Week 2 - Psychosis and Schizophrenia Flashcards
Define Psychosis
a collection of symptoms of impaired sense of reality
- Delusions, hallucinations and disorganised thinking
- Positive, negative and cognitive symptoms
- Beliefs that are not grounded in reality
Identify the main characteristics or symptoms of psychosis
- Delusions
- Hallucinations
- Cognitive impairment or thought disorder
agitation and agression
What are delusions
Fixed belifs which the consumer holds to be true but which are not grounded in reality
* not changed by compelling counterargument or proof of the contrary
* held with absolute conviction
* can solidify to become their reality
Bizarre vs non-bizzare delusions
Bizarre - delusions which are implausible or impossible
Non-bizarre - delusions which are exagerrated or very unlikely but could technically be true
Identify and describe the types of delusions
- Delusions of reference - belief that a random event is aimed at them personally
- Delusions of grandeur - belief that they have a unique and extreme significance or power
- Paranoid/persecutory delusions - belief they are being harmed or watched
- Delusions of control - belief that another person/group/force is in control of their thoughts or actions
- Erotomanic delusions - belief that a person is romantically in love with them (celebrity, stranger)
What are hallucinations
Sensual perceptions in the absence of external stimuli which have qualities of real percepiton
* often vivid and detailed
Identify and describe the different types of hallucinations
- Auditory hallucinations - most common, voices, commentary, spoken commands
- Visual hallucinations - colours, faces, people, objects, can be clear and identifiable or more abstract
- Gustatory (taste) hallucinations - less common
- Tactile hallucinations - less common, associated with substance misuse
- Olfactory (smell) hallucinations - less common
Disorganised thinking and disorganised behaviour
Disorganised thought - indirectly observed through speech, an unusual or interrupted pattern of thought which impacts speech and writing
Disorganised behaviour - directly observed, bizarre, inappropriate or unusual behaviour or movement in the context of the situation
Speech patterns which suggest disorganised thought
- Poverty of content (alogia) - speech is brief, with little content or elaboration, and non-spontaneous
- Tangenital speech - speech progresses off topic
- Thought blocking - losing train of thought and stopping speech suddenly for seconds or minutes. often when speech resumes there is a change in topic
- Word salad - words are combined in a sentence with no sense or meaning
- Preservation - the repetition of words or ideas due to an inability to switch from the topic mentally
Biological/genetic causes of psycosis
- Dopamine dysregulation - increased levels in the brain
- structural changes to amygdala and hippocampus - affects memory and learning AND may be attributed to the perceptual disturbances of hallucinations and delusions
- genetic heritability/family history
- birth
Psychological causes of psychosis
- preexisting mental illness eg. schizophrenia, depression, BPD
- negative/threatening perception of the world
- avoidant personality
- stress - exacerbates risk of relapse
environmental/social causes of psychosis
- birth trauma and foetal brain developmental issues
- perinatal malnutrition and illness
- childhood adversity/trauma
- birth season (late winter/early spring)
- cannabis use (especially with genetic vulnerability)
- low SES - education, healthcare
- lack of social connection/support systems
List the symptoms of psychosis
- hallucinations
- delusions
- thought and speech disorder
- suicidal thoughts
- severe mood swings
- agitation and hostility
- paranoia
- insomnia
- thought insertion - the belief that one’s thoughts are not their own and have been placed in the mind by someone else
Puerperal psychosis
Experience of psychosis symptoms in the postpartum period
requires prompt treatment and sensitive but quick separation of mother and baby to prevent
* infanticide
* maternal suicide
* child abuse/neglect
* ongoing psychotic illness
Women often present with
* severely impaired judgement
* insomnia
* anorexia
* agitation
* paranoia
* depressive symptoms
Women with PMHx of bipolar disorder are at increased risk
Screen for infection to eliminate sepsis as the cause
Typical antipsychotics
MOA: D2 receptor antagonists block dopamine receptors in the brain to decrease dopaminergic activity and effect
- very good at treating positive symptoms
- poorer response to negative symptoms - can even make them worse
- increased risk of serious side effects
Side effects include:
* NMS
* EPS
* TD
* prolonged QT interval
* hypotension
* sedation
* convulsions
Atypcial antipsychotics
