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schizophrenia ppt Flashcards

1
Q

psychosis

A

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

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2
Q

schizophrenia

A

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

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3
Q

schizophrenia risk factors

A

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

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4
Q

schizophrenia dx and tx

A

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

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5
Q

positive symptoms

A

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

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6
Q

negative symptoms

A

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

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7
Q

cognitive sx of schizophrenia

A 
disorganized thinking
inability to make decisions
poor problem solving
difficulty concentrating
short term memory deficits 
impaired abstract thinking
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8
Q

affective sx of schizophrenia

A

hopelessness
suicidal ideation
labile mood

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9
Q

schizophrenia assessment

A 
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
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10
Q

hallucinations

A

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

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11
Q

illusions

A

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

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12
Q

echopraxia

A

involuntary imitation of the movements of another person

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

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13
Q

delusions

A

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

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14
Q

ideas of reference

A

false impression that world events have personal meaning:

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

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15
Q

delusions of persecution

A

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

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16
Q

delusions of grandeur

A

exaggerated feeling of importance, power, knowledge or identity

often to protect person from low self-esteem

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17
Q

somatic delusions

A

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

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18
Q

magical thinking

A

belief that thoughts or behaviors can control situations or people

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

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19
Q

thought withdrawal

A

belief that someone can steal their thoughts

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20
Q

associated looseness

A

ideas shift from one unrelated thought to another

thoughts are fragmented and do not connect

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21
Q

neologisms

A

made up words that have symbolic meaning to the client

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22
Q

clang association

A

meaningless words whose choice is governed by sound

always rhyme

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23
Q

circumstantial speech

A

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

the result of a non-linear thought pattern

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24
Q

tangential speech

A

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

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25
Q

perseveration

A

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

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26
Q

echolalia

A

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

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27
Q

ambivalence

A

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

voices give contradictory directions

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28
Q

disturbances in affect

A

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

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29
Q

avolition

A

inability to initiate goal-directed activity

30
Q

concrete thinking

A

sometimes called literal thinking

reasoning that focuses on physical objects, immediate experiences, and exact interpretations

31
Q

waxy flexibility

A

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

32
Q

regression

A

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

33
Q

desired outcomes of tx

A

decreased sx

compliance with tx

34
Q

antipsychotics

A

effective for most acute exacerbations of schizophrenia and for preventing relapse

decreases dopamine and sometimes serotonin

full therapeutic effect may be 1-3 weeks

35
Q

noncompliance

A

primary reason for readmission

usually r/t adverse effects

36
Q

long-acting antipsychotics

A

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

37
Q

conventional antipsychotics

A

block dopamine and treat positive symptoms

Haldol, Thorazine

38
Q

chlorpromazine (thorazine)

A

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

39
Q

chlorpromazine (thorazine) side effects

A

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.

40
Q

haloperidol (haldol)

A

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

41
Q

haloperidol (haldol) side effects

A

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.

42
Q

atypical antipsychotics

A

treat positive AND negative sx

risperidone, clozapine, olanzapine, quetiapine

43
Q

risperidone

A

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

44
Q

risperidone side effects

A

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

45
Q

clozapine (clozaril)

A

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

46
Q

clozapine (clozaril) adverse effects

A

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

47
Q

clozapine (clozaril) nursing interventions

A

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

48
Q

olanzapine (zyprexa)

A

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

49
Q

olanzapine (zyprexa) adverse effects

A

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

50
Q

olanzapine (zyprexa) interventions

A

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

51
Q

third-gen antipsychotics

serotonin-dopamine activity monitors

A

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

52
Q

cariprazine (vraylar)

A

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

53
Q

cariprazine (vraylar) adverse effects

A

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

54
Q

cariprazine (vraylar) interventions

A 
assess mental status
watch for cheeking
administer with or without meals
assess for rash
monitor BP ↑↓
55
Q

anticholinergic effects

A 
blurred vision
urinary retention
dry mouth
dry eyes
constipation
orthostatic hypotension
photosensitivity
56
Q

extrapyramidal effects

A

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

57
Q

pseudoparkinsonism

A 
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
58
Q

tx of extrapyramidal effects

A

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

59
Q

neuroleptic malignant syndrome

A

a life-threatening neurologic emergency associated with the use of antipsychotic agents

AMS, delirium, rigidity, hyperpyrexia, dysautonomia, elevated CPK, diaphoresis, tachycardia, tachypnea, salivation

60
Q

neuroleptic malignant syndrome tx

A

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

61
Q

tardive dyskinesia

A

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

62
Q

tardive dyskinesia tx

A

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

63
Q

agranulotcytosis

A

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

64
Q

agranulocytosis diagnosis

A

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

65
Q

agranulocytosis tx

A

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

66
Q

post injection syndrome

A

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

67
Q

antipsychotic adverse effects: nursing interventions

A

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

68
Q

antipsychotic adverse effects: tx

A

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)

69
Q

benztropine (cogentin)

A

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.

70
Q

anger interventions

A

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

71
Q

hallucination interventions

A 
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
72
Q

delusion interventions

A

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

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