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Mental Health Exam 4 > Week 10: Schizophrenia > Flashcards

Week 10: Schizophrenia Flashcards

1
Q

Common antipsych SE (6)

A
  1. Orthostatic hyp
  2. Hyperprolactinemia (especially Risperidone)
  3. Sedation
  4. weight gain
  5. Anticholinergic
  6. New-onset diabetes
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2
Q

Extrapyramidal antipsych SE (4)*

A

Parkinsonism
Acute dystonia
Akathisia
Tardive dyskinesia

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3
Q

Serious antispych SE (4) *

A

NMS
Anticholinergic crisis
Agranulocytosis (with clozapine)
Metabolic syndrome

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4
Q

Second gen antipsychotics

A 
Aripiprazole
Asenapine
Clozapine
Risperidone
Olanzapine
Quetiapine
Ziprasidone
Lurasidone

(zole, pine, done)

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5
Q

Treatment for anticholinergic crisis

A

Discontinuation of meds

Physostigmine – increases AcH

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6
Q

Parkinsonism
Period of onset
Symptoms

A

5-30 d

Resting tremor, rigidity, bradykinesia or akinesia, mask-like face, shuffling gait, decreased arm swing

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7
Q

Acute dystonia
Period of onset
Symptoms

A

1-5 d

Intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk and limbs

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8
Q

Akathisia
Period of onset
symptoms

A

1 – 30 d

Obvious motor restlessness evidenced by pacing, rocking, shifting from foot to foot

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9
Q

Tardive dyskinesia
Period of onset
symptoms

A

Months to years

Abnormal dyskinetic movements of the face, mouth, and jaw

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10
Q

Treatment for EPS***

A

Reduce Ach – give anticholinergics (reinstate balance between DA and Ach)

Diphenhydramine
Benztropine

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11
Q

Lowest weight gain risk of antipsychs (3)

A

Aripriprazole
lurasidone
ziprasidone

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12
Q

Most sedating of 2nd gen antipsych

A

Clozapine

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13
Q

Alternate use for Risperidone

A

autism, manage irritability

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14
Q

Arapiprazole alternate use

A

BPD
irratibility with autism
depression

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15
Q

antipsychotic drugs that target both positive and negative symptoms

A

2nd generation

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16
Q

Benztropine

action/indication

A

treat EPS by lowering acetylcholine

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17
Q

abrupt discontinuation of benztropine

A

Cholinergic rebound - bad!

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18
Q

Schizophrenia

Psych domain: assess cognitive impairments

A

Mini Mental
spell WORLD backwards
3 word recall
How are bike and train similar?

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19
Q

Schizophrenia

Psych domain: intervention

A

Education about syndrome
Patient edu
family edu
crisis plan

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20
Q

Schizophrenia:

Social domain: assessment

A

Strength of social skills
Role impact
Family assessment (high emotional reactivity?)

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21
Q

Schizophrenia:

Social domain: interventions

A

promoting safety
social skills training
vocational support
implementing family interventions

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22
Q

ACT Team

A

Assertive community treatment: specialty community based care including medication, mgmt, psychotherapy, vocational support, 24 hr support

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23
Q

Other psychotic disorders (4)

A

schizoaffective disorder
schizophreniform disorder
delusional disorder
brief psych disorder

24
Q

Schizoaffective disorder (3) factors

A
  • Characterized by periods of intense symptom exacerbation alternating with periods of adequate psychosocial functioning
  • At times marked by psychosis, other times by mood disturbance
  • Long-term outcome is generally better than that of schizophrenia, but worse than that of mood disorder
25
Q

Schizophreniform (3 factors)

A

Identical features of schizophrenia

Duration less than 6 months with symptoms present at least 1 month

26
Q

Delusional disorder

A
27
Q

Delusion:

A

fixed false beliefs that cannot be changed by conflicting evidence

28
Q

Delusions

A

fixed false beliefs that cannot be changed by conflicting evidence*
-situations that could occur in real life and are plausible in the context of the person’s ethnic and cultural background or clearly impossible*

29
Q

Brief psychotic disorder

A
  • Duration is at least 1 day, but less than 1 month

- Onset is sudden and includes at least one of the positive symptoms of schizophrenia

