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Mental Health - PPN 303 > Week 5 - schizophrenia, schizoaffective & psychosis conditions > Flashcards

Week 5 - schizophrenia, schizoaffective & psychosis conditions Flashcards

1
Q

Psychotic Disorders

A

 Approximately 3% of the population will experience psychosis at one point in their lives
 Individuals with psychotic disorders have a 15 year reduction in life expectancy attributable to a high prevalence of comorbid physical health conditions
 Schizophrenia is one of the top 20 contributors to years lived with disability
 Risk factors include stress in perinatal period, pregnancy complications, genetics
 Most people diagnosed in late adolescence or early adulthood (reading), more men than women
 Types of Psychotic Disorders (DSM-5, 2013)
o Schizophrenia
o Schizoaffective disorder
o Delusional disorder
o Brief psychotic disorder
o Substance/medication induced psychotic disorder
o Schizophreniform disorder

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2
Q

What are the positive psychotic symptoms?

A

HDBS
* Hallucinations
* Delusions
* Disorganized behaviour
* Disorganized speech

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3
Q

What are delusions?

A

fixed false beliefs
o Because it’s fixed, you cannot convince someone otherwise because they believe its reality

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4
Q

What is grandiose delusion?

A
  • Grandiose – belief one has exceptional powers, wealth, skill, influence, or destiny
    o E.g., thinking they are super rich, model, president, etc.
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5
Q

What is a somatic delusion?

A

belief that something is wrong w/ their body

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6
Q

What is delusion of control?

A

Belief that someone is trying to control them

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7
Q

What is the nihilistic delusion?

A

Belief that they are dead

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8
Q

What is persecutory delusion?

A

Belief that they are about to be harmed or mistreated

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9
Q

How many senses can be affected by hallucinations?

A
  • Hallucination -perceptual disturbance - a sight, sound, smell, taste or touch that a person perceives but is not perceived by others
    o All five senses can have hallucinations, but visual and auditory most common
    o E.g., I’m hearing noises right now
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10
Q

What are the negative psychotic symptoms?

A

5 A’s
* Affective flattening (facial expression is neutral or flat) - blunted affect
o difficulty or cannot express emotion, FACE is unable to tell if sad, mad, happy, etc.
o E.g., Can understand a joke and think it’s funny, but does not smile
* Alogia - reduction in quantity of words spoken
* Avolition - reduced goal directed activity due to decreased motivation
* Asociality – lack of motivation to engage in social interactions
* Anhedonia-reduced experience of pleasure
 e.g., not getting as excited for fun events or experiences
* Ambivalence – mixed feelings and cannot make a decision

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11
Q

What neurotransmitters influence psychotic symptoms?

A

Dopamine and serotonin

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12
Q

What is the diagnostic criteria for schizophrenia?

A
  • Positive and negative symptoms and social or occupational dysfunction

Diagnostic Criteria: Schizophrenia

Two or more of the following symptoms each present for a significant length of time during a 1-month period (at least one must be from the first 3)
 Delusions
 Hallucinations
 Disorganized speech
 Grossly disorganized or catatonic behavior
 Negative symptoms -avolition, anhedonia, affective flatting, asociality, amotivation
 Social or occupational dysfunction

Diagnostic Criteria: Schizophrenia
 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

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13
Q

What is the diagnostic criteria for schizoaffective disorder?

A
  • More severe form and requires manic or depressive episode
    Schizoaffective Disorder: Diagnostic Criteria (DSM-5, 2013)
    Diagnostic Criteria: Schizoaffective Disorder
    At least 2 symptoms of a psychotic disorder for 2 or more weeks
     Delusions
     Hallucinations
     Disorganized speech
     Grossly disorganized or catatonic behavior
     Negative symptoms-flat affect, anhedonia, avolition, amotivation, asociality

AND
 A major mood episode (manic or depressive) that lasts for an uninterrupted period of time
 Mood symptoms present for the majority of the illness

Additional diagnostic Criteria: Schizoaffective Disorder
 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

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14
Q

What do first generation/typical antipsychotic meds do in terms of pharmacological action?

A

decrease dopamine in the brain to help reduce or relieve the symptoms of schizophrenia

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15
Q

What do second generation/atypical antipsychotic meds do in terms of pharmacological action?

A
  • decrease both dopamine and serotonin to help reduce or relieve the symptoms of schizophrenia
  • They block receptors (antagonist)
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16
Q

What antipsychotic medications are associated with weight gain as a side effect?

A
  • Weight gain is a side effect and reason why many ppl stop taking it
    o especially olanzapine and clozapine
    o OLANZAPINE makes you fat like an O
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17
Q

What are the main class of drugs used to treat schizophrenia?

A

Antipsychotic medications
* They are also used to treat people with psychosis that occurs in bipolar disorder, depression and Alzheimer’s disease.
* Other uses of antipsychotics include stabilizing moods in bipolar disorder, reducing anxiety in anxiety disorders and reducing tics in Tourette syndrome.

