schizophrenia ppt

Question 1

psychosis

Answer 1

abnormal mental state that alters an individual’s thoughts, feelings, perceptions, and behaviors

Question 2

schizophrenia

Answer 2

most common psychotic disorder
hallucinations, delusions, illusions
serotonin and dopamine are high
symptoms are milder as pts age

Question 3

schizophrenia risk factors

Answer 3

genetics
early life adversity
lower socioeconomic class
psychoactive substance abuse, especially from a young age

Question 4

schizophrenia dx and tx

Answer 4

symptoms must be present for 6 months or more
no known cure, but remission is possible
often inpatient tx required

Question 5

positive symptoms

Answer 5

manifestations of things not normally present; thought to be caused by excessive dopamine
disturbances in perception, thought content, speech
ambivalence
echopraxia and echolalia

Question 6

negative symptoms

Answer 6

the absence of things normally present harder to treat these symptoms

disturbances in affect, lack of emotional expression, apathy, avolition, lack of interest, anergia, anhedonia, concrete thinking
poor ADLs

Question 7

cognitive sx of schizophrenia

Answer 7

disorganized thinking
inability to make decisions
poor problem solving
difficulty concentrating
short term memory deficits 
impaired abstract thinking

Question 8

affective sx of schizophrenia

Answer 8

hopelessness
suicidal ideation
labile mood

Question 9

schizophrenia assessment

Answer 9

personal hx: functioning, how they spend leisure time
family hx
hx of suicide attempts 
drug screen
identify support systems
labs for underlying illnesses
physical exam

Question 10

hallucinations

Answer 10

disturbance in perception

auditory: most common, can be positive and negative content, may be multiple voices. client learns to ignore them.
command: instructs the client to perform an action to hurt self or others. They are considered dangerous and are a psychiatric emergency.
visual: see people or things
rare: olfactory, gustatory, tactical

Question 11

illusions

Answer 11

misperceptions of environment; anyone can experience an illusion
(optical, AKA mirage)

Question 12

echopraxia

Answer 12

involuntary imitation of the movements of another person

echopraxia is a feature of schizophrenia, Tourette syndrome, and some other neurologic diseases

Question 13

delusions

Answer 13

false beliefs that cannot be corrected by reasoning

ideas of reference, delusions of persecution, delusions of grandeur, somatic delusion, being controlled, religiosity, magical thinking, thought insertion, thought broadcasting, thought withdrawal

Question 14

ideas of reference

Answer 14

false impression that world events have personal meaning:

a client believes that COVID19 is his fault because his birthday is on the 19th.

Question 15

delusions of persecution

Answer 15

(paranoid delusions) feeling of being watched, ridiculed, or followed by someone or something

Question 16

delusions of grandeur

Answer 16

exaggerated feeling of importance, power, knowledge or identity

often to protect person from low self-esteem

Question 17

somatic delusions

Answer 17

convinced there is something medically, physically, or biologically wrong with them
can experience a range of “symptoms” that verify their worst fears
not dissuaded by diagnostics

Question 18

magical thinking

Answer 18

belief that thoughts or behaviors can control situations or people

“step on a crack, break your mother’s back”

Question 19

thought withdrawal

Answer 19

belief that someone can steal their thoughts

Question 20

associated looseness

Answer 20

ideas shift from one unrelated thought to another

thoughts are fragmented and do not connect

Question 21

neologisms

Answer 21

made up words that have symbolic meaning to the client

Question 22

clang association

Answer 22

meaningless words whose choice is governed by sound

always rhyme

Question 23

circumstantial speech

Answer 23

the individual is delayed in reaching the point because they include a lot of unnecessary details

the result of a non-linear thought pattern

Question 24

tangential speech

Answer 24

the individual never gets to the point because they go off on a tangent

Question 25

perseveration

Answer 25

the repetition of a single word or phrase in response to every question

Question 26

echolalia

Answer 26

involuntary parrotlike repetition of a word or sentence just spoken by another person

Question 27

ambivalence

Answer 27

the experience of having an attitude towards someone or something that contains both positive and negative components voices give contradictory directions

Question 28

disturbances in affect

Answer 28

labile: mood swings flat: no expression blunted: minimal expression inappropriate: does not belong to the situation

Question 29

avolition

Answer 29

inability to initiate goal-directed activity

Question 30

concrete thinking

Answer 30

sometimes called literal thinking | reasoning that focuses on physical objects, immediate experiences, and exact interpretations

Question 31

waxy flexibility

Answer 31

condition in which the client allows body parts to be put into bizarre or uncomfortable positions once placed, the body part remains in the position until released

Question 32

regression

Answer 32

the client often retreats to the Erikson stage of trust vs. mistrust

Question 33

desired outcomes of tx

Answer 33

decreased sx | compliance with tx

Question 34

antipsychotics

Answer 34

effective for most acute exacerbations of schizophrenia and for preventing relapse decreases dopamine and sometimes serotonin full therapeutic effect may be 1-3 weeks

