, delusions, disorganized speech (associative looseness), bizarre behavior
Negative symptoms of schizo?
Blunted or flat affect, poverty of thought (alogia), loss of motivation (avolition), inability to experience pleasure or joy (anhedonia)
Affective symptoms of schizo?
Dysphoria, suicidality, hopelessness
Cognitive symptoms of schizo?
Inattention, easily distracted, impaired memory, poor problem-solving skills, poor decision-making skills, illogical thinking, impaired judgment
What are alterations in perception for schizophrenics?
Depersonalization, hallucinations, relealization.
What are alterations in thinking for schizophrenics?
Delusions, aka fixed false beliefs that cannot be corrected by reasoning.
Concrete thinking, the impaired ability to think abstractly
Alterations in speech?
Associative looseness, neologisms, clang association, word salad, pathologic repeating of another’s words (echolalia)
What should be done in the initial assessment for schizo?
Mental status exam. Medical workup, urine drug screen. Common hallucinations or paranoid delusions. Violence potential and suicide evaluation. Precipitating events. Co-occuring disorders. Later: family response, support systems, comorbid conditions
What are examples of nursing diagnoses for schizo?
Risk for self-directed violence, other-directed violence. Impaired verbal communication. Impaired nutrition. Altered sleep. Social isolation. Impaired social interaction. Risk for loneliness. Leisure skill deficit. Constipation. Ineffective coping.
What are initial goals and interventions for the early acute phase?
Safety, therapeutic milieu. Therapeutic communication. Manage symptoms, medications. Manage basic needs.
Communication with hallucinations?
Assess the content and determine whether they’re command. Reflect the feeling and reality orient or distract into self-esteem activity. Reality check.
Communication with delusions?
Reality orient (focus on the environment) but don’t argue. Reflect the feeling. Avoid talking about delusional material.
Communication with paranoia?
Allow pt space. Brief, frequent contact. Manage your own anxiety. Respectful, non-judgmental, honest, and consistent. Avoid laughing, whispering, talking quietly.
Communication with associative looseness?
Do not pretend you understand. Blame yourself for not understanding. Listen for themes. Focus on here and now.
What are goals and interventions for the late acute phase and some of the stabilization phase?
Social supports, client and family. Stress and vulnerability (psychotherapy, individual or group outpatient therapy). Living arrangements, most live with their family (assertive community treatment, case management). Daily activities.
What are goals and interventions for the stabilization phase?
Understanding and acceptance of illness. Medication and side effect management. Relapse prevention. Health promotion and maintenance, social skills training. Family therapy.
What are the goals and interventions for the maintenance phase?
Social, vocational, and self-care skills. Recovery model.
Alterations in behavior?
Bizarre behavior, extreme motor agitation, echopraxia, stereotyped behaviors, waxy flexibility, stupor, negativism, automatic obedience.
If behavior symptoms predominant, it’s termed catatonia. Lack of impulse control may result in agitated behaviors.
What do antipsychotic medications do for schizo? Predictors of relapse?
Alleviate symptoms but cannot cure underlying psychotic processes.
Medication status is the strongest predictor of relapse, stopping meds increases relapse risk five fold
What are consequences of schizo relapse?
Accelerated rate of deterioration, increased resistance to treatment, enhanced impairment to cognitive function, failure to recover full functionality.
What do conventional, first-generation antipsychotics do?
Target postiive symptoms and block dopamine.
What do atypical, second-generation antipsychotics do?
Target positive and negative symptoms. Block dopamine preferentially and act on serotonin (5-HT2). Atypical agents have fewer side effects. treat anxiety, depression, decrease suicidal behavior.
What are examples of extrapyramidal symptoms (EPS)? What meds can cause it?
Akathisia, pseudoparkinsonism, acute dystonia, tar dive dyskinesia (TD).
Conventional (first-generation) antipsychotics
What are other side and adverse effects of first-gem antipsychotics?
