Schizophrenia

Question 1

Schizophrenia is a devastating brain disorder that affects?

Answer 1

Thinking, language, emotions, social behavior. Lost ability to perceive reality accurately.

Question 2

Positive symptoms are schizo?

Answer 2

Hallucinations, delusions, disorganized speech (associative looseness), bizarre behavior

Question 3

Negative symptoms of schizo?

Answer 3

Blunted or flat affect, poverty of thought (alogia), loss of motivation (avolition), inability to experience pleasure or joy (anhedonia)

Question 4

Affective symptoms of schizo?

Answer 4

Dysphoria, suicidality, hopelessness

Question 5

Cognitive symptoms of schizo?

Answer 5

Inattention, easily distracted, impaired memory, poor problem-solving skills, poor decision-making skills, illogical thinking, impaired judgment

Question 6

What are alterations in perception for schizophrenics?

Answer 6

Depersonalization, hallucinations, relealization.

Question 7

What are alterations in thinking for schizophrenics?

Answer 7

Delusions, aka fixed false beliefs that cannot be corrected by reasoning.
Concrete thinking, the impaired ability to think abstractly

Question 8

Alterations in speech?

Answer 8

Associative looseness, neologisms, clang association, word salad, pathologic repeating of another’s words (echolalia)

Question 9

What should be done in the initial assessment for schizo?

Answer 9

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

Question 10

What are examples of nursing diagnoses for schizo?

Answer 10

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.

Question 11

What are initial goals and interventions for the early acute phase?

Answer 11

Safety, therapeutic milieu. Therapeutic communication. Manage symptoms, medications. Manage basic needs.

Question 12

Communication with hallucinations?

Answer 12

Assess the content and determine whether they’re command. Reflect the feeling and reality orient or distract into self-esteem activity. Reality check.

Question 13

Communication with delusions?

Answer 13

Reality orient (focus on the environment) but don’t argue. Reflect the feeling. Avoid talking about delusional material.

Question 14

Communication with paranoia?

Answer 14

Allow pt space. Brief, frequent contact. Manage your own anxiety. Respectful, non-judgmental, honest, and consistent. Avoid laughing, whispering, talking quietly.

Question 15

Communication with associative looseness?

Answer 15

Do not pretend you understand. Blame yourself for not understanding. Listen for themes. Focus on here and now.

Question 16

What are goals and interventions for the late acute phase and some of the stabilization phase?

Answer 16

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.

Question 17

What are goals and interventions for the stabilization phase?

Answer 17

Understanding and acceptance of illness. Medication and side effect management. Relapse prevention. Health promotion and maintenance, social skills training. Family therapy.

Question 18

What are the goals and interventions for the maintenance phase?

Answer 18

Social, vocational, and self-care skills. Recovery model.

Question 19

Alterations in behavior?

Answer 19

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.

Question 20

What do antipsychotic medications do for schizo? Predictors of relapse?

Answer 20

Alleviate symptoms but cannot cure underlying psychotic processes.
Medication status is the strongest predictor of relapse, stopping meds increases relapse risk five fold

Question 21

What are consequences of schizo relapse?

Answer 21

Accelerated rate of deterioration, increased resistance to treatment, enhanced impairment to cognitive function, failure to recover full functionality.

Question 22

What do conventional, first-generation antipsychotics do?

Answer 22

Target postiive symptoms and block dopamine.

Question 23

What do atypical, second-generation antipsychotics do?

Answer 23

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.

Question 24

What are examples of extrapyramidal symptoms (EPS)? What meds can cause it?

Answer 24

Akathisia, pseudoparkinsonism, acute dystonia, tar dive dyskinesia (TD).
Conventional (first-generation) antipsychotics

Question 25

What are other side and adverse effects of first-gem antipsychotics?

Answer 25

Anticholinergic effects, orthostasis, sedation

Agranulocytosis, lowered seizure threshold, neuroleptic malignant syndrome (NMS)

Question 26

A subjective feeling or objective signs of muscle unrest, particularly in the lower extremities

Answer 26

Akathisia
Difficulty remaining seated, agitation, restlessness.
Treat with anticholinergic, benzo, beta blocker

Question 27

What is seen in parkinsonism?

Answer 27

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

Question 28

Tonic muscular contractions localized to one or several muscle groups, particularly in the eyes, mouth, throat, or neck.

Answer 28

Dystonia

Treat urgently with diphenhydramine or benztropine AKA Benadryl or Cogentin

Question 29

What are examples of manifestations of dystonia for each muscle group?

Answer 29

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

Question 30

A permanent movement disorder characterized by involuntary choreiform movements of the tongue, face, mouth, extremities.

Answer 30

Tardive dyskinesia
Puckering, chewing movements, involuntary movement of the extremities.
Stop antipsychotic medication

Question 31

Extrapyramidal side effects often appear early in therapy and can be minimized with treatment, which consists of what?

Answer 31

Lowering the dose, administering antiparkinsonian or anticholinergic drugs such trihexyphenidyl, benzotropine mesylate, biperiden, amantadine hydrochloride

Question 32

What are anticholinergic side effects?

Answer 32

Dry mouth, constipation, urinary retention, blurry vision, memory difficulties, confusion, photophobia, narrow-angle glaucoma

Question 33

What are other problematic side affects of anticholinergic drugs?

Answer 33

Photosensitivity, weight gain, interference with sexual function: ejaculatory difficulties

Question 34

What are some disadvantages of atypical (second-gen) antipsychotics?

Answer 34

Metabolic syndrome: weight gain, dyslipidemia, altered glucose, risk of diabetes, hypertension, atherosclerosis, increase in heart disease.
More expensive than conventional antipsychotics.

Question 35

What are the advantages of clozapine? Disadvantage?

Answer 35

Lower incidence of RPS, may lower the risk of drug and alcohol use.
Rapid withdrawal may lead to psychosis

Question 36

What are side effects of clozapine? Adverse effects?

Answer 36

Side: drowsiness, dizziness, excessive drooling, anticholinergic side effects
Adverse: agranulocytosis, seizures, metabolic syndrome

Question 37

What are the advantages of risperidone? Side effects?

Answer 37

No seizures or drooling, movement disorders less common (only at high doses), less anticholinergic side effects
Side: moderate metabolic effects, orthostatic hypotension, sexual dysfunction

Question 38

What are the advantages of olanzapine?

Answer 38

No drooling, less movement disorders

Question 39

What are the side effects and adverse effects of olanzapine?

Answer 39

Side: Dizziness, drowsiness, anticholinergic side effects, hyperprolactinemia
Adverse: Significant metabolic side effects, seizure risk when initiate therapy

Question 40

What are the advantages, side effects, and adverse effects of quetiapine?

Answer 40

Low anticholinergic effects.
Side: drowsiness, moderate orthostasis
Adverse: Metabolic syndrome, cataracts reported in animals given high doses

Question 41

Advantages and adverse effects of ziprasidone?

Answer 41

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)

Question 42

What are some adjuncts to antipsychotic drug therapy?

Answer 42

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.

Question 43

What questions should be asked when giving medications?

Answer 43

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?