Week 7 Flashcards
define psychosis
- a syndrome of neurocognitive symptoms that impairs cognitive capacity, leading to deficits of perception, functioning, and social relatedness
- a state in which the individual is experiencing hallucinations, delusions, or disorganized thoughts, speech, or behavior
what is primary psychosis related to (3)
- schizophrenia spectrum
- other psychotic disorders
- or psychiatric illnesses
what are examples of psychotic disorders (4)
- delusional disorder
- schizoaffective disorder
- catatonia
- brief psychotic disorder
secondary psychosis can result from (6)
non-psychiatric illnesses such as:
- untreated medical issue (ex. delirium)
- dementia
- medical illness (ex. adrenal or thyroid disorders, vitamin defic., epilepsy, hydrocephalus, MS, encephalitis)
- toxins (carbon monoxide, arsenic, mercury)
- drugs (cannabis, alcohol, cocaine, meth, LSD, anabolic steroids)
- meds (sedative-hypnotics, anticholinergics, anti-seizure meds, corticosteroids)
describe the onset, symptoms, course, and duration of schizophrenia
- onset: usually insidious, gradual
- symptoms: many
- course: chronic
- duration: >6 months
describe the onset, symptoms, course, duration of schizoaffective disorder
- onset: usually insidious
- symptoms: varying, schizophrenia & mood disorder
- course: chronic
- duration: > 6 months
what is delusional disorder
- 1 fixed, ongoing delusion, but can function
describe the onset, symptoms, course, and duration of delusional disorder
- onset: varies, but usually insidious
- symptoms: delusions only
- course: chronic
- duration: >1 month
describe the onset, symptoms, course, and duration of brief psychotic disorder
- onset: sudden
- symptoms: varies
- course: limited
- duration: < 1 month
define schizophrenia
- a complex biochemical brain illness
- affecting a variety of aspects of behaviors, thinking, and emotions
describe the cause of schizophrenia
- unknown
describe how schizophrenia affects diff people
- affects each person differently
- can follow a varying course over time
T or F: there is a higher risk of developing schizophrenia if a close family member has it
- Truew
describe the “positive” and “negative” symptoms of schizophrenia
- positive: addition of features not normally found in healthy people
- negative: absence of features typically present in healthy people
what are 4 categories of positive symptoms of schizophrenia
- hallucinations
- delusions
- disorganized thinking
- behaviors
what are some examples of hallucinations r/t schizophrenia
- visual
- auditory
- tactile
- etc.
what are some examples of delusions r/t schizophrenia (6)
- paranoia, suspicion
- grandoise
- persectutory
- ideas of reference
- thought broadcasting
- religious
what are some examples of disorganized thinking r/t schizophrenia (4)
- tangentiality
- loose associations
- incoherence
- thought blocking
what are some examples of behaviors r/t schizophrenia (3)
- agitation
- potential aggression
- repetitive/ritualistics activity (ex. pacing, folding and unfolding facecloths
what are some negative symptoms of schizophrenia
- affect (flat or blunt)
- alogia
- anergia
- ambivalence
- anhedonia
- avolition
what is alogia
- poverety of speech
- reduced amt, brief answers
what is anergia
- lack of energy
what is ambivalence
- inability to make a decision
- unsure
what is anhedonia
- inability to experience pleasure
- feeling emotionally barren
what is avolition
- reduced motivation
- inability to initiate tasks such as social outings or ADLs
what are the 3 main categories of symptoms of schizophrenia
- positive
- negative
- neurocognitive impairment
what neurocognitive impairment may occur w schizophrenia (4)
may be problems with:
- memory (working)
- sustained attention
- verbal fluency
- executive functioning (processing info & making decisions)
people w schizophrenia may sometimes lack…
- insight into their illness = anosognosia
what are the implications of lack of insight r/t schizophrenia (5)
- may not seek help
- prolonged psychosis
- multiple hospitalizations
- impairs rehab & recovery
- requires ongoing teaching
see the ppt for the DSM-V Diagnostic Criteria for Schizophrenia
- kinda long, no point of memorizing for an open book exam
what are the 3 phases of a psychotic episode
- prodome (early symptoms)
- acute
- recovery
describe the prodome phase of psychosis
- 1 month to a year before acute psychotic episode
- symptoms: feeling strange or unusual, loss of interest, withdrawal, etc.
describe the acute phase of psychosis
- clearly psychotic symptoms such as disorganized thinking, hallucinations, delusions
describe the recovery phase of psychosis
- stabilization
- symptom management
what are the neurobiological theories for the causes of schizophrenia (4)
- neurotransmitters, pathways, and receptors (neurochemical imbalances)
- neurodevelopmental (prenatal exposure –> viruses, infections)
- neuroanatomic changes (ex. enlarged ventricles, decreased grey matter)
- genetic predisposition (first-degree biologic relatives have 10x greater risk)
what plays a significant role in controlling symptoms that can affect ability to function?
