Week 8 psychosis

Question 1

What is psychosis?

Answer 1

unable to do reality testing

Question 2

What is schizophrenia?

Answer 2

when someone has a break from reality
hallucinations/illusions
grandeur

onset is 15-35 age

affects ADLs, physical health, and QOL

Question 3

people with schizophrenia tend to have higher risk for what comorbidities?

Answer 3

Diabetes
heart disease
etc

Question 4

What are the causes of schizophrenia?

Answer 4

neurotransmitters: (excess)
dopamine
serotonin
glutamate

neurodevelopmental: prenatal exposure to viruses & infections

Neuroanatomic changes - enlarged ventricles, decreased grey matter

Genetic predisposition - first degree relative raises risk 10x

Psychosocial factors - aces, toxins, developmental & social stressors

Question 5

What makes schizophrenia and mood disorders different with neurotransmitters?

Answer 5

schiz- too much neurotransmitters

mood disorders - decreased neurotransmitters

Question 6

What is the diagnosis criteria for schizophrenia?

Answer 6

must have at least 1 of
1. delusions
2. halluciantions
3. disorganized speech

for most of the time for 1 month period

plus one of:
1. stupor/catatonic behaviour
2. negative symptoms
3. social/occupational dysfunction
4. continuous signs for at least 6 months

Question 7

what are positive symptoms in schizophrenia?

Answer 7

something not usually there
- responds well to anti-psychotic meds

• hallucinations
• delusions
• disorganized speech
• bizarre behaviour

Question 7

What might someone with schizophrenia experience in the Prodomal stage?

Answer 7

-feel strange
- odd beliefs
- odd behaviour
- socially withdrawn
- lose interest in previously enjoyed activities

Question 8

What are negative symptoms in schizophrenia?

Answer 8

develop slowly
interfere with coping
-blunted affect
- poverty of thought (alogia)
- loss of motivation (avolition)
- no joy (anhedonia)

Question 9

what are cognitive symptoms of schizophrenia?

Answer 9

• inattention/ easily distracted
• imparied memory
• poor problem solving
• poor decision making
• illogical thinking
• impaired judgement

Question 10

What are affective symptoms of schizophrenia?

Answer 10

• dysphoria
• suicidality
• hopelessness

Question 11

what is anosognosia and which disorder is affected by it?

Answer 11

lacking insite into your disorder

schizophrenia

Question 12

What is the goal of phase 1 (acute) for schizophrenia intervention?

Answer 12

1. safety & crisis intervention
2. drugs

Question 13

What is the goal of phase 2 (stabilization) for schizophrenia intervention?

Answer 13

1. med follow through
2. coping with +/- symptoms
3. promote recovery

Question 14

What is the goal of phase 3 (maintenance) for schizophrenia intervention?

Answer 14

1. ongoing recovery
2. health education
3. encourage family involvement
4. liase with community supports

Question 15

What are neuroleptic antipsychotics?

Answer 15

1st gen (typical)
- haldol
- chlorpromazine

2nd gen (atypical)
-risperidone
- quetiapine
- clozapine

3rd gen
- aripiprazole

Question 16

what do the first generation antipsychotics affect?

Answer 16

dopamine
positive symptoms

Question 17

what do 2nd generation antipsychotics affect?

Answer 17

seratonin
negative symptoms

Question 18

what do 3rd generation antipsychotics affect?

Answer 18

dopamine stabilizers

Question 19

which disorder can medications be given by DEPOT?

Answer 19

antipsychotics- schitzophrenia

Question 20

What symptoms can occur with antipsychotic medications (usually atypical or 1st gen)

Answer 20

EPS - parkinsonism , acute dystonia symptoms, Akathisia
- treatable

Tardive dyskinesia
-irreversible

Question 21

What do we do if someone experiences Akathisia symptoms?

Answer 21

decrease dosage
propanolol

Question 22

what med is given to help with EPS (parkinson symptoms?

Answer 22

Benztropine mesylate (cogentin)

if acute - cogentin or benadryl IM

Question 23

What is neuroleptic malignant syndrome from?

Answer 23

typical or high potency antipsychotics

Question 24

When does NMS usually occur?

Answer 24

within first 30 days of antipsychotic use

Question 25

What are the risk factors for NMS?

Answer 25

dehydration
history of NMS
recent dose increase
switching rapidly from one dopamine receptor agonist to another

Question 26

What is used in NMS to help ?

Answer 26

stop that antipsychotic
bromocriptine
supportive nursing

Question 27

symptoms of NMS

Answer 27

Incontinence
Change in mental status: confusion, delirium, stupor, coma
Dehydration
Potential renal failure
Elevated Creatinine phosphokinase
Hyperpyrexia
Tachycardia
Labile hypertension
Tachypnea or hypoxia
Diaphoresis
Lead pipe muscle rigidity
Tremor
Drooling

Question 28

what are the typical antipsychotics?

Answer 28

Chlorpromazine (Thorazine) Loxapine (Loxitane)
Fluphenazine (Prolixin) Thiothixene (Navane)
Haloperidol (Haldol) - “Haloperidol for Hallucinations”

Question 29

what is the MOA of typical antipsychotics (1st gen)

Answer 29

dopamine D2 receptor antagonist in both limbic and motor centers

Question 30

Anticholinergic side effects present with which drug class?

Answer 30

typical antipsychotics (1st gen)

Question 31

what are the main symptoms of NMS?

Answer 31

Fever
aLOC
rigidity
tremors
autonomic dysfunction

Question 32

What are serious side effects of clozapine that make it not a first line treatment?

Answer 32

agranulocytosis - loss of neutrophils for fighting infection - need routine CBCs

myocarditis - need annual EKGs

Question 32

When is clozapine used?

Answer 32

symptoms of treatment-resistant schizophrenia

Question 33

what are the atypical antipsychotics - 2nd&3rd gen?

Answer 33

Clozapine Olanzapine (Zyprexa)
Risperidone (Risperdal) Quetiapine (Seroquel)
Lurasidone Paliperidone
Ziprasidone Aripiprazole (Abilify)

Question 34

Which drug class is used for both positive and negative symptoms?

Answer 34

Atypical antipsychotics

Question 35

Which drug class is used for positive symptoms only?

Answer 35

typical antispychotics

Question 36

what do we need to monitor in people taking atypical antipsychotics?

Answer 36

agranulocytosis - low WBC, high infection risk

Question 37

what do we need to monitor in someone with clozapine?

Answer 37

sore throat, fever
d/t agranulocytosis

Question 38

What antispsychotic do we not give in dementia?

Answer 38

Risperidone

Question 39

At what point might someone with schizophrenia be hospitalized?

Answer 39

• can’t do ADLs
• safety