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NURS 3514 - Mental Health > Week 7 > Flashcards

Week 7 Flashcards

1
Q

define psychosis

A
  • 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
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2
Q

what is primary psychosis related to (3)

A
  • schizophrenia spectrum
  • other psychotic disorders
  • or psychiatric illnesses
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3
Q

what are examples of psychotic disorders (4)

A
  • delusional disorder
  • schizoaffective disorder
  • catatonia
  • brief psychotic disorder
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4
Q

secondary psychosis can result from (6)

A

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)
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5
Q

describe the onset, symptoms, course, and duration of schizophrenia

A
  • onset: usually insidious, gradual
  • symptoms: many
  • course: chronic
  • duration: >6 months
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6
Q

describe the onset, symptoms, course, duration of schizoaffective disorder

A
  • onset: usually insidious
  • symptoms: varying, schizophrenia & mood disorder
  • course: chronic
  • duration: > 6 months
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7
Q

what is delusional disorder

A
  • 1 fixed, ongoing delusion, but can function
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8
Q

describe the onset, symptoms, course, and duration of delusional disorder

A
  • onset: varies, but usually insidious
  • symptoms: delusions only
  • course: chronic
  • duration: >1 month
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9
Q

describe the onset, symptoms, course, and duration of brief psychotic disorder

A
  • onset: sudden
  • symptoms: varies
  • course: limited
  • duration: < 1 month
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10
Q

define schizophrenia

A
  • a complex biochemical brain illness

- affecting a variety of aspects of behaviors, thinking, and emotions

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11
Q

describe the cause of schizophrenia

A
  • unknown
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12
Q

describe how schizophrenia affects diff people

A
  • affects each person differently

- can follow a varying course over time

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13
Q

T or F: there is a higher risk of developing schizophrenia if a close family member has it

A
  • Truew
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14
Q

describe the “positive” and “negative” symptoms of schizophrenia

A
  • positive: addition of features not normally found in healthy people
  • negative: absence of features typically present in healthy people
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15
Q

what are 4 categories of positive symptoms of schizophrenia

A
  • hallucinations
  • delusions
  • disorganized thinking
  • behaviors
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16
Q

what are some examples of hallucinations r/t schizophrenia

A
  • visual
  • auditory
  • tactile
  • etc.
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17
Q

what are some examples of delusions r/t schizophrenia (6)

A
  • paranoia, suspicion
  • grandoise
  • persectutory
  • ideas of reference
  • thought broadcasting
  • religious
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18
Q

what are some examples of disorganized thinking r/t schizophrenia (4)

A
  • tangentiality
  • loose associations
  • incoherence
  • thought blocking
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19
Q

what are some examples of behaviors r/t schizophrenia (3)

A
  • agitation
  • potential aggression
  • repetitive/ritualistics activity (ex. pacing, folding and unfolding facecloths
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20
Q

what are some negative symptoms of schizophrenia

A
  • affect (flat or blunt)
  • alogia
  • anergia
  • ambivalence
  • anhedonia
  • avolition
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21
Q

what is alogia

A
  • poverety of speech

- reduced amt, brief answers

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22
Q

what is anergia

A
  • lack of energy
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23
Q

what is ambivalence

A
  • inability to make a decision

- unsure

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24
Q

what is anhedonia

A
  • inability to experience pleasure

- feeling emotionally barren

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25
Q

what is avolition

A
  • reduced motivation

- inability to initiate tasks such as social outings or ADLs

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26
Q

what are the 3 main categories of symptoms of schizophrenia

A
  • positive
  • negative
  • neurocognitive impairment
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27
Q

what neurocognitive impairment may occur w schizophrenia (4)

A

may be problems with:

  • memory (working)
  • sustained attention
  • verbal fluency
  • executive functioning (processing info & making decisions)
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28
Q

people w schizophrenia may sometimes lack…

A
  • insight into their illness = anosognosia
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29
Q

what are the implications of lack of insight r/t schizophrenia (5)

A
  • may not seek help
  • prolonged psychosis
  • multiple hospitalizations
  • impairs rehab & recovery
  • requires ongoing teaching
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30
Q

see the ppt for the DSM-V Diagnostic Criteria for Schizophrenia

A
  • kinda long, no point of memorizing for an open book exam
31
Q

what are the 3 phases of a psychotic episode

A
  • prodome (early symptoms)
  • acute
  • recovery
32
Q

describe the prodome phase of psychosis

A
  • 1 month to a year before acute psychotic episode

- symptoms: feeling strange or unusual, loss of interest, withdrawal, etc.

33
Q

describe the acute phase of psychosis

A
  • clearly psychotic symptoms such as disorganized thinking, hallucinations, delusions
34
Q

describe the recovery phase of psychosis

A
  • stabilization

- symptom management

35
Q

what are the neurobiological theories for the causes of schizophrenia (4)

A
  • 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)
36
Q

what plays a significant role in controlling symptoms that can affect ability to function?

