Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Treatment Spring 2024 (Test) > Week 8: Psychotic Disorders > Flashcards

Week 8: Psychotic Disorders Flashcards

1
Q

Schizophrenia Positive Symptoms

A

Hallucinations, delusion, disorganized speech and/or behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How many positive or negative symptoms does one need for a schizophrenia diagnosis?

A

One

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Schizophrenia negative symptoms

A

anhedonia, flattening of affect, social isolation, lack of self-care and daily tasks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When do schizophrenia symptoms usually appear

A

late adolescence and early adulthood (16 - 30)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Type of approach, what to assess, what to attend to, and what’s critical?

Schizophrenia Treatment as whole; the counselor’s approach, assessment, attendance to, and outreach

Counselor considerations

Four items listed

A
  1. strength-based approach –> utilize and build on the clients’ strengths
  2. Thoroughly assess symptoms and other life experiences
  3. Attend to physical wellness
  4. Family engagement and support are critical in treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the ‘three pillars’ of treatment?

A
  1. medications
  2. psychosocial interventions
  3. vocational rehabilitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What’s so important about the specific phase of schizophrenia

A

Goals and focus of treatment for schizophrenia are dependent on each one.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the three phases of schizophrenia treatment?

A
  1. Acute phase
  2. Stabilization phase
  3. Stable Phase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the main goals of the acute phase of treatment planning for schizophrenia?

Two of them

What are we working towards?

A

stabilization & crisis management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What types of things would a counselor see during the acute phase of schizophrenia treatment?

A

active symptoms of psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the first line of treatment for schizophrenia and how long should it take?

Three Items

What, aproximate time period, and goals

A
  • Psychopharmacology
  • It will take between four and eight weeks
  • Goal to decrease hallucinations, delusions, and agitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

During the acute phase of treatment for schizophrenia, what four things would the counselor focus on or do?

A
  1. Build therapeutic rapport
  2. Connect family and engage with them if they provide support.
  3. Provide psycho-education
  4. Promote medicinal compliance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What would tell us that we have reached the stabilization phase?

Two of them

A
  • Fewer symptoms
  • Renewed self-control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Schizophrenia

What are the goals of treatment planning during the stabilization phase?

Two of them

What are we doing and how are we helping and to what end?

A
  1. Help reduce stress
  2. Provide support

To Promote Recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Schizophrenia

Schizophrenia Stabilization Phase: focus on pharmacology

What we want to focus on and what could happen if we didn’t.

A
  • focus on compliance
  • High risk of relapse if discontinued
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Schizophrenia

Schizophrenia Stabilization Phase: Counselor’s focus

Goal and risk

What might elicit relapse? What could we do to help prevent relapse?

A

Help the client alleviate or manage stressors.
* Hightened risk of relapse due to stress.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Schizophrenia

Schizophrenia Stabilization Phase: considerations for Psychoeducation

Too whom, for what, and alternative modality

A

For Client and their family.
* To foster understanding of the disorder & symptoms.
* To educate about medications and their side effects.
* To connect them to group modalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Schizophrenia

Schizophrenia Stabilization Phase: benefits of group modalities

Two benefits noted

A
  1. Very effective treatment.
  2. Helps with social isolation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Schizophrenia

Schizophrenia Stabilization Phase: Referral to other supportive services

Three mentioned

A
  1. Peer support
  2. Advocacy groups
  3. Case Management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Schizophrenia

Schizophrenia Stabilization Phase: Beneifts of Case Management

Three points

What kinds of things can a CM link the client to?

A

Facilitates linkage to
* mental health
* housing
* rehabilitation agencies/services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Schizophrenia Stable Phase

What is the Stable Phase for Schizophrenia?

outcome and expected duration

A
  • We’d see stability for a significant amount of time
  • Six months to a year
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Schizophrenia Stable Phase

Therapeutic Goals for Schizophrenia Stable Phase

Three listed

A
  1. Maintain Recovery
  2. Prevent Relapse of Symptoms
  3. Promote higher levels of functioning in various psychosocial domains
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Schizophrenia Stable Phase

Schizophrenia Stable Phase: Counselor’s Focus

Two mentioned

What are we monitoring and what are we providing?

