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Schizophrenia Spectrum Disorders Flashcards

1
Q

What is schizophrenia?

A

A disorder that affects a persons ability to think and behave clearly

It Disturbs
1. thought processes
2. perception
3. affect/ behavior

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2
Q

What is psychosis?

A

Reality is distorted
- People with schizophrenia cant distinguish between whats real or whats not real
- Will have hallucinations or delusional thinking

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3
Q

What is the onset of schizophrenia?

A
  1. Early childhood and late adolescence ( 15-25 years old )
  2. Childhood onset ( before 15 years old )
  3. Late onset ( after 40 years old )
    • will go through the PRODROMAL PHASE- mild sx for months or years before full onset= WARNING
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4
Q

What is the Prodromal Phase of Schizophrenia?

A
  • 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 )
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5
Q

What is the Acute Phase of Schizophrenia?

A
  • 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 ) *
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6
Q

DSM 5 Criteria

A

Must rule out:
1. Schizoaffective and mood disorders ( ex. bipolar ), substance abuse, medications ( make sure it isnt causing psychosis ), medical condition

  1. If pt has hx of autisim spectrum disorder or communication disorder * must have prominent delusions or hallucinations to dx *
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7
Q

What are positive (+) symptoms of schizophrenia?

A

The patient HAS something that regular people dont
1. Hallucinations
2. Delusions

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8
Q

What are negative (-) symptoms of schizophrenia?

A

The patient DOESNT have something that regular people have
1. lack of ability to experience pleasure
2. lack of ability to express emotions well

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9
Q

Are Delusions a (+) or (-) symptom and what is it?

A

Delusions = a fixed false beliefs
It is a positive symptom of schizophrenia

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10
Q

Are Speech Alterations a (+) or (-) symptom and what is it?

A

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

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11
Q

Is Disorganized Thinking a (+) or (-) symptom and what is it?

A

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

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12
Q

Is Altered Perception a (+) or (-) symptom and what is it?

A

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?

  1. Illusions- there is something in the environment but the person perceives it differently (ex: a computer screen seen as a portal )
  2. Derealization = reality seems odd
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13
Q

Is Altered Behavior a (+) or (-) symptom and what is it?

A

Altered behavior is a positive symptom

EX:
1. Catatonia- unusual/ lack of movement ( muscles are rigid or waxy flexible )

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14
Q

Are the A’s a (+) or (-) symptom and what is it?

A

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)

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15
Q

Is Altered Cognition a (+) or (-) symptom and what is it?

A

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

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16
Q

what is the Maintenance or Residual phase of Schizophrenia

A
  • 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 *
17
Q

Risk factors

A

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 )

18
Q

Brain Structure Abnormalities

A
  1. Enlarged lateral cerebral ventricles
  2. Cerebellar atrophy
  3. Increased size of fissures ( sulci )
  4. Reduced connectivity in various brain regions
19
Q

Comorbidities with schizophrenia

A
  • 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
20
Q

Other psychotic disorders

A
  1. Brief psychotic disorder = 1 day but less than a month
  2. 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

21
Q

Treatment

A

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

22
Q

What are examples of Typical (1st gen), Atypical ( 2nd generation) Antipsychotics?

What is the MOA and Use?

A

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)

23
Q

Adverse reactions of antipsychotics

A
  1. orthostatic hypotension ( especially if taking beta blocker)
  2. Gynecomastia and retrograde ejaculation ( semen enters the bladder)
  3. Weight gain
  4. Amenorrhea ( no period)
  5. PROLONGED QT INTERVALS ( >500=NO)
  6. Reduction of seizure threshold
  7. **CLOZARIL - Agranulocytosis ***
24
Q

What is Extrapyramidal Symptoms (EPS)

A

Umbrella of sx: adverse reactions of antipsychotics

  1. Psuedoparkinsonism= tremors, shuffling feet, drooling, rigidity, mask-like face, pill rolling, dysphagia
  2. Akinesia= muscle weakness
  3. Akathisia= restlessness ( continuous figiditing)
  4. Acute Dystonia Reaction (EMERGENCY)= acute painful contractions of tongue, face, neck ( causes backward arching of the head, neck and spine
  5. Oculogyric Crisis (EMERGENCY)= eyes roll back
  6. Tardive Dyskinesia (TD) [EMERGENCY]= Bizarre facial and tongue movements, stiff neck, difficulty swallowing , POTENIALLY IRREVERSIBLE, use AIMS rating scale
25
Q

What is Neurologic Malignant Syndrome?

A

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

26
Q

what are the nursing considerations when giving antipsychotics?

A
  1. give med with food
  2. Need to have regular blood test done (WBC, ANC when taking CLOZARIL)- know sx of infection
  3. monitor bleeding time and plt counts
  4. monitor for worsening depression or behavior
  5. increase fluid and fiber intake
  6. monitor blood sugars
  7. educate pt about exercise/ healthy diet
27
Q

What med do you give for Pseudoparkinson syndrome?

A

Give antiparkinsonian agent
-BENSTROPINE (Cogentin)
-TRIHEXYPHENIDY (Artane)

*anticholinergic that will help restore the balance of acetylcholine and dopamine in the CNS

28
Q

What med do you give for Tardive Dyskinesia (TD)

A
  1. Immediately hold the antipsychotic and notify he physician
  2. COGENTIN to help
  • Can be permanent must catch early
29
Q

What med do you give to help with Neuroleptic Malignant Syndrome?

A
  • DANTROLENE (dantrium)
  • BROMOCRPTINE (Parlodel)
  • muscle relaxers to help stop the neuroleptic syndrome
30
Q

What are the side effects that are specific to Atypical (2nd generation) antipsychotics?

A
  • Dry: mouth, eyes, blurred vision, constipation
  • Anticholinergic toxicity (AMS )- give Olanzapine (Zyprexa)
    -Metabolic Syndrome
31
Q

How to prevent EPS

A

prophylactic anticholinergic agent

32
Q

Special considerations for IM antipsychotic

A

Injection site reactions: pain, redness, swelling

Risk of: CVA, TIA in elderly patients w/ dementia/ neurocognitive disorders related to psychosis

33
Q

Antipsychotics: patient /family teaching

A
  1. dont stop abruptly
  2. women of childbearing age - need contraception
  3. if taking CLOZAPINE- need blood draws weekly
  4. no other meds (OTC, Herbal )
  5. REPORT SYMPTOMS IMMEDIATELY- tongue twisting or weird feeling in tongue/jaw, fever, malaise, persistent N/V, rapid HR, excessive urination
34
Q

Schizophrenia: prevention of SI

A

Only consistent protective factor for suicide = delivery of+ adherence to effective tx

35
Q

If patient is hallucinating ask..

A

are you hearing voices or seeing something

Psychiatric (8 decks)

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