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18
Q

Name a common first generation/typical antipsychotic

A
  • Haloperidol (Haldol)
  • Thorazine (Chlorpromazine)
  • Fluphenazine (Moditen, Modecate)
  • Trilafon (Perphenazine)
  • Loxapine (Loxitane)
  • Thioridazine (Mellaril)

-zine??

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19
Q

What is the suffix ending for second generation/atypical antipsychotics?

A

-pine
* Olanzapine (Zyprexa)
* Quetiapine (Seroquel)
* Ziprasidone (Zeldox)
* Paliperadone (Invega)
* Aripripazolole (Abilify)
* Risperidone (Risperdal)
* Clozapine (Clozaril)

20
Q

What is a dangerous side effect of clozapine?

A
  • Can lower WBC count so would require weekly bloodwork continuously so it is NOT first choice for treatment
  • Exceptional and can work when other medications fail
  • Most effective, but has challenges
21
Q

Possible Side Effects of Antipsychotic Medications

A

Anticholinergic effects - dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased HR, decreased sweating

CNS effects - dizziness, agitation, confusion

Metabolic syndrome - increased BP, high blood sugar, weight gain, excess body fat around the waist, abnormal cholesterol and triglyceride levels, diabetes

Sexual side effects - decreased sex drive and function, amenorrhea, galactorrhea

Movement disorders - tremors, muscle stiffness, tics

Tardive dyskinesia - involuntary facial movements

Neuroleptic malignant syndrome - fever, muscle stiffness, delirium

22
Q

What are anticholinergic effects symptoms?

A

Dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased HR, decreased sweating

23
Q

What are extrapyramidal symptoms?

A
  • Parkinsonism/pseudoparkinsonism
  • Tardive dyskinesia – involuntary facial movements
  • Acute dystonia - involuntary contractions of muscles of the extremities, face, neck, abdomen, pelvis, or larynx
  • Tardive dystonia - ^ same but more delayed onset
  • Tardive akathisia - restlessness, inability to sit still
  • Akathisia - Inability to sit still
24
Q

The risk of movement disorders is less with first or second generation antipsychotics.

A

Second

25
Q

What medication can be used to control movement effects such as Parkinson’s (improves muscle control and reduces stiffness)

A

Benztropine (anticholinergic)
* To treat movement/extrapyramidal, we reduce antipsychotic dosage and give anticholinergic drug
o Discontinuation of anticholinergic drugs should never be abrupt, it can cause cholinergic rebound and result in withdrawal symptoms such as vomiting, excessive sweating, altered dreams and nightmares
 Should be reduced gradually over several days

26
Q

What is tardive dyskinesia?

A
  • Involuntary facial movements/tics
  • Typical movements involve mouth, tongue, and jaw including lip smacking or sucking
  • There is a 5% increase in risk of developing TD every year a person takes antipsychotic medications
  • Risk of TD is highest with first generation antipsychotics
  • TD can worsen when an individual stops taking medications and can be permanent
27
Q

What is neuroleptic malignant syndrome?

A
  • Fever, muscle stiffness, delirium
  • Any patients w/ fever, fluctuating vital signs, and abrupt changes in LOC should be suspected of NMS
  • More common with first generation antipsychotics
    o If they show these symptoms, you should take action immediately
    o Discontinue administration of any neuroleptic drugs
28
Q

Non-Pharmacological Treatment of Psychotic Disorders

A

Psychotic Disorders: Non-Pharmacotherapeutic Interventions: Psychotherapy
* Cognitive Behavioral Social Skills Training (CBSST)
* Cognitive Behavior Therapy for Psychosis (CBT-P)
* Family Intervention Training (FIT)
* Cognitive Adaptation Training (CAT)
* Illness Management and Recovery (IMR)

29
Q

Cognitive Behavioral Social Skills Training (CBSST)

A
  • An empirically supported manualized intervention that helps individuals with schizophrenia achieve recovery goals
    o Patient go through modules of how to perform skills
  • Interweaves three evidence-based practices:
    o Cognitive behavior therapy
    o Social skills training
    o 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
  • Usually offered as an outpatient intervention to improve functioning and negative symptoms
    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
30
Q

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
    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
    Points:
  • Psychosocial interventions were long overlooked as a treatment for psychosis
  • Cognitive Behavioral Therapy for psychosis (CBTp) was initially developed as an individual treatment, and later as a group-based intervention, to reduce the distress associated with the symptoms of psychosis and improve functioning.
  • Studies have demonstrated that CBTp can result in decreased positive symptoms, improvement in negative symptoms, and improved functioning (
  • In addition, there is evidence to suggest that CBTp can be effective in preventing, or delaying, the transition to full psychosis when used with individuals identified as being at risk of developing psychosis
  • CBTp has emerged as an evidence-based intervention recommended as an adjunct to medication management
31
Q

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:
    o Education about schizophrenia
    o Skill teaching around identifying signs and symptoms of relapse
    o 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
    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
    Points:
  • Family intervention can be started in the in-patient setting or community and is considered an essential component of quality dare for people with schizophrenia by Health Quality Ontario .
  • Specific structured therapeutic activities are assigned to families in session to be completed between sessions
32
Q

