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Schizophrenia and other Psychotic Disorders Flashcards

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1
Q

Psychosis

A
  • Loss of contact with reality
  • Disorganization of personality
  • Deterioration of social functioning
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2
Q

Psychotic Disorders - Defined by Abnormalities in 1 of 5 Domains

A
  • Delusions
  • Hallucinations
  • Disorganized Thinking
  • Grossly disorganized or abnormal motor behavior, including catatonia (inability to move normally)
  • Negative symptoms
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3
Q

Delusions

  • Persecutory
  • Referential
  • Grandiose
  • Somatic
A

Fixed False Beliefs

  • Persecutory (think others are against you)
  • Referential (think everything refers to them)
  • Grandiose (think they are like god)
  • Somatic (bodily delusions, think something is wrong with them)
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4
Q

Hallucinations

A
  • Perception like experience without external stimulus
  • Vivid and clear like normal perceptions
  • Auditory, visual, olfactory, gustatory, and tactile
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5
Q

Disorganized Thinking

A
  • Thought Disorder
  • Inferred from person’s speech: loose associations, word salad, tangential speech
  • Must be severe enough to substantially impair effective communication
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6
Q

Catatonic: definition and what disorders is it associated with?

A
  • Marked Decrease in reactivity to the environment.

- schizophrenia, bipolar, and depression

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7
Q

Negative Symptoms

  • Avolition
  • Alogia
  • Anhedonia
  • Asociality
A

Diminished emotional expressions

  • Avolition: lack of drive or motivation to pursue goals
  • Alogia: inability to speak
  • Asociality: not social
  • Anhedonia: lack of pleasure
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8
Q

Schizophrenia

A
  • Syndrome of variable but profoundly disruptive, psychopathology including cognition, emotion, perception, and other aspects of behavior.
  • Peak onset 10-25 in men; 25-35 in women
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9
Q

Schizophrenia - Epidemiology

A
  • High mortality rate

- 80% have comorbid illnesses (substance abuse is common comorbid)

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10
Q

Schizophrenia - Prevalence in Populations

A
  • Child of 2 parents with Schizophrenia - 40%

- Monozygotic twin of schizophrenia - 47%

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11
Q

Schizophrenia - Biochemical factors

A
  • Dopamine - dysregulation

- Serotonin - Excess

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12
Q

Schizophrenia - Anatomical Abnormalities

A
  • Ventricular Enlargement
  • Sulci enlargement
  • Cerebellar Atrophy
  • Decreased frontal lobe size
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13
Q

Schizophrenia - Positive Symptoms

A
  • Hallucinations
  • Delusions
  • Illusions
  • Disorganized thinking
  • Bizarre Behavior
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14
Q

Schizophrenia - Negative Symptoms

A
  • Flat Affect
  • Anhedonia
  • Avolition
  • Social Isolation
  • Diminished self-care
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15
Q

Schizophrenia - Mental Status Exam

A
  • Appearance: ranges from disheveled, screaming, agitated, to obsessively groomed, silent and immobile
  • Affect: reduced emotional response, inappropriate, flat, or overly active
  • Mood: anxious, depressed, adhedonic
  • Perceptual Disturbances: Hallucinations
  • Memory: usually intact
  • Judgment and insight - poor insight
  • Cognitive Impairment: dysfunction in working memory, attention, functioning, episodic memory
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16
Q

Schizophrenia - Thought Disorders (thought content)

A
  • Delusions
  • Religiosity
  • Paranoid
  • Magical Thinking
17
Q

Schizophrenia - Form of Thought

A
  • Looseness of associations
  • Concrete thinking
  • Word salad
  • Circumstantiality/Tangetiality
18
Q

Psychomotor Behavior

A
  • Anergia: lack of energy
  • Waxy flexibility: person remains in position that they were placed in; also called catalepsy
  • Posturing: Fixed, strange and bizarre positions; aka catatonic positioning
  • Pacing and rocking
19
Q

Suicide Risk

A
  • Many have suicidal ideation
  • May be related to command hallucinations
  • Risk higher with unemployment, depression, period after psychosis and hospitalization (2 months)
20
Q

Comorbidities

A
  • substance
  • over 50% tobacco
  • Anxiety
  • OCD
  • Diabetes
  • Weight gain
  • Metabolic syndrome
  • Cardiovascular disease
  • Pulmonary disease
21
Q

Treatment

A
  • NAVIGATE
  • Hospitalization
  • Pharm
  • Psychosocial therapy
  • ECT
  • Partial hospitalization program
  • Etc..
22
Q