A

-antipsychotics

37
Q

what are 2 primary categories of antipsychotic drugs

A
  • typical or convential antipsychotics (first-generation)

- atypical (second & third generations)

38
Q

what are 3 examples of first generation antipsychotics

A
  • chlorpromazine
  • fluphenazine*
  • haloperidol (haldol)*
  • = also available in long-acting (depot) format
39
Q

what are 2 categories of side effects of typical antipsychotics

A
  • extrapyramidal side effects

- neuroleptic malignant syndrome

40
Q

what are extrapyramidal side effects

A
  • parkinsonism tremors (small regular movements)
  • dystonia (involuntary strained muscle contractions)
  • akathisia (muscle tension, motor restlessness)
  • tardive dyskinesia (irreversible)
41
Q

what is often the first sign of tardive dyskinesia

A
  • tongue movement
42
Q

what are some parkinsonism symptoms seen w schizophrenia (9)

A
  • tremors
  • bradykinesia/akinesia
  • cogwheel rigidity
  • postural instability
  • stooped/hunched posture
  • shuffling gait
  • restricted movement
  • masked face (loss of mobility of facial muscles)
  • hypersalivations & drooling
43
Q

what are some symptoms of acute dystonia (4)

A
  • 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
44
Q

what are some symptoms of akathisia (3)

A
  • “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
45
Q

what are some symptoms of tardive dyskinesia (3)

A
  • 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)
46
Q

describe treatment of tardive dyskinesia

A
  • irreversible

- switch to a second generation neuroleptic or decrease dosage (individualized)

47
Q

what is used to assess Tardive Dyskinesia (2)

A
  • abnormal involuntary movement scale (AIMS)

- dyskinesia identification system

48
Q

what can be used to treat EPS

A
  • benztropine mesylate (cogentin)
49
Q

what can benzotropine mesylate (Cogentin) be used for

A
  • for medication-related movement disorders: pseudoparkinsonism, rigidity, akathisia
  • anitparkinson agent
50
Q

what is the treatment for acute dystonias (acute or urgent situation)

A
  • cogentin

- benadryl (IM)

51
Q

what is neuroleptic malignant syndrome

A
  • rare but potentially fatal
  • ranges from acute renal failure to rhabdomyolysis
  • can occur within first 2 weeks of antipsychotic use
52
Q

what are risk factors for neuroleptic malignant syndrome

A
  • dehydration
  • hx of NMS
  • recent dose increase
  • psychomotor agitation
53
Q

what is included in the diagnostic criteria of NMS

A
  • 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
54
Q

what is the treatment of NMS

A
  • nursing care
55
Q

what are some side effects of atypical antipschotics (5)

A
  • orthostatic hypotension
  • metabolic syndrome (weight gain, hyperlipidemia, impaired glucose metabolism –> diabetes)
  • sedation
  • cardiac arrhythmias
  • sexual side effects (amenorrhea, gynecomastia, decreased libido)
56
Q

what are examples of atypical antipsychotics (4)

A
  • resperidone
  • olanzapine
  • quetiapine
  • clozapine
57
Q

what impact does atypical antipsychotics have

A
  • affect several neurotransmitter systems

- addresses both positive & negative symptoms of schizophrenia

58
Q

what is clozapine used for

A
  • used effectively for mngmt of symptoms of treatment resistance schizophrenia
  • not first line d/t risk of serious side effects
59
Q

what does clozapine require

A
  • ongoing blood monitoring for agrunalocytosis

- blood tests q4weeks

60
Q

at what point might a person be hospitalized r/t psychosis

A
  • self-harm

- cant compelte ADLs

61
Q

what is important to assess in acute care setting (9)

A
  • 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)
62
Q

what are priority care ussues during an acute phase of psychosis

A
  • safety
  • managing immediate symptoms
  • decrease stimuli
63
Q

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)

A
  • 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
64
Q

what is the benefit of early identification of psychosis

A
  • can result in better outcomes
65
Q

what are nursing interventions for nutritional intake in acute care setting?

A
  • rehydrate (dehydration can be a trigger)
66
Q

what is a nursing intervention for ADLS in acute care settings

A
  • pt may not perform spontaneously –> be firm, but kind
67
Q

what is a nursing intervention for ADLS in acute care settings

A
  • pt may not perform spontaneously –> be firm, but kind
68
Q

what is a nursing intervention in acute care settings

A
  • reassurance
69
Q

what are nursing interventions for fear/anxiety/paranoia in acute care settings (2)

A
  • reassurance

- assess thought content

70
Q

what is a nursing intervention for acute care settings

A
  • reality testing –> “I know you’re hearing that but…”
71
Q

what are some family interventions to provide family support

A
  • ask “how ru”
  • crisis intervention model –> perception of event, coping, resources
  • partnership w families
  • education for families
72
Q

what are community interventions for psychosis

A
  • community mental health program
  • program of assertive community treatment (PACT)
  • “putting housing first” project
72
Q

what is PACT

A
  • designed to meet the needs of people w severe and persistent mental illness
73
Q

describe the key finding of the “putting housing first project”

A
  • makes better use of public funding by shifting dollars aware from expensive services, resulting in cost savings

NURS 3514 - Mental Health (11 decks)

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