WK5: Thought Disorders Flashcards by Christine Esty

Characteristics of Schizophrenia

break w/ reality
hallucinnations, delusions, disorganized thinking
poor self care

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What is the most common psychosis related disorder?

schizophrenia

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When is schizophrenia typically seen?

late adolescence/early adulthood

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psychosis

pt experiences symptoms: hallucinations, delusions, disorganized thoughts, speech or behanior

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Hallucinations

sensory disturbances (seeing hearing things that aren’t there

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Delusions

beliefs about things that aren’t true

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Types of delusions

grandiosity, nihilistic, persecutory, somatic

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Describe the clinical course of schizophrenia (5 steps)

Prodromal period (often noticed in retrospect)
acute illness
stabilization
maintenence and recovery
relapses

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Diagnostic Criteria: (szh) “Positive symptoms” are and would include?

symptoms that exist but should not

- delusions and hallucinations

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Diagnostic criteria: (szh) “negative symptoms” are and would include?

symptoms that should be present ut are not (flattening of emotion, withdrawl)

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Diagnostic Criteria (SZ)
Neurocognitive impairment is?

involving memory, vigilance, verbal fluency, and excutive function (ie disorganized symptoms)

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Disorganized symptoms: Disorganized thinking - what are some examples of this?

echolalia, loose associations, flight of ideas, word salad, neologisms, paranoia, concrete thinking, pressured speech

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Disorganized symptoms: Disorganized Behavior - What are some examples of this?

Aggression, agitation, catatonia/catatonic excitement, echopraxia, hypervigilance

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Risk factors of sz

genetics/environment

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SZ - gender differences?

earlier diagnosis and poorer prognosis in men

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SZ - familial differences

1st degree biologic relatives w/ greater risk

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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