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NURS 406 > Schizophrenia ppt > Flashcards

Schizophrenia ppt Flashcards

1
Q

Schizophrenia when is it diagnosed?

A

Usually diagnosed in late adolescence or early adulthood

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2
Q

Peak incidence of onset for schizophrenia is what for women

A

25 to 35 years of age for women.

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3
Q

Peak incidence of onset for schizophrenia is what for men

A

Peak incidence of onset is 15 to 25 years of age for men

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4
Q

What is the estimated prevalence of schizophrenia?

A

Prevalence is estimated at about 1% of total population

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5
Q

Clinical course of Schizophrenia (onset and diagnosis)

A

Onset: most with slow, gradual development of signs and symptoms

Diagnosis usually with more actively positive symptoms of psychosis

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6
Q

Clinical Course: What are the two courses

A
  1. Intermediate term course
  2. Long term course
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7
Q

Intermediate term course

A

two patterns

Ongoing psychosis, never fully recovering

Episodes of psychotic symptoms alternating with episodes of relatively complete recovery

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8
Q

Long-term course:

A

Long-term course: intensity of psychosis diminishes with age; disease becomes less disruptive

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9
Q

Etiology of Schizophrenia

A

Genetic factors*

Neuroanatomic and neurochemical factors (less brain tissue and cerebrospinal fluid;
Dopamine excess

Stress enhancement

Alcohol & Drugs

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10
Q

What is Phase I of Schizophrenia

A

Prodromal Phase

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11
Q

Prodromal Phase of Schizophrenia: How long does it last?

A

Lasts from a few weeks to a few years

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12
Q

What occurs during the Prodromal Phase?

A

Deterioration in role functioning and social withdrawal

Sleep disturbance, anxiety, irritability

Depressed mood, poor concentration, fatigue

Can be focused on certain topics, such as religion, the government, or a particular public figure.

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13
Q

Phase II of Schizophrenia

A

Schizophrenia

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14
Q

Phase II of Schizophrenia- What occurs

A

In the active phase of the disorder, psychotic symptoms are prominent

Delusions
Hallucinations
Impairment in work, social relations, and self-care

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15
Q

Phase III of Schizophrenia: what is it called

A

Residual Phase

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16
Q

Residual Phase of Schizophrenia

A

The more intense symptoms, like hallucinations, start to fade.

Still have some strange beliefs.

Likely to withdraw into oneself and talk less

Trouble concentrating

May become depressed* with increased awareness

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17
Q

Most common symptoms of schizophrenia:

A

Delusions

Hallucinations

Disorganized Speech

Grossly disorganized or catatonic Behavior

Negative symptoms

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18
Q

Positive Symptoms of Schizophrenia:

A

Excessive or distorted thoughts & perceptions within the individual but are not experienced by others.

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19
Q

Negative Symptoms of Schizophrenia

A

Emotions and behaviors that should be present but are diminished in persons with schizophrenia.

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20
Q

Target of Antipsychotic Drugs for Positive Symptoms of Schizophrenia

A

Target of antipsychotic medications:

Delusions
Distortions
Disorganized speech
Disorganized, catatonic or agitated behavior
Hallucinations

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21
Q

Delusions of Positive Symptoms

A

Fixed, false beliefs, despite evidence

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22
Q

Positive Symptoms: Types of Delusions

A

Persecutory

Referential have reference to the individual i.e. news

Grandiose

Somatic

Guilt

Religious

Jealousy

Control

Thought insertion *One’s thoughts are not one’s own, but rather belong to someone else and have been inserted into one’s mind
Thought broadcasting

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23
Q

Positive Symptoms: Content of Thought includes

A

Delusions:

Religiosity:

Paranoia:

Magical thinking:

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24
Q

Positive Symptoms (Content of Thought): Delusions

A

false personal beliefs

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25
Q

Positive Symptoms (Content of Thought): Religiosity

A

excessive demonstration of obsession with religious ideas and behavior

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26
Q

Positive Symptoms (Content of Thought): Paranoia

A

extreme suspiciousness of others

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27
Q

Positive Symptoms (Content of Thought): Magical Thinking

A

ideas that one’s thoughts or behaviors have control over specific situations

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28
Q

Positive Symptoms: Form of Thought includes:

A

Associative looseness

Neologisms:

Concrete thinking:

Clang associations:

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29
Q

Positive Symptoms: Form of Thought (Associative looseness)

A

A thought-process disorder characterized by a confusing connection between

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30
Q

Positive Symptoms: Form of Thought (Neologisms)

A

made-up words that have meaning only to the person who invents them

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31
Q

Positive Symptoms: Form of Thought (Concrete Thinking)

A

Literal interpretations of the environment

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32
Q

Positive Symptoms: Form of Thought (Clang associations)

A

choice of words is governed by sound (often rhyming) Click, clack, clutch”

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33
Q

Positive Symptoms: Word Salad

A

Jumble of words that is meaningless

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34
Q

Positive Symptoms: Perseveration:

A

persistent repetition of the same word or idea in response to different questions

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35
Q

Positive Symptoms: Mutism

A

inability or refusal to speak

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36
Q

Positive Symptoms: Circumstantial

A

delay in reaching the point of a communication because of unnecessary and tedious details

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37
Q

Positive Symptoms: Tangential:

A

Completely off topic that never reaches the point of the conversation.

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38
Q

Perception

A

interpretation of stimuli through the senses

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39
Q

Positive Symptoms: Hallucinations

A

false sensory perceptions not associated with real external stimuli

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40
Q

Positive Symptoms: Types of Hallucinations

A

Auditory
Visual
Tactile
Gustatory
Olfactory

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41
Q

Positive Symptoms: Illusions

A

misperceptions of real external stimuli

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42
Q

Sense of self:

A

The uniqueness and individuality a person feels

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43
Q

Echolalia:

A

repeating words that are heard

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44
Q

Echopraxia:

A

repeating movements that are observed

45
Q

Identification and imitation:

A

taking on the form of behavior one observes in another

46
Q

Depersonalization:

A

you persistently or repeatedly have the feelingthat you’re observing yourself from outside your body

47
Q

Negative Symptoms: Affect

A

the feeling state or emotional tone

48
Q

Inappropriate affect

A

emotions are incongruent with the circumstances

49
Q

Flat Affect

A

appears to be void of emotional tone

50
Q

Apathy:

A

disinterest in the environment/Is a feeling of generalized indifference and unaffectedness

51
Q

Volition:

A

Negative Symptoms

impairment in the ability to initiate goal-directed activity

52
Q

Example of volition

A

Deterioration in appearance: impaired personal grooming and self-care activities

53
Q

Negative Symptoms: Impaired interpersonal functioning

A

Impaired social interaction

social isolation

54
Q

Psychomotor behavior of schizophrenia: what kind of symptoms

A

Anergia

Waxy flexibility

Posturing

Pacing and rocking

55
Q

Anergia:

A

deficiency of energy

56
Q

Waxy flexibility:

A

condition in which a patient’s limbs retain any position into which they are manipulated by another person

57
Q

Posturing:

A

voluntary assumption of inappropriate or bizarre postures

58
Q

Pacing and rocking:

A

pacing back and forth and rocking the body

59
Q

Associated features of Negative Symptoms

A

Anhedonia:

Regression:

60
Q

Associated feature of negative symptoms Anhedonia:

A

Engaging in an activity that previously brought you joy or positive feelings, but no longer elicits those feelings

61
Q

Associated Feature of Negative symptoms: Regression:

A

retreat to an earlier level of development

62
Q

Nursing Priorities of Schizophrenia

A

Risk to self or others*

Command hallucinations

Impaired Judgement

Does the client believe he or a loved one are being threatened or in danger?

Ability to care for oneself i.e. food, self care

Co-occurring disorders i.e. depression, substance abuse,
medical

Medication Compliance

63
Q

Nursing Interventions of Schizophrenia

A

Establish trust and ensure a safe environment

Do not touch client without first informing client exactly what nurse is going to do.