A
  1. Monitor medication compliance
  2. Provide ongoing psycho-education & Skills Training
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Schizophrenia Stable Phase

Schizophrenia Stable Phase: Cindy’s components of psychoeducation and skills training

Which type of skills? Which relationships should we promote?

A
  1. Social Skills
  2. Problem Solving
  3. Coping Skills
  4. Foster active engagement with treatment providers (i.e., help list questions to ask their medication provider)
  5. If supportive, keep the family in the loop
  6. Help the client manage weight
  7. Refer to services
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Schizophrenia Stable Phase

Schizophrenia Stable Phase: Referral Services

Three listed

Who/what should we consider referring the client to?

A
  1. Peer support
  2. Peer delivered services
  3. Supportive employment
  4. etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Schizophrenia Stable Phase

Schizophrenia Stable Phase: CBT interventions

Three listed

A
  1. Cognitive Restructuring
  2. Behavioral experimentation and reality testing
  3. self-monitoring skills
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Schizophrenia Treatment for Youth

Schizophrenia Treatment for Youth: Psychopharmocology consideration

A

Despite not approved for youth (poor research), medication prescribers prescribe medications anyway.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Schizophreniform

Schizophreniform

Very basic definition

The major symptom set and diagnostically important duration

A

A mental health condition that causes symptoms of psychosis, like hallucinations, delusions and disorganized speech. It lasts fewer than six months.

https://my.clevelandclinic.org/health/diseases/9571-schizophreniform-disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Schizophreniform

Schizophreniform: Positive prognosis factors

Four factors listed

A
  • optimal occupational & social functioning prior to episode
  • rapid onset of (+) symptoms
  • confusion/distress in relation to symptoms
  • ➡️ The client may be confused about wtf these symptoms are all about.
  • absence of (-) symptoms
  • ➡️ No negative symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Schizophreniform

According to Cindy–difference between Schizophreniform and schizophrenia re: negative symptoms

A
  • Rapid onset with (+) sxs
  • Slow deterioration & positive sxs will probably turn into a schizophrenia diagnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Schizophreniform

The most important elements of Schizophreniform recovery

Three listed

A
  1. Medication
  2. Family psychoeducation
  3. Supported employment
  • Remember… prior optimal performance right before decompensation would imply current employment & trying to work with or about employment will help reduce stress post-recovery (thereby reducing likelihood of relapse)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Schizophreniform

Schizophreniform Multidisciplinary Team & integrated approach

Four components

A
  • Medications
  • Manualized CBT strategies
  • Individual crisis management
  • Family counseling and psychoeducation

longer-term reminission & prevention of relapse

Pill popping (as per usual); crisis stabilization CM or at least crisis planning with tx (CBT) that wraps family/supports in for psychoedudation purposes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Brief Psychotic Disorder

Brief Psychotic Disorder duration requirements

A
  • At least one day
  • Fewer than one month
  • Return to premorbid level of functioning

Symptoms lasting beyond 30 days are probably schizophreniform disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Brief Psychotic Disorder

Brief Psychotic Disorder Criterion A

A

Presence of at least one of the following symptoms and one must be either 1, 2, or 3

  1. delusions
  2. hallucinations
  3. disorganized speech (frequent derailment or incoherence)
  4. grossly disorganized or catatonic behavior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Brief Psychotic Disorder

Onset of Brief Psychotic Disorder signs of psychosis

A

Sudden signs of psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Brief Psychotic Disorder

Three subtypes of Brief Psychotic Disorder

A
  1. with marked stressor(s)
  2. without a marked stressor(s)
  3. postpartum onset – usually within the first four weeks

With or without a precipitating stressful event, basically.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Brief Psychotic Disorder

Brief Psychotic Disorder: Counselor Considerations

Four components (three of which we must do)

A
  • Might not see the diagnosis (especially in private practice) because symptoms remit quickly
  • Counselors must identify the timeline of stressor/traumatic event connected to the timeline of the symptoms
  • Counselors must identify whether the client has had a previous episode(s) of psychosis
  • Counselors must assess for differential diagnoses

Take a recent history that includes potential precursors to symptoms onset, longer term history that accounts for previous events and any potential disorder that has these symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Brief Psychotic Disorder

Brief Psychotic Disorder: Assessment for differential diagnoses

Four Rule Outs

A
  • Rule out medical conditions by referring to a doctor
  • Rule out substance-induced…
  • Rule out personality disorder
  • Rule out psychotic disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Brief Psychotic Disorder

