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Week 4 Schizophrenia & Bipolar > Week 4 Schizophrenia & Bipolar > Flashcards

Week 4 Schizophrenia & Bipolar Flashcards

1
Q

Bipolar Spectrum Disorders:

A

Bipolar I Disorder(male and female equally)
- At least one episode of mania
- Major depressive episodes
- Possible psychosis
Refers to delusions or hallucinations
- paranoid delusions
-Mania: Persistent / elevated / irritable mood

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2
Q

Bipolar II Disorder [ more in female]

A
  • At least one period of hypomania
  • Can be missed bc they are function
  • No mania
    One or more periods of depression
  • Depressive characteristics
  • Hopelessness / sadness
  • Suicidal thoughts
  • Inability to concentrate / make decisions
    No psychosis
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3
Q

Symptoms of Hypomania

A
  • Treats everyone with familiary and confidential; often borders on crude
    -May have a voracious appetite, eat on the run, or gobble food during brief periods
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4
Q

Symptoms of Mania

A

Mania:
- Becomes inappropriately demanding of people’s attention, and intrusive nature
repels others
- intrusive
- No time to eat- to distracted and disorganized

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5
Q

Delirious Mania signs

A
  • Happens acutely and rapidly
  • Quickly and suddenly
  • Disoriented
  • Confused, catatonic
  • May hallucinate
  • Psychosis
  • Catatonia
  • Frozen, zombie like state
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6
Q

Cyclothymic Disorder

A
  • Alternate between hypomania and depression
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7
Q

Nursing Process Assessment: Bipolar

A

-Dehydration
- Cardiac status
- Receive adequate sleep
- Safety ; Pt may impulsively hurt themselves
- Behavior ;Assess for impulsivity
- Check for mood ; Labile mood [ switching from one mood to another
- Profane and manipulative
- Thought Content /Pt may be talking too fast
- Assess for psychosis
- Cognition
-Poor memory and attention span
-Not being able to function

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8
Q

Nursing Process Outcomes: Bipolar

A
  • Well hydrated
  • Maintain stable vital signs
    -Get 4-6 hours of sleep
  • Demonstrate self-control by not harming others
    -Make no attempt to self-harm
  • Understand disease process
    Attend support / therapy
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9
Q

Nursing Process Implement: Bipolar

A
  • Address physiological needs
  • Pt are competitive
  • Distract patients / Milieu therapy
  • Do not give a roommate (stimulating)
  • Safety measures
    -Use de-escalation techniques - Seclusion / (restraint - Last resort Danger to self or others)
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10
Q

Interdisciplinary Treatments: Bipolar

A

-Interpersonal and Social Rhythm Therapy(Help adjusting to change)
- Family therapy
- Family conflicts may be occuring
Support groups

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11
Q

Bipolar Tx:

A

Pharm Therapies
Mood stabilizers
Anticonvulsants
Anxiolytics
Second-gen antipsychotics
ECT

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12
Q

Lithium (First line of treatment) for bipolar

A
  • Acute mania
  • Acute bipolar depression
  • Prevention of manic and depressive episodes
  • MOA unknown
    3-6 for full response
    Therapeutic levels: 0.5 - 1.2 mEq/L
  • Inverse relationship with sodium
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13
Q

Lithium side effects:

A

-Fine hand tremors
-Polyuria, mild thirst
- Nausea
-Weight gain
-Sedation
-Acne

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14
Q

Iithium toxicity (1.2-1.5)

A
  • Low sodium levels
  • Skipping a dose may be enough to bring down to safer range
  • Dose re-evaluated
  • N/V/D
  • Slurred speech
  • Muscle Weakness
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15
Q

Lithium toxicity (1.5-2) S/S
Tx: Administer Sodium bolus

A
  • Coarse hand tremor
  • Gl upset
  • Mental confusion
  • Muscle hyperirritability
  • EEG Changes
  • Incoordination
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16
Q

Lithium Toxicity (2+)

A

-Ataxia
- Serious EEG changes
- Blurred vision
-Clonic movements, seizures
-Stupor
- Coma
- Death
- Long term side effects
- Hypothyroidism / goiter
- Kidney dysfunction
Monitor creatinine

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17
Q

What do Anticonvulsants treat?

A

-Bipolar mania
- Hypomania
-Mixed states
- Rapid cycling

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18
Q

Some anticonvulsants

A

Valproic Acid / Depakote / Divalproex / Valproate

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19
Q

Anticonvulsant side effects:

A
  • GI Pain
  • Tremors
  • Sedation
  • Hair loss
  • Weight gain
  • Blood dyscrasias
  • Hepatotoxicity
  • Pancreatitis
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20
Q

Anticonvulsant toxicity S/S

A

-Toxicity
- Ataxia
-Confusion
- Somnolence
- Coma

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21
Q

What does Carbamazepine 4 - 12 mcg / mL
Treat?