If necessary, postpone procedures until less suspicious or agitated.

Use accepting, consistent approach, and clear, unambiguous language.

Address identified barriers to medication adherence.

Encourage the client to comply with the medication regimen to prevent relapse.

64
Q

Nursing Interventions of Schizophrenia continued

A

Reduce external stimulation.

Monitor client’s thinking, perceptions, and associated behavior.

Ask about voices, and monitor for increased negativity of content, anxiety and agitation, or social withdrawal.

Do not argue with delusional statements but express doubt.

Address feelings reflected in delusions.

If the client expresses suicidal thoughts, institute suicide precautions.

Report increased anxiety and/or increasing risk for violence.

65
Q

Nursing interventions for hallucinations suicidal or homicidal

A

themes require appropriate safety measures. Focus on reality based conversations “The voice your hear is part of your illness; it cannot hurt you”

66
Q

Nursing interventions for associative looseness

A

Reflects poorly organized thinking. Place the difficulty in understanding on yourself not on the pt. “I am having trouble following what you are saying”

67
Q

Nursing interventions for Delusions

A

It is Never useful to debate or attempt to dissuade patient regarding a delusion. Clarify misinterpretation of the environment

Acknowledge client’s concern about false belief(s) but do not agree with them.
Avoid reinforcing delusion by going along with what client says.

Focus on feelings such as fear or anxiety and offer alternative thoughts and behaviors to reduce negative feelings.
Help client minimize effects of delusional thoughts.

68
Q

Schizoaffective

A

Major mood episode (major depression or manic) concurrent with schizophrenia

Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depression or mania)

Major mood episode are present for the majority of the total duration of the active and residual portion of the illness

69
Q

What are the FGA antipsychotics - in general

A

Dopamine antagonists (blocks dopamine) (D2 receptor antagonists)

70
Q

What do dopamine antagonists target?

A

Target positive symptoms of schizophrenia

71
Q

Advantages of Conventional Antipsychotics (FGA)

A

Less expensive than atypical antipsychotics

72
Q

Disadvantages of Conventional Antipsychotics (FGA)

A

Do not treat negative symptoms

Extrapyramidal side effects (EPSs)

Tardive dyskinesia

Anticholinergic side effects

Lower seizure threshold

73
Q

List of Conventional Antipsychotics

A

Chlorpromazine
Trifluoperazine
Thiothixene
Pimozide
Thioridazine

Fluphenazine*
Loxapine
Perphenazine
Molindone
Haloperidol*

74
Q

Which of the conventional antipsychotics come in long acting preparation?

A

Haloperidol (Haldol)*
Fluphenazine (Prolixin)*

75
Q

Conventional Antipsychotics can cause the following Extrapyramidal Side Effects

A

Akathisia:
Pseudo parkinsonism:
Tardive dyskinesia:
Acute dystonia :
Akinesia:
Oculogyric crisis:

76
Q

Akathisia:

A

Extrapyramidal Side Effect

restlessness, shuffling from one foot to another

77
Q

Pseudo parkinsonism:

A

Extrapyramidal Side Effect

tremor, shuffling, stooped posture, rigidity

78
Q

Tardive dyskinesia:

A

Extrapyramidal Side Effect

repetitive tic like motions in facial muscles, rapid blinking, stick out your tongue, smack or pucker your lips

79
Q

Acute dystonia :

A

Extrapyramidal Side Effect

abnormal movements i.e. head rotated to one side

80
Q

Akinesia

A

Extrapyramidal Side Effect

the inability to perform movement

81
Q

Oculogyric crisis:

A

Extrapyramidal Side Effect

uncontrolled rolling back of the eyes

82
Q
A
83
Q

What medication is used to treat EPS?

A

Benztropine (anticholinergic) treats involuntary movements r/e FGAs.

84
Q

Benzotropine

A

Benztropine (anticholinergic) treats involuntary movements r/e FGAs.

85
Q

What does Benztropine (anticholinergic) do?