Question 35

noncompliance

Answer 35

primary reason for readmission | usually r/t adverse effects

Question 36

long-acting antipsychotics

Answer 36

fluphenazine and haloperidol are formulated in sesame oil for slow absorption risperidone, paliperidone, and olanzapine are encapsulated forms for slow absorption administered every 2-4 weeks rather than daily to increase compliance

Question 37

conventional antipsychotics

Answer 37

block dopamine and treat positive symptoms Haldol, Thorazine

Question 38

chlorpromazine (thorazine)

Answer 38

decreases dopamine in CNS caution with valproic acid, tricyclic antidepressants, amphetamines, phenytoin, other anticholinergics avoid in pregnancy and lactation, bone marrow depression, angle-closure glaucoma consider depot preparations to increase compliance monitor BP

Question 39

chlorpromazine (thorazine) side effects

Answer 39

can cause drowsiness, agranulocytosis, anticholinergic side effects, pseudoparkinsonism, akathisia, tardive dyskinesia, neuroendocrine effects, orthostatic hypotension, neuroleptic malignant syndrome, extrapyramidal symptoms, sedation, seizures, dysrhythmias, sexual dysfunction, skin effects, liver impairment, tardive dyskinesia.

Question 40

haloperidol (haldol)

Answer 40

alters effects of dopamine in CNS. anticholinergic caution with antihypertensive drugs, CNS depressants, levodopa avoid if pregnant or lactating, bone marrow depression, parkinson’s disease haloperidol decanoate is the long-acting form observe for cheeking

Question 41

haloperidol (haldol) side effects

Answer 41

Can cause agranulocytosis, anticholinergic side effects, pseudoparkinsonism, akathisia, tardive dyskinesia, neuroendocrine effects, orthostatic hypotension, neuroleptic malignant syndrome, extrapyramidal symptoms, sedation, seizures, dysrhythmias, sexual dysfunction, skin effects, liver impairment, tardive dyskinesia.

Question 42

atypical antipsychotics

Answer 42

treat positive AND negative sx | risperidone, clozapine, olanzapine, quetiapine

Question 43

risperidone

Answer 43

blocks serotonin and dopamine in the CNS caution with immunosuppressive medications, opioids, alcohol, levodopa, tricyclic antidepressants, clarithromycin, barbiturates avoid with pregnancy & lactation, bone marrow suppression

Question 44

risperidone side effects

Answer 44

can cause metabolic syndrome, orthostatic hypotension, anticholinergic symptoms, agitation, dizziness, mild EPS, elevated prolactin, sexual dysfunction

Question 45

clozapine (clozaril)

Answer 45

atypical antipsychotic reduces dopamine in CNS caution with bone marrow depression, Parkinson disease, lactation avoid use with antihypertensives, CNS depressants, levodopa, lithium, other anticholinergic drugs

Question 46

clozapine (clozaril) adverse effects

Answer 46

can cause agranulocytosis (highest risk of any psych med), seizures!, neuroleptic malignant syndrome, ventricular arrhythmias, type 2 diabetes, anticholinergic side effects, orthostatic hypotension caffeine increases side effects

Question 47

clozapine (clozaril) nursing interventions

Answer 47

periodic WBC counts WBC is ≤3000, hold drug. If WBC is ≤1500 d/c monitor BP ↓↑ and change positions slowly give with food or milk

Question 48

olanzapine (zyprexa)

Answer 48

atypical antipsychotic/mood stabilizer antagonizes dopamine and serotonin in the CNS caution with phenylketonuria, lactation avoid use with antihypertensives, CNS depressants, levodopa, nicotine, fluvoxamine

Question 49

olanzapine (zyprexa) adverse effects

Answer 49

agranulocytosis, seizures, neuroleptic malignant syndrome, drug reaction with eosinophilia, type 2 diabetes, anticholinergic side effects, orthostatic hypotension

Question 50

olanzapine (zyprexa) interventions

Answer 50

monitor BP ↓↑, monitor for side effects, observe for cheeking, assess for falls

Question 51

third-gen antipsychotics | serotonin-dopamine activity monitors

Answer 51

developed to control for the side effects of the other classes of antipsychotic medications and still be effective in dealing with both positive and negative symptoms of schizophrenia aripiprazole (abilify), cariprazine, lumateperone

Question 52

cariprazine (vraylar)

Answer 52

third gen antipsychotic stabilizes dopamine to reduce antipsychotic symptoms caution with lactation, third trimester pregnancy avoid use with diuretics, antihypertensives

Question 53

cariprazine (vraylar) adverse effects

Answer 53

Stevens Johnson, agranulocytosis, neuroleptic malignant syndrome, drowsiness, blurred vision, headache, dyspepsia, orthostatic hypotension, akathesia, constipation

