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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
Lamotrigine side effects?
-SJS - Aseptic meningitis -Lower effectiveness of BC
26
What are Anxiolytics Tx for ?
Adjunctive agent Acute mania Psychomotor agitation
27
Second Gen Antipsychotics Tx for ?
- Acute mania -Bipolar depression -Prevent relapse of mania and depression
28
Psychotic Disorders: Example of primary / Secondary
Primary: schizophrenia, genetic Secondary: psychosis due to another factor like meds
29
Comorbidities for Psychotic Disorders?
-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
Schizophrenia - Prodromal Phase
- 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
Schizophrenia - Acute phase
-Pt has a full psychotic break - Start having delusions
32
Schizophrenia- Stabilization phase
- Pt decrease in severity - Not acute but not back to baseline
33
Schizophrenia - Maintenance Phase
- Mild but not notifiable symptoms - Can go back into acute phase -Poor concentration or difficulty sleeping - Have a relapse plan
34
Positive schizophrenia symptoms?
- 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
Positive schizophrenia symptoms? (Thought process; Manifested in way pt speaks)
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
Schizophrenia behavior
-Behavior Bizarre demeanor - Make weird movements - Eccentric dress, grooming, and rituals - Impaired impulse control - Can be blurred something out or hurting someone
37
Schizophrenia personal Boundaries
- Depersonalization (Feeling of detached/Feeling body part are not real - Derealization (Feels like the world around is not real)
38
Negative Symptoms of schizophrenia
- 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
First Gen Antipsychotics
- Traditional dopamine antagonists - Block dopamine receptors = more dopamine - Used less frequently - Minimal impact on neg symptoms -Side effects are experienced more
40
First Gen antipsychotics medications
- Chlorpromazine - Loxapine - Fluphenazine - Haloperidol
41
Extrapyramidal Symptoms & Tx ?
- Pseudoparkinson;Risk for falls Tx: - Benztropine - trihexyphenidyl
42
Acute dystonia Symptoms & Tx ?
- 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
Akathisia Symptoms & Tx ?
- Internal restlessness - Hard time standing still - Monitor for suicide Treatment: - Propranolol - Benzodiazepines
44
Tardive Dyskinesia:
Almost like a chewing motion - Sucking and smacking movement of lips - irreversible Treatment: - Lower dosage or switch med -Benztropine
45
Other side Effects of antipsychotics?
-Sedation - Ortho hypotension -Lower seizure threshold -Increased prolactin
46
Metabolic Syndrome
- Weight gain - HIN -Diabetes -Dyslipidemia -Prolong QT Interval (Heart forgets to pump and stops beating)
47
Anticholinergic Toxicity
- Anxiety - Delirium - Disorientation - Hallucinations - Hyperactivity - Seizures
48
Neuroleptic Malignant Syndrome (DVT & rhabdo??)
Muscle rigidity - High fever - Fluctuating BP - Irregular and increased HR - Increase RR - AMS
49
Second / Third Gen Antipsychotics meds?
-Clozapine - Lurasidone - Olanzapine -Quetiapine - Risperidone
50
Olanzapine (Antipsychotic) Tx ?
- Extreme weight gain - Administered to eating disorder
51
Quetiapine (Antipsychotic)
- Highly addicting - Very sedating
52
Risperidone (Antipsychotic) Risk for ?
- Risk for heat stroke
53
Clozapine (Antipsychotic)
Agranulocytosis - WBC > 3,500 - Risk for sepsis - Contra: Low WBC -Myocarditis -Sialorrhea (Drools a lot) Last-resort med - 250-350 ng/mL
54
Long Acting Injectable ( antipsychotic) Must take OP then can go to long acting Injectable
- Also benefits bipolar - Olanzapine -Paliperidone -Ziprasidone - Haldol -Aripiprazole
55
Lithium Advanced: 1.5 - 2
Coarse hand tremors GI Upset - Confusion Muscle hyperirritability - EEG Changes
56
Lithium [Therapeutic Range 0.5 - 21
- Early Signs: > 1.5 - NIID Slurred Speech - Muscle Weakness
57
Lithium Severe: 2+
Ataxia Coma Stupor Death Serious EEG Changes Long Term Effects: Hypothyroidism Goiter Kidney Dysfunction
58
Clozapine
WBC <3,500 - To diagnose, look for flu-like symptoms Sore throat Fever
59
Olanzapine:
Main Side effect: - Weight Gain
60
EPS: Pseudoparkinsonism
Shuffling gait Treatment: Benztropine
61
EPS: Acute Dystonia:
- Muscle spasms Monitor airway Laryngeal spasms Treatment: Benztropine
62
EPS: Akathisia
- Internal restlessness - Treatment: Benzodiazepines
63
EPS: Metabolic Syndrome:
- Motor: - [HTN] BP, [Dyslipidemia] Lipids, [Diabetes] HbA1c, Weight - Anticholinergic: [Can't See, Can't Spit, Can't Pee, Can't Shit]
64
EPS: Neuro Malignant Syndrome:
- Muscle rigidity - Fluctuating BP - Increase temp, HR, RR
65
Anticonvulsants:Valproic Acid
- Treats: Bipolar Mania, Hypomania, Mixed states, rapid cycling - Side Effects: GI Pain, Tremors, Sedation, Hair loss, Weight gain, blood dyscrasias, hepatotoxicity, pancreatitis
66
What do you do for ; Bipolar:
- 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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