schizophrenia spectrum disorders Flashcards
psychosis
altered cognition and perception, reality base could be medical or substance (15-28y)
dsmv criteria: highlights
Two or more of the following for a significant portion of time in 1 month:
- Delusions
- Hallucinations
- Disorganized speech
- Gross disorganization or catatonia
- Negative symptoms (diminished emotional expression or avolition)
- Functional impairment of some kind
Continuous disturbance for at least 6 months
delusions
fulse beliefs, held despite a lack of evidence to support them
hallucinations
sensory experiences that are not real
ex) visual, auditory
phases of schizophrenia
Prodromal
- Onset; mild changes
Acute
- Exacerbation of symptoms
Stabilization
- Symptoms diminishing
- Movement toward previous level of functioning
Maintenance or residual
- New baseline is established
prodormal
onset; mild changes
- early onset (warning signs)
- disroganized thoughts
- not answering questions correctly
- auditory hallucinations
- magical thinking
acute
exacerbation of s/s
- s/s get worse, harm to self/others, greatly need help
- hearing voices to kill others
- ask what they are telling you
stabilization
Symptoms diminishing
Movement toward the previous level of functioning
- not completely gone, positive s/s go away, negative are residual
- making an effort to not to listen to them
- don’t need acute care but maybe partial hospitalization
maintenance or risdual
new baseline is established
- back at baseline
- know how to control symptoms
assessment
- During the prodromal phase
General assessment
- Positive symptoms
- Negative symptoms
- Cognitive symptoms
- Affective symptoms
positive symptoms
- hallucinations
- delusions
- disorganized speech
- bizarre behavior (talking to self)
negative symptoms
- blunt affect
- no expression
- alogia- the poverty of thoughts
- avolition- lack of motivation
- anhedonia- lack of pleasure
cognitive symptoms
- thought process
- memory
- locx4
- distracted
- memory impaired
- trouble problem solving
affective symptoms
- thoughts of suicide
- hopeless
- ysphoria: s/s of uneasiness
- depression and anxiety
alterations in speech
- associative losseness
- clang association
- neologisms
- echolalia
associative looseness
Word salad—most extreme form; jumble of words meaningless to a listener
clang association
Words chosen based on sound
neologisms
Meaning for the patient only
echolalia
Pathological repetition of another’s words
circumstantiality
trying to have a convo and going in a circle, say a lot of other things than go back to the question
tangentiality
talking on a tangent, does not get back to question
cognitive retardation
delay in response
pressured speech
word vomit, talking so fast cant get a word in
flight of ideas
- one thought to next thought, transfentile
“sunny, grandma coming over, pet died”
symbolic speech
- symbols to describe what they say
- “ needs are pinching me”
Disorders or Distortions of Thought
Thought blocking Thought insertion Thought deletion Magical thinking Paranoia
thought blocking
reduction/stopage of thought
thought insertion
inserted thoughts not there own
thought deletion
deleted their thoughts
magical thinking
dont step on a crack
- what there doing will curse someone
paranoia
irrational fear but believes it
- dont trust or believe
alterations in perception
- Depersonalization
- Derealization
Hallucinations
- Auditory: voices and sounds
- Visual: spots, animals, people
- Olfactory: smell something not there
- Gustatory: taste something not there
- Tactile: begs crawling on them
- Command: need interventions, voices telling them to hurt them/someone
Illusions: spiders crawling on wall, black dots
depersonalization
unreal
loss of idenity
arm not part of body
derealization
environment has changed
“everything tiny”
alterations in behavior
- Catatonia: very expressive or no movement
- Motor retardation: don’t move: atican challenge
- Motor agitation
- Stereotyped behaviors
- Waxy flexibility: arm stuck in strange way of motion
- Echopraxia: copy movement
- Negativism
- Impaired impulse control
- Gesturing or posturing
- Boundary impairment
cognitive symptoms
- Concrete thinking: inability to think obstractly
- Impaired memory: short term memory
- Impaired information processing: delayed response, misperception
