Week 8 - Important Concepts Flashcards
Describe the public stigma that individuals with psychotic disorders may face.
Stereotype of danger and criminality
Prejudice leading to fear
Discrimination: alienation, marginalization
What self-stigma may individuals with psychotic disorders develop?
Stereotype of incompetence
Lower self esteem and negative self concept as a result of prejudice
Fail to pursue goals as a result of discrimination
What are some key components of all psychotic disorders?
Which is the defining feature?
Abnormal thinking and perception
Disconnect with reality - (defining feature of many psychotic disorders)
Significant inability to exercise good judgement
Significant impairment in functional capacity
What are the different components of biological theories in explaining the development of schizophrenia?
Biological theories - structural brain changes, neurochemical abnormalities, genetic mutations, prenatal stressors contribute to the development of schizo
Describe psychological theories in the etiology of schizophrenia.
Problems in early childhood development lead to difficulty achieving milestones
Describe social theories in describing schizo etiology.
No good theories; some interest in family patterns influencing later outcomes
What are some risk factors for developing schizophrenia?
Prenatal stressors, obstetrical complications, genetic/family susceptibilities
Describe the genetic role in the development of schizo.
Dr. Shieba Sing published research on twins indicating that genetic mutations take place in schizo development
First degree biologic relatives have 10x greater risk for schizo than the general population
Schizophrenia:
_____ in children prior to adolescence.
Often we find symptoms of schizo _______.
What are some issues in children that may lead to a schizophrenia diagnosis?
Rare retroactively Delays in attainment of verbal/motor development Problems in social adjustment Poor academic performance Hallucinations, delusions (rare)
What is important if signs and symptoms may indicate schizophrenia in children?
Rule out other disorders first
Late onset schizophrenia:
- Diagnostic criteria met after ____
- Most likely to include these
- May report a period of time with ________ symptoms. Why?
- How is late onset schizophrenia usually diagnosed?
45
positive symptoms
improved
- may be because younger patients have not lived with schizophrenia long enough to experience symptom reprieve, like adults may
Often pts come in for a comorbid condition, and the schizophrenia is only caught then
Schizophrenia diagnosis:
- Presence of at least ____ of the following (Delusions, hallucinations, disorganized speech, disorganized/catatonic behaviour, negative symptoms)
- One of the ____ symptoms must be one of the these. Which ones?
- Continuous signs of disturbance persist for __ ______
- Symptoms must be active for at least _______ with marked ______/_______ deterioration
2
2
hallucinations, delusions, disorganized speech
6 months
1 month at least with marked social/occupational deterioration
Excess/distortion of something normal
Lessening/loss of normal functions.
Positive symptoms
Negative symptoms
Which of the following is a positive symptom? Which is a negative? 1 - delusions 2 - blunting 3 - Alogia 4 - Nihilism 5 - Somatic symptoms 6 - Hallucinations 7 - Avolition 8 - Anhedonia
1 - positive 2 - negative 3 - negative 4 - positive 5 - positive 6 - positive 7 - negative 8 - negative
Client believes he or she is dead, or that an imminent catastrophic event is incomining
Nihilism/nihilistic
Believes that something is occurring to the body that isn’t
somatic
Absence of speech, directly related to overwhelming nature of the mental illness
Alogia
Lack of motivation
Avolition
Schizophrenia
- More prevalent in this gender
- onset in men
- onset in women
men
early 20s
late 20s
Seemingly innocuous things that appear that precede evolution of mental illness - may not seem odd at first, but looking back, we realize it was peculiar
Prodromal symptoms
What are the different of schizophrenia treatment?
Initial, stabilization, maintenance and recovery, relapse
Early interventions in schizophrenia may produce these benefits.
Decrease duration of untreated psychosis
Minimize disability/prevent relapse
What is the acronym for schizophrenia treatment?
AIMSSS
- assessments, initiation of medications, suicide risk, sleep, substance use
Treatment is intense during this period as medication regimens are established.
Stabilization
During this phase of schizophrenia treatment, socialization with others increases and rehabilitation begins.
stabilization phase
Describe recovery in schizophrenia traetment.
Recovery focuses on regaining function, minimizing disability and improving QOL.
