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mental health > Class 7 (psychosis) > Flashcards

Class 7 (psychosis) Flashcards

1
Q

what is a psychotic disorder

A

a person living with schizophrenia or another thought disorder may have difficultly distinguishing between what “is” or “isn’t” real
-person may also be withdrawn or unresponsive and may experience difficultly expressing their emotions
-affects perception via hallucinations/delusions

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2
Q

what is schizophrenia

A

syndrome/groups symptoms
-can be successfully managed once diagnosed
-early tx is better
-most can function independently once tx
-20-50% attempt suicide
-20-30% make a full recovery

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3
Q

schizophrenia co-morbidity

A

-substance misuse
-depression
-anxiety
-diabetes mellitus
-psychogenic polydypsia

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4
Q

the emotional impact of schizophrenia

A

-fear comes from stigma, delayed care, minimizes symptoms
-understanding & speak openly with patient

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5
Q

research on schizophrenia

A

researchers now believe that schizophrenia is actually a group of different illlnesses.
each illness is caused by environmental and social factors, these genes “malfunction” and produce distinct symptoms

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6
Q

risk factors for schizophrenia

A

-perinatal and obstetrical complications
-increased parental age (50+)
-environment (poverty, lack of services)
-increased immune system activation (inflammation, autoimmune diseases)
-taking mind-altering drugs during teen years & young adultood)

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7
Q

things to consider with schizophrenia that may be risk factors

A

-age of onset (males; 15-25, females: 25-35)
-ethnic & cultural considerations (decreased reports in asian people)
-genetics(familial tendencies, but still unsure how its “passed on”
-neurobiological (dopamine & limbic system)

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8
Q

signs and symptoms of schizophrenia in kids

A

visual hallucinations increase common

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9
Q

signs and symptoms of schizophrenia in under 25

A

increased negative s&s

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10
Q

signs and symptoms of schizophrenia in over 50

A

increase positive S&S (first 4 of 5 key features)

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11
Q

5 key features of schizophrenia

A

1.Delusions
2.hallucinations
3.disorganized thinking
4.abnormal motor behaviour
5.negative symptoms (take something away that should be there) i.e. loss of motivation/joy

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12
Q

positive symptoms in schizophrenia

A

-added to the person, not normally present
-occur earlier & easier to identify=earlier tx
-delusions (ideas of reference, perseuction, grandeur, somatic, jealousy)
-perceptual alterations(hallucinations)
-alterations in speech (loosening og associations, neologism, echolalia, clang association, word salad)
-alterations in behaviour (echopraxia, catatonia)
-disorganized thoughts(thought broadcasting, insetion, withdrawl, delusion of control)

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13
Q

negative symptoms seen in schizophrenia

A

-taking away from the person (absence of something that should be present)
-apathy
-avolition(decreased motivation)
-anhedonia(decreased pleasure)
-alogia(decerase speech)
-affective flattening
-anergia

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14
Q

paranoid schizophrenia

A

-included delusions & auditory hallucinations
-normal intellecual functioning & expression of emotion
-anxious, angry, argumentative, aloof

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15
Q

disorganized schizophrenia

A

-ADL’s disrupted
- alteration in speech & behaviours
-difficult to understand
-flattening of inappropriate emotions
-preoccupied with own thoughts

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16
Q

catatonic schizophrenia

A

muscle rigidity

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17
Q

residual schizophrenia

A

-past history of schizophrenia
-no positive s&s
-at least 1 past episode
-between acute & remission

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18
Q

undifferentiated schizophrenia

A

-both positive and negative S&S
-not enough s&s to diagnose one specific type
-mix of multiple types

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19
Q

pre-psychotic/prodromal phase of schizophrenia

A

-notices something is wrong
-“warning” signs
-bizarre behaviours

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20
Q

acute phase of schizophrenia

A

-best if caught early
-psychosis begins
-delusions, distortion of thought

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21
Q

stabilization phase of schizophrenia

A

-Dx is made, medication is started
-S&S become less acute
-adapting to med side effects
-some social interaction

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22
Q

maintenance phase of schizophrenia

A

-recovery phase
-monitoring for chnages
-support med adherence
-education for pt & family
-watch for s&s of relapse

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23
Q

things a person living with schizophrenia needs to recover

A

-knowledgable and caring team
-effective medication
-“talk therapy”
-peer, family, and friend support
-psych & social support programs
-personal relapse prevention plan

