Schizophrenia Spectrum Disorders Flashcards
What is schizophrenia?
A disorder that affects a persons ability to think and behave clearly
It Disturbs
1. thought processes
2. perception
3. affect/ behavior
What is psychosis?
Reality is distorted
- People with schizophrenia cant distinguish between whats real or whats not real
- Will have hallucinations or delusional thinking
What is the onset of schizophrenia?
- Early childhood and late adolescence ( 15-25 years old )
- Childhood onset ( before 15 years old )
- Late onset ( after 40 years old )
- will go through the PRODROMAL PHASE- mild sx for months or years before full onset= WARNING
What is the Prodromal Phase of Schizophrenia?
- A person starts having trouble w/ school, work and friends ( deterioration of role functioning and social withdrawl)
- A late sign= Suspiciousness ( THIS HAPPENS BEFORE PSYCHOSIS STARTS )
What is the Acute Phase of Schizophrenia?
- Acute phase and Psychosis goes hand and hand *
Sx ( 2 or more- but at least one of these has to be #1,2, or 3 )
1. DELUSIONS
2. HALLUCINATIONS
3. DISORGANIZED SPEECH
4. Grossly Disorganized
5. Negative symtoms
- Must last at least for 6 months, 1 months of symptoms ( or less if successfully treated ) *
DSM 5 Criteria
Must rule out:
1. Schizoaffective and mood disorders ( ex. bipolar ), substance abuse, medications ( make sure it isnt causing psychosis ), medical condition
- If pt has hx of autisim spectrum disorder or communication disorder * must have prominent delusions or hallucinations to dx *
What are positive (+) symptoms of schizophrenia?
The patient HAS something that regular people dont
1. Hallucinations
2. Delusions
What are negative (-) symptoms of schizophrenia?
The patient DOESNT have something that regular people have
1. lack of ability to experience pleasure
2. lack of ability to express emotions well
Are Delusions a (+) or (-) symptom and what is it?
Delusions = a fixed false beliefs
It is a positive symptom of schizophrenia
Are Speech Alterations a (+) or (-) symptom and what is it?
Speech alterations is a positive symptom of schizophrenia
Ex:
1. Circumstantiality = a lot of details but the person eventually gets to the points
2. Tangentiality= goes on a tangent, never really gets an answer
3. Pressured speech= talking really fast
4. Flight of ideas = talking all over the place, rapid speech ( cant follow what they are trying to say )
5. Symbolic speech= telling you what happened to them through their delusions
Is Disorganized Thinking a (+) or (-) symptom and what is it?
Disorganized Thinking is a positive symptom
Ex:
1. Cognitive Retardation= slowing of you thoughts
2. Thought Blocking= when you’re in the middle of talking but forget
3. Thought insertion= other people putting thoughts in their head
4. Thought Deletion= other people taking thoughts out their heads
5. Magical thinking= if you think something you can affect the other person
6. Paranoia
Is Altered Perception a (+) or (-) symptom and what is it?
Altered Perception is a positive symptom
Ex:
1. Hallucinations= auditory, visual, tactile (touch), gustatory (taste), olfactory (smell)
Command Hallucinations- DANGER - telling or showing you to do something- what are they saying to do?
- Illusions- there is something in the environment but the person perceives it differently (ex: a computer screen seen as a portal )
- Derealization = reality seems odd
Is Altered Behavior a (+) or (-) symptom and what is it?
Altered behavior is a positive symptom
EX:
1. Catatonia- unusual/ lack of movement ( muscles are rigid or waxy flexible )
Are the A’s a (+) or (-) symptom and what is it?
The A’s are a negative symptom
Ex:
1. Anhedonia= inability to experience pleasure
2. Affective Blunting= minimal range of expression of emotion
- flat/blank expression, inappropriate or incongruent with emotional response ( ex. blank face but says their happy, socially inappropriate behaviors)
Is Altered Cognition a (+) or (-) symptom and what is it?
Altered cognition is a negative symptom
Ex:
1. Concrete thinking= literal thinkers
2. Impaired memory
3. Impaired information processing
4. Impaired executive functioning
5. Anosognosia= dont believe that they are sick
what is the Maintenance or Residual phase of Schizophrenia
- No sx of scute phase ( no hallucinations ) but will have sx of prodromal phase ( flat affect + impairment in role functioning - negative sx)
- This is their baseline
- The more acute episodes they have , the worse they become *
Risk factors
BIOLOGICAL
- Strong genetic correlation : twins 50%
- Dopamine theory: increased dopamine = acute sx/ manifestations of schizophrenia
- Parental: pregnancy/ birth complications, viral ( herpes), yeast, psychological trauma ( increases cortisol), father > 35 years old
PSYHOLOGICAL
- Stress: contributes to the severity ad course of illness, can precipitate psychotic episodes if genetically vulnerable ( epigenetics )
Brain Structure Abnormalities
- Enlarged lateral cerebral ventricles
- Cerebellar atrophy
- Increased size of fissures ( sulci )
- Reduced connectivity in various brain regions
Comorbidities with schizophrenia
- Anxiety, depression, SI, physical illness, nicotine dependence ( hinders antipsychotic ), substance abuse ( more likely )
- Polydipsia ( increased thirst ) : can lead to fatal water intoxication –> hyponatremia –> confusion –> worsening psychotic symptoms –> coma–> death
Other psychotic disorders
- Brief psychotic disorder = 1 day but less than a month
- Schizophreniform= last 1 month but less than 6 months
Psychotic disorder due to general medical condition
- Neurological, endocrine, metabolic, autoimmune
Drug abuse, medications, and toxin exposure can cause psychosis
Treatment
Goal: safety + stabilize ( acute phase), maintain and increased symptom control ( maintenance phase )
Individual psychotherapy= is REALITY ORIENTED
Program of Assertive community treatment (PACT)
- team/ case management approach, comprehensive, community based tx, rehab and support
Recovery Model: functional recovery process
What are examples of Typical (1st gen), Atypical ( 2nd generation) Antipsychotics?
