Unit 12 - Schizophrenia and Dementia

Question 1

Define Dementia

Answer 1

D- The degrading of neurocognitive function.
E- Genetic. Drugs. Trauma to brain. Stress
A - Take Mini Mental State examination.
T- PET, or CT. Family education and respite care. ***Home health. Nursing home for Mod/Severe stage. Meals on wheels. Transportation service.

Question 2

Define Delirium

Answer 2

an acute loss of neurocogntive function related to an underlying cause. 50% of hospital patients experience this.

Question 3

S/S of Delirium

Answer 3

-Confusion, disorganized thinking *
-Irritability, or agitation
-Poor recall
-Moments of lucidity*
-Can’t follow through with stuff
-Inattention*
-Potential hallucinations or delusions. Ex. DT
-ALOC**
Safety always priority. Least to most restriction.

Question 4

AD Cardinal Symptoms

Answer 4

-Memory loss
-Inability to do ADLs, problem solving
-Aphasia: loss of language
-Apraxia
-Agnosia: inability to recognize objects.

Question 5

Mild Dementia

Answer 5

able to complete ADLs. Forget items. Have long term memory, but short term impaired

Question 6

Moderate Dementia

Answer 6

persons has loss of short term and long term function. Dresses inappropriately for weather. Perseverance: repeats statements.

Question 7

Severe Dementia

Answer 7

Unable to do ADLs. Safety risk for aspiration***.

Question 8

Types of Dementia

Answer 8

• Alzheimer’s
• Lewy body: Lewy buildup in brain
• Vascular: stroke accumulation
• Mixed dementia
  -Frontotemporal: idiopathic shrinking of brain.

R/t..
-Trauma
-HIV
-Substance abuse
-Parkinsons
-Huntington

Question 9

Alzheimer’s

Answer 9

Most common type of Alzheimer’s. Patho: demyelination of neurons combined with overabundance of proteins?

Question 10

Positive Speech alterations

Answer 10

Positive Symptom

-Clang associations
-Associative looseness***:
-Echolia: like myth abt Echo
-Neologism: make new words
-Tangential speech:, or “tangents”. Person keeps digressing from original topic.
-Pressured speech
-Cognitive retardation: slow speech
-Flight of ideas: jump from one thought to another. Like flight pit stops.

Question 11

Positive Alteration in behavior

Answer 11

Positive symptoms
-Catatonia
-Motor retardation: slow movement
-Posturing, gesturing: faces and posture that don’t match situation.
-Echopraxia: copy person’s movements.
-Motor agitation: increased response to external stimuli, irritability
-Stereotyped behaviors: antsy, pacing
-Impaired impulse control
-Negativism: resistance to requests.
-Boundary impairment: everything near person is theirs.

Question 12

Alteration in perception

Answer 12

Positive symptom

-Hallucination
-Delusion
-Derealization
-Depersonalization: out of body experience

Question 13

Positive Cognitive Distortion

Answer 13

Positive symptom

-Thought blocking: thinking someone is blocking thoughts
-Thought insertion: Belief someone put thought in your head.
-Thought deletion
-Magical thinking: belief that an action with ex. guarantee another will happen.
-Paranoia

Question 14

Negative symptoms (General)

Answer 14

-Apraxia: lack of purposeful movement
-Alogia: lack of speech
-Ahedonia: lacks pleasure from life. “Hed” will to live.
-Avolition: volition, decision. Can’t make decisions
- Asociality
-Affective blunting. **Beware! depression w negative affect.
-Apathy

Question 15

Affective blunting

Answer 15

flat, blunted (minimum/reduced expression), inappropriate (to scenario), bizarre, constrict (to ex. 2 emotions)

Question 16

Anosognosia

Answer 16

pt can’t comprehend they are ill.

Question 17

Negative Cognitive Symptoms for

Answer 17

-Concrete thinking
-Impaired memory, info processing, executive function (thinking, problem solving)

Question 18

Define psychosis

Answer 18

altered 1) reality 2) cognition 3) perception (sight, hearing, touch)

Question 19

Define Schizophrenia

Answer 19

-Definition: two or more of the below for 1+month
Delusions: false beliefs that they can’t be convinced out of.
Hallucination: sense something not there. Tactile, hear, touch.
Wacky speech
Gross (*movement) disorganization
Negative symptoms
Functional impairment: ADLs? Cognitive impairment
-Etiology:
onset preteen to young adult. Genetic, prenatal.
Comorbidity of nicotine, substance abuse. Anxi and Depr.
Polydipsia r/t dopamine
-Appearance/asses: depends on if they have positive or negative symptoms. Positive similar to mania. Negative similar to depression. NOT THE SAME.
Assess affect, cognitive, and for pos/neg symptoms.
-Treatment: Limit outside stimuli. Promote safety. Supervision. antipsychotics: 1st and 2nd Gen.
-Highlights: safety priority.

Question 20

Phases of Schizophrenia

Answer 20

-Promodal Phase: baseline. onset; not guaranteed to have break, but possible.
-Phase I, or Acute: safety priority. Med admin to bring back to earth.
-Phase II, or Stabilization: symptoms subside.
-Phase III, or Maintenance: new basline. Education: TAKE THE MEDDDDS

Question 21

Assess what with Schizophrenia?

Answer 21

For:
-Hallucinations, delusions
-Suicidal Ideation
-Meds
-Functional impairment level
-Family/pt knowledge of issue

Question 22

Define Schizoaffective Disorder

Answer 22

??????

Question 23

Meds

Answer 23

Antipsychs:
First Gen: Haloperidol. Chlorpromazine. Solely Dopamine agonist. Tx positive effects.
Second Gen: Clozapine. Dopamine and serotonin. Treat negative and positive symptoms.
Third Gen: Abilify. Subset of second Gen.
Mood Stabilizers: Lithium, Valroaic Acid

Secondary:
Antidepressants: SSRIs, SNRIs, TCA, MAOIs, Atypical
***Phenelzine easy toxicity.
Anxiolytics: Benzo, Barbituates,

Question 24

LITHIUM

Answer 24

Therapeutic range: 0.6 - 1.2
Interventions: watch fluid and Na balance
Admin: encourage normal fluid and food consumption
***S/S of lithium toxicity: confusion, fever.

Question 25

Neuroleptic Malignant Syndrome

Answer 25

From First Gen toxicity

Question 26

Serotonin Syndrome

Question 27

Dysdaria Tardive

Answer 27

Tremors of the extremities