schizophrenia (halter ch 12, [3]) Flashcards
what % of schizophrenic cases begin between ages of 15-35 yo (stressful time of life)
75%
what is DSM 5 classification for schizophrenia (presence of 2 symptoms for atleast 1 month) (5)
- delusions
- prominent hallucinations
- incoherent speech, loose associations
- catatonic, disorganized behavior
- negative symptoms
positive symptoms (added to someone) of schizophrenia (4)
- delusions
- hallucinations
- thought disorders
- bizarre behaviors
negative symptoms (taken away from someone) of schizophrenia (5)
- flat affect
- anhedonia (unable to enjoy things)
- alogia (unclear speech)
- avolition (unmotivated to do things)
- attention impairment
predisposing factors of schizophrenia (3)
- family h/o
- neurobiology (brain structure, neurotransmitters dopamine and serotonin, neurodevelopment)
- viral
cognitive assessment findings schizophrenia (6)
- short attention span
- poor decision making
- thought disorder
- non-reality-based thought content
- poor insight
- concrete thinking
5 types delusions
- paranoid (/persecutory)
- grandiose (feeling really important/special abilities)
- religious
- somatic (about their body)
- nihilistic (end of world/everything is horrible)
5 types hallucinations
- auditory
- olfactory
- visual
- gustatory (taste)
- tactile
emotional assessment findings schizophrenia (5)
- usually “hypoexpressive”
- broad
- restricted
- flat
- blunt
- inappropriate
behavioral assessment findings schizophrenia (6)
- decreased ADLs
- poor health
- agitation/aggression
- catatonia
- “waxy” flexibility (holding position they’re put in)
- apraxia (lack of movement), echopraxia (copying movements)
socialization assessment findings schizophrenia (3)
- inappropriateness
- poor communication
- disinterest
physical assessment findings schizophrenia
thorough H&P needed!
-have higher pain threshold
symptoms of altered mental status (7)
- loose associations
- clang associations
- neologisms
- echolalia
- thought insertion
- magical thinking
- ideas of reference
symptom of altered mental status: thoughts seem unrelated
loose association
symptom of altered mental status: rhyming/alliterative
clang associations
symptom of altered mental status: create their own words
neologism
symptom of altered mental status: repeating back your words
echolalia
symptom of altered mental status: thoughts from external source
thought insertion
symptom of altered mental status: thoughts make things happen
magical thinking
symptom of altered mental status: special meaning/importance of unrelated events
ideas of reference
other psychotic disorders besides schizophrenia (5)
- schizophreniform disorder
- schizoaffective disorder
- delusional disorder
- brief psychotic disorder
- folie a deux
psychotic disorder: similar to schizophrenia but lasts 1-6 months. rapid onset
schizophreniform disorder
psychotic disorder: psychosis and mood disorder
schizoaffective disorder
psychotic disorder: non-bizzare delusions, no hallucinations, no thought disorders; cling to a belief
delusional disorder
psychotic disorder: short duration less than one month
brief psychotic disorder
psychotic disorder: two people have same delusional system
folie a deux
what is term for when pt doesn’t realize they have a problem
anosognosia
nursing interventions for delusions
- develop trust**
- assess characteristics of delusions
- promote distraction
- reorient, refer to them by name
- acknowledge what they believe and what you believe
- avoid trying to “prove them wrong”
- validate real part of delusion
- meet the need/emotion the delusion does
- teach reality testing
4 categories hallucinations
- comforting
- condemning
- controlling/commanding
- conquering
nursing interventions for hallucinations
- confirm reality
- help pt distinguish bw reality and hallucinations
- identify pattern and triggers
- teach distractions
- teach them to request corrective feedback
- teach socially appropriate behaviors
- cognitive responses to hallucinations
pt teaching relapse prevention for schizophrenia (4)
- teach pts to get help early (prodromal phase)
- teach families to identify recurrence
- stay on meds
- manage life stress
what do 1st gen antipsychotic meds help manage
positive symptoms
what do 2nd gen antipsychotic meds help manage
positive and negative symptoms
are 1st or 2nd gen antipsychotic meds used more
2nd gen, newer but more costly
2nd gen antipsychotic med side effects (6)
- weight gain (especially w/ olanzapine and clozapine)
- sedation
- dizziness
- constipation
- prolactin elevation (especially w/ risperidone and paliperidone)
- metabolic syndrome (weight gain, diabetes, hyperlipidemia, CV problems)
rare but serious 2nd gen antipsychotic med side effects (4)
- agranulocytosis (w/ clozaril)
- extrapyramidal symptoms
- tardive dyskinesia
- neuroleptic malignant syndrome (NMS)
what are the down sides to 1st gen antipsychotic meds
- more side effects
- more monitoring needed
S+S neuroleptic malignant syndrome
- hyperthermia
- hyperreflexia
- tremor
- clonus
- often hypertensive
- tachycardia
- diaphoresis
- agitation
- increased bowel sounds, maybe diarrhea
what causes NMS
decreased dopamine
can be caused by antipsychotics
how to treat NMS (4)
- reduce temp
- give fluids
- discontinue antipsychotic
- give bromocriptine or dantrolene
action of 1st gen antipsychotics
decrease dopamine
action of 2nd gen antipsychotics
decrease dopamine
increase serotonin
anticholinergic side effects of antipsychotics
- constipation
- dry mouth
- blurred vision
- memory impairment
- confusion
- dizziness
- urinary retention
- nasal congestion
Tx mild symptoms of anticholinergic side effects with antipsychotic meds (3)
- hard candy
- sips of water
- stool softeners
S+S toxicity of antipsychotic meds (4)
- hyperthermia
- delirium
- unstable VS
- musculoskeletal changes
extrapyramidal symptoms (pseudo-parkinsonism) of antipsychotic meds (6)
- muscle rigidity
- tremors
- akathisia (constant movement)
- drooling
- shuffling gait
- acute dystonia and oculogyrus (involuntary movements)
Tx extrapyramidal S+S of antipsychotic meds (3)
- decrease dosage
- change to diff antipsychotic
- administer anticholinergic (benztropine), antihistamine (benadryl), or dopamine agonist (symmetrel)
S+S tardive dyskinesia (3)
- involuntary mouth movements
- foot tapping
- pill rolling
Tx tardive dyskinesia
valbenazine (ingrezza)
test for tardive dyskinesia
what is considered positive score
test: AIMS (abnormal involuntary movements)
positive: 2+
2nd gen antipsychotic meds
Olanzapine (zyprexa) Quetiapine (seroquel) Clozapine (clozaril) Asenipine (saphris) Paliperidone (invega) Risperidone (risperidal) Ziprasidone (geodon) Iloperidone (fanapt) Lurasidone (latuda) Aripiprazole (abilify) Brexpiprazole (rexulti) Capriprazine (vraylar)
1st gen antipsychotic meds
Chlorpromazine (thorazine)
Fluphenazine (prolixin)
Haloperidol (haldol)