A
  • Rapid cycling
  • Mixed states
  • Acute mania
  • Prevents relapse of mania
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22
Q

Carbamazepine Side effects?

A
  • Monitor rashes
  • Hepatic disease
  • Blood dyscrasias
  • Hypervolemia
    -Hyponatremia
  • Lower effectiveness of BC
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23
Q

Carbamazepine toxicity signs?

A
  • Fatigue, nausea
    -Diplopia
  • Blurry vision
  • Ataxia
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24
Q

Lamotrigine Tx of?

A

-Bipolar depression
- Both acute and maintenance

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25
Q

Lamotrigine side effects?

A

-SJS
- Aseptic meningitis
-Lower effectiveness of BC

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26
Q

What are Anxiolytics Tx for ?

A

Adjunctive agent
Acute mania
Psychomotor agitation

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27
Q

Second Gen Antipsychotics Tx for ?

A
  • Acute mania
    -Bipolar depression
    -Prevent relapse of mania and depression
28
Q

Psychotic Disorders: Example of primary / Secondary

A

Primary: schizophrenia, genetic
Secondary: psychosis due to another factor like meds

29
Q

Comorbidities for Psychotic Disorders?

A

-Substance use disorder
- Tobacco use disorder
- Cannabis
- Can reduce and can induce
-Attempted suicide
- Hallucinations may commend pt to attempt suicide
- Anxiety disorders
- Metabolic syndrome
-HIVIAIDS

30
Q

Schizophrenia - Prodromal Phase

A
  • Before a person is diagnosed
  • Hard to identify
  • Pt may be socially withdrawn
  • Social problems; depression, strange
    Notice something is off but not too sure
31
Q

Schizophrenia - Acute phase

A

-Pt has a full psychotic break
- Start having delusions

32
Q

Schizophrenia- Stabilization phase

A
  • Pt decrease in severity
  • Not acute but not back to baseline
33
Q

Schizophrenia - Maintenance Phase

A
  • Mild but not notifiable symptoms
  • Can go back into acute phase
    -Poor concentration or difficulty sleeping
  • Have a relapse plan
34
Q

Positive schizophrenia symptoms?

A
  • Alterations: Thinking
  • Delusions ; False belief but strongly believe it is true
  • Ideas of reference ; Specific event has a personal meaning
  • Paranoid/persecutory ; Someone is out to get you
  • Grandiosity ; “my lawyer will sue you”
  • Somatic ;Belief they are preg but has a tumor
  • Jealousy ;Feeling significant other is unfaithful
  • Control ; One’s mind is being controlled by another
  • Thought broadcasting ; insertion, withdrawal
    Belief that others can listen to their thoughts
  • Concrete thinking ; Straightforward thinking
35
Q

Positive schizophrenia symptoms? (Thought process; Manifested in way pt speaks)

A

Associative looseness ; Illogical shift in topics
- Circumstantiality Tangential ; Off topic
- Neologisms ; Make up words
-Word salad
- Echolalia ; Keep saying one word
- Clang associations
- Rhyme association

36
Q

Schizophrenia behavior

A

-Behavior Bizarre demeanor
- Make weird movements
- Eccentric dress, grooming, and rituals
- Impaired impulse control
- Can be blurred something out or hurting someone

37
Q

Schizophrenia personal Boundaries

A
  • Depersonalization (Feeling of detached/Feeling body part are not real
  • Derealization (Feels like the world around is not real)
38
Q

Negative Symptoms of schizophrenia

A
  • Anergia
  • Loss of energy
  • Avolition
  • Loss of motivation
  • Anhedonia
  • Loss of pleasure / joy
  • Affective blunting
  • Inability to express emotions
  • Poverty of speech
  • One word answers
  • Social withdrawal
  • Isolated, not communicating
39
Q

First Gen Antipsychotics

A
  • Traditional dopamine antagonists
  • Block dopamine receptors = more dopamine
  • Used less frequently
  • Minimal impact on neg symptoms
    -Side effects are experienced more
40
Q

First Gen antipsychotics medications

A
  • Chlorpromazine
  • Loxapine
  • Fluphenazine
  • Haloperidol
41
Q

Extrapyramidal Symptoms & Tx ?

A
  • Pseudoparkinson;Risk for falls
    Tx:
  • Benztropine
  • trihexyphenidyl
42
Q

Acute dystonia Symptoms & Tx ?

A
  • Facial grimacing with involuntary upward eye movement
  • Muscle spasms on tongue, neck, back, face
  • Laryngeal spasms
    -Dosage starting too high
    -Monitor Airway
  • Treatment:
    -Benztropine / Diphenhydramine
43
Q

Akathisia Symptoms & Tx ?

A
  • Internal restlessness
  • Hard time standing still
  • Monitor for suicide

Treatment:
- Propranolol
- Benzodiazepines

44
Q

Tardive Dyskinesia:

A

Almost like a chewing motion
- Sucking and smacking movement of lips
- irreversible

Treatment:
- Lower dosage or switch med
-Benztropine

45
Q

Other side Effects of antipsychotics?

A

-Sedation
- Ortho hypotension
-Lower seizure threshold
-Increased prolactin

46
Q

Metabolic Syndrome

A
  • Weight gain
  • HIN
    -Diabetes
    -Dyslipidemia
    -Prolong QT Interval (Heart forgets to pump and stops beating)
47
Q

Anticholinergic Toxicity

A
  • Anxiety
  • Delirium
  • Disorientation
  • Hallucinations
  • Hyperactivity
  • Seizures
48
Q

Neuroleptic Malignant Syndrome (DVT & rhabdo??)

A

Muscle rigidity
- High fever
- Fluctuating BP
- Irregular and increased HR
- Increase RR
- AMS

49
Q

Second / Third Gen Antipsychotics meds?

A

-Clozapine
- Lurasidone
- Olanzapine
-Quetiapine
- Risperidone

50
Q

Olanzapine (Antipsychotic) Tx ?

A
  • Extreme weight gain
  • Administered to eating disorder
51
Q

Quetiapine (Antipsychotic)

A
  • Highly addicting
  • Very sedating
52
Q

Risperidone (Antipsychotic) Risk for ?

A
  • Risk for heat stroke
53
Q

Clozapine (Antipsychotic)

A

Agranulocytosis
- WBC > 3,500
- Risk for sepsis
- Contra: Low WBC
-Myocarditis
-Sialorrhea (Drools a lot)
Last-resort med
- 250-350 ng/mL

54
Q

Long Acting Injectable ( antipsychotic)
Must take OP then can go to long acting Injectable

A
  • Also benefits bipolar
  • Olanzapine
    -Paliperidone
    -Ziprasidone
  • Haldol
    -Aripiprazole
55
Q

Lithium Advanced: 1.5 - 2

A

Coarse hand tremors
GI Upset
- Confusion
Muscle hyperirritability
- EEG Changes

56
Q

Lithium [Therapeutic Range 0.5 - 21

A
  • Early Signs: > 1.5
  • NIID
    Slurred Speech
  • Muscle Weakness
57
Q

Lithium Severe: 2+

A

Ataxia
Coma
Stupor
Death
Serious EEG Changes
Long Term Effects:
Hypothyroidism
Goiter
Kidney Dysfunction

58
Q

Clozapine

A

WBC <3,500
- To diagnose, look for flu-like symptoms
Sore throat
Fever

59
Q

Olanzapine:

A

Main Side effect:
- Weight Gain

60
Q

EPS: Pseudoparkinsonism

A

Shuffling gait
Treatment: Benztropine

61
Q

EPS: Acute Dystonia:

A
  • Muscle spasms
    Monitor airway
    Laryngeal spasms
    Treatment: Benztropine
62
Q

EPS: Akathisia

A
  • Internal restlessness
  • Treatment: Benzodiazepines
63
Q

EPS: Metabolic Syndrome:

A
  • Motor:
  • [HTN] BP, [Dyslipidemia] Lipids, [Diabetes] HbA1c, Weight
  • Anticholinergic: [Can’t See, Can’t Spit, Can’t Pee, Can’t Shit]
64
Q

EPS: Neuro Malignant Syndrome:

A
  • Muscle rigidity
  • Fluctuating BP
  • Increase temp, HR, RR
65
Q

Anticonvulsants:Valproic Acid

A
  • Treats: Bipolar Mania, Hypomania, Mixed states, rapid cycling
  • Side Effects:
    GI Pain, Tremors, Sedation, Hair loss, Weight gain, blood dyscrasias, hepatotoxicity, pancreatitis
66
Q

What do you do for ; Bipolar:

A
  • Priority
    Energy depletion / lack of nutrition
  • Finger foods
    Incorporate rest
  • Milieu therapy
    No roommate
    -Safety:
  • Impulsive

Week 4 Schizophrenia & Bipolar (1 decks)

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