Brief Psychotic Disorder Treatment dependencies

Two listed

A
  1. severity of symptoms
  2. onset of symptoms

Refer clients presenting with severe psychotic symptoms to inpatient setting for stabilization.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Brief Psychotic Disorder

Brief Psychotic Disorder Treatment: What a counselor should attend to with a client who has Sudden Onset of psychosis

Three components

A

Attend to…
* clients’ confusion about their subjective experience
* overall health and wellbeing (i.e., nutrition & hygiene)
* safety (as they have hightened risk for self-harm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Brief Psychotic Disorder

Brief Psychotic Disorder: Medication

Type (class) and two examples

A

Common atypical antipsychotics like…
* Zyprexa
* Geodon (intramuscular)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Brief Psychotic Disorder

Brief Psychotic Disorder counseling goals upon stability

Three components

A
  1. explore the triggering traumatic event / stressor
  2. enhance coping skills
  3. refer to group counseling for stress management and/or conflict resolution :(
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Delusional Disorder

A major generality of delusional disorder in light of psychotic disorders

A

It does not impair functioning & therefore makes diagnosis more elusive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Delusional Disorder

Considerations for Delusional Disorder diagnosis and treatment

re: sensitivity and assessment

A
  1. Remain alert to sensitivity, irritability, or hostility when you challenge or question a belief.
  2. Attune attention to the client’s social relationships as the delusions have probably impacted them.
    * The client may show distress by their relationships
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Delusional Disorder

Seven subtypes of Delusional Disorder

A
  • erotomanic type
  • grandiose type
  • jealous type
  • persecutory type
  • somatic type
  • mixed type (no one predominant theme)
  • unspecified type (when the theme does not fit a unique type)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Delusional Disorder

Popular treatments for Delusional Disorder

Two listed

A
  1. CBT
  2. ACT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Delusional Disorder

ACT for Delusional Disorder

Two and a half methods and two benefits (ECT)

A
  • Focus on clients to accept disruptive thoughts
  • Acknowledge the situation and increase mindfulness about the difficult situation
  • –> shown to reduce harmful thoughts and feelings
  • Clients developed better abilities to identify delusional thoughts
  • Clients reduced need for hospitalization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Delusional Disorder

Psychopharmacology and Delusional Disorder

A
  • Mixed research on effectiveness
  • Might help those with somatic and persecutory subtypes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Delusional Disorder

Psychopharmacology and Delusional Disorder: two medications

Has good results

A
  • Risperidone
  • Zyprexa

Remember, research suggests that medication might help those with somatic & persecutory type most of all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Schizoaffective Disorder

Characteristics of Schizoaffective Disorder

Symptoms and stipulations

A
  1. psychotic symptoms (with stipulations)
  2. Symptoms of psychosis experienced without the presence of a manic or depressive episode for at least two weeks

Stipulations: experienced concurrently with predominant major depressive episode and/or manic episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Mood disorder with psychotic features.

A

If someone’s dominant symptoms are mood symptoms but he experiences some periods of psychotic features

[https://www.healthyplace.com/thought-disorders/schizoaffective-disorder-information/what-is-schizoaffective-disorder-dsm-5-criteria]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Most likely has schizoaffective disorder.

A

Two week period of time with only psychotic symptoms but also has a period of time carrying sxs of a mood d/o.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Schizoaffective disorder

Subtypes of Schizoaffective disorder

Two

A
  1. Bipolar Type: manic episode
  2. Depressive Type: major depressive episode

Determined by mood episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Schizoaffective disorder

Diagnostic Considerations of Schizoaffective disorder & DSM-5 specific instructions

Two sections comprising of five pieces

A

Debate surrounds the diagnosis
* Does it exist?
* Where does it belong on the continuum between schizophrenia and mood disorders?

Things to consider:
* Diagnose as schizophrenia if the psychotic symtoms proportionally dominate over mood.
* Consider the timing of symptoms carefully
* ➡️ Was there a 2-week period of time with psychotic sxs exclusively (sans mood d/o sxs)?
* Remember that diagnoses, symptoms, and client needs can shift over time

55
Q

Schizoaffective disorder

What makes the diagnosis of Schizoaffective disorder difficult?

A

Observation of two weeks of time when the person does not experience a mood episode & still experiences psychotic symptoms

I need to look further into this as I do not understand

56
Q

Schizoaffective disorder

Treatment approach for Schizoaffective disorder

A

Complicated Treatment course and not thoroughly well researched!
* Consider treatment strategies for both schizophrenia and bipolar disorder / major depressive disorder
* In severe psychosis? The client should seek inpatient services
* Psychoeducation & social skills training
* Most likely, we should promote a multi-disciplinary approach

57
Q

Schizoaffective disorder

Medication approach for Schizoaffective disorder Treatment

A
  • Psychopharmacology combination of antipsychotics & mood stabilizers
58
Q

psychotic disorders

Key Treatment Components for psychotic disorders

Five Major components

A
  1. Engagement Strategies
  2. Psychoeducation
  3. Cognitive Therapy
  4. Behavioral Skills Training
  5. Relapse Prevention Strategies
59
Q

Engagement strategies for psychotic disorders

Basic counseling strategies

Key Tx Components of Psychotic Disorders

A
  • build rapport
  • patience
  • transparency
    * explain the process and why
60
Q

Engagement strategies for psychotic disorders

Importance of therapeutic rapport

Key Tx Components of Psychotic Disorders

A

The client…
* may have had adverse interactions with mh professionals, LE, and etc.
* may have felt penalized for revealing psychosis to others
* ➡️ Radical acceptance
* might have active paranoia

61
Q

Engagement strategies for psychotic disorders

Assessment questions about counseling expectations

Three

Key Tx Components of Psychotic Disorders

A

Potential Questions Include:
1. What was it like when you saw a counselor before?
2. What did you do in counseling?
3. What are your ideas about what we will do with our time together?

62
Q

Engagement strategies for psychotic disorders

Getting a clear and shared understanding of the client’s symptoms & difficulties

Key Tx Components of Psychotic Disorders

A
  • symptoms trump diagnosis
  • Assessments
  • Clinical interviews
63
Q

Engagement strategies for psychotic disorders

Assessment considerations

Key Tx Components of Psychotic Disorders

A

They help with diagnosis and reveal the severity of symptoms
Make sure to help the client understand
* the need for the assessments
* how we’ll use the information
* who will have access to the information

64
Q

Engagement strategies for psychotic disorders

Clinical Interview question examples

Two

Key Tx Components of Psychotic Disorders

A

Open questions like…
* What do you think has caused this?
* What has your doctor told you about these problems?

Get their perspective of their sxs and their perspective of how they view the way others perceive their sxs.

65
Q

Engagement strategies for psychotic disorders

Three considerations in information gathering about AH

Key Tx Components of Psychotic Disorders

A
  • Physical characteristics
  • Content
  • Beliefs about the voices
66
Q

Engagement strategies for psychotic disorders

Physical characteristics about AH

Five

Key Tx Components of Psychotic Disorders

A
  • number of voices
  • frequency
  • loudness
  • clarity
  • perceived location
67
Q

Engagement strategies for psychotic disorders

Content about AH

Key Tx Components of Psychotic Disorders

A

Assist in generating specifics
* What do the voices say?
* Does the voice(s) give commands? Do they tell you what to do?
* Does it comment about your actions?
* Does it criticize, abuse, give advice, or compliment

68
Q

Engagement strategies for psychotic disorders

Beliefs about the voices/AH

Four Listed

Key Tx Components of Psychotic Disorders

A
  • Who do you think these voices belong to?
  • How much power does it have? How do you know it has such power?
  • ➡️ What happens when you do not listen to the voice?
  • ➡️ What would happen if you chose to not listen to the voice?
69
Q

Engagement strategies for psychotic disorders

Cues/Triggers of AH

Three Listed

Key Tx Components of Psychotic Disorders

A
  • Some people say they hear more voices some times than other times. Have you noticed this about your voices?
  • What times or situations do you notice the voices behave more active?
  • Which times do the voices go away?
70
Q

Engagement strategies for psychotic disorders

AH Emotional and behavioral consequences

Six

Key Tx Components of Psychotic Disorders

A

Voices can have positive, netural, or negative emotional and behavioral consequences. Therefore ask…
* How do you end up feeling when you hear the voice?
* What do you do when you hear the voice?
* Do you willingly listen to the voice or end up hearing it unwillingly?
* Have you tried shouting at the voice?
* Do you ignore it?
* Do you try to stop it from talking?

71
Q

Engagement strategies for psychotic disorders

What do we assess when it comes to AH?

Five

Key Tx Components of Psychotic Disorders

A
  1. Physical characteristics
  2. Content of the voices
  3. Beliefs about the voices
  4. Cues / Triggers
  5. Emotional and Behavioral Consequences
72
Q

Engagement strategies for psychotic disorders

Assessing Delusions

Method, goals, and suggestions

Key Tx Components of Psychotic Disorders

A

Clinical Interview while using a visual analog scale.
* Goal: understanding predisposing, precipitating, and maintaining factors
* Try determining the degree to which the delusions preoccupy the client
* Use the words that the client uses
* Use words like beliefs, concerns, worries, & preoccupations

73
Q

Engagement strategies for psychotic disorders

Three Factors about Delusions to understand

Key Tx Components of Psychotic Disorders

A
  1. predisposing
  2. precipitating
  3. maintaining
74
Q

Engagement strategies for psychotic disorders

Three things to identify re: delusions

Key Tx Components of Psychotic Disorders

A
  1. belief
  2. worry
  3. concern
    * Rate the degree of preoccupation with these beliefs, worries, and concerns along a gradient of zero to 100.
75
Q

Engagement strategies for psychotic disorders

What other areas should we explore?

Key Tx Components of Psychotic Disorders

A
  1. disabilities / quality of life (which factors does the client experience more or less difficulty?)
  2. associated distress (depression or anxiety going on?)
  3. goals to attend to secondary distress
  4. motivation
76
Q

Engagement strategies for psychotic disorders

Trying to develop targets for setting goals and trying to alleviate secondary distress

Three

Key Tx Components of Psychotic Disorders

A
  • coping skills
  • relaxation skills
  • behavioral activation skills
77
Q

Key Tx Components of Psychotic Disorders

Psychoeducation

A
  • Normalize experience of the symptoms
  • Promote alternative perspective taking about symptoms
  • Promote understanding of symptoms and context for which they occur
  • ➡️ Collaborate: identify & create shared understanding of difficulties
  • You need to pace this
  • ➡️ structure based on client’s level of insight into client’s illness
  • ➡️ ➡️ Start by talking about the stress vulnerability model
  • ➡️ Education about psychosis & symptoms of psychosis
78
Q

Key Tx Components of Psychotic Disorders (Cognitive Therapy)

Cognitive Therapy

Theory, proximity, why

A
  • Verbal Challenges and Behavioral Experiments
  • When the client has reached stability & only residually symptomatic
  • Found to reduce believability of delusions & hallucinations
79
Q

Key Tx Components of Psychotic Disorders (Cognitive Therapy)

ABC Model

A
  • Antecedents, Beliefs, & Consequences
  • Targets thoughts and feelings
  • Emphasizes the belief ↔️ consequence connection
80
Q

Key Tx Components of Psychotic Disorders (Cognitive Therapy)

Disputing Delusional Beliefs

A
  • Highly dependent on rapport and trust
  • Help the client recognize feelings when having the belief
  • Generate alternatives / other possibilities
  • Examine the evidence about truthfulness
81
Q

Key Tx Components of Psychotic Disorders (Cognitive Therapy)

Behavioral Experiments

A
  • To test the beliefs about the voices/AH
  • Experiment Log Worksheet
  • ➡️ Carefully plan this out
  • ➡️ Promotes experiential learning that combats the delusional belief
82
Q

Key Tx Components of Psychotic Disorders (Cognitive Therapy)

CBT: What is it good for?

A
  • Disputing Voices
  • ➡️ by disputing automatic thoughts we can disarm the power of the voices
  • ➡️➡️ Look for alternative posibilites
83
Q

Key Tx Components of Psychotic Disorders (Behavioral Skills Training)

Behavioral Skills Training ➡️ purpose and benefits

A

To improve coping with residual symptoms
* Relaxation
* Activity Scheduling
* Distraction & Problem Solving

84
Q

Key Tx Components of Psychotic Disorders (Relapse Prevention Strategies)

Relapse Prevention Strategies

A
  • Identify early warning signs
  • Develop plans of action in response to indicators
85
Q

Psychotic Disorders: Psychopharmacology

Components that antipsychotic medication effectively treat

A
  • Positive symptoms of schizophrenia & other psychotic disorders
  • Mania
  • Drug Intoxication
  • Some medical conditions
  • Agitation
86
Q

Psychotic Disorders: Psychopharmacology

What antipsychotic meds do not treat so effectively (if at all)

A
  • negative symptoms
  • cognitive symptoms
87
Q

Psychotic Disorders: Psychopharmacology

First-Generation antipsychotics

Seven

A
  • Thorazine
  • Haldol
  • Prolixin
  • Loxapine
  • Compazine
  • Navane
  • Mellaril

Contemporarily used minimally; daunted by motor side effects

88
Q

Psychotic Disorders: Psychopharmacology

Second-Generation Antipsychotics

Twelve

A

AKA: atypical antipsychotics
* Clozapine
* Zyprexa
* Risperidone
* Seroquel
* Geodon
* Latuda
* Invega
* Abilify
* Rexulti
* Saphris
* Vraylar
* Fanapt

89
Q

Psychotic Disorders: Psychopharmacology

Term used interchangeably with antipsychotic

Especially “first generation”

A
  • neuroleptic
90
Q

Psychotic Disorders: Psychopharmacology

Other effects of antipsychotics

A
  • Sedating & helpful with agitation
  • Effectively stabilize mood seroquel, risperidone
  • Augment antidepressants abilify
  • Used in OCD tx when paired with SSRI
  • Can treat anxiety disorders
  • Sometimes: Autism (behavioral problems)
91
Q

Psychotic Disorders: Psychopharmacology

Considered a major breakthrough in schizophrenia treatment

A

Second-Generation (Atypical) Antipsychotics
* Fewer side effects

92
Q

Psychotic Disorders: Psychopharmacology

Risks of Clozapine

A
  • Can provoke the body to stop producing white blood cells
  • Monitored with regular blood tests
  • ➡️ Monitor weekly for 18 weeks
  • ➡️ Then every 28 days
93
Q

Psychotic Disorders: Psychopharmacology – How they work

How do antipsychotics work (generally)?

A
  • Block the D2 dopamine receptor

There exist Five Dopamine Receptors (D1 - D5)

94
Q

Psychotic Disorders: Psychopharmacology – How they work

How many dopamine pathways exist in the brain?

A

Four Major pathways

95
Q

Psychotic Disorders: Psychopharmacology – How they work

Blocked by First-Generation Antipsychotics

A

The four major dopamine pathways

96
Q

Psychotic Disorders: Psychopharmacology – How they work

Name the four major pathways in the brain that first generation antipsychotics block.

A
  1. Brainstem to Limbic System (mesolimbic pathway)
  2. Brainstem to frontal lobe cortex (surface)
  3. Brainstem to basal ganglion (nigrostriatal pathway)
  4. Dopamine pathway
97
Q

Psychotic Disorders: Psychopharmacology – How they work – Four Pathway

1) Brainstem to Limbic System

A

mesolimbic pathway

  • medication that blocks dopamine in this pathway decreases psychotic symptoms
  • substances that increase dopamine here increases or causes psychotic symptoms
98
Q

Psychotic Disorders: Psychopharmacology – How they work – Four Pathway

2) Brainstem to frontal lobe cortex

Cortex = Surface

A

Addition of dopamine stimulates behavior, thought, expression, & motivation

Blocking dopamine here may exaggerate / exacerbate schizophrenia’s negative symptoms.

To block dopamine here is to…
* decrease motivation
* decrease spontaneity
* decreases resiliency
* ➡️ the ability to persist and follow through with things

99
Q

Psychotic Disorders: Psychopharmacology – How they work – Four Pathway

Brainstem to Basal Ganglion

This one is tricky

A
  • Nigrostiatal Pathway
  • Control System for the extrapyramidal motor system 😳
  • To block dopamine here for longer time periods can lead to the development of the extrapyramidal side effects
  • Second-Gen antipsychotics are less risky than First-Gen (not perfect, though)
  • ➡️ potentially leading to permanent disordered movement
100
Q

