Test 2- Schizophrenia, Psychosis, Cognition Flashcards
What are DSM criteria for Dx of schizophrenia?
2 or more symptoms for at least 1 month and at least one specific symptom (1,2 or 3)
What are the 3 specific symptoms for DSM Dx of schizophrenia?
- Impairment of a major area of functioning (self care, interpersonal relations, or work)
- Signs lasting for at least 6 months
- Schizoaffective + bipolar or depression; + psychotic features
What are the s/s of schizophrenia? Which are positive? Which are negative? name at least 2 of each
Positive: hallucinations, delusions, disorganized speech, bizarre behavior
Negative: blunted affect, poverty of thought (alogia), loss of motivation (avolition), inability to experience pleasure or joy (anhedonia)
What is a prodromal symptom? What are some related to schizophrenia? Name at least 3
An early s/s before dx of disorder
Social withdrawal, hyper religiosity, odd or schizotypal preoccupations, worsening hygiene/self care, deteriorating academics, deep sense of wrongness (dysphoria), bizarre behaviors, other conduct problems, substance abuse, aggressive behaviors
What are DSM criteria to Dx schizoaffective disorder?
Uninterrupted duration of illness during which there is a major mood episode (manic or depressive) in addition to the criteria for schizophrenia
What are s/s of schizoaffective disorder?
Delusions, racing thoughts, anxiety, hopelessness, hallucinations, psychosis, impulsivity, restlessness, rapid speech
What is catatonia?
Behavioral syndrome causing patients to be unable to move normally
What are some s/s of catatonia? Name at least 3
Sustained abnormal positions, stupor/unresponsiveness, waxy flexibility, weakness, staring, rigidity, echolalia, purposeless/repetitive overactivity, mutism, echopraxia, limited range of emotions, deep sadness
What does EPS stand for/mean? What causes it?
EPS= Extrapyramidal Symptoms. It is alterations in movement (akathisia, tardive dyskinesia, acute dystonia, pseudoparkinsonism) caused by a blockade of dopamine or a depletion in the basal ganglia
What does acute dystonia look like? How is it treated?
Muscle cramps in the head/neck/abdomen/pelvis; can lead to abnormal posture/paralysis. Treat immediately with cogentin and can be treated with Benadryl
What does pseudoparkinsonism look like? How is it treated?
Stiffened extremities/fine motor tremors; antipsychotic + anticholinergic or mantadine
What does akathisia look like? How is it treated?
Internal and external restlessness, can include rocking/pacing/grunting or moaning; treat with a beta blocker, benzos, and/or anticolinergic
What does tardive dyskinesia look like? How is it treated?
Facial grimaces, tongue movements, lip smacking, or tremors. There is currently no treatment-it is permanent
How is Lithium used with schizophrenia?
Atypical- it is normally used as a mood stabilizer-it reduces aggressive behaviors
How are SSRIs, SNRIs or MAOIs used with Schizophrenia?
Atypical- they are normally used as antidepressants. They treat depression r/t schizophrenia
How are anti-tremor meds used with schizophrenia?
It is used to treat abnormal muscle movements and can treat some EPS in schizophrenia patients. Benztropine
How do BP meds help with Schizophrenia?
Clonidine is an antihypertensive and it can act as a sedative
Propanalol is a beta blocker and it can be used for tremors
Is Fluphenazine (Prolixin) a typical or atypical antipsychotic?
Typical
is Haloperidol (Haldol) typical or atypical?
Typical
Is Chlorpromazine (thorazine) typical or atypical?
Typical
Is Loxaine (Loxitane) typical or atypical?
Typical
How do typical antipsychotics work? Side effects?
They are dopamine antagonists
They may cause EPS, neuroleptic malignant syndrome, tachycardia, agranulocytosis, seizures, arrhythmias, and hypotension
Is clozapine (clozaril) typical or atypical? Side effects?
Atypical; severe neutropenia leading to infection, agranulocytosis, and possibly death
Is aripiprazole (abilify) typical or atypical? Side effects?
Atypical; interact negatively with SSRIs/antidepressants, can cause sedation or drowsiness
Is Olanzipine (zyprexa) typical or atypical? Side effects?
Atypical; sedation or drowsiness, neuroleptic malignant syndrome
Is Quetiapine (seroquel) typical or atypical? Side effects?
Atypical; arrhythmias, tachycardia
Is paliperidone (invega) typical or atypical? Side effects?
Atypical; NMS if combined with CNS depressants, tongue paralysis, respiratory depression, and neutropenia
What are treatments for schizophrenia?
Antipsychotics, therapy
What is the RN concerned about for a schizophrenic patient?
Decreasing anxiety, establishing trust, client self care, ensuring safety, and encouraging social interaction
What are the advantages and disadvantages of atypical antipsychotics?
Advantage: alleviate positive and negative s/s, minimal EPS s/s, improves cognition, decrease anxiety and depression and suicidal thoughts and behaviors
Disadvantage: metabolic syndrome, more expensive than typical antipsychotics
How is catatonia treated? What does the nurse worry about?
Benzos, ECT, muscle relaxers, tricyclics, talk to/treat them as if they were awake
Maintain patient safety, hydration, and nutrition
What are non-pharmacologic treatments for schizophrenia?
PAC team (treatment compliance assistance), therapy, and social skills training
What are treatment options for schizoaffective disorder?
Antipsychotics, anticonvulsants, SSRIs, therapies, psychoeducation
How does the RN help the schizoaffective patient?
Reinforce reality, establish trust, positive reinforcement, avoid stress, strive for regular routine
What are criteria and s/s for a dx of developmental delay?
Onset prior to age 18, impaired intellectual performance and adaptive skills. Common delays: gross or fine motor, language, social skills, thinking skills
What does the RN consider when treating a pt with a developmental delay?
- Assessment of the child-caregiver relationship (is there abuse or neglect?)
- Assessment for spurts or lags in development or loss of previous abilities
What treatment is used for developmental delays?
PT, OT, adaptive skill therapy, target specific symptoms
What are the DSM criteria for dx of autism spectrum disorder?
- Defects in social communication/interaction, -Restricted repetitive patterns of behavior, interests, or activities
- Symptoms present during early developmental period
- S/s impair everyday functioning
- S/s not caused by intellectual disability or developmental delay
What are s/s of autism spectrum disorder?
Stereotypical repetitive speech, obsessive focus on objects, over adherence to routines, hyper/hypo activity to sensory output, hand flapping, not responding to name, lack of eye contact
What does the RN consider when treating an ASD patient?
Assess pt for abuse/neglect, reduce sensory stimuli, explain thoroughly, stick to a schedule
What medications can manage ASD?
Risperdol (risperidone)
Abilify (aripiprazole)
What are the 4 cardinal features of delerium?
- Acute onset & fluctuating course
- Inattention
- Disorganized thinking
- Disturbance of consciousness
What are other s/s of delerium?
Rambling/pressured/irrelevant speech, impaired reasoning, goal directed behaviors, disorientation, sleep disturbance, agitation, anger, illusions, hallucinations, labile mood swings
What does the RN worry about with a pt experiencing delerium?
Pt safety, treatment of underlying cause, reorientation, minimize distractions/stimuli
What causes delerium?
Underlying medical condition
- Common in hospitalized pt or older adults
- Common cause may be a UTI
What are the DSM criteria for a dx of ADHD?
Inattention, hyperactivity, impulsivity
Difficult to dx before age 4
What meds are used to treat ADHD?
Ritalin
Wellbutrin
Catapres
Strettera
What are non-pharm treatments for ADHD?
Omega3 diet, cognitive-behavioral therapy, exercise, limit stimuli, neuro feedback
What is the RN concerned about with an ADHD patient?
Limiting stimuli, weekly weights, anorexia, take meds at least 6 hrs before bed, eat before taking meds, monitor growth r/t malnutrition
Explain Alzheimer’s (not what it means, what does it look like/some facts about it).
Slow onset, no cure, periods of stability, stages range from mild to severe
What are the cardinal symptoms of Alzheimer’s?
apraxia, aphasia, amnesia, agnosia
If there is no cure for Alzheimer’s, why do patients take meds?
To slow the progression- the earlier you intervene, the slower the disease progresses
What medications might an Alzheimer’s patient be on?
Donepezil (Aricept)
Memantine (Nameda)
Galantamine (Razadyne)
Rivastigmine (Exelon)
What is the RN worried about r/t Alzheimer’s patients?
Hygiene, nutrition, safety, social interaction, communication (speak slowly and in simple phrases)
How might the nurse help an Alzheimer’s patient?
Memory boards, distraction during agitation, reminiscence therapy, familiar items in their environment, provide them with few and simple choices, puzzles
What is the difference in lewy body dementia and vascular dementia?
Lewy body: protein clusters in nerve cells
Vascular: Series of mini strokes causing oxygen deprivation in the brain
What are the s/s of Lewy body dementia?
Visual hallucinations, delusions, REM sleep behavior disorder, change in walking or movement, unpredictable levels of cognitive abilities
What are the s/s of vascular dementia?
Confusion, disorientation, stroke symptoms, trouble speaking and understanding
Treatments for lewy body dementia?
Cholinesterase inhibitors (donepezil)
Anti-parkinson meds (levodopa)
Anti-depressants (SSRIs)
Clonazepam
Treatment for Vascular dementia?
Cognition enhancement meds (Memantine)
Pt safety
Comorbidity management (HTN, DM, etc)