Question 54

cariprazine (vraylar) interventions

Answer 54

``` assess mental status watch for cheeking administer with or without meals assess for rash monitor BP ↑↓ ```

Question 55

anticholinergic effects

Answer 55

``` blurred vision urinary retention dry mouth dry eyes constipation orthostatic hypotension photosensitivity ```

Question 56

extrapyramidal effects

Answer 56

akathesia: feeling of restlessness and need for constant movement. Worse in women. Increased risk with increased dosage dystonia: acute muscle rigidity in any muscle of the body; mostly tongue, neck. can occur in first week of treatment laryngospasm, torticollis is a stiff neck with muscle spasms causing lateral contracture, oculogyric crisis eyes roll up in the head, opisthotonos is tightness in entire body with head, back and arched neck pseudoparkinsonism

Question 57

pseudoparkinsonism

Answer 57

``` stooped posture masklike face w minimal affect noted drooling (clozapine) bradykinesia tremors pill-rolling cogwheel rigidity: ratchet-like movement of joints. festinating gait with shuffling, baby steps ```

Question 58

tx of extrapyramidal effects

Answer 58

AIMS to assess treat dystonia with benadryl, report signs of muscle stiffness treat akathesia with antiparkison, beta-blocker, or benzo lowering dose usually helps

Question 59

neuroleptic malignant syndrome

Answer 59

a life-threatening neurologic emergency associated with the use of antipsychotic agents AMS, delirium, rigidity, hyperpyrexia, dysautonomia, elevated CPK, diaphoresis, tachycardia, tachypnea, salivation

Question 60

neuroleptic malignant syndrome tx

Answer 60

d/c drug and switch medication muscle relaxers, antiparkinson drugs 1-2 week recovery time

Question 61

tardive dyskinesia

Answer 61

irreversible neurological syndrome that results in involuntary and repetitive body movements; associated with long-term therapy with conventional antipsychotics more common in females and > 50 y/o

Question 62

tardive dyskinesia tx

Answer 62

change drugs AIMS to assess no cure, but tx to decrease sx

Question 63

agranulotcytosis

Answer 63

medication causes the bone marrow to slow down production of white blood cells highest risk with clozapine lethargy, sore throat, malaise, fever, and mouth ulcers

Question 64

agranulocytosis diagnosis

Answer 64

WBC counts done weekly for six months then every two weeks throughout therapy ≤3500 mm3, the medication is held until it returns to the normal levels of 4000-11000 mm3. ≤1500 mm3, the drug is discontinued forever

Question 65

agranulocytosis tx

Answer 65

d/c associated medication antibiotics to treat infections that have developed. granulocyte colony-stimulating factor: the medications filgrastim (Neupogen®), and lenograstim (Granocyte®). immune suppression: prednisone bone marrow transplants: last resort

Question 66

post injection syndrome

Answer 66

client must be monitored for 3 hrs after injection for s/s of post-injection delirium (olanzapine/zyprexa) Post-Injection Delirium/Sedation Syndrome: dizziness, AMS, reduced level of consciousness, slurred speech, disorientation, difficulty ambulating, hypertension

Question 67

antipsychotic adverse effects: nursing interventions

Answer 67

do not stop taking the drug abruptly smoking increases the metabolism of some antipsychotics avoid extremes in temperature do not drink alcohol do not take OTCs without physician approval be aware of risks during pregnancy continue to take the med even if feeling well

Question 68

antipsychotic adverse effects: tx

Answer 68

antiparkinson agents increase dopamine to decrease side effects Benztropine (Cogentin) Trihexyphenidyl (Artane) antihistamines have some anticholinergic properties Diphenhydramine (Benadryl) benzodiazepines will relax some rigidity Diazepam (Valium) beta blockers relieve anxiety and tension Propranolol (Inderal) dopaminergic agents will increase dopamine Amantadine (Symmetrel)

Question 69

benztropine (cogentin)

Answer 69

antiparkinson drug restores natural balance of neurotransmitters in CNS caution with antihistamines, tricyclic antidepressants, antacids, antidiarrheals. avoid with tardive dyskinesia, pregnancy, lactation can cause anticholinergic side effects, decreased sweating assess EPS, monitor pulse and BP, administer PO with food.

Question 70

anger interventions

Answer 70

anger becomes negative when it is suppressed, denied or expressed inappropriately NEVER approach an angry client alone remain calm and in control, describe options clearly: express feelings verbally; be truthful, punch the pillow or mattress allow space, de-escalation, maintain eye contact decrease the environmental stimuli offer medication or time out in their room

Question 71

hallucination interventions

Answer 71

``` assess what the voices are saying reassure them that they are safe reduce noise and distract them if a command hallucination, ask if they usually obey the command do NOT send them to their room alone ```

Question 72

delusion interventions

Answer 72

do not argue with the client; this only reinforces the delusion matter-of-factly state the truth distraction teach the client how to ignore the delusion CBT