A

Decrease side effects such as muscle stiffness/rigidity (extrapyramidal signs-EPS)

86
Q

What is Benztropine NOT helpful for?

A

It is not helpful in treating movement problems caused by tardive dyskinesiaand may worsen them

87
Q

How long does it take Benztropine to take effect?

A

It may take 2-3 days before the benefit of this drug takes effect.

88
Q

Anticholinergic affects

A

Remember! Anticholinergic effects Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter.

89
Q

What are the medications used for Tardive Dyskinesia?

A

There are two FDA-approved medicines to treat tardive dyskinesia:

Deutetrabenazine
Valbenazine

90
Q

Neuroleptic Malignant Syndrome (NMS) what is it caused by

A

Is fatal

Caused by medications, mainly antipsychotic, that alter dopamine levels in the brain

Either taking the medication or withdrawal of medications increase central nervous system levels of dopamine.

91
Q

Signs and Symptoms of NMS

A

Severe muscle rigidity, elevated temperature (hyperthermia), altered consciousness, sweating, seizures and death.

“Hot, stiff and out of it”

Serum creatinine kinase (CK) elevation (kidney failure)

92
Q

What is the typical serum creatinine for men:

A

For adult men, 0.74 to 1.35 mg/dL

(65.4 to 119.3 micromoles/L)

93
Q

What is the typical serum creatinine for women:

A

0.59-1.04 mg/dL

(52.2 to 91.9 micromoles/L)

94
Q

Treatment for NMS (nonmedicinal)

A

Early recognition of symptoms; withholding of antipsychotic medications, ICU

Frequent vital signs monitoring, treating fever, laboratory testing
Supportive measures and promoting safety

95
Q

Treatment for NMS (medicine)

A

Dopamine agonists (bromocriptine);

muscle relaxants (dantrolene or benzodiazepine)

96
Q

STUDY SLIDE 43 you don’t understand it

A

STUDY SLIDE 43 you don’t understand it

97
Q

What are second generation first line treatment for schizophrenia?

A

Atypical Antipsychotics

98
Q

What do Atypical Antipsychotics treat (what kind of symptoms)?

A

Treat both positive and negative symptoms

99
Q

Benefits of atypical antipsychotics?

A

Treat both positive and negative symptoms

Minimal to no extrapyramidal side effects (EPSs) or tardive dyskinesia

100
Q

Disadvantages of Atypical Antipsychotics?

A

Disadvantage tendency to cause significant weight gain & metabolic issues. Hyperglycemia, HTN

101
Q

Examples of Atypical Antipsychotics (Serotonin-dopamine antagonists or Second Generation)

A

Clozapine
Risperidone *
Olanzapine*
Ziprasidone
Aripiprazole *
Lurasidone

Prolong QT
Asenapine
Paliperidone*
Quetiapine
Iloperidone

102
Q

Atypical Antipsychotics (Serotonin-dopamine antagonists or Second Generation) that cause Prolong QT

A

Asenapine (Saphris)
Paliperidone (Invega)*
Quetiapine (Seroquel)
Iloperidone (Fanapt)

103
Q

Which Atypical Antipsychotics (Serotonin-dopamine antagonists or Second Generation) that come in long acting preparation

A

Risperidone (Risperdal)*
Olanzapine* (Zyprexa)Metabolic effects
Aripiprazole (Abilify)*
Paliperidone (Invega)*

104
Q

SLIDE 46 and 47 you don’t know study again

A

SLIDE 46 and 47 you don’t know study again

105
Q

When is Tardive Dyskinesia seen most often?

A

Most often seen in FGA and can be seen when client is on the medication 3 months or more

106
Q

Anticholinergic Crisis

A

Life-threatening condition: overdose or sensitivity to drugs with anticholinergic properties

107
Q

Anticholinergic Crisis is also known as

A

anticholinergic delirium

108
Q

Treatment for Anticholinergic Crisis

A

Discontinuation of medication

Physostigmine (acetylcholinesterase inhibitor)

Gastric lavage, charcoal, catharsis for intentional overdoses

109
Q
A

NURS 406 (29 decks)

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