WK5: Thought Disorders Flashcards
Characteristics of Schizophrenia
- break w/ reality
- hallucinnations, delusions, disorganized thinking
- poor self care
What is the most common psychosis related disorder?
schizophrenia
When is schizophrenia typically seen?
late adolescence/early adulthood
psychosis
pt experiences symptoms: hallucinations, delusions, disorganized thoughts, speech or behanior
Hallucinations
sensory disturbances (seeing hearing things that aren’t there
Delusions
beliefs about things that aren’t true
Types of delusions
grandiosity, nihilistic, persecutory, somatic
Describe the clinical course of schizophrenia (5 steps)
- Prodromal period (often noticed in retrospect)
- acute illness
- stabilization
maintenence and recovery - relapses
Diagnostic Criteria: (szh) “Positive symptoms” are and would include?
- symptoms that exist but should not
- delusions and hallucinations
Diagnostic criteria: (szh) “negative symptoms” are and would include?
- symptoms that should be present ut are not (flattening of emotion, withdrawl)
Diagnostic Criteria (SZ) Neurocognitive impairment is?
involving memory, vigilance, verbal fluency, and excutive function (ie disorganized symptoms)
Disorganized symptoms: Disorganized thinking - what are some examples of this?
echolalia, loose associations, flight of ideas, word salad, neologisms, paranoia, concrete thinking, pressured speech
Disorganized symptoms: Disorganized Behavior - What are some examples of this?
Aggression, agitation, catatonia/catatonic excitement, echopraxia, hypervigilance
Risk factors of sz
genetics/environment
SZ - gender differences?
earlier diagnosis and poorer prognosis in men
SZ - familial differences
1st degree biologic relatives w/ greater risk
SZ - pregnancy
viral infections during pregnancy according to newer research
SZ: Comorbidity
- substance use and depression
- Type 2 diabetes
- disordered water balance
Why is DM2 a comorbidity of SZ?
- The meds we put them on cause lots of metabolic changes and can cause weight gain (changes in blood pressure and changes in glucose metabolism)
Social stressors contributing to changes in brain function
social stigma, absence of good, affordable, and supportive housing; frangmented mental health care delivery system
No accepted psychosocial theories…what does this mean?
There’s no theory that can predict schz. Social stressors can contribute, but will not make you schz. by themselves
Nursing Management: Biologic assessment components
Current and past health status and physical exam
Physical functioning
Nutritional Assessment
Fluid imbalance assessment
Pharmacologic assessment (meds, abnormal motor movements)
Nursing Dx’s for the biologic domain
Self care deficit, disturbed sleep pattern, ineffective therapeutic regimen management, imbalanced nutrition, excess fluid volume, sexual dysfunction, constipation
Interventions for the Biologic domain
promote self care activities, activity/exercise/nutritional interventions, thermoregulation interventions, promotion of normal fluid balance and prepvention of water intoxication
Pharmacologic interventsions: antipsychotics and anticholinergics
Antipsychotics: Monitoring and administration
1-2 weeks to effect a cx in sympts; usually, trail of 6-12 weeks before a change
Antipsychotics purpose
blockage of dopamine transmission
2nd gen antipsychotics
effective in treating neg and positives symptoms (boxes 22.6 and 22.7)
Extrapyramidal side effects of antipsychotics
table 22.3
Parkinsonisms and anticholinergic effects (antipsychotics)
table 22.2
Dystonic reactions
box 22.9
Antipsychotics: side effects
OS HTN, hyperprolactermia, sedation/weight gain, new onset diabetes, cardiac arrhythmias, agranulocytosis, Drug/Drug interactions
Case: Pt presents erratic, hallucinatory, and expressing sx of sz. What info do you want?
Where are his parents?
Labs (CBC, CMP (organ function), uranialysis, EKG, CXR, RPR (tests for siphilis) and HIV tests.)
Toxicology?
Second Gen antipsychotics have:
better effectiveness profile and generally fewer side effects
Complications: Neuroleptic Maligant Syndrome (rare/life threatening condition)
- ## severe muscle rigidity, elevated temperature w/ a rapidly accelerating cascade of symptoms (box 22.`0)
Complications: Neuroleptic Maligant Syndrome (rare/life threatening condition)
- severe muscle rigidity, elevated temperature w/ a rapidly accelerating cascade of symptoms (box 22.`0)
- Usually occurs 1-2 wks after meds started
- Early recognition of symptoms; withholding of any antipsychotic meds
Dopamine agonists (bromocriptine); muscle relaxants (dantrolene or benzodiazepine) - frequent vital sign monitoring
- supportive measures
Complications: Anticholinergic crisis (life threatening condition)
overdose or sensitivity to drugs with anticholinergic properties:
Signs/Symps: box 22.11
- “hot as a hare, blind as a bat, mad as a hatter, dry as a bone”
- Self limiting - usually 3 days after drug discontinued
- Tx: Discontinue med, physostigmine, gastric lavage/charcoal/catharsis for intentional overdoses
Antipsychotics: side effects
OS HTN, hyperprolactermia, sedation/weight gain, new onset diabetes, cardiac arrhythmias, agranulocytosis (only carbimezole) , Drug/Drug interactions
Psychological assessment includes
mental status/appearance
mood/affect
speech
thought processes and delusions/hallucinations/disorganized communication
cog. impairments
memory and orientation
insight/judgement
self concept
stress and coping patterns
risk assessment
Interventions for psychological domain
- development of trust/acceptance/hope
- mgmt of distrubed thoughts and sensory preceptons
- education about symptoms
- teaching and coping with stress
- pt/family education and pscytherapy
Nursing mgmt social domain: social assessment
functional status, social systems, quality of life, family assessement
evaluation and tx outcomes
successfull tx and management w/ significant improvement or recovery (not cure!)
Continuity of care as a major goal of recovery
mental health promotion with a positive support system for stressful periods
community tx - ACT teams