-antipsychotics
what are 2 primary categories of antipsychotic drugs
- typical or convential antipsychotics (first-generation)
- atypical (second & third generations)
what are 3 examples of first generation antipsychotics
- chlorpromazine
- fluphenazine*
- haloperidol (haldol)*
- = also available in long-acting (depot) format
what are 2 categories of side effects of typical antipsychotics
- extrapyramidal side effects
- neuroleptic malignant syndrome
what are extrapyramidal side effects
- parkinsonism tremors (small regular movements)
- dystonia (involuntary strained muscle contractions)
- akathisia (muscle tension, motor restlessness)
- tardive dyskinesia (irreversible)
what is often the first sign of tardive dyskinesia
- tongue movement
what are some parkinsonism symptoms seen w schizophrenia (9)
- tremors
- bradykinesia/akinesia
- cogwheel rigidity
- postural instability
- stooped/hunched posture
- shuffling gait
- restricted movement
- masked face (loss of mobility of facial muscles)
- hypersalivations & drooling
what are some symptoms of acute dystonia (4)
- involuntary strained muscle contarctions
- torticollis –> neck muscle contraction, pulling head to side
- oculogyric crisis –> eyes twist up and can’t look down
- opisthotonos –> severe doral arching of neck & back
what are some symptoms of akathisia (3)
- “not sitting”
- pacing, motor restlessness, rocking, foot tapping, energy like jolts of electric currents
- subjective complaint of inner restlessness, irritability, inability to sit still or lie down
what are some symptoms of tardive dyskinesia (3)
- late occurring abnormal movements
- oral, buccal, lingual, and masticatory movements (tongue thrusting, lip pursing & smacking, facial grimaces, chewing movements) –> classic description
- rapid, jerky, slow, and writhing movements (choreoathetoid movements)
describe treatment of tardive dyskinesia
- irreversible
- switch to a second generation neuroleptic or decrease dosage (individualized)
what is used to assess Tardive Dyskinesia (2)
- abnormal involuntary movement scale (AIMS)
- dyskinesia identification system
what can be used to treat EPS
- benztropine mesylate (cogentin)
what can benzotropine mesylate (Cogentin) be used for
- for medication-related movement disorders: pseudoparkinsonism, rigidity, akathisia
- anitparkinson agent
what is the treatment for acute dystonias (acute or urgent situation)
- cogentin
- benadryl (IM)
what is neuroleptic malignant syndrome
- rare but potentially fatal
- ranges from acute renal failure to rhabdomyolysis
- can occur within first 2 weeks of antipsychotic use
what are risk factors for neuroleptic malignant syndrome
- dehydration
- hx of NMS
- recent dose increase
- psychomotor agitation
what is included in the diagnostic criteria of NMS
- changes in mental status
- tachycardia
- HTN or hypotension
- tachypnea or hypoxia
- diaphoresis
- tremor
- incontinence
- elevated creatine phosphokinase
- lead pipe muscle rigidity
- confusion, delirium, stupor, coma
what is the treatment of NMS
- nursing care
what are some side effects of atypical antipschotics (5)
- orthostatic hypotension
- metabolic syndrome (weight gain, hyperlipidemia, impaired glucose metabolism –> diabetes)
- sedation
- cardiac arrhythmias
- sexual side effects (amenorrhea, gynecomastia, decreased libido)
what are examples of atypical antipsychotics (4)
- resperidone
- olanzapine
- quetiapine
- clozapine
what impact does atypical antipsychotics have
- affect several neurotransmitter systems
- addresses both positive & negative symptoms of schizophrenia
what is clozapine used for
- used effectively for mngmt of symptoms of treatment resistance schizophrenia
- not first line d/t risk of serious side effects
what does clozapine require
- ongoing blood monitoring for agrunalocytosis
- blood tests q4weeks
at what point might a person be hospitalized r/t psychosis
- self-harm
- cant compelte ADLs
what is important to assess in acute care setting (9)
- MSE
- risk of suicide
- comorbidities
- what symptoms are they having now
- home situation, supports, contact person
- med side effects , what they’re on
- barriers to med adherence
- triggers, substance abuse
- collateral info (from family MD, friends, family)
what are priority care ussues during an acute phase of psychosis
- safety
- managing immediate symptoms
- decrease stimuli
what can a nurse do if a pt tells the nurse that they believe the hospital food is poisoned and they refuse to eat it (5)
- help them make food themselves
- allow them to watch you make food
- encourage family to bring food
- try to reinforce reality
- shared your perspective but emphasize you want to hear about theirs
what is the benefit of early identification of psychosis
- can result in better outcomes
what are nursing interventions for nutritional intake in acute care setting?
- rehydrate (dehydration can be a trigger)
what is a nursing intervention for ADLS in acute care settings
- pt may not perform spontaneously –> be firm, but kind
what is a nursing intervention for ADLS in acute care settings
- pt may not perform spontaneously –> be firm, but kind
what is a nursing intervention in acute care settings
- reassurance
what are nursing interventions for fear/anxiety/paranoia in acute care settings (2)
- reassurance
- assess thought content
what is a nursing intervention for acute care settings
- reality testing –> “I know you’re hearing that but…”
what are some family interventions to provide family support
- ask “how ru”
- crisis intervention model –> perception of event, coping, resources
- partnership w families
- education for families
what are community interventions for psychosis
- community mental health program
- program of assertive community treatment (PACT)
- “putting housing first” project
what is PACT
- designed to meet the needs of people w severe and persistent mental illness
describe the key finding of the “putting housing first project”
- makes better use of public funding by shifting dollars aware from expensive services, resulting in cost savings