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24
Q

questions to ask during inital schizophrenia assessment

A

-keep it broad & open initially
-assess for hallucinations
-what are you seeing/feeling/experiencing
-substance misuse?
-SI/HI->plan?
-how long has this been otg
-have you ADL’s changed

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25
Q

first step of nursing process for schizophrenia (biological interventions)

A

-history & physical assessment
-bloodwork
-rule out medical or physiological impact

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26
Q

second step of nursing process for schizophrenia (biological interventions)

A

-monitor/assess ADL’s to determine need for assistance

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27
Q

third step of nursing process for schizophrenia (biological interventions)

A

-pharmacotherapy: typical antipsychotics
-task description

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28
Q

fourth step of nursing process for schizophrenia (biological interventions)

A

-ECT if determined to be effective
(not as effective for chronic but good for catatonia or life-threatening situation i.e risk of suicide, food paranoia etc)

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29
Q

typical antipsychotics

A

first generation antipsychotics
-haloperiodol(halodol)
-perphenazine(trilafon)
–chloropromazine(largactil or thorazaine)

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30
Q

how do typical antipsychotics work

A

they block dopamine receptors

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31
Q

side effects of typical antipsychotics

A

-anticholinergic side effects (dry mouth, urinary retention, tachycardia)
-extra pyramidal side effects (4 categories)
-sedation
-increase HR
-decerased BP
-increased prolactin
-agitation
-nausea
-dyspepsia

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32
Q

what are the 4 extrapyramidal side effects

A

1.dystonic reactions
2.akathesia
3.pseudo-parkinsonism
4.tardive dyskinesia

33
Q

extrapyramidal side effects: dystonic reactions

A

abnormal movements:
-torticollis(contraction of neck muscles)
-oculogyric crisis(eyes diviate upwards)
-orolaryngeal pharyngeal hypertonus(difficulty swallowing & protrusion of the tongue)

34
Q

extrapyramidal side effects: akathesia

A

significant restlessness
-fidgeting
-pacing
-occurs 2 hours->60 days after drug is started

35
Q

extrapyramidal side effects: pseudo-parkinsonism

A

medication induced impaired body movements
-shuffling gait
-tremors
-usually in 1st week of starting med (may give congentin to help but NO KIDS AND NO OLDER ADULTS)

36
Q

extrapyramidal side effects: tardive dyskinesia

A

most serious of the 4
-tongue protrusion
-rocking back & forth
-foot taping, jaw movement
can start short term, may not be reversible, usually seen in long term use + high dose

37
Q

what scale is used to assess for eps?

A

abnormal involuntary movement scale “AIMS”

38
Q

atypical antipsychotics

A

-emerged in 1990s, second generation antipsychotics
-OFTEN FIRST CHOICE d/t improved side effect profile
-can also be used as mood stabilizers

39
Q

common atypical antipsychotics

A

-clozapine(clozaril)
-olanzapine(zyprexia)
-risperidone(risperdal)
-quentiapine(seroquel)
-ziprasidone(zeldox)
-aripiprazole(abilify)

40
Q

side effects common to olanzapine

A

weight gain, tachycardia, increased risk for diabetes, sedating, bone marrow suppression

41
Q

what atypical antipsychotics can be prescribed if the pt is prone to weight gain?

A

ziprasidone (zeldox)
aripiprazole (abilify)

42
Q

side effects common in risperidone

A

increased prolactin
enlarged breast
irregular menses
-sexual dysfunction
sedation
hypotension
increased dose=EPS is a concern

43
Q

side effects common in clozapine

A

agraunulocytosis
seizures
tachycardia
weight gain
sedating

44
Q

side effects for atypical antipsychotics

A

metabolic syndrome
sedation & hypotension common

45
Q

what is metabolic syndrome?

