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303 mental health > week 5 psychotic disorders > Flashcards

week 5 psychotic disorders Flashcards

1
Q

Types of Psychotic Disorders

A
  • Schizophrenia
  • Schizoaffective disorder
  • Delusional disorder
  • Brief psychotic disorder
  • Substance/medication induced psychotic disorder
  • Schizophreniform disorder
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2
Q

PSYCHOTIC SYMPTOMS
positive symptoms

A

-hallucinations
-delusions
-disorganized behaviour
-disorganized speech

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3
Q

PSYCHOTIC SYMPTOMS
negative symptoms

A

-affective flattening
-anhedonia
-alogia
-avoliition
-asociality

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4
Q

schizophrenia -neurobiology

A

-genes
-psychosocial adversity in childhood
-ongoing or recent psychological stress
-dopamine
-serotonin

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5
Q

hallucinations

A

Perceptual Disturbances- anything that alters the 5 senses

  • Perceptual experiences that occur in the absence of actual external sensory stimuli and
    may be auditory, visual, tactile, gustatory, or olfactory
    -auditory is the most common
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6
Q

delusions

A

○ A false, fixed belief, based on an incorrect inference about reality, not shared by others,
inconsistent with the individual’s intelligence or cultural background and which cannot be corrected by reasoning

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7
Q

Persecutory/Paranoid
delusions

A

Think being watched, ridiculed, harmed or plotted against ● Someone spying on me..they will hurt me

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8
Q

magical thinking delusions

A

If I do ___, there will be an earthquake

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9
Q

grandiose delusions

A

exceptional powers, wealth, skill, influence or destiny
● I am prime minister, I am(/will be) famous

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10
Q

Somatic delusions

A

Think they have abnormality in body or medical problem
● My hand doesn’t belong to me,
● infested w/ parasites

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11
Q

Affective Flattening or blunting:

A

restriction or flattening in the
range and intensity of emotion, (little or no emotion shown- they understand the emotion, they cannot express it

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12
Q

Alogia:

A

Reduced fluency and productivity of thought and speech
■ reduction in quantity of words spoken
poverty of speech- difficulty getting words out

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13
Q

Anhedonia

A

inability to experience pleasure.

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14
Q

Avolition

A

withdrawal and inability to initiate and persist in goal-directed activity (may not do ADLs..ex:dressing)
■ decreased motivation
-loss of ability to do anything

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15
Q

Asociality

A

no desire to be social or to be around people

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16
Q

difference between amotivation and avolition

A

-amotivation- loss of motivation towards anything, can be social, work, etc.

-avolition is loss of motivation towards a goal oriented activity- ex. work, school

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17
Q

Neurotransmitter Influence on Psychotic Symptoms-
dopamine

A

-influences decision making –> disorganized behaviour –> disorganized thinking

-influence motivation –> amotivation- avolition

-influence arousal- asociality
-signals pleasure and reward -anhedonia

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18
Q

Neurotransmitter Influence on Psychotic Symptoms
-seratonin

A

-feeling –> affective flattening -mood
-energy level–> avolition
-social behaviour –> ascoiality -anhedonia
-sexual desires –> amotivation- anhedonia
-perception -hallucinations -delusions
-Sensorium & cognitive functions –> memory -attention
-somatic functions –> appetite -sleep

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19
Q

Schizophrenia: Diagnostic Criteria (DSM-5, 2013)
Diagnostic Criteria: Schizophrenia

Two or more of the following symptoms each present for a significant length of time over 1 month

A

-Delusions
-Hallucinations
-Disorganized speech
-Grossly disorganized or catatonic behavior
-Negative symptoms -avolition, anhedonia, affective flatting, asociality, amotivation
-Social or occupational dysfunction
- Symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning
- Episode not attributable to physiological effects of a substance or another medical condition
- Episode not better explained by schizoaffective disorder, schizophreniform disorder, delusional disorder, or other psychotic disorder

20
Q

Schizoaffective Disorder: Diagnostic Criteria (DSM-5, 2013)

Diagnostic Criteria: Schizoaffective Disorder

At least 2 symptoms of a psychotic disorder for 2 or more weeks

A

-Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms-flat affect, anhedonia, avolition, amotivation, asociality
+
-A major mood episode that lasts for an uninterrupted period of time
- Mood symptoms present for the majority of the illness

  • The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features
  • The episode is not attributable to the physiological effects of a substance
21
Q

Psychotic Disorders: Pharmacotherapeutic Interventions: Antipsychotics

A

-First generation or atypical antipsychotics increase dopamine in the brain to help reduce or relieve the symptoms of schizophrenia

-Second generation or atypical antipsychotics increase both dopamine and serotonin

-Antipsychotics are always offered with adjunctive non-pharmacological interventions to improve clinical outcomes

22
Q

Psychotic Disorders: Pharmacological Interventions: Antipsychotics

FIRST GENERATION
“TYPICAL”