However, the person will not return to their original sense of normalcy
What are ways in which family are involved in schizophrenia treatment?
Family support is important - only if supportive
Educate family for signs and symptoms of relapse
Help family cope with relapse
What is a major factor leading to relapse in schizophrenia patients?
Non-adherence to medication
Safety and suicide risk assessment would be completed during this schizophrenia treatment phase.
Relapse
Describe issues with water balance in schizophrenia.
Pts may compulsively drink obscene amounts of water - unrelated to thirst - which may lead to water intoxication, sharp hyponatremia, brain edema, increased intracranial pressure and death
What is the relationship between diabetes and schizophrenia?
Schizophrenia pts have increased fasting glucose - are more tolerant to glucose (insulin resistant)
Which antipsychotics are used in schizophrenia treatment?
Newer (atypical) antipsychotics - since efficacious and safer
Pharmacology of schizophrenia treatment:
- Takes __-___ ____ to work (although some improvement may occur immediately)
- need at least __ _____ to truly gauge effectiveness of meds
- _______ to medication is the best prevention of relapse
- ______ is rare - i.e. the person no longer needs drugs
1-2 weeks to work
need 6 weeks to gauge effectiveness
adherence
discontinuation
Describe teaching points in schizophrenia for:
- Side effects and management
abrupt cessation of drugs is not the solution for sides
Identical symptoms to PD. Treated with _______ medications.
Parkinsonism
anticholinergic
Dystonia:
- caused by an imbalance in what?
- this population is more vulnerable
- Eyes point upward (_______) and ______/________ (head back and turned to the side/neck goes back) - can be a ________ risk
Ach and dopamine young men ocylogyric crisis torticollis/retrocollis swallowing risk
Restlessness, uncomfortable drive to keep moving.
How is it treated?
Akathesia
- Reduce dose of antipsychotic
(limited evidence for beta blockers helping)
Involuntary movement of face, tongue, limbs, body.
Treatment?
When does it appear?
_____ hazard
TD
No treatment, often irreversible
Often appears later (3-6 months after Tx initiation)
choking hazard
Neuroleptic malignant syndrome: - serious potentially fatal - typical onset within \_\_ days, once started \_\_-\_\_\_ evolution - What are the symptoms? What medications usually cause it?
10 days for onset
evolution 2-72h
Symptoms include:
- severe muscle rigidity, fever, autonomic instability, change in LOC
(renal failure, seizure, coma, death may occur if prompt treatment is not initiated)
Generally 1st gen meds cause it, but can also be due to atypical ones as well
What are some nursing interventions for neuroleptic malignant syndrome?
Stop administration of offending medications
Monitor vitals
Reduce body temp (may be very febrile)
Protect muscles
What is the proverb for anticholinergic crisis?
Hot as a hare (hyperthermia), blind as a bat (mydriasis), mad as a hatter (hallucinations, confusion), dry as a bone (dry mouth/eyes)
Nursing interventions for anticholinergic crisis:
- Episodes usually ___-______ - typically lasting __ days
- Sometimes hard to notice since the symptoms are similar to those of _________
- if untreated, may progress to this
- _______ is frequently used for treating and diagnosing anticholinergic crisis
What other treatments are there?
Self-limiting - 3 days
schizophrenia
if untreated, may progress to coma or cardiac/respiratory depression
Physostigmine
other treatments include gastric lavage and activated charcoal
(catharsis - moves thing faster through bowel - no evidence to support)
Describe command hallucinations.
Hallucinations which tell the person to do something
Describe an errorless learning environment?
Directive environment - will not let the person screw it up and mess it up - will kind of force the person
Describe how a nurse should interact with a hallucinating patient?
need to take the hallucinations/delusions seriously, but do not feed into them
What is a tool that is used in the social nursing assessment for schizophrenia?
WHODAS - WHO Disability Assessment schedule
What is a very important consideration for schizophrenic patients before they go back to the community?
Aggression - need to acknowledge that aggression may occur and the need help to circumvent these situations or manage them
What is an important consideration for the spiritual side for schizophrenic patients?
They may find difficulty in finding meaning in life, as things will likely not go back to normal.
Must help minimize disability and maximize function.
Where does most care for schizophrenic patients occur?
in the community