- Impaired executive functioning: difficulty with reasoning
affective symptoms
- Assessment for depression is crucial
- May herald impending relapse
- Increases substance abuse
- Increases suicide risk: ask if they have a plan
- Further impairs functioning
anosognosia
- Inability to realize they are ill
- Caused by the illness itself
- May result in resistance to or cessation of treatment
- Often combined with paranoia so that accepting help is impossible
nurses self assessment
Anxiety or fear
Frustration
Expectations
- give them space
- look for waning s/s
- hat I’m injection
- haldol give w another med to prevent epis s/s
assessment guidelines
- Any medical problems
- Medical problems that mimic psychosis
- Drug or alcohol use disorders
- Mental status examination
- Include cognitive assessment (e.g., reality testing)
what to assess for
Assess for hallucinations Assess for delusions Assess for suicide risk Assess ability to ensure personal safety and health Assess prescribed meds Assess symptoms’ impact on functioning Assess family knowledge
nursing diagnosis: postive symptoms
Disturbed sensory perception
Risk for self-directed or other-directed violence
Impaired verbal communication
nursing diagnosis: negative symptoms
Social isolation
Chronic low self-esteem
risk for succide
outcomes and planning phase 1
phase 1- acute
- Patient safety and medical stabilization
Best strategies to ensure patient safety and provide symptom stabilization
outcomes and planning phase 2
- stabilization
- Help patient understand illness and treatment
- Stabilize medications
- Control or cope with symptoms
outcomes and planning phase: maintenance
maintenance
Maintain achievement
Prevent relapse
Achieve independence, satisfactory quality of life
Provide patient and family education
Relapse prevention skills are vital
implementation
Acute phase
- Psychiatric, medical, and neurological evaluation
- Psychopharmacological treatment
- Support, psychoeducation, and guidance
- Supervision and limit setting in the milieu
- Monitor fluid intake
- Working with aggression
+ Regularly assess for risk and take safety measures
- basic eating, urinating, drinking, safety
interventions
Stabilization and maintenance phases
- Medication administration/adherence
- Relationships with trusted care providers
- Community-based therapeutic services
- Teamwork and safety
- Activities and groups
Counseling and communication techniques
- Hallucinations
- Delusions
- Associative looseness
- Health teaching and health promotion
- silence
- base them back to reality
psychobiological intervention
Antipsychotic medications
- First-generation
- Second-generation
- Third-generation
Injectable antipsychotics
- Short-acting
- Long-acting
first gen antipsychotics
Dopamine antagonists (D2 receptor antagonists) Target positive symptoms of schizophrenia
first gen antipsychotics advantage
Less expensive than second generation
disadvantange of first gen
- Extrapyramidal side effects (EPS)
- Anticholinergic (ACh) side effects
- Tardive dyskinesia
- Weight gain, sexual dysfunction, endocrine disturbances
second gen
- Serotonin (5-HT2A receptor) and dopamine (D2 receptor) antagonists, e.g., clozapine (Clozaril)
- Treat both positive and negative symptoms
- Minimal to no EPS or tardive dyskinesia
2nd gen disadvantage
tendency to cause significant weight gain; risk of metabolic syndrome
3rd gen
- Really a subset of the SGAs
- Aripiprazole (Abilify), brexpiprazole (Rexulti), and cariprazine (Vraylar)
- Dopamine system stabilizers
- May improve positive and negative symptoms and cognitive function
+Little risk of EPS or tardive dyskinesia
Potentially Dangerous Responses to Antipsychotics
- ACh toxicity
- Neuroleptic malignant syndrome (NMS)
- Agranulocytosis
- Prolongation of the QT interval
- Liver impairment
Advanced Practice Interventions
Individual and group therapy Psychoeducation Medication prescription and monitoring Basic health assessment Cognitive remediation Family therapy
evaluation
- Reevaluate progress regularly and adjust treatment when needed
- Even after symptoms improve outwardly, inside the patient is still recovering.
- Set small goals; recovery can take months.
- Active, ongoing communication and caring is essential.