A

Haloperidol (Haldol) - commonly used in the ED but should not be repeated doses

Thorazine (Chlorpromazine)
Fluphenazine (Moditen, Modecate)
Trilafon (Perphenazine) Loxapine (Loxitane)
Thioridazine (Mellaril)

23
Q

Psychotic Disorders: Pharmacological Interventions: Antipsychotics

SECOND GENERATION “ATYPICAL”

A

Olanzapine (Zyprexa) - causes the MOST weight gain, also the most common drug and can be used orally or a long-acting injection

Quetiapine (Seroquel) Ziprasidone (Zeldox) Paliperadone (Invega) Aripripazolole (Abilify) Risperidone (Risperdal) - oral and long-acting injection

Clozapine (Clozaril)-lowers WBC count = risk of infection so constantly needs blood work, stop taking if reaction occurs but there are less side effects and a better response

24
Q

Possible Side Effects of Antipsychotic Medications

Anticcholinergic effects

A

Dry mouth (can use a life saver or butter scotch candy to counter this), constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, decreased sweating

25
Q

Possible Side Effects of Antipsychotic Medications

Central Nervous System Effects

A

Dizziness, agitation, confusion

26
Q

Possible Side Effects of Antipsychotic Medications

Metabolic syndrome

A

Increased blood pressure, high blood sugar, weight gain, excess body fat around waist, abnormal cholesterol and triglyceride levels, diabetes,

27
Q

Possible Side Effects of Antipsychotic Medications

Sexual Side Effects

A

Decreased sex drive and function, amenorrhea, galactorrhea

28
Q

Possible Side Effects of Antipsychotic Medications

Movement Disorders

A

Tremors, muscle stiffness, tics
(dystonia)

29
Q

Possible Side Effects of Antipsychotic Medications

Tardive Dyskinesia

A
  • Repetitive Involuntary movements-lots of the 1st generation medication do that
30
Q

Possible Side Effects of Antipsychotic Medications

Neuroleptic Malignant Syndrome

A
  • Fever, muscle stiffness, delirium

** medical emergency- super fast and fever will spike up, assess quickly and act quickly

“start low and start slow” when introducing new meds

31
Q

Psychotic Disorders: Non-Pharmacotherapeutic Interventions: Psychotherapy

A

-Cognitive Behavioral Social Skills Training (CBSST)
Illness Management and Recovery (IMR)
-Cognitive Behavior Therapy for Psychosis (CBT-P)
-Cognitive Adaptation Training (CAT)
-Family Intervention Training -(FIT)

32
Q

Psychotic Disorders: Non-Pharmacological Interventions
* Cognitive Behavioral Social Skills Training (CBSST)

A

-An empirically supported manualized intervention that helps individuals with schizophrenia achieve recovery goals
* Interweaves three evidence-based practices:
* Cognitive behavior therapy
* Social skills training
* Problem-solving training
* CBSST is delivered over 12 sessions by appropriately trained practitioners in individual or group contexts
* Offered as adjunct treatment to improve functioning and negative symptoms

33
Q

Psychotic Disorders: Non-Pharmacological Interventions
* Cognitive Behavioral Social Skills Training (CBSST)

benefits/drawbacks

A

BENEFITS
* User friendly intervention
* Structured activities are assigned to participants between sessions to reinforce new learning and solidify skills

DRAWBACKS
* Initial training is expensive
* Cost of weekly clinical supervision to maintain fidelity to the model
* Intervention may not always be available in all jurisdictions

34
Q

Psychotic Disorders: Non-Pharmacological
Interventions
* Cognitive Behavior Therapy for Psychosis (CBT-P)

A

-An evidence-based talk therapy that helps individuals diagnosed with psychosis to become
aware of their thoughts and behaviors and explore how these impact their emotions
* The “here and now” focus allows for the development of skills to identify and address unhelpful thinking patterns and behaviors
* CBT-P is delivered over 12-16 sessions by appropriately trained practitioners in either individual or group contexts
* CBT-P is recommended as an adjunct to pharmacological treatment

35
Q

Psychotic Disorders: Non-Pharmacological
Interventions
* Cognitive Behavior Therapy for Psychosis (CBT-P)

benefits and drawbacks

A

BENEFITS
* Well tolerated -not painful or disruptive
* No hospitalization or anesthesia required
* No systemic side effects
* No memory loss

DRAWBACKS
* Initial training is expensive
* Cost of weekly clinical supervision to maintain fidelity to the model
* Intervention may not always be available in all jurisdictions

36
Q

Psychotic Disorders: Non-Pharmacological Interventions

Family Intervention Training (FIT)

A
  • A family intervention that aims to improve family members’ support and resilience of one another
    and enhance the quality of their communication and problem solving
  • The intervention seeks to provide:
  • Education about schizophrenia
  • Skill teaching around identifying signs and symptoms of relapse
  • Strategies to improve family members; ability to anticipate and help reduce the risk of relapse
  • Families are offered 10 planned sessions facilitated by an appropriately trained practitioner
37
Q

Psychotic Disorders: Non-Pharmacological Interventions
* Family Intervention Training (FIT)-benefits and drawbacks

