Week 8 psychosis Flashcards
What is psychosis?
unable to do reality testing
What is schizophrenia?
when someone has a break from reality
hallucinations/illusions
grandeur
onset is 15-35 age
affects ADLs, physical health, and QOL
people with schizophrenia tend to have higher risk for what comorbidities?
Diabetes
heart disease
etc
What are the causes of schizophrenia?
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
What makes schizophrenia and mood disorders different with neurotransmitters?
schiz- too much neurotransmitters
mood disorders - decreased neurotransmitters
What is the diagnosis criteria for schizophrenia?
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
what are positive symptoms in schizophrenia?
something not usually there
- responds well to anti-psychotic meds
- hallucinations
- delusions
- disorganized speech
- bizarre behaviour
What might someone with schizophrenia experience in the Prodomal stage?
-feel strange
- odd beliefs
- odd behaviour
- socially withdrawn
- lose interest in previously enjoyed activities
What are negative symptoms in schizophrenia?
develop slowly
interfere with coping
-blunted affect
- poverty of thought (alogia)
- loss of motivation (avolition)
- no joy (anhedonia)
what are cognitive symptoms of schizophrenia?
- inattention/ easily distracted
- imparied memory
- poor problem solving
- poor decision making
- illogical thinking
- impaired judgement
What are affective symptoms of schizophrenia?
- dysphoria
- suicidality
- hopelessness
what is anosognosia and which disorder is affected by it?
lacking insite into your disorder
schizophrenia
What is the goal of phase 1 (acute) for schizophrenia intervention?
- safety & crisis intervention
- drugs
What is the goal of phase 2 (stabilization) for schizophrenia intervention?
- med follow through
- coping with +/- symptoms
- promote recovery
What is the goal of phase 3 (maintenance) for schizophrenia intervention?
- ongoing recovery
- health education
- encourage family involvement
- liase with community supports
What are neuroleptic antipsychotics?
1st gen (typical)
- haldol
- chlorpromazine
2nd gen (atypical)
-risperidone
- quetiapine
- clozapine
3rd gen
- aripiprazole
what do the first generation antipsychotics affect?
dopamine
positive symptoms
what do 2nd generation antipsychotics affect?
seratonin
negative symptoms
what do 3rd generation antipsychotics affect?
dopamine stabilizers
which disorder can medications be given by DEPOT?
antipsychotics- schitzophrenia
What symptoms can occur with antipsychotic medications (usually atypical or 1st gen)
EPS - parkinsonism , acute dystonia symptoms, Akathisia
- treatable
Tardive dyskinesia
-irreversible
What do we do if someone experiences Akathisia symptoms?
decrease dosage
propanolol
what med is given to help with EPS (parkinson symptoms?
Benztropine mesylate (cogentin)
if acute - cogentin or benadryl IM
What is neuroleptic malignant syndrome from?
typical or high potency antipsychotics
When does NMS usually occur?
within first 30 days of antipsychotic use
What are the risk factors for NMS?
dehydration
history of NMS
recent dose increase
switching rapidly from one dopamine receptor agonist to another
What is used in NMS to help ?
stop that antipsychotic
bromocriptine
supportive nursing
symptoms of NMS
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
what are the typical antipsychotics?
Chlorpromazine (Thorazine) Loxapine (Loxitane)
Fluphenazine (Prolixin) Thiothixene (Navane)
Haloperidol (Haldol) - “Haloperidol for Hallucinations”
what is the MOA of typical antipsychotics (1st gen)
dopamine D2 receptor antagonist in both limbic and motor centers
Anticholinergic side effects present with which drug class?
typical antipsychotics (1st gen)
what are the main symptoms of NMS?
Fever
aLOC
rigidity
tremors
autonomic dysfunction
What are serious side effects of clozapine that make it not a first line treatment?
agranulocytosis - loss of neutrophils for fighting infection - need routine CBCs
myocarditis - need annual EKGs
When is clozapine used?
symptoms of treatment-resistant schizophrenia
what are the atypical antipsychotics - 2nd&3rd gen?
Clozapine Olanzapine (Zyprexa)
Risperidone (Risperdal) Quetiapine (Seroquel)
Lurasidone Paliperidone
Ziprasidone Aripiprazole (Abilify)
Which drug class is used for both positive and negative symptoms?
Atypical antipsychotics
Which drug class is used for positive symptoms only?
typical antispychotics
what do we need to monitor in people taking atypical antipsychotics?
agranulocytosis - low WBC, high infection risk
what do we need to monitor in someone with clozapine?
sore throat, fever
d/t agranulocytosis
What antispsychotic do we not give in dementia?
Risperidone
At what point might someone with schizophrenia be hospitalized?
- can’t do ADLs
- safety
