- paranoid (/persecutory) - grandiose (feeling really important/special abilities) - religious - somatic (about their body) - nihilistic (end of world/everything is horrible)

schizophrenia (halter ch 12, [3]) Flashcards by McKenna Michael

what % of schizophrenic cases begin between ages of 15-35 yo (stressful time of life)

75%

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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

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positive symptoms (added to someone) of schizophrenia (4)

delusions
hallucinations
thought disorders
bizarre behaviors

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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

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predisposing factors of schizophrenia (3)

family h/o
neurobiology (brain structure, neurotransmitters dopamine and serotonin, neurodevelopment)
viral

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cognitive assessment findings schizophrenia (6)

short attention span
poor decision making
thought disorder
non-reality-based thought content
poor insight
concrete thinking

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5 types delusions

paranoid (/persecutory)
grandiose (feeling really important/special abilities)
religious
somatic (about their body)
nihilistic (end of world/everything is horrible)

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5 types hallucinations

auditory
olfactory
visual
gustatory (taste)
tactile

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emotional assessment findings schizophrenia (5)

usually “hypoexpressive”
broad
restricted
flat
blunt
inappropriate

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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)

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socialization assessment findings schizophrenia (3)

inappropriateness
poor communication
disinterest

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physical assessment findings schizophrenia

thorough H&P needed!

-have higher pain threshold

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symptoms of altered mental status (7)

loose associations
clang associations
neologisms
echolalia
thought insertion
magical thinking
ideas of reference

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symptom of altered mental status: thoughts seem unrelated

loose association

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symptom of altered mental status: rhyming/alliterative

clang associations

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symptom of altered mental status: create their own words

neologism

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symptom of altered mental status: repeating back your words

echolalia

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symptom of altered mental status: thoughts from external source

thought insertion

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symptom of altered mental status: thoughts make things happen

magical thinking

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symptom of altered mental status: special meaning/importance of unrelated events

ideas of reference

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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)