A

BENEFITS
* Intervention is offered to anyone the client considers family relatives, caregivers or people from a broader circle
* Recognizes the vital role family members play in supporting a person’s recovery, promoting their well- being and providing care
* Can be delivered virtually or in person to meet needs of families

DRAWBACKS
* Initial training is expensive
* Cost of weekly clinical supervision to maintain fidelity to the model
* Intervention may not always be available in all jurisdictions

38
Q

Psychotic Disorders: Non-Pharmacological Interventions
Cognitive Adaptation Training (CAT)

A

An evidence-based intervention designed to address functional impairment caused by cognitive deficits of schizophrenia
* Individuals are taught environmental supports and compensatory strategies to use to improve their social & occupational functioning
* Voice alarm clocks
* Large Calendars
* Checklists/schedules
* Reminder signs

39
Q

Psychotic Disorders: Non-Pharmacological Interventions
Cognitive Adaptation Training (CAT)

benefits and drawbacks

A

BENEFITS
* Indepth cognitive assessment is conducted with the FRISBEE© tool prior
* Approach can be used to address goals related to living, learning, working and socializing
* Studies have found CAT improves community functioning, adaptive functioning, medication adherence, performance of ADLs and quality of life

DRAWBACKS
* CAT training/recertification is expensive
* Costs of weekly clinical supervision
* Intervention may not always be available in all jurisdictions

40
Q

Psychotic Disorders: Non-Pharmacological Interventions
Illness Management & Recovery (IMR)

A

An evidence-based intervention designed to promote illness self-management
* Psychoeducational content includes:
* Recovery strategies
* Using medication effectively
* Building social supports
* Coping with stress
* Managing persistent symptoms
* Reducing relapses
* Getting needs met by the mental health system

41
Q

Psychotic Disorders: Non-Pharmacological Interventions
Illness Management & Recovery (IMR)

drawbacks/benefits

A

BENEFITS
* Can be delivered in individual or group contexts
* User friendly intervention delivered by trained practitioners over 6 months

DRAWBACKS
* Training/recertification is expensive
* Costs associated with weekly clinical supervision
* Intervention may not always be available in all jurisdictions

42
Q

Psychotic Disorders : Peer Support Interventions

Wellness Recovery Action Planning (WRAP)

A

A peer support group intervention developed & delivered by people with lived experience of psychosis
The foundation of WRAP is a wellness toolbox A WRAP plan has six components:
* Daily plan
* Stressors
* Early warning signs
* Signs that things are breaking down or getting worse
* Crisis plan

43
Q

Psychotic Disorders : Peer Support Interventions

Wellness Recovery Action Planning (WRAP)

A

BENEFITS
* Intervention incorporates key recovery concepts and wellness tools
* Helps individuals to develop simple, safe and effective tools to create and maintain wellness
* Helps individuals to develop a daily plan to stay on track with life and wellness goals
* Encourages people to identify challenges that throw them off track
* Helpspeopletoidentify ways to gain support and stay in control in a crisis

DRAWBACKS
* WRAP Level 2 Master Trainer certification courses may be cost prohibitive for many people
* WRAPLevel1&2 courses may not be available in all jurisdictions especially in smaller communities

44
Q

Psychotic Disorders : Peer Support Interventions

Hearing Voices Groups

A

A peer support group intervention developed & delivered by people with lived experience of auditory hallucinations
* Living and making sense of voices groups aim to:
* Raise awareness of the diversity of voices
* Challenge negative stereotypes, stigma and discrimination
* Help create more spaces for people to talk freely about voice hearing
* Raise awareness of different ways to manage distressing, confusing or difficult voices

45
Q

Psychotic Disorders : Peer Support Interventions

Hearing Voices Groups

benefits/drawbacks

A

BENEFITS
* Groups are based firmly on an ethos of self help, mutual respect and empathy
* Provide a safe space for people to share their experiences of hearing voices and support one another
* Hearing Voices groups are available in large cities around the world

DRAWBACKS
* Group facilitator training is expensive which limits access for many individuals
* Groups are not usually available in smaller communities

46
Q

Psychotic Disorders: Tiered Model of Community Mental Health Treatment

A

All individuals should receive Early Intervention in Psychosis (EPI) services to reduce the duration of untreated psychosis and reduce the probability of relapse
ALL
* Many individuals should receive community-based
Intensive Case Management (ICM) services to
promote optimal social & occupational functioning ICM
EPI
* Individuals with the most functional disability should receive m community-based Assertive Community Treatment (ACT) or Flexible Assertive Community Treatment (FACT) services provided by interprofessional teams

47
Q

Mood Disorders: Nursing Interventions

A

-Medication monitoring,
management & administration

-Skill Teaching- illness self- management

-Supportive Counselling

-Facilitating CBSST

-Facilitating CAT

-Facilitating FIT

-Facilitating CBT-P

-Facilitating IMR

-Symptom and Behavior

-Monitoring & Management

-Crisis prevention & intervention

-Delivering EPI, ICM, ACT & FACT Services

-Individual & Systems level advocacy

303 mental health (8 decks)

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