Psychotic Disorders: Psychopharmacology – How they work – Four Pathway

extrapyramidal motor system side-effects

Re: Brainstem to Basal Ganglion

A

Can occur with antipsychotics (espeically first gen), lithium, and antidepressants

  • ➡️ Parkinson-like tremors
  • ➡️ muscle spasms (dystonia)
  • ➡️ motor restlessness (akathisia)
  • ➡️ involuntary facial movements (tardive dyskinesia)
101
Q

Psychotic Disorders: Psychopharmacology – How they work – Four Pathway

Pyramidal System

Re: Brainsgtem to Basal Ganglion

A

voluntary muscle movement

102
Q

Psychotic Disorders: Psychopharmacology – How they work – Four Pathway

Extrapyramidal Motor System

definition-ish

A

System involved with making muscles move smoothly by setting muscle tension correctly.

103
Q

Psychotic Disorders: Psychopharmacology – How they work – Four Pathway

4) Dopamine pathway

A

Blocking dopamine raises prolactin
* Leads to gynecomastia development
* ➡️ ♂ breast enlargement & milk-like liquid secretion
* ➡️ ➡️ Can happen in women, but not referred to as gynecomastia
* can lead to other sexual side effects such as decreased libido

104
Q

Psychotic Disorders: Psychopharmacology – How they work – Four Pathway

Prolactin

A

One of the sex-related hormones

105
Q

Psychotic Disorders: Psychopharmacology – How they work - 2nd gen

Serotonin

A

Messages the dopamine-containing nerve cells to stop producing and releasing dopamine.

they put the brake on dopamine release

106
Q

Psychotic Disorders: Psychopharmacology – How they work - 2nd gen

2nd generation antipsychotic medications

What do they do?

A
  • Block the D2 receptors in the limbic pathways and leave the other three pathways largely unaffected
  • Utilizes the serotonin neurotransmitter system
  • ¡Getting the right balance of the serotonin and dopamine blockade reduces psychotic symptoms while leaving the other pathways intact, thereby causing fewer side effects!
107
Q

Psychotic Disorders: Psychopharmacology – How they work - 2nd gen

Unique effect of 2nd generation antipsychotics

A

Unique effects on a variety of receptors including…
* D2
* 5HT2A (Serotonin)
* ➡️… which leads to differences in effects of medication and side-effects

108
Q

Psychotic Disorders: Psychopharmacology – How they work - 2nd gen

2nd generation antipsychotics affect various receptors in different ways…

A
  • on/off state rather than consistent blockade
  • partial agonists
  • ➡️ partially block and stimulate the receptors
109
Q

Psychotic Disorders: Psychopharmacology – Common Side Effects

Re: 1st gen antipsychotics, potency, and side effects

A

Side effects have relation to potency
* Low-Potency (100 mg Thorazine)
* High-Potency (2 mg Haldol)

110
Q

Psychotic Disorders: Psychopharmacology – Common Side Effects

Low-Potency example provided

A

100 mg Thorazine
* More sedating, more anticholinergic side effects, weight gain
* dry mouth, constipation, blurred vision, drop in blood pressure
* Fewer (bot not entire) motor side effects

111
Q

Psychotic Disorders: Psychopharmacology – Common Side Effects

High-Potency example provided

A

2 mg Haldol
* Less sedating, less weight gain, fewer anticholinergic side effects
* commonly cause extrapyramidal effects or motor effects (EPS)
* ➡️ tremor, stiffness, severe muscle cramps (dystonia), motor restlessness (akathisia)

112
Q

Psychotic Disorders: Psychopharmacology – Common Side Effects

Medication to control extrapyramidal side-effects

A

Cogentin

used also in Parkinson’s

113
Q

Psychotic Disorders: Psychopharmacology – Common Side Effects

Overall difference between 1st and 2nd gen side effects

A

2nd Gen…
* less likely to cause motor effects
* less likely to make people feel drugged
* more likely to cause significant weight gain, elevated cholesterol, predispose people towards diabetes

114
Q

Psychotic Disorders: Psychopharmacology – Common Side Effects

2nd gen antipsychotics that tend to cause prolactin elevation

A

Risperdal & Invega

prolactin elevation: sexual side-effects and gynecomastia

115
Q

Psychotic Disorders: Psychopharmacology – Common Side Effects

2nd gen antipsychotics most likely to cause akathisia

A

Geodon & Abilify

movement disorder / inability to sit still

116
Q

Psychotic D/o: Psychopharmacology - Common Side Effects

Four broad categories of general side effects

A

1) Metabolic problems
…..➡️ weight gain & diabetes
2) EPS (muscle related side-effects)
3) Common non-muscle-related side effects
…..➡️ not life threatening, but quite uncomfortable
4) Rare & dangerous problems

117
Q

Psychotic d/o: Psychopharmacology - Four Common Side Effects

  1. Metabolic side-effects: Weight Gain & Diabetes
A
  • Weight gain seems related to carbohydrate cravings
  • …..➡️ BTW: This is a side-effect of SSRI’s, too!
  • Antipscyhotics can also change how the body handles glucose & insulin.
  • …..➡️ Development of diabetes sans weight gain
118
Q

Psychotic d/o: Psychopharmacology - Four Common Side Effects

2) Extrapyramidal Side Effects (EPS)

A
  • Dystonia
  • Pseudo-Parkinsonism
  • Akathisia
  • Akinesia
  • Tardive Dyskinesia

Less likely in Second Generation

119
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects–EPS

Distonia

A

Sudden spasms of head, neck, lips, and tongue

EPS related

120
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects–EPS

Psuedo-Parkinsonism

A
  • muscular rigidity
  • mask-like face
  • stiff-walk
  • shuffling gait

EPS related

121
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects–EPS

Akathisia

A

Persistent & very uncomfortable motor restlessness

EPS Related

122
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects–EPS

Akinesia

A
  • Motor and emotional woodenness
  • lack of spontaneity in facial expression or gesturing
  • …..➡️ similar in appearance to negative symptoms

EPS related

123
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects–EPS

Tartive Dyskinesia

A

Repetitive movement of…
* fingers
* lips
* tongue
* other body areas

EPS related

124
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects

3) Common, uncomfortable, & usually temporary / reversible side-effects

A
  • Toxic side-effects that can occur with any medication
  • Psychotoxic effects
  • Anticholinergic effects
  • Prolactin Elevation
125
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects-Temp. & Rvsble

Psychotoxic Effects

A

Feeling drugged or out of it
* depersonalization
* depression
* confusion

126
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects-Temp. & Rvsble

Anticholinergic Effects

A
  • Dry mouth
  • Dry eyes & blurred vision
  • Constipation
  • Hypotension
  • …..➡️ Drop in blood pressure as the Client stands up
127
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects

Rare & serious side-effects

A
  • Blood dyscrasia
  • Neuroleptic Malignant Syndrome (NMS)
  • Fatal Heat Stroke
  • Seizures
128
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects- Rare/Serious

Blood Dyscrasia

A
  • Blocking white blood cell production
  • …..➡️ Requires monitoring (too low WBC count can threaten life
129
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects- Rare/Serious

Neuroleptic Malignant Syndrome (NMS)

A

High Fever and Muscle Stiffness
* Significant threat of hypothermia (105° F) without immediate & vigorous treatment

130
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects- Rare/Serious

Fatal Heat Stroke

A

All antipsychotics can interfere with temperature regulation system while in hot weather
* Requires the client to seek an air conditioned or cool space
* Drink fluids to stay hydrated

131
Q

Psychotic d/o: Psychopharmacology - 4 Common Side Effects- Rare/Serious

Seizures

A

Rare but potential side effects of any medication

132
Q

Psychotic d/o: Psychopharmacology: Know

Know the medications your client takes and the med’s common side effects

A
  • The Client’s psychiatrist or other prescriber depends on you to alert them to problems.
  • You may have to refer the Client to seek medical attention
133
Q

Psychotic d/o: Psychopharmacology: Know

Take a sympathetic approach to the side-effects your Clients report

A

Help educate Clients about their medications and potential side-effects
* Depends on your Client’s capacity/capability
* Lead them to uncover knowledge on their own. Show them how to research these medications
* Help generate questions for their prescriber(s) and trouble-shoot ways to remember them.

134
Q

Psychotic d/o: Psychopharmacology: Know

Remain aware of drug interactions

A

Refer the Client to their prescriber or bring it to their prescriber’s attention
* The Client can also take questions to their Pharmacist

Treatment Spring 2024 (Test) (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions