Thought Disorders Flashcards
1
Q
What is Schizophrenia ?
A
a psychotic disorder that disturbs the fundamental ability to determine what is real
- may be aware or unaware
2
Q
What are the criteria for diagnosis of Schizophrenia ?
A
2 or more with 1 month:
- delusions
- hallucinations
- disorganized speech
- gross disorganization or catatonia
- negative symptoms: diminished emotional expression or avolition
- continuous disturbance for at least 6 months
3
Q
What is the difference between delusions and hallucinations ?
A
Delusions: involves thought patterns
- believing the FBI is after you
Hallucinations: involves visual or hearing
- you see a bunny hopping around the room when it’s not there
4
Q
What are some risk factors for Schizophrenia ?
A
- multi-factorial: psychodynamic, biological & environmental
- dopamine hypothesis: makes us feel elated or excited
- neurostructural differences in the brain of those with schizophrenia
- inherited predisposition to schizophrenia
- significant changes in brain functioning for those with schizophrenia
- stress can exacerbate the process
5
Q
What are examples of positive symptoms of schizophrenia ?
A
- delusions
- disorganized speech: word salad, loos associations
- paranoia
- hallucinations
- bizarre behavior: catatonia, waxy flexibility, echopraxia
6
Q
What are some nursing interventions for delusions ?
A
- acknowledge the pt’s experiences & feelings
- convey empathy regarding fearfulness and reassurance of intentions
- AVOID questioning the delusion itself and focus on help the patient feel safe
- ask question to assure safety like,” I understand the FBI is listening, what are they telling you?”
7
Q
What are delusions ?
A
- false
- fixed beliefs without evidence to support
8
Q
What is neologisms ?
A
made up words
- meaning for the patient only
9
Q
What is echolalia ?
A
pathological repetition of another’s words
10
Q
What are some nursing interventions for alterations in speech ?
A
- do not pretend to understand when you don’t
- place difficulty in understanding on yourself, not the patient (“I’m having difficulty understanding” not “you’re not making sense”)
- tell pt what you do understand and reinforce clear communication of needs
- look for reoccurring issues or themes in what the patient is saying
- summarize or paraphrase the patient’s communication to role model clearer communication
- speak concisely, clearly, and concretely in sentences rather than paragraphs
11
Q
What is paranoia ?
A
irrational fear, ranging from mild (wary, guarded) to profound (believing irrationally that another person intends to kill you)
- may result in defensive actions
12
Q
What is thought blocking ?
A
a reduction or stoppage of thought
- interruption of thought by hallucinations can cause this
13
Q
What is thought insertion ?
A
the uncomfortable belief that someone else has inserted thoughts into their brains
14
Q
What is thought deletion ?
A
a belief that thoughts have been taken or are missing
15
Q
What is magical thinking ?
A
beliving their actions or thoughts are able to control a situation or affect others
- Ex.) wearing a certain hat makes them invisible to others
16
Q
What are nursing interventions for distortions of thought ?
A
Paranoia
- reduce excess stimuli
- acknowledge pt’s feelings, then work on bringing them back to reality
- explore the pt’s feelings and promote verbal expression of negative thoughts
- increase supervision when risk is present and ensure safe environment
- medications/seclusion/physical restraints as a last resort
17
Q
What is circumstantiality ?
A
including unnecessary and often tedious details in conversation but eventually reaching the point
18
Q
What is tangentiality ?
A
wandering off topic or going off on tangents and never reaching the point
19
Q
What is cognitive retardation ?
A
generalized slowing of thinking, which is represented by delays in responding to questions or difficulty finishing thoughts
20
Q
What are nursing interventions alterations in perception (hallucinations) ?
A
- assess for symptoms of hallucinations
- focus on understanding the patient’s experiences and responses
- ensure safety when suicidal or homicidal themes are present
- close monitoring required
- help the patient feel safe
- call the patient by name and speak clearly and concisely in a supportive manner
- maintain eye contact and redirect the patient’s focus to your conversation
- ask: what are you hearing/seeing ?
- focus on reality
- do not negate or validate
- address underlying emotions
- provide alternative activity
21
Q
What are examples of alterations in behavior ?
A
- catatonia
- motor retardation
- motor agitation
- stereotypes behaviors
- waxy flexibility
- echopraxia
- negativism
- impaired impulse control
- gesturing or posturing
- boundary impairment
22
Q
What is catatonia ?
A
a pronounced increase or decrease in the rate and amount of movement
23
Q
What is waxy flexibility ?
A
maintaining a given posture inappropriately
- Ex.) when a nurse manipulates the person’s limbs and they maintain that same position (like a statue)
24
Q
What is motor agitation ?
A
excited behavior such as running or pacing rapidly
- often in response to internal or external stimuli
- can put the patient or others at risk
25
What is stereotyped behaviors ?
repetitive behaviors that do not serve a logical purpose
26
What is gesturing or posturing ?
assuming unusual and illogical expressions
or positions
- often grimaces
27
What is boundary impairment ?
an impaired ability to sense where one's body or influence ends and another's begins
28
What is the nursing outcomes for alterations in behaviors ?
performance of self-care activities within a few days of treatment for symptoms
29
What is anhedonia ?
a reduced ability or inability to experience pleasure in everyday life
30
What is avolition ?
loss of motivation, difficult beginning and sustaining goal-directed activities reduction in motivation or goal-directed behaviors
31
What is asociality ?
decreased desire for or comfort during social interaction
32
What is affective blunting ?
reduced or constricted affect (emotional response)
33
What is apathy ?
feeling of indifference for activities or beliefs that would otherwise be interesting or important
34
What is alogia ?
reduction in speech, sometimes called poverty of speech
35
What is constricted affect ?
reduction in range or intensity
- Ex.) shows sadness or anger but no other moods
36
What does positive symptoms mean ?
behaviors & thought patterns that aren't usually present
- ex.) hallucinations, paranoia, delusions
37
What does negative symptoms mean ?
behavior & thoughts that reflect an absence of something that should be present
- ex.) anhedonia, flat affect, avolition
38
What does affective symptoms mean ?
those that involve the experience and expression of emotions
39
What can cognitive symptoms effect ?
can cause impairments that lead to poor judgement and leave the patient less able to cope, learn, manage health, or succeed in school or work
40
What are some examples of negative symptoms ?
- lack of self-care/personal hygiene
- anhedonia
- avolition
- asociality
- affective blunting
- apathy
- alogia
41
What is schizophreniform disorder ?
schizophrenic issues or concerns that haven't reached the time limit for official diagnosis
- <6 months
42
What is brief psychotic disorder ?
short-lived and usually happens because of a different issue
- 1 day to 1 month
43
What is delusional disorder ?
prescence of psychotic symptoms but not as severe as brief psychotic disorder and it doesn't severely affect the ADLs as much
- > 1 month
44
What is schizoaffective disorder ?
has schizophrenia and also an uninterrupted period of depression, mania, or mixed episodes (additional conditions)
- fits criteria for both schizophrenia and depression or bipolar disorder
45
How do we improve the poor social skills in schizophrenia ?
encourage group therapy
46
What is some nursing care for patient with severe mental illnesses ?
- emphasize quality of life rather than focusing on symptoms (we want to convey interest in pt and not the illness)
- trust in providers to overcome anosognosia and get adherence
- pt's with SMI often need extended periods to form these connections
- focus on coping with current issues rather then past difficulties
- encourage reality testing to teach pt's to counter hallucinations and delusional thinking
- promote social skills and provide opportunities (positive role models like other pt's further in recovery)
- expose pt's to others who they can relate to ("have been there")
47
What is anosognosia ?
lack of awareness of one's own illness or disability
48
What is the prodromal phase of schizophrenia ?
subtle symptoms can go unnoticed
- mild changes (doesn't fit schizophrenia criteria)
- deterioration in school or job, and concentration
- may feel "strange" or "something isn't right"
- appear a month to more than a year before the first full-blown episode
- Ex.) withdrawal, misinterpreting, poor concentration, preoccupation with religion
49
What happens in the acute phase of Schizophrenia ?
the patient starts to experience disruptive symptoms and loss of function
- Ex.) hallucinations, delusions, apathy, social withdrawal, anhedonia, impaired judgement, or diminished affect
50
What happens in the stabilization phase of Schizophrenia ?
