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Nurs 243 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

psychosis

A

a state in which an individual experiences positive symptoms of schizophrenia - hallucinations; delusions; disorganized thoughts, speech, or behavior

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2
Q

Emil Kraepelin described symptoms as

A

dementia praecox​
1st person to identify

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3
Q

Who identified a group of schizophrenias and renamed it to schizophrenia

A

Eugen Bleuler

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4
Q

Kurt Schneider

A

differentiated behaviors​

“First-rank” symptoms (psychotic delusions, hallucinations) ​

“Second-rank” symptoms (all other experiences and behaviors associated with the disorder)

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5
Q

What are the stages of schizophrenia?

A

Prodromal period​ early stage, loss of interest in eating/sleeping, restless, forgetful, depressed, tense/nervous, decreased enjoyment in usual interests, socially withdrawn, hearing voices/visual. Not necessarliy require hospitalization

Acute illness period​ people around them get concerned, staying up all night often, aggressive, conversations not coherent, hallucinations. Need to be at hopsital

Stabilization period​Typically back on medications/therapy/admitted to hospital

Recovery period​Working to get back into the community/discharge

Relapses noncompliant with meds

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6
Q

What is the Diagnostic Criteria​for schizophrenia?

A

Postive symptoms - Excessive or distorted thoughts and perceptions​delusions and hallucinations
Negative symptoms - Emotions and behaviors that should be present but are diminished
Neurocognitive impairment - Involving memory, vigilance, verbal fluency, and executive function (i.e., disorganized symptoms)

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7
Q

Echolalia

A

repeat exact words you say

ex. you ask “what is todays date” they repeat “what is todays date?”

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8
Q

Circumstantially

A

pts give a lot of detail about a topic but not necesarrily related.

ex. you ask “tell me more about ohmaha” they ramble on about that topic and vere off topic

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9
Q

Loose associations

A

going from topic to topic and not making connections in between

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10
Q

Tangentiality

A

start on topic but talk about information but not really the info you asked for

ex. ask for info on ohmaha, they start with info on ohmaha but not when they lived there.

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11
Q

Neologisms

A

Made up words with no meaning

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12
Q

Referential thinking

A

belief that neutral stimuli have special meaning
ex. TV is speaking to them

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13
Q

Autistic thinking

A

Restrictive thinking. Own private rules.
ex. when they eat they have to put their plate on a certain place on table

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14
Q

Concrete thinking

A

No able to abstract. Hard time extracting meaning from statement
they will give facts instead of interpretation

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15
Q

verbigeration

A

purposeless repeatitive words or phrases

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16
Q

Clang association

A

Rhyming words
light, sight, right, bite

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17
Q

1.

Stilted language

A

Formal language/stiff
may not fit tone of conversation

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18
Q

Pressured speech

A

Its where there is a punch behind each word

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19
Q

Catatonia

A

psychomotor disturbance
posturing like a statue, mute

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20
Q

Catatonic excitment

A

Abnormal movements
stiff/straight - sitting or standing in one position
ex. he person may move around, but their movement seems pointless and impulsive

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21
Q

echopraxia

A

mimic activity of others
echoing others

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22
Q

Stereotypy

A

Repetition of an act with no purpose
ex. thumb sucking, nail or lip biting, hair twirling, body rocking, self-biting, teeth clenching or grinding, and head banging.

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23
Q

hypervigilance

A

Elevated state of constantly checking for threats around you

ex. keep checking their surroundings and find it hard to focus on conversations.

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24
Q

akathisia

A

restless and driven to keep moving
*if caused by EPS - give a beta andrenergic blocker

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24
Q

Waxy flexibility​

A

Specific symptom of catatonia

ex. if the doctor raises one of your arms or legs, you’ll stay that way for a while.

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25
Q

What are the gender differences with schizophrenia?

A

earlier diagnosis and poorer prognosis in men

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26
Q

What is a B52

A

Haladol
Atavan
benedril

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27
Q

If dopamine is too low what does it cause?
antipsychotics can cause?

A

EPS - Extrapramidal symptoms
symptoms of parkinsons

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28
Q

When is Clozapine used for schizophrenia?

A

when no other 2nd generation agent was effective bc immature white blood cells will mass produce and person cannot fight infection

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29
Q

What are EPS side effects

A

parkinson symptoms/movements
Dystonic reactions - stiff
akathisia -constant movement, pacing, rocking
Tardive dyskinesia - stiff neck
Orthostatic hypotension​
Hyperprolactinemia​
Sedation; weight gain​
New-onset diabetes​
Cardiac arrhythmias​
Agranulocytosis

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30
Q

what med do you give for EPS

A

Anitcholinergic

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31
Q

Neuroleptic Malignant Syndrome (NMS)​
Treated with

A

EPS + A fever
Needs to be treated in hospital
Severe muscle rigidity, autonomic changes (elevated temp, HTN, tachycardia, tachypnea, diaphoresis, incontinence, mutism, leukocytosis, lab evidence of muscle injury)

Dopamine agonists (bromocriptine); muscle relaxants (dantrolene or benzodiazepine)

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32
Q

Anticholinergic Crisis/delirum
treatment?
Treatment if OD?

A

Life-threatening condition: overdose or sensitivity to drugs with anticholinergic properties

Physostigmine​

Gastric lavage, charcoal, catharsis for intentional overdoses

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33
Q

What is Electroconvulsive Therapy

A

Possible alternative when schizophrenia is not being successfully treated by medication alone​

Not indicated unless the patient is catatonic or has depression that is not treatable by other means​

May be useful for those persons who are medication resistant, assaultive, and psychotic

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34
Q

Schizoaffective Disorder (SAD)

A

Periods of intense symptom exacerbation alternating with periods of adequate psychosocial functioning

At times psychosis and other times mood disorder, when occur at same time then SAD diagnosis is made

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35
Q

Delusional Disorder

A

Stable and well-systematized delusions that occur in the absence of other psychiatric disorders presence of one or more delusions for at least 1 month

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36
Q

Schizophreniform Disorder

A

Features identical to those of schizophrenia, with the duration of the illness lasting less than 6 months

1/3 recover, 2/3 develop schizophrenia

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37
Q

Brief Psychotic Disorder

A

Length of the episode is at least 1 day but less than 1 month

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38
Q

Avolition

A

lack of interest or motivation in goal-directed behavior, such as getting dressed or going to work

39
Q

Nihilistic

A

belief that one is dead or a calamity is impending

40
Q

Persecutory

A

belief that one is being watched, ridiculed, harmed or plotted against

41
Q

Somatic

A

Beliefs about abnormalities in bodily functions of structures

42
Q

ambivalence

A

concurrent experience of equally strong opposing feelings that it is impossible to make a decision

43
Q

Anhedonia

A

loss of ability to feel pleasure

44
Q

Tardive dyskinesia

A

Motor abnormalities
Tardive - late - appear after taking for some time
Constant movment - lip smacking, puckering, worm like movement, rocking from hips, jerking movement, foot tapping
*deutetrabenzine and Valbenazine have been approved to alievate movements

45
Q

In a patient with suspected NMS the nurse should also check the labs for

A

Increased creatine phosphokinase
elevated white blood cell count
elevated liver enzymes
myoglobinuria

46
Q

How does Cholinergic rebound happen?
what are symptoms?

A

-abruptly stop taking anitcholinergic meds
-Vomiting, excessive sweating, altered dreams/nightmares

46
Q

Anticholinergic crisis
Symptoms
antidote

A

Life treatening emergency caused by overdose or sensitivity to anticholinergic drugs (atropine, scopolamine or belladonna alkaloids, which are present in OTC meds)

-Acute delirium or psychoitc reaction resembeling schizphrenia / fever, dry mouth, burnign thirst, dry skin, decreased salvition, decreased secretions, dilated eyes, increased heart rate, consitpation, diff urinating, HTN or hypotension, anxiety, aggitation, confusion, hallucinations, seizures
HOT AS A HARE, BLIND AS A BAT, MAD AS A HATTER, DRY AS A BONE

-Physostigmine - given slowly over 5 mins / relieves symptoms in 2-3 hours / gastic lavage, charcoal, catharsis

47
Q

MOOD

A

pervasive and sustained emotion that colors one’s perception of the world and how one functions in it

48
Q

AFFECT
Ways to describe:
BLUNTED -
BRIGHT -
FLAT -
INAPPROPRIATE -
LABILE -
RESTRICTED/CONSTRICTED

A

-Expression of mood on face
BLUNTED - Significantly reduced
BRIGHT - positive attitude
FLAT - emotion is absent
INAPPROPRIATE - affect doesnt match topic of speech
LABILE - changing rapidly
RESTRICTED/CONSTRICTED - mildly reduced

49
Q

Define depressive disorder

A

A sad, irritable, or empty mood is present with somatic and cognitive changes that interfere with functioning

50
Q

What is diagnostic criteria for MDD

A

5 out of 9 in 2 weeks
- depressed mood most of the day
- Diminished interest or pleasure in activites in day
- SIgnificant weight loss
- insomnia or hypersomnia
- psychomotor agitiation/retardation
- Fatique or loss of energy
- feelings of worthlessness
- diminished ability to think or concentrate
- recurrent thoughts of death

51
Q

What are risk factors for depression?

A

Prior episode of depression​
Family history of depressive disorder​
Lack of social support​
Lack of coping abilities​
Presence of life and environmental stressors​
Current substance use or abuse​
Medical and/or mental illness comorbidity

52
Q

What are the Psychological theories for developing depression?

A

Psychodynamic factors​ fruad/ early lack of love

Behavioral factors​ lack of positive reinforcement

Cognitive factors​ develop irratational beliefs/ distorted thinking

Developmental factors - lost a parent / missing emotional parenting

53
Q

What are the social theories of developing depression

A

Family - pattern in family is disfunctional/poor decisions
Environmental - tramatic response to a life event

54
Q

What is combination therapy for depression?

A

mediation and talk therapy

55
Q

Persistent depressive disorder (dysthymia)

A

Major depressive disorder symptoms lasting for 2 years (adult) and 1 year (children and adolescents)

56
Q
A
57
Q

Premenstrual dysphoric disorder​

A

Recurring mood swings, feelings of sadness, or sensitivity to rejection in the final week prior to menses​

58
Q

Disruptive mood dysregulation disorder ​

A

Severe irritability and outbursts of temper​

Begins before the age of 10 ​

Similar to pediatric bipolar disorder

59
Q

what are “Target symptoms”

A

specific symptoms expected to improve with treatment, measurable

60
Q

Pharmacodynamics

4 sites of action

A

-where drugs act / action or effect of drug on living organisms- in CNS

Receptors - agonist or antagonsts
Ion channels​- block receptors
Enzymes​- protiens / break down neurotransmitters
Carrier proteins - membrane protien transports across cell membrane

61
Q

agonist vs antagonists

A

agonist - increase the affinity of receptor
antagonists - decrease/block receptors

62
Q

Selectivity
Affinity
intrinisic activity

A

Selectivity - ability of drug to be for a specific receptor
Affinity - strength or bond of drug and target
*weaker the more the effects are reversible
*covalant bonds are stronger and not reversible for a while
**Intrinisic activity **- ability to interact with given receptor and produce a given response

63
Q

Efficacy:

A

ability of drug to produce response​/ effect that we want to drug to produce

64
Q

Potency:

A

drug dose needed for effect ​

65
Q

Desensitization

A

rapid decrease in drug effects​

66
Q

Tolerance:

Toxicity:

Therapeutic index:

A

Tolerance :gradual decrease in drug action​

Toxicity: drug concentration harmful to body​

Therapeutic index: ratio of maximum nontoxic dose to minimum effective dose

67
Q

first pass effect

A

go to liver and gets broken down so only a part of the drug makes it to circulation.

First doses may be higher so the body can accumulate enough med to be effective

*lithium

68
Q

Soluabilty

A

availability of a substance to cross membrane

69
Q

metabolism or biotransformation

where can they be broken down

A

how a drug is broken down into metabolites

in liver, kidneys, lungs, intestines

70
Q

Bioavailablity

A

amount of drug that reaches circulation unchanged

71
Q

Pharmacogenomics:

Ethnopsychopharmacology:

A

Pharmacogenomics: how a person’s genetic makeup affects their response to drugs​

Ethnopsychopharmacology: cultural variations and differences influencing effectiveness

72
Q

Liver tests
SGPT, SGOT
why would be elevated

A

elevated liver labs - could be alcoholism or tynelol OD

73
Q

Phases of drug treatment

Initiation phase​
Stabilization phase​
Maintenance phase​
Discontinuation phase

A

Initiation phase​ started on drug
Stabilization phase​ reduce side effects/reach therapeutic level
Maintenance phase​on drug for period of time
Discontinuation phase - when they can come off drug

74
Q

Antipsychotic meds
indication
metabolism

A

Indications: schizophrenia; mania; autism; and the symptoms of psychosis, such as hallucinations, delusions, bizarre behavior, disorganized thinking, and agitation

metabolism: liver

75
Q

Deconoate

A

injectable, long acting slow release form of med

*Aripiprazole (aristada) - monthly
*Risperidone (Perseris) - monthly
*Haloperidol (Haldol) - 3 weeks

76
Q

can adavan, haldol and benedril go in 1 syringe?

A

only if given in a 5 min window, otherwise benedryl will turn the other 2 liquids into particular matter and cant get through syringe

77
Q

Acute extrapyramidal syndromes​
3 main symptoms

A

Dystonia: (movement disorder/involuntarily) onset within a few days of initiating therapy​

Pseudoparkinsonism: abrupt or sudden onset within first 30 days of treatment​

Akathisia: (inability to remain still) possibly misdiagnosed as agitation or increased psychotic symptoms

78
Q

what is treatement for EPS?
at home?
at hospital?

A

at home: Benedryl 2 tabs = 50mg
at hosptial: IM cogentin / IM artane (anticholinergics)

79
Q

Symptoms of serotonin syndrome​

A

Mental status changes (hallucinations, agitation)​

Autonomic instability (tachycardia, hyperthermia, BP changes)​

Neuromuscular problems: hyperreflexia, incoordination​

GI disturbances (nausea, vomiting, diarrhea)

80
Q

What are herbal supplements for anxiety/depression

A

St. Johns wart - depression, pain, anxiety, insomnia, and premenstrual syndrome
Kava - for anxiety reduction
Valerian for insomnia and nervousness

81
Q

What are nutritional therapies for depression and anxiety

A

Iron, folic acid, pantothenic acid, magnesium, vitamin C, or biotin: used for fatigue, apathy, and depression ​

Tryptophan: relates to low serotonin levels and increased aggression ​

Melatonin: used for treatment of insomnia and prevention of “jet lag” in air travelers​

Lecithin: used to improve memory and treat dementia

82
Q

What are non medication treatments for depression/anxiety

A

**ECT
Light therapy
Transcranial magnetic stimulation (TMS) - cerebral cortex
Vagus nerve stimulation (VNS): **adjunct for severe depression in adults unresponsive to four or more adequate antidepressant treatments; permanent implant

83
Q

Mania: ​

Elevated mood:

Expansive mood:

Irritable mood:

A

Mania: an abnormally and persistently ​

Elevated mood: euphoria or elation​

Expansive mood: lack of restraints in expression; overvalued self-importance​
Irritable mood: easily annoyed and provoked to anger​

84
Q

Manic episode:

Mood lability:

A

Manic episode: distinct period of mania​

Mood lability: rapid shifts in mood with little or no change in external events

85
Q

Bipolar I

Mania:

A

**Bipolar I **(major depressive, manic, or mixed episode)​
Classic manic-depressive disorder with mood swings alternating from depressed to manic​

Mania: a distinct period (of at least 1 week or less if hospitalized) of abnormally and persistently elevated, expansive, or irritable mood with abnormally increased goal-directed behavior or energy ​

86
Q

Bipolar II

Cyclothymic disorder:

A

**Bipolar II **(major depression and hypomania)​

Cyclothymic disorder (hypomania and depressive episodes not meeting full criteria for major depressive episode)

87
Q

How does bipolar 1 show up in a child?

A

Depression usually occurring first; marked by intense rage

88
Q

What lab testing is important for people with bipolar

A

Laboratory testing: thyroid function

89
Q

Pharmacokinetics

A

process by which the drug is absorbed, distributed, metabolized, and eliminated by body

90
Q

Substrate

A

the drug or compound that is identified as a target of enzyme

91
Q

Inhibitor

Inducer

A

slows down metabolism & decreases clearance of substance and elevates its plasma level

speeds up metabolism, increases clearance and decreases plasma level

92
Q

Augmentation

A

strategy of adding another medication

93
Q

What form of med for an antipsychotic has greater bioavailability

A

IM
bc it avoids first pass effect

Nurs 243 (7 decks)

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