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Psychiatric Nursing > schizophrenia spectrum disorders > Flashcards

schizophrenia spectrum disorders Flashcards

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1
Q

psychosis

A

altered cognition and perception, reality base could be medical or substance (15-28y)

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2
Q

dsmv criteria: highlights

A

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

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3
Q

delusions

A

fulse beliefs, held despite a lack of evidence to support them

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4
Q

hallucinations

A

sensory experiences that are not real

ex) visual, auditory

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5
Q

phases of schizophrenia

A

Prodromal
- Onset; mild changes

Acute
- Exacerbation of symptoms

Stabilization

  • Symptoms diminishing
  • Movement toward previous level of functioning

Maintenance or residual
- New baseline is established

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6
Q

prodormal

A

onset; mild changes

  • early onset (warning signs)
  • disroganized thoughts
  • not answering questions correctly
  • auditory hallucinations
  • magical thinking
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7
Q

acute

A

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
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8
Q

stabilization

A

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

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9
Q

maintenance or risdual

A

new baseline is established

  • back at baseline
  • know how to control symptoms
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10
Q

assessment

A
  • During the prodromal phase

General assessment

  • Positive symptoms
  • Negative symptoms
  • Cognitive symptoms
  • Affective symptoms
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11
Q

positive symptoms

A
  • hallucinations
  • delusions
  • disorganized speech
  • bizarre behavior (talking to self)
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12
Q

negative symptoms

A
  • blunt affect
  • no expression
  • alogia- the poverty of thoughts
  • avolition- lack of motivation
  • anhedonia- lack of pleasure
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13
Q

cognitive symptoms

A
  • thought process
  • memory
  • locx4
  • distracted
  • memory impaired
  • trouble problem solving
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14
Q

affective symptoms

A
  • thoughts of suicide
  • hopeless
  • ysphoria: s/s of uneasiness
  • depression and anxiety
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15
Q

alterations in speech

A
  • associative losseness
  • clang association
  • neologisms
  • echolalia
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16
Q

associative looseness

A

Word salad—most extreme form; jumble of words meaningless to a listener

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17
Q

clang association

A

Words chosen based on sound

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18
Q

neologisms

A

Meaning for the patient only

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19
Q

echolalia

A

Pathological repetition of another’s words

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20
Q

circumstantiality

A

trying to have a convo and going in a circle, say a lot of other things than go back to the question

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21
Q

tangentiality

A

talking on a tangent, does not get back to question

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22
Q

cognitive retardation

A

delay in response

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23
Q

pressured speech

A

word vomit, talking so fast cant get a word in

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24
Q

flight of ideas

A
  • one thought to next thought, transfentile

“sunny, grandma coming over, pet died”

25
Q

symbolic speech

A
  • symbols to describe what they say

- “ needs are pinching me”

26
Q

Disorders or Distortions of Thought

A 
Thought blocking
Thought insertion
Thought deletion
Magical thinking
Paranoia
27
Q

thought blocking

A

reduction/stopage of thought

28
Q

thought insertion

A

inserted thoughts not there own

29
Q

thought deletion

A

deleted their thoughts

30
Q

magical thinking

A

dont step on a crack

- what there doing will curse someone

31
Q

paranoia

A

irrational fear but believes it

- dont trust or believe

32
Q

alterations in perception

A
  • 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

33
Q

depersonalization

A

unreal
loss of idenity
arm not part of body

34
Q

derealization

A

environment has changed

“everything tiny”

35
Q

alterations in behavior

A
  • 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
36
Q

cognitive symptoms

A
  • Concrete thinking: inability to think obstractly
  • Impaired memory: short term memory
  • Impaired information processing: delayed response, misperception
  • Impaired executive functioning: difficulty with reasoning
37
Q

affective symptoms

A
  • Assessment for depression is crucial
  • May herald impending relapse
  • Increases substance abuse
  • Increases suicide risk: ask if they have a plan
  • Further impairs functioning
38
Q

anosognosia

A
  • 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
39
Q

nurses self assessment

A

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
40
Q

assessment guidelines

A
  • Any medical problems
  • Medical problems that mimic psychosis
  • Drug or alcohol use disorders
  • Mental status examination
  • Include cognitive assessment (e.g., reality testing)
41
Q

what to assess for

A 
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
42
Q

nursing diagnosis: postive symptoms

A

Disturbed sensory perception
Risk for self-directed or other-directed violence
Impaired verbal communication

43
Q

nursing diagnosis: negative symptoms

A

Social isolation
Chronic low self-esteem
risk for succide

44
Q

outcomes and planning phase 1

A

phase 1- acute
- Patient safety and medical stabilization

Best strategies to ensure patient safety and provide symptom stabilization

45
Q

outcomes and planning phase 2

A
  • stabilization
  • Help patient understand illness and treatment
  • Stabilize medications
  • Control or cope with symptoms
46
Q

outcomes and planning phase: maintenance

A

maintenance
Maintain achievement
Prevent relapse
Achieve independence, satisfactory quality of life

Provide patient and family education
Relapse prevention skills are vital

47
Q

implementation

A

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
48
Q

interventions

A

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
49
Q

psychobiological intervention

A

Antipsychotic medications

  • First-generation
  • Second-generation
  • Third-generation

Injectable antipsychotics

  • Short-acting
  • Long-acting
50
Q

first gen antipsychotics

A 
Dopamine antagonists (D2 receptor antagonists)
Target positive symptoms of schizophrenia
51
Q

first gen antipsychotics advantage

A

Less expensive than second generation

52
Q

disadvantange of first gen

A
  • Extrapyramidal side effects (EPS)
  • Anticholinergic (ACh) side effects
  • Tardive dyskinesia
  • Weight gain, sexual dysfunction, endocrine disturbances
53
Q

second gen

A
  • 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
54
Q

2nd gen disadvantage

A

tendency to cause significant weight gain; risk of metabolic syndrome

55
Q

3rd gen

A
  • 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
56
Q

Potentially Dangerous Responses to Antipsychotics

A
  • ACh toxicity
  • Neuroleptic malignant syndrome (NMS)
  • Agranulocytosis
  • Prolongation of the QT interval
  • Liver impairment
57
Q

Advanced Practice Interventions

A 
Individual and group therapy
Psychoeducation
Medication prescription and monitoring
Basic health assessment
Cognitive remediation
Family therapy
58
Q

evaluation

A
  • 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.

Psychiatric Nursing (22 decks)

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