MOA: D2 receptor antagonists block dopamine receptors in the brain to decrease dopaminergic activity and effect
- First line treatment of psychosis and schizophrenia
- more tolerable and effective in treating positive and negative symptoms
- decreased risk of some side effects due to more specific receptor targeting ability
Side effects include:
* NMS
* TD
* MS
* headache
* GI upset
* insomnia
Metabolic syndrome
ATYPICAL
A cluster of conditions including high blood pressure, BGL, body fat percentage and cholesterol levels
* increase risk of heart attack, T2DM, and stroke
Symtoms
* thirst and hypersalivation
* appetite stimulation
* increased sedation
* negative symptoms
Nursing management
* frequent weight check and assessment
* fasting glucose and lipids every 3-4 months
Post injection syndrome
Sudden and unexpected onset of delirium or sedation and their related signs and symptoms within the first several hours of receiving olanzapine LAI
Neuroleptic malignant syndrome
TYPICAL OR ATYPICAL
A life threatening neurologic emergency
- can develop within hours
- rigidity
- altered mental state/consciousness
- hyperthermia
- autonomic dysfunction
Nursing management
* immediate cessation
* control hyperthermia, rigidity
* airway management
* fluids
Extrapyramidal symptoms
TYPICAL
A series of movement symptoms ranging in severity and intensity
Akathisia - restlesness
Parkinsonism - forward tilt, trembling, rigidity, shuffling
tardive dyskinesia - distortion of facial features with long-term antipsychotic use, does not always respond to treatment
acute dystonia - potentially fatal muscle spasms in the neck and back, eyes, and tongue (may lead to resp distress)
Non-pharmacological treatment approaches to psychosis and schizophrenia
Psychosis
*
Schizophrenia
* Music therapy
* CBT
* ACT
* Psychoeducation
Define Schizophrenia
psychotic disorder characterised by significant disturbances in thinking, emotions and behavior
Identify and explain the three stages of schizophrenia
Prodrome - the early stages of schizophrenia where behavioural changes and diminishing functioning may be emerging in a range of areas -
* gradual development - subthreshold symptoms
* does not yet warrant an official diagnosis
* the most prudent stage for early intervention
* typically through adolescence
Symptoms include changes to affect, beliefs, social withdrawal, mild negative symptoms
Active - characterised by psychosis and acute symtoms
* person typically requires mental health admission for treatment and management of acute symptoms
* may go on for weeks or months if untreated
Residual - no longer experiencing psychosis but may be experiencing other symptoms eg. blunted affect, lack of concentration, social withdrawal, other bizzare behaviours
* still may experience some odd beliefs, but not to the extent of delusions
* recovery stage
what is the difference between positive, negative and cognitive symptoms
Positive symptoms - something that adds to the person’s thoughts or behaviour
Negative symptoms - something that takes away from a person’s thoughts or behaviour
Cognitive symptoms - Impairments of concentration, memory or other cognitive processes
List positive symptoms of schizophrenia
- hallucinations
- delusions
- thought and speech disorder
- agitation and hostility
- movement disorders
- paranoia and suspicion
- flight of ideas
- thought insertion - the belief that one’s thoughts are not their own and have been placed in the mind by someone else
List negative symptoms of schizophrenia
- blunted affect (decreased ability to outwardly express emotion)
- anhedonia (lack of pleasure in activities)
- apathy (lack of concern or care)
- avolition (lack of motivation)
- poverty of speech
- social withdrawal
List cognitive symptoms of schizophrenia
- Issues with executive functioning - planning, attention, memory, multitasking
- difficulty planning
- difficulty engaging in goal-directed behaviour
- difficulty in problem solving
- poor concentration
- poor memory
- inability to process social cues
- impaired sensory perception
Nursing interventions and rationale for supporting people with psychosis and schizophrenia
Regular MSE and risk assessment
Build Rapport
Monitor adherance to medication regiment
initiate psychoeducation
attempt negotiation to provide patient with feelings of control
take environmental preautions to promote patient safety
Decrease environmental stimulation
Offer distraction activities to calm/settle patient
promote calming strategies such as a warm shower, limited lighting to assist with agitation and anxiety
Administer medication as charted
Monitor for changes in behaviour
exercise
engaging in conversations about their experiences
setting and maintaining boundaries and limits
engage a consumer who is withdrawn or asocial
guiding consumers to develop routines (for sleep, relaxation, withdrawal, anxiety)