Anticholinergic effects, orthostasis, sedation
Agranulocytosis, lowered seizure threshold, neuroleptic malignant syndrome (NMS)
A subjective feeling or objective signs of muscle unrest, particularly in the lower extremities
Akathisia
Difficulty remaining seated, agitation, restlessness.
Treat with anticholinergic, benzo, beta blocker
What is seen in parkinsonism?
Shuffle gait, rigidity (increased muscle tone of a uniform general nature), cog wheeling (observed as a uniform steady resistance to passive movements of the limbs), drooling, pill-rolling.
Treat with anticholinergic or benztropine
Tonic muscular contractions localized to one or several muscle groups, particularly in the eyes, mouth, throat, or neck.
Dystonia
Treat urgently with diphenhydramine or benztropine AKA Benadryl or Cogentin
What are examples of manifestations of dystonia for each muscle group?
Eye manifestations include spasm of extra ocular muscles (oculogyric crisis)
Neck manifestations include torticollis
Back manifestations include opisthotonus
Pharyngeal muscle spasm or laryngospasm can be life-threatening
A permanent movement disorder characterized by involuntary choreiform movements of the tongue, face, mouth, extremities.
Tardive dyskinesia
Puckering, chewing movements, involuntary movement of the extremities.
Stop antipsychotic medication
Extrapyramidal side effects often appear early in therapy and can be minimized with treatment, which consists of what?
Lowering the dose, administering antiparkinsonian or anticholinergic drugs such trihexyphenidyl, benzotropine mesylate, biperiden, amantadine hydrochloride
What are anticholinergic side effects?
Dry mouth, constipation, urinary retention, blurry vision, memory difficulties, confusion, photophobia, narrow-angle glaucoma
What are other problematic side affects of anticholinergic drugs?
Photosensitivity, weight gain, interference with sexual function: ejaculatory difficulties
What are some disadvantages of atypical (second-gen) antipsychotics?
Metabolic syndrome: weight gain, dyslipidemia, altered glucose, risk of diabetes, hypertension, atherosclerosis, increase in heart disease.
More expensive than conventional antipsychotics.
What are the advantages of clozapine? Disadvantage?
Lower incidence of RPS, may lower the risk of drug and alcohol use.
Rapid withdrawal may lead to psychosis
What are side effects of clozapine? Adverse effects?
Side: drowsiness, dizziness, excessive drooling, anticholinergic side effects
Adverse: agranulocytosis, seizures, metabolic syndrome
What are the advantages of risperidone? Side effects?
No seizures or drooling, movement disorders less common (only at high doses), less anticholinergic side effects
Side: moderate metabolic effects, orthostatic hypotension, sexual dysfunction
What are the advantages of olanzapine?
No drooling, less movement disorders
What are the side effects and adverse effects of olanzapine?
Side: Dizziness, drowsiness, anticholinergic side effects, hyperprolactinemia
Adverse: Significant metabolic side effects, seizure risk when initiate therapy
What are the advantages, side effects, and adverse effects of quetiapine?
Low anticholinergic effects.
Side: drowsiness, moderate orthostasis
Adverse: Metabolic syndrome, cataracts reported in animals given high doses
Advantages and adverse effects of ziprasidone?
No movement disorders, apparently little weight gain, low anticholinergic effects, may be helpful for depression and anxiety.
Adverse: diabetic ketoacidosis, can slow electrical conduction through the heart (prolonged QT interval)
What are some adjuncts to antipsychotic drug therapy?
Antidepressants are administered for severe depression. Lithium and other mood stabilizers reduce aggressive behavior. Benzodiazepine augmentation improves positive and negative symptoms. Clonazepam decreases anxiety, agitation, and possibly psychosis.
What questions should be asked when giving medications?
Not hurt self or others? Decrease intensity of voices? Less talk about delusions?
Compliant with medications? Side effects? Able to state administration times? Knows where to get medication refill?
Able to attend groups? Doing hygiene?