the symptoms are becoming managed, and functioning is recovered
- may be in an outpatient setting, residential crisis center, or a staff-supervised residential group
- moving towards their functioning baseline
51
What happens in the maintenance phase of Schizophrenia ?
the condition has stabilized and a new baseline is established
- positive symptoms are usually absent or significantly reduced
- negative symptoms may continue
- monitor for relapse
52
What are first-generation antipsychotics ?
dopamine antagonists
- works only on positive symptoms of schizophrenia
- less expensive than 2nd generation
- since it blocks the D2 receptors in motor areas is can cause extrapyramidal side effects
53
What are some disadvantages for 1st generation antipsychotics medications ?
Extrapyramidal side effects:
- acute dystonia
- akasthisia
- pseudoparkinsonism
Tardive dyskinesia
54
What is acute dystonia ?
acute, sudden, painful contraction of one or more several muscle groups (tongue, face, neck and back)
- usually tongue and jaw first
- spasms causing backward arching of the head, neck, and spine
- drooling
- eyes roll back (oculogyric crisis)
- laryngeal dystonia: could threaten airway (rare)
55
What are some side effects of 1st gen antipsychotics ?
- muscle stiffness
- sedation
- weight gain
- sexual dysfunction
- endocrine disturbances
56
What are some nursing care and considerations for acute dystonic reactions ?
- monitor and assure open airway
- administer antiparkinsonian agent as above (IM for facial response) & relief in 5-15 mins
- consider diphenhydramine hydrochloride (Benadryl) IM/IV
- prevent further dystonia with antiparkinsonian agent
- reassure pt that although scary, dystonia's aren't dangerous except for rare airway complications
- stay with pt to provide comfort & support
- assist pt to understand the event and avert mistrust of meds
57
What is Akathisia ?
motor restlessness
- pacing
- unable to stand still or stay in one location
- rocking while seated or shifting from one foot to other while standing
58
What are some nursing care and considerations for akathisia ?
- consult HCP for possible med changes
- give antiparkinsonian agent or lorazepam (ativan) as ordered
- propranolol, lorazepam, or diazepam may be used
- relaxation exercises
- distinguish akathisia from simple anxious repetitive movement
- in severe cases, may cause great distress and contribute to suicidality
- usually subsides when antipsychotics is discontinued (expect: tardive dorm of akathisia)
59
What is pseudoparkinsonism ?
- mask-like face
- stiff and stooped posture
- shuffling gait
- drooling
- tremor
- pill-rolling finger movements
- dysphagia or reduction in spontaneous swallowing
60
What is some nursing care and considerations for pseudoparkinsonism ?
- admin antiparkinsonian agent:
- Like Trihexyphenidyl (Artane) or Benztropine (Cogentin)
- if intolerable, consult HCP in dose reduction or med change
- provide towel or handkerchief to wipe excess saliva
- educate on how to reduce fall risk
61
What is tardive dyskinesia ?
involuntary repetitive body movements
- Face: protruding or writhing tongue, blowing, smacking, licking, facial distortion
- Chorea: rapid, purposeless, and irregular movements
- Athetoid: slow, complex, and serpentine movements
- Trunk: neck and shoulder movements, hip jerks and rocking, or twisting pelvic thrusts
62
What is some nursing care and considerations for Tardive Dyskinesia ?
- about 20% of pt's taking 1st gen antipsychotics for more than 2 yrs develop this
- No FDA approved med, tetrabenazine can be off-label
- screening for abnormal movements at least q3 months
- purposeful muscle contractions overrides and masks involuntary tardive movements
- discontinuing meds won't reverse this but onset may merit reconsideration of meds
- may contribute to stigmatizing response by other
- provide support
- educate pt on ways to conceal involuntary movements such as holding one had with the other
63
What do second-generation antipsychotics do ?
serotonin and dopamine antagonists
- treats both positive and some negative symptoms
- minimal to no EPS or tardive dyskinesia
64
What are some disadvantages to second-gen antipsychotics ?