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
    o Voice alarm clocks
    o Large Calendars
    o Checklists/schedules
    o Reminder signs
    BENEFITS
  • In depth 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
    Points:
  • Living with schizophrenia involves having a complex disorder often characterized by deficits in cognition as a core symptom. These cognitive impairments have been associated with difficulties in community functioning, including engagement in activities of daily living, occupational functioning, and social relationships.
  • Studies have found CAT improves community functioning, adaptive functioning, performance in activities of daily living, medication adherence, social functioning, work performance, motivation, and quality of life while lessening hospitalizations and relapses rates.
33
Q

Illness Management & Recovery (IMR)

A
  • An evidence-based intervention designed to promote illness self-management
  • Psychoeducational content includes:
    o Recovery strategies
    o Using medication effectively
    o Building social supports
    o Coping with stress
    o Managing persistent symptoms
    o Reducing relapses
    o Getting needs met by the mental health system
    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
    Illness Management and Recovery (IMR) is an evidence-based psychiatric rehabilitation practice whose primary aim is to empower consumers to manage their illnesses, find their own goals for recovery, and make informed decisions about their treatment by teaching them the necessary knowledge and skills.
34
Q

Peer Support Interventions for Psychotic Disorders
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:
    o Daily plan
    o Stressors
    o Early warning signs
    o Signs that things are breaking down or getting worse
    o Crisis plan
    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
  • Helps people to identify 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
  • WRAP Level 1 & 2 courses may not be available in all jurisdictions especially in smaller communities
    Wellness toolbox- skills and strategies for keeping oneself well and and for feeling better when not feeling well
35
Q

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:
    o Raise awareness of the diversity of voices
    o Challenge negative stereotypes, stigma and discrimination
    o Help create more spaces for people to talk freely about voice hearing
    o Raise awareness of different ways to manage distressing, confusing or difficult voices
    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
36
Q

For community treatment of psychotic disorders, what treatment should all people with psychosis or risk of psychosis receive?

A

Psychotic Disorders: Tiered Model of Community Mental Health Treatment
* All individuals should receive Early Intervention in Psychosis (EPI) services to reduce the duration of untreated psychosis and reduce the probability of relapse
o Psychotic education on condition, medications, etc.
o Peer support specialist
o EPI team will be working w/ patient for 3 years so will have same team for years which is good
o Should be able to access these services (EPI team), if you’ve ever experience psychosis (early intervention, does not need to be diagnosed with psychosis to prevent progression)
* Many individuals should receive community-based Intensive Case Management (ICM) services to promote optimal social & occupational functioning
* Individuals with the most functional disability should receive community-based Assertive Community Treatment (ACT) or Flexible Assertive Community Treatment (FACT) services provided by interprofessional teams
o Huge team to support clients for multiple years
o Most intense support for most intense symptoms
in Canada models of care applying principles of supportive community mental health care are common. The tiered model of care is recognized that effective efficient allocation of resources is required to respond to the diversity of needs of people experiencing psychosis.

37
Q

Nursing Screening & Assessment

A

Psychotic Disorders: Nursing Assessment
* Screening
o Brief Psychiatric Rating Scale (BPRS-6)
* Assessment
o Positive and Negative Symptom Scale (PANSS)
o Scale for the Assessment of Negative Symptoms (SANS)
o Scale for the Assessment of Positive Symptoms (SAPS)
o Clinical Global Impression Schizophrenia Scale (CGI-SCH)
* Mental Status Examination
* Suicide Risk Assessment

38
Q

Nursing Interventions

A

Mood Disorders: Nursing Interventions
* 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

39
Q

Anxiety Disorders: Cultural Perspectives & Experiences

A
  • Culture affects the way we express our thoughts, emotions and behaviors
  • There are cultural differences in the way schizophrenia is manifested and treated
  • One of the main differences seen across cultures is the way schizophrenia are expressed
40
Q

Delusional Disorder

A
  • Delusions that are typically non bizarre and adherence to possible situations that can occur in real life
  • E.g., real life situations such as being followed, poisoned, loved at a distance, or deceived by a spouse or lover, loved by a celebrity
  • Unchanged delusion even with reasonable arguments
  • More rare are bizarre delusions that are not ordinary life experiences
41
Q

What is schizophreniform?

A
  • Identical criteria to schizophrenia with exception that duration lasts about 1-6 months, instead of the rest of your life
  • May be early manifestation of schizophrenia
42
Q

Brief Psychotic Disorder

A
  • Episode is brief (at least 1 day and up to a month)
  • Sudden onset and includes at least one of the positive symptoms of schizophrenia
43
Q

Substance-/Medication-Induced Psychotic Disorder

A
  • prominent hallucinations or delusions that are the direct physiologic effects of medication or a substance
  • develop during or after intoxication or withdrawal of a substance
44
Q

What movement side effect of first-generation Haldol antipsychotic?

A

Extrapyramidal effects

45
Q

What generation of antipsychotics have the HIGHER risk for movement disorders, tardive dyskinesia, neuro malignant syndrome, and extrapyramidal effects?

A

First generation/typical

Mental Health - PPN 303 (6 decks)

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