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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
Schizophreniform (3 factors)
Identical features of schizophrenia | Duration less than 6 months with symptoms present at least 1 month
26
Delusional disorder
-Logical, stable, well systematize delusions that occur in the absence of other psych disorders -
27
Delusion:
fixed false beliefs that cannot be changed by conflicting evidence
28
Delusions
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
Brief psychotic disorder
- 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
Schizophrenia 6 criteria
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
3 delusion types
grandiose persecutory somatic
32
3 Positive symptoms of schizo
- hallucinations - Delusions - disorganized thoughts
33
5 negative symptoms of schizo
- alogia - affective flattening - avolition - anhedonia - asociality
34
Alogia
Reduced speech even when encouraged | Lack of emotional and facial expression
35
Cognitive deficits* (4)
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
Verbigeration
Purposeless repetition of words or phrases
37
Metonymic speech
Use of words with similar meanings interchangeably
38
Disorganized behavior
``` Aggression Agitation Catatonia Catatonic excitement Echopraxia Regressed behavior Stereotypy Hypervigilance Waxy flexibility ```
39
Catatonia
Stupor, mutism, posturing, repetitive behavior
40
Catatonic excitement
Hyperactivity characterized by purposeless activity and abnormal movements, such as grimacing and posturing
41
Stereotypy
Repetitive purposeless movements that are idiosyncratic to the individual
42
Waxy flexibility
Posture held in an odd or unusual fixed position
43
High occurrence of what comorbidities (3)*
Diabetes Obesity Psychogenic polydipsia
44
Psychosis*
State in which person experiences hallucinations, delusions, or disorganized thoughts, speech, or behavior (key diagnostic factor in schizophrenia spectrum disorder)
45
Phases of schizophrenia (5)*
1. Prodromal period 2. Acute 3. Stabilization 4. Maintenance 5. Relapse
46
Prodromal period
Stage of early changes that are precursor to disorder (usually early childhood)
47
Acute
Disruptive or bizarre behaviors/perceptions that impede function (usually late adolescence or early adulthood)
48
Stabilization
Adjusting to the prospect of long-term severe mental illness, aim to reduce/eliminate risk factors for relapse
49
Maintenance
Maintaining healthy lifestyle, managing stresses of life, developing meaningful interpersonal relationships
50
What is there a high risk of during stabilization phase*
Substance abuse
51
What are the risk factors for relapse (3)
Stressors Medication non-adherence Substance abuse
52
Schizophrenia Biologic theories (5)
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
Neuroanatomic findings*
Larger lateral and third ventricles, smaller total brain volume
54
Psychosocial theories (5)
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
What cog fxs are DA involved in (4)
Action, emotion, motivation, and attention
56
Assessment: biologic domain
- 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
Pharmacologic interventions | What is last resort?
- 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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