- tendency to cause weight gain
- risk for metabolic syndrome
65
What is metabolic syndrome ?
a group of symptoms that can lead to increased risk for cardiovascular disease, diabetes, and other serious medical conditions
- weight gain: especially around the abdomen area
- dyslipidemia: abnormal lipid levels
- increased insulin resistance
66
What is some nursing care and considerations for metabolic syndrome ?
- educate pt on how to minimize weight gain through proper nutrition and exercise
- educate on importance of regular medical evaluation and care to identify and correct possible changes that could lead to this syndrome and increase risk of premature illness and death
67
What do third-gen antipsychotics do ?
dopamine system stabilizers
- less side effects/safer
- may improve positive and negative symptoms and cognitive function
- little risk of EPS or tardive dyskinesia
- a subset of second-gen antipsychotics
68
What are some examples of third-gen antipsychotics ?
- Aripiprazole (Abilify)
- Brexipiprazole (rexulti)
- Cariprazine (Vraylar)
69
What are some dangerous side effects of antipsychotics ?
- anticholinergic toxicity
- agranulocytosis
- cholestatic jaundice
- neuroleptic malignant syndrome
70
What are some examples of typical antipsychotics ?
- haloperidol
- chlorpromazine
71
What are some side effects of Anticholinergic Toxicity ?
- reduced or absent peristalsis (can lead to bowel obstruction)
- urinary retention
- mydriasis: dilated pupils
- hyperpyrexia without diaphoresis: hot, dry skin
- delirium with tachycardia
- unstable VS
- agitation
- disorientation
- hallucinations
- reduced responsiveness
- worsening of psychotic symptoms
- seizures
- repetitive motor movements
72
What are some nursing care and considerations for anticholinergic toxicity ?
potentially life-threatening medical emergency
- hold all meds
- consult prescriber immediately
- implement emergency cooling measures as ordered (cooling blanket, alcohol, ice bath)
- urinary catheterization as needed
- admin a benzodiazepine or other sedations as ordered
- admin Physostigmine if ordered
- eval for toxicity any time psychosis appears to be worsening
73
What is Physostigmine ?
the antidote to reverse the toxicity of anticholinergic effects
74
What is Agranulocytosis and the S&S ?
dangerously low WBC counts
- reduced neutrophil counts and increased frequency and severity of infections
- any SE suggesting infections: sore throat, fever, malaise, body aches should be carefully evaluated
75
What is some nursing care and considerations for agranulocytosis ?
potentially fatal blood dyscrasia
- monitor neutropenia weekly for 6 months, then 2x monthly for 6 more months, then monthly
- if neutropenia develops, hold med and consult prescribed
- moderate neutropenia (500-999) and severe (<500) should result in tx interruption
- clozapine may be continued if levels return to normal
- reverse isolation may be initiated temporarily
- educate pt to watch for signs of infection and to report them immediately
76
What is Cholestatic Jaundice ?
body is breaking down substances that cause jaundice
- rare, reversible, and usually benign if caught in time
- early symptoms are fever, malaise, nausea, and abdominal pain
- jaundice appears 1 week later
77
What are some nursing care and considerations for Cholestatic Jaundice ?
- consult prescriber regarding possible med change
- bed rest and high-protein, high-carb diet if ordered
- liver function tests should be performed q6 months
78
What is Neuroleptic Malignant Syndrome (NMS) ?
rare, but dangerous severe muscle rigidity
79
What are some S&S of Neuroleptic Malignant Syndrome ?
- muscle rigidity
- dysphasia
- temp over 103 F (hyperpyrexia is main S&S)
- HTN, tachycardia
- diaphoresis
- incontinence
- delirium, stupor, coma
- flexor-extensor posturing
- reduced or absent speech and movement
- decreased responsiveness
80
What are some nursing care and considerations for Neuroleptic Malignant Syndrome ?
acute life-threatening medical emergency
- early detection increases pt's chance of survival
- hold all antipsychotics
- transfer to a critical care unit (if community then 911 to transport to ER)
- Bromocriptine & dantrolene can relieve muscle rigidity and reduce the heat generated by muscle contractions
- cool body to reduce fever (cooling blankets, alcohol, cool water, or ice bath as ordered)
- maintain hydration with oral or IVF; correct electrolyte imbalances
- treat dysrhythmias
- small doses of heparin may decrease possibility of pulmonary emboli