Indications for Hospitalization

A
  • Acute psychosis (focuses on safety and alleviating severe symptoms. May use IM antipsychotics with benzodiazepine)
  • Suicidal ideation
  • Homicidal ideation
  • Threatening behavior/severe agitation
  • Inability to care for self
  • Grossly disorganized or inappropriate behavior
23
Q

Pharmacotherapy + FGA vs SGA + goals of both

A

FGA: first generation antipsychotics or typical antipsychotics
- Associated with immediate or long-term motor problems

SGA: second generation antipsychotics or atypical antipsychotics
- less likely to cause EPS or TD

  • Equally effective; SGA more widely used
  • Symptom reduction usually within 1-2 weeks
  • Goal is reduction of positive symptoms
24
Q

Clozapine (Clozaril)

  • risks
  • type
A
  • SGA
  • First effective antipsychotic with low Extrapyramidal symptoms
  • Given to those who failed standard therapies
  • Associated with substantial risk of agranulocytosis: assess for infection and report immediately
  • Risk for myocarditis
  • Monitor WBC: first 6 months weekly, second 6 months bi-monthly, maintenance monthly
  • Slow titration 300 mg/qd
25
Q

SGA Side Effects

A
  • Weight Gain
  • Dyslipidemia (elevated levels of fat or cholesterol in blood)
  • Type II Diabetes
  • Accelerated Cardiovascular disease
26
Q

Metabolic Syndrome with SGA

  • what is it?
  • diagnosis criteria
A
  • Cluster of abnormalities associated with obesity, contribute to an increased risk of Type II Diabetes
  • Diagnosed when patient has 3 or more of the following: Abnormal obesity, low HDL cholesterol levels, high triglyceride levels, Hypertension and elevated glucose levels
27
Q

Metabolic Syndrome Criteria (Values) - Abnormal obesity, waist circumference, triglycerides

A
  • Men: > 102 cm (40 in)
  • Women: > 88 cm (35 in)
  • Triglycerides: Greater than or equal to 150 mg/dL
28
Q

Metabolic Syndrome Criteria (Values) - HDL Cholesterol, BP, Fasting Glucose

A
  • Men
29
Q

Monitoring Metabolic Syndrome

A

Before Initiation of Treatment of SGA:

  • Baseline weight and BMI, vitals, fasting glucose and lipid profile
  • Every 3 months for first 6 months
  • Every 6 months after
30
Q

FGA (Typical) Side Effects

A

EPS:

  • Cogwheeling
  • Dystonia (involuntary muscle contractions that cause twisting or repetitive movements)
  • Akathisia (state of agitation, distress, and restlessness)
  • Tardive dyskinesia (TD)
  • Parkinsonianism

Orthostatic hypotension
NMS - Neuroleptic Malignant Syndrome: potentially life threatening

31
Q

Medications to Counter EPS

A
  • Congentin (Benztropine)

- Symmetrel (Amantadine)

32
Q

Tardive Dyskinesia (TD)

A

Syndrome characterized by abnormal involuntary movements of patient’s mouth, trunk, face, or limbs

affects 20-30% particularly those taking FGA

Monitor with AIMS Scale

33
Q

Abnormal Involuntary Movement Scale (AIMS)

A

Aids in early detection and ongoing assessment of movement disorders

34
Q

Psychiatric Disorders with Psychotic Symptoms

A
  • Major depression with psychotic features
  • Bipolar disorder, manic episode
  • Shizoaffective disorder
  • Delusional disorders
  • Personality Disorders: Paranoid disorders, shizotypical and borderline personality disorder
35
Q

Substances associated with psychosis

A
  • Alcohol
  • Cannabis
  • Hallucinogens,
  • Cocaine,
  • Methamphetamine
  • Sedatives
  • Hypnotics
  • Anxiolytics
  • Etc.
36
Q

Toxins Associated with Psychosis

A
  • Anticholisterase
  • Organophosphate insecticides
  • Sarin
  • Carbon Monoxide
  • Volatile Substances: Paint, fuel
37
Q

Nursing Interventions

A
  • Provide safe environment
  • Do not argue or deny delusional material
  • Attitude of acceptance
  • Reinforce and focus on reality
  • Intervene at first sight of increased anxiety, irritation, or verbal or behavioral aggression
  • Administration of Medications: PRN, monitor side effects, Teach client and patients
  • Assist with ADLs if necessary
  • Paranoid Patients: avoid physical contact, maintain assertive approach, and explain what you do
38
Q

Nursing Diagnosis

A
  • Social Isolation
  • Ineffective coping
  • Disturbed Thought Process
  • Disturbed Sensory Perception
  • Impaired verbal communication
  • Self-care deficit
  • Insomnia

Psych (8 decks)

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