Schizoprenia Flashcards
Severe chronic/biological disorder that destroys tissue and disrupts brain circuit and neural connectivity
Schizophrenia
Symptoms last at least how long for Schizophrenia?
6 months
Can schizophrenia be cured?
No
Features of schizophrenia but lasting only 1-6 months
Schizophreniform
Has symptoms of schizophrenia and mood disorder like bipolar and depression
Schizoaffective disorder
The stage of schizophrenia:
- may have schizoid or schizotypal personality
- quiet, passive, introverted, solitary activities
Premorbid
The stage of schizophrenia:
- subtle gradual decline over 2 years
- early symptoms not specific to psychosis
Prodromal
The stage of schizophrenia:
- first psychotic episode: delusions, hallucinations, bizarre behavior, angry outbursts, social withdrawal
- EARLY TREATMENT MEANS LESS DAMAGE!
- good response if med adherence
- dx usually occurs here!
Acute psychosis
The stage of schizophrenia:
- brain is damaged by recurrent psychotic episodes
- associated with treatment resistance
- WARNING SIGN: INSOMNIA
Relapse
The stage of schizophrenia:
- chronic state of unremitting positive, negative and cognitive symptoms
- severe social and vocational withdrawal
Residual
The highest rate of ________ in a patient with schizophrenia occurs after the patient is discharged from the hospital
Suicide
The gold standard used for measuring the symptom severity and treatment efficiency in schizophrenia
Positive and negative syndrome scale (PANSS)
_________ symptoms of schizophrenia
- delusions
- hallucinations
- altered/disorganized speech
- catatonia
Positive
___________ symptoms of schizophrenia
- affective flattening
- alogia
- anergia
- avolition
- anhedonia
- social withdrawal
Negative
____________ symptoms of schizophrenia
- inability to make decisions
- decreased attention/focus
- decreased short term memory
- decreased problem-solving/abstract thinking
Cognitive
_________ symptoms of schizophrenia
- depression
- irritability
- suicidal ideation
- hopelessness
Mood
Damage to frontal/parietal lobe
- poor insight - of illness/situation
- increased refusal of treatment and poor medication adherence
Anosognosia
Fixed, false beliefs
- cannot be corrected by reasoning
- usually bizarre
- “delulu”
Delusions
Believes that certain gestures, comments, or cues are directed at oneself, despite evidence to the contrary
- ex. believes that someone who is in the distance who is talking about their meal is talking about them
Ideas of reference
Unfounded fear that people are out to harm them
- use projection and displacement
- RISK FOR VIOLENCE!
- NSG: provide personal space, make sure have exit, approach in calm manner, assess threat, decrease stimuli
Persecution
Belief that outside forces are controlling their actions
- CONTROL OVER BODY AND MIND
- ex. thought insertion, thought deletion, and thought broadcasting
Control
Belief in unrecognized power, fame, wealth, talent, identity, or genius
- can be symptom of paranoia, mania or dementia
Grandiose
Is obsessed with religious beliefs
- NSG: remain passive and refer to clerical professional
Religious
Beliefs that another person, usually a stranger, high status, or famous, is in love with him/her
- NSG: refer to specialist who looks at cycles and patterns of behavior
Erotomanic
Beliefs that their body is diseased or that their body is changing in an unusual way
- ex. Infestation, foul body odor, growing third arm
- NSG: present reality without disproving, redirecting and limit discussion of content
Somatic
Belief that things, including self or part of ones body, do not exist
- the world is reduced to nothingness
- believing major catastrophe will occur
Nihilistic
False sensory perceptions without real external stimulus
- can be auditory, visual, olfactory, gustatory, tactile
- NSG: decrease stimuli, ask what they see/hear, present nurses reality, distract/redirect, administer PRNs
Hallucinations
Unconscious inability to concentrate on a single thought
- shifting between unrelated topics
- leaps from one topic to another
Associative looseness
Quickly moving from one idea to another
Flight of ideas
Made-up words that have meaning only to client
Neologisms
The client repeats words spoken to them
Ex. Mocking bird
Echolalia
Meaningless rhyming of words, often forceful
- Ex. “Oh box, fox, and lox”
Clang association
Words jumbled together with little meaning or significance to listener
- ex. “hip hooray, the flip is cast and wide sprinting in the forest”
Word salad
Including multiple and unneeded details during a conversation
- ex. Describing great detail about weather and clothes when asked about plan for the day
Circumstantiality
Starts talking about trivial information rather than focusing on main topic in conversation.
Tangentially
Motionless for long periods of time, coma-like
Stupor
Maintaining a specific position for an extended period of time
Wavy flexibility
Nonspecific feeling that a client has lost their personality
- self is different or unreal
Depersonalization
Main antidepressant used to treat depression in patients with psychotic disorders
- don’t abruptly stop!
Paroxetine
_______-generation antipsychotic (typical)
- ex. haloperidol, loxapine, perphenazine
- treat positive symptoms of psychotic disorders
- adverse effects: EPS, sedation, anticholinergic effects, NMS
First
_________-generation antipsychotics (atypical)
- ex. clozapine, iloperidone, lurasidone, olanzapine, quetiapine, paliperidone, ziprasidone
- treat positive and negative symptoms
- adverse effects: agranulocytosis, orthostatic hypotension, mild EPS, hyperprolactemia
Second
Includes acute dystonia, akathesia, tardive dyskinesia, pseudoparkinsonism, NMS
EPS
- S/SX: Severe spasm of tongue, neck, face, back
- Tx: benztropine, diphenhydramine(Benadryl)
- NSG: stay with client, monitor airway
Acute dystonia
- S/Sx: bradykinesia, rigidity, shuffling gait, drooling, tremors(pill-rolling)
- Tx: benztropine, diphenhydramine(Benadryl)
- NSG: risk for falling
Pseudoparkinsonism
- S/Sx: Inability to sit or stand still, continually pacing and agitation
- Tx: benztropine, beta blockers, lorazepam/diazepam
- NSG: monitor for risk of suicide
Akathisia
- CM: late EPS; involuntary movements of tongue, face, arms, legs; lip smacking, tongue fascinations
- NSG: lower dosage, or switch to SGA
Tardive dyskinesia
- S/Sx: severe muscle rigidity, sudden high fever, diaphoresis, tachycardia, fluctuations in BP
- Tx: dantrolene, acetaminophen (antipyretic)
- NSG: STOP ANTIPSYCHOTIC, monitor v/s, apply cooling blankets, increase fluids
NMS
- SGA
- AGRANULOCYTOSIS!!
- monitor CBC/WBC/ANC
- weekly labs for 6 months than every other week
- increase risk of seizures and increase secretions
Clozapine
- SGA
- increased weight gain and hyperglycemia
- give at night; fall risk
Olanzapine
- SGA
- given sublingually
- SE: numb tongue, odd taste
- do not eat or drink for ten minutes after taking
Asenapine
- SGA
- long acting injectable: long term maintenance of schizophrenia
Risperdone
- SGA
- extended release tablets/injections
SE: weight gain, sedation, musculoskeletal pain
Paliperidone
- SGA
- give with 500 calories of food!
- can prolong QT (get baseline EKG and monitor)
Ziprasidone
- SGA
- MUST TITRATE! (over 4 days to minimize orthostatic hypotension)
- SE: anticholinergic effects
Iloperidone
- SGA
- give with 350 calories of food
- take once a day
- SE: nausea, sedation, akathisia
Lurasidone
- SGA
- SE: sedation/drowsiness, cataracts, anticholinergic effects
Quetiapine