30
Q

Schizophrenia 6 criteria

A
  1. 2 or more of the following, each present for a significatn portion of time during a 1-month period (delusions, hallucinations, disorg speech, grossly disorg or catatonic behavior) + negative symptoms?
  2. Level of function reduced
  3. disturbance for at least 6 months
  4. not schizoaffective, not depressive or BPD with psych features
  5. not from drugs
  6. not autism?
31
Q

3 delusion types

A

grandiose
persecutory
somatic

32
Q

3 Positive symptoms of schizo

A
  • hallucinations
  • Delusions
  • disorganized thoughts
33
Q

5 negative symptoms of schizo

A
  • alogia
  • affective flattening
  • avolition
  • anhedonia
  • asociality
34
Q

Alogia

A

Reduced speech even when encouraged

Lack of emotional and facial expression

35
Q

Cognitive deficits* (4)

A

Difficulties with the following aspects of cognition can make it hard to live a normal life
-memory
-attention
-planning
-decision making
(impairment involving memory, vigilance, verbal fluency, executive functions)

36
Q

Verbigeration

A

Purposeless repetition of words or phrases

37
Q

Metonymic speech

A

Use of words with similar meanings interchangeably

38
Q

Disorganized behavior

A 
Aggression
Agitation
Catatonia
Catatonic excitement
Echopraxia
Regressed behavior
Stereotypy
Hypervigilance
Waxy flexibility
39
Q

Catatonia

A

Stupor, mutism, posturing, repetitive behavior

40
Q

Catatonic excitement

A

Hyperactivity characterized by purposeless activity and abnormal movements, such as grimacing and posturing

41
Q

Stereotypy

A

Repetitive purposeless movements that are idiosyncratic to the individual

42
Q

Waxy flexibility

A

Posture held in an odd or unusual fixed position

43
Q

High occurrence of what comorbidities (3)*

A

Diabetes
Obesity
Psychogenic polydipsia

44
Q

Psychosis*

A

State in which person experiences hallucinations, delusions, or disorganized thoughts, speech, or behavior (key diagnostic factor in schizophrenia spectrum disorder)

45
Q

Phases of schizophrenia (5)*

A
  1. Prodromal period
  2. Acute
  3. Stabilization
  4. Maintenance
  5. Relapse
46
Q

Prodromal period

A

Stage of early changes that are precursor to disorder (usually early childhood)

47
Q

Acute

A

Disruptive or bizarre behaviors/perceptions that impede function (usually late adolescence or early adulthood)

48
Q

Stabilization

A

Adjusting to the prospect of long-term severe mental illness, aim to reduce/eliminate risk factors for relapse

49
Q

Maintenance

A

Maintaining healthy lifestyle, managing stresses of life, developing meaningful interpersonal relationships

50
Q

What is there a high risk of during stabilization phase*

A

Substance abuse

51
Q

What are the risk factors for relapse (3)

A

Stressors
Medication non-adherence
Substance abuse

52
Q

Schizophrenia Biologic theories (5)

A
  1. Neuroanatomic findings
  2. Familial patterns
  3. Reduced size and activity in the PFC
  4. Neurotransmitters, pathways, receptors
  5. Dopamine hyperactivity ins some areas of the brain
53
Q

Neuroanatomic findings*

A

Larger lateral and third ventricles, smaller total brain volume

54
Q

Psychosocial theories (5)

A
  1. Social stressors contributing to changes in brain function*
  2. Social stigma
  3. High emotional reactivity in families increases relapse
  4. Fragmented mental health care delivery system
  5. Poor family response to disorder
55
Q

What cog fxs are DA involved in (4)

A

Action, emotion, motivation, and attention

56
Q

Assessment: biologic domain

A
  • Current and past physical health status and physical exam (DM II, COPD, Hyperlipidemia)*
  • physical functioning (clumsiness, physical awkwardness)
  • Nutritional assessment and hydration (psychogenic polydipsia)*
  • Substance use (smoking and respiratory problems), alcohol use*
  • monitor for side effects EPS, NMS
  • Pharm assessment (meds, abnormal motor movements, medication adherence)
57
Q

Pharmacologic interventions

What is last resort?

A
  • Antipsychotics
  • second-generation antipsychotic drug effective in treating negative and positive symptoms
  • administration and monitoring for 1-2 weeks to monitor changes in symptoms*
  • Clozapine used as last resort

Mental Health Exam 4 (3 decks)

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