Unit 4 & 6 - schizophrenia+psychosis Flashcards
what neurotransmitter is thought to cause positive symptoms of schizophrenia
dopamine
what are the 3 key categories of a schizophrenia diagnosis
- disorganized thinking
- delusions
- hallucinations
4 nursing interventions for a pt with schizophrenia
- risk assessment
- TR
- low stress/focused activities
- promote routine & ADLs / independence
What does the term psychosis mean?
conditions that affect the mind where there is some loss of contact with reality
What does the term psychosis mean?
conditions that affect the mind where there is some loss of contact with reality
what is schizophrenia
a disturbance of the brain’s functioning. It can seriously disturb the way people think, feel and relate to others.
- No single cause has been found for schizophrenia, although there is a clear genetic link
- Men and women are affected equally
- Men tend to have their first episode in late teens or early twenties
- Women onset is usually a few years later
What is the prodromal phase of psychosis? (it is the same for schizophrenia)
- Early symptoms may be vague and hardly noticeable.
- There may be changes in the way the person describes their thoughts, feelings, perception and may become more difficult for them over time.
- People may begin to lose interest in their usual activities
- May begin to withdraw from friends and family members
- May become easily confused
- May have trouble concentrating
- May feel apathetic
- May prefer to spend most of their days alone
- May become intensely preoccupied with religion or philosophy
- This phase can last weeks or months.
What is the acute phase of psychosis? (it is the same for schizophrenia)
- active phase
- This phase there are clear psychotic symptoms that are experiences.
- These may include
Delusions
Hallucinations
Marked distortions in thinking - This phase is often the most frightening to the person experiencing the symptoms but also to others around them
- During this phase people are often hospitalized.
What is the tertiary/recovery phase of psychosis? (it is the same for schizophrenia)
- After the persons symptoms have stabilized
- The goal of recovery is to regain the previous level of functioning and improve the quality of life for the patient.
- Some will recover back to their previous level of functioning
- Some will require medications and support for the rest of their lives.
- As with every chronic illness, stresses of life can contribute to an exacerbation of acute symptoms
positive SIGNS AND SYMPTOMS OF SCHIZOPHRENIA
Delusions- False fixed beliefs that usually involve a misinterpretation of the experience
(grandiose, persecutory, somatic)
Hallucinations (all 5 senses)- perception:
Most common are auditory and visual
negative SIGNS AND SYMPTOMS OF SCHIZOPHRENIA
- Affective flattening
- alogia (poverty of speech and content)
- Avolition/Apathy (lack of interest, concern, enthusiasm. Decrease in the motivation to initiate and perform self-directed purposeful activities)
- Anhedonia- (inability to experience pleasure- few recreational activities/interests. Detached, uncommunicative, impaired social and personal relationships, distant)
- Inattention- (impaired concentration, social inattentiveness; poor rapport, lack of focus during conversation)
- Ambivalence- (not able to make decisions or contribute to conversations with other)
Neuro COGNITIVE SYMPTOMS of schizophrenia
- Loss of short-term memory and organizational skills in planning, prioritizing and decision making.
- Disorganized thinking and speech- trouble understanding language or communicating coherent sentences or carrying on a conversation. Odd word associations- word salad.
- Disorganized behaviour- slow, rhythmic or ritualistic movements
risk factors for people with schizophrenia
40-50% of people with schizophrenia attempt suicide. Approximately 12-15% succeed. People who experience schizophrenia have a higher risk of suicide
how do antipsychotics work
- Antipsychoticsreduce or increase the effect of neurotransmitters in thebrain toregulate levels.
- Generally effect of blocking DOPAMINE transmission in the brain which decrease the positive symptoms of schizophrenia.
- Newer antipsychotic medications such as Risperidone, Olanzapine, Quetiapine affect other neurotransmitters in the brain including Serotonin. Therefore are effective in the treatment of positive and negative symptoms of schizophrenia.
what is Agranulocytosis
- Can be seen in Clozapine
- Blood disorder characterized by decrease in WBC
- Fatalities are due to infections related to a compromised immune system
- hyperthermia (high fever)
- Blood work qweek X 6months; then q2weeks
- Symptoms:
Chills
Mouth Ulcerations
Sore throat
Fatigue
Signs of infection
Hyperthermia
Neuroleptic Malignant Syndrome
- medical emergency
- 3-9 days after beginning or a change in medication
- Symptoms:
Sweating
Tremor
Changes in LOC
Tachycardia
Leukocytosis
Difficulty swallowing
Incontinence
Elevated/labile blood pressure
EPS
- seen in up to 90% of pts getting typical antipsychotics
- Involuntary and uncontrollable movement disorder caused by meds (anti psych)
- Akinesia (weakness)
Akathisia (restlessness)
Acute Dystonic reactions (muscle spasms)
Parkinsonism
Pisa syndrome
Rabbit syndrome
Acute Dystonic Reaction
- EPS
- Appear early in neuroleptic treatment (first 3 days)
Often are 1st to appear and most dramatic
More common in younger males
Severe Involuntary Muscle Spasms
Difficulty swallowing
Stiff neck, torticollis
Oculogyric crisis (rotation of eyes upward)
Extreme facial grimacing
Thick tongue, protrusion of tongue
Parkinsonism
- EPS
- Mask-like Face
Tremor at rest
Rigidity of Muscles
Motor Retardation
Hypersalivation (Drooling)
Shuffling gait, stooped posture
Incidence increases with age
Develop within a few weeks to months
Akinesia
- EPS
- Slowed movement
Immobility, weakness
Fatigue
Lack of muscle movement
Painful muscles
Develop mostly by 3rd week in 33% of patients.
Akathisia & Rabbit Syndrome
- EPS
- Subjective feeling of restlessness, restless legs, jittery feeling, nervous energy.
- Leg swinging or repeated crossing
Need to rapidly sit and stand
Need for movement or pacing
Foot shuffling
20-25% will develop within 10 days.
What might this be confused for? (agitation, anxious, example) - Rabbit Syndrome =
Fast rhythmic movement of the lips
pisa syndrome
person leans to one side
TD (Tardive Dyskinesia)
- Involuntary movement d/o appearing later in treatment (chronic exposure to dopamine receptor-blocking agents).
- Will worsen with stress or when trying to hide it, etc.
- Will stop with sleep
- Ranges from mild to severe
1/3 of pts. show mild symptoms
ANTIPARKINSONIAN AGENTS
Used to treat EPS and other Movement Disorders induced by medication