What is the MOA and Use?
Typical (1st generation)
- HALOPERIDOL (Haldol),
Atypical (2nd generation)
- CLOZAPINE (Clozaril)
- OLANZAPINE (Zprexa)
- PALLEPERIDONE (Invega)
- QUENTIAPINE (Seroquel)
- RISPERIDONE (Risperdal)
MOA:
- Dopamine Antagonist: inhibits dopamine transmission at the synapses
Use:
- Psychosis, schizophrenia, Bipolar disorders (mood stabilizer)
Adverse reactions of antipsychotics
- orthostatic hypotension ( especially if taking beta blocker)
- Gynecomastia and retrograde ejaculation ( semen enters the bladder)
- Weight gain
- Amenorrhea ( no period)
- PROLONGED QT INTERVALS ( >500=NO)
- Reduction of seizure threshold
- **CLOZARIL - Agranulocytosis ***
What is Extrapyramidal Symptoms (EPS)
Umbrella of sx: adverse reactions of antipsychotics
- Psuedoparkinsonism= tremors, shuffling feet, drooling, rigidity, mask-like face, pill rolling, dysphagia
- Akinesia= muscle weakness
- Akathisia= restlessness ( continuous figiditing)
- Acute Dystonia Reaction (EMERGENCY)= acute painful contractions of tongue, face, neck ( causes backward arching of the head, neck and spine
- Oculogyric Crisis (EMERGENCY)= eyes roll back
- Tardive Dyskinesia (TD) [EMERGENCY]= Bizarre facial and tongue movements, stiff neck, difficulty swallowing , POTENIALLY IRREVERSIBLE, use AIMS rating scale
What is Neurologic Malignant Syndrome?
Rare/fatal adverse reaction from taking antipsychotics
Sx:
-severe parkinsonian muscle rigidity
-hyperpyrexia= very high fever (>103 F)
-tachycardia, tachypnea, fluctuations in BP
-diaphoresis
-rapid deterioration of mental status to stupor and coma
what are the nursing considerations when giving antipsychotics?
- give med with food
- Need to have regular blood test done (WBC, ANC when taking CLOZARIL)- know sx of infection
- monitor bleeding time and plt counts
- monitor for worsening depression or behavior
- increase fluid and fiber intake
- monitor blood sugars
- educate pt about exercise/ healthy diet
What med do you give for Pseudoparkinson syndrome?
Give antiparkinsonian agent
-BENSTROPINE (Cogentin)
-TRIHEXYPHENIDY (Artane)
*anticholinergic that will help restore the balance of acetylcholine and dopamine in the CNS
What med do you give for Tardive Dyskinesia (TD)
- Immediately hold the antipsychotic and notify he physician
- COGENTIN to help
- Can be permanent must catch early
What med do you give to help with Neuroleptic Malignant Syndrome?
- DANTROLENE (dantrium)
- BROMOCRPTINE (Parlodel)
- muscle relaxers to help stop the neuroleptic syndrome
What are the side effects that are specific to Atypical (2nd generation) antipsychotics?
- Dry: mouth, eyes, blurred vision, constipation
- Anticholinergic toxicity (AMS )- give Olanzapine (Zyprexa)
-Metabolic Syndrome
How to prevent EPS
prophylactic anticholinergic agent
Special considerations for IM antipsychotic
Injection site reactions: pain, redness, swelling
Risk of: CVA, TIA in elderly patients w/ dementia/ neurocognitive disorders related to psychosis
Antipsychotics: patient /family teaching
- dont stop abruptly
- women of childbearing age - need contraception
- if taking CLOZAPINE- need blood draws weekly
- no other meds (OTC, Herbal )
- REPORT SYMPTOMS IMMEDIATELY- tongue twisting or weird feeling in tongue/jaw, fever, malaise, persistent N/V, rapid HR, excessive urination
Schizophrenia: prevention of SI
Only consistent protective factor for suicide = delivery of+ adherence to effective tx
If patient is hallucinating ask..
are you hearing voices or seeing something