A

-significant concern in most atypical antipsychotics
-risk for altered glucose metabolism diabetes (hyperglycemia), dyslipidemia (cholesterol changes), abdominal obesity weight gain
-comorbidity of serious mental illness and metabolic syndrome contributes to the reduced lifespan of those diagnosed with a serious mental illness

46
Q

what atypical antipsychotics are highest risk for metabolic syndrome

A

clozapine and olanzapine

47
Q

what should the nurse be montioring for metabolic syndrome

A

-get baseline body weight & reassess at visits
-routine blood cultures, weight, blood pressure

48
Q

what is neuroleptic malignant syndrome (NMS)

A

life-threatening neurological disorder most often caused by an adverse reaction to antipsychotic medication
-usually occurs when medication is stopped abruptly
-if detected early prognosis is good

49
Q

what causes NMS

A

sudden, marked reduction in dopamine activity, either from withdrawl of dopaminergic agents or from blockade of dopamine receptors
seen when meds are stopped abruptly

50
Q

signs and symptoms of NMS

A

muscle cramps & tremors
fever over 40
unstable blood pressure
drooling
diaphoresis
renal failure
alterations in mental status (agitation, delirium, coma)

51
Q

treatment for NMS

A

discontinue medication, supportive measures, and possibly ECT
generally supportive care: no drug to combat, benzo’s may help

52
Q

what is anticholinergic crisis

A

many medications prescribed in the psychiatric setting can produce anticholinergic effects due to sensitivity or over dose

53
Q

physical symptoms of anticholinergic crisis

A

blurred vision
hypertension
flushing
dry skin
unstable vital signs
euphoria (overdose results in delirium and extreme agitation)

54
Q

treatment of anticholinergic crisis due to overdose

A

gastric lavage
cooling blankets
give benzodiazepines for agitation

55
Q

reasons for decreased med adherence in pts with psychiatric disorder

A

-lack of insight into medications
-thinking meds are not needed
-medication side effects
-insufficient knowledge about tx
-cultural shame
promote through education & collaborative care

56
Q

nursing process: psychological interventions

A

-MSE
-nursing management
-education
-safety
-support
-psychotherapy (CBT, DBT)

57
Q

what may cause a first episode of psychosis (FEP)

A

-use of psychoactive substances
-stress
- significant lifestyle changes
-emotional attitudes and beliefs of family members

58
Q

nursing process: social interventions

A

therapeutic milieu
group activities
safety for self and others

59
Q

community supports for psychiatric disorder clients

A

-peer support groups
-educational workshops
-advocacy
-create a meaningful life in community
-connecting with people/services

60
Q

schizoaffective disorder

A

-S&S typical of both schizophrenia and a mood disorder (MDD or mania)
-positive symptoms: hallucination, delusion, disorganized speech, acatonia
-negative symptoms: affective flattening, alogia, avolition
-appear to have more insight into their illness vs true schizophrenia

61
Q

what is delusional disorder

A

-presence of non-bizzare delusions (not outside the realm of possibility)
-delusions are not due to the efects of medications, drugs, or medical conditions
-denies psychiatric bases for problems
-could exhibit odd/bizzare behaviour

62
Q

erotomanic delusional disorder ex:

A

belief that a famous person is in love with you

63
Q

grandiose delusional disorder ex:

A

belief they are the most important/intellegent

64
Q

jealous delusional disorder ex:

A

belief that a partner is cheating

65
Q

somatic delusional disorder ex:

A

hypochondriac but really believe it

66
Q

mixed delusional disorder

A

characteristics of several types

67
Q

unspecified delusional disorder

A

other type of delusion; most common persecutory delusions

68
Q

schizophreniform disorder

A

-similar to schizophrenia but shorter lasting (min; 1 month, max: 6 months. if continued=schizophrenia Dx)
-S&S of schizophrenia are present (hallucinations, disorganized speech, catatonic behaviour, negative symptoms)
-may/ may not be impaired social or occupational functioning
-not a result os schizoaffective disorder or a mood disorder
-ensure it’s not d/t a physical issue or substance use

69
Q

brief psychotic disorder

A

emotional turmoil
confusion
may also experience hallucinations/deusions/bizarre behaviour
comes on suddenly (min 1 day max <1 month) with MIN 1 positive symptom
after tx goes back to baseline

70
Q

psychotic disorders due to drugs and alcohol

A

need blood work to Dx
psychosis due to consuming drugs or alcohol

71
Q

psychosis or catatonia d/t another medical or mental illness

A

i.e. hypothyroidism, cva, head injury

72
Q

commonalities with cluster A personality disorders

A

most have had a depressive episode
30-50% have concurrent depression

73
Q

schizotypal personality disorder

A

-pattern of social and interperosnal deficits
-discomfort with and reduced capacity for close relationships
-cognitive or perceptual distortions(ideas of reference, belief events have a true meaning to them)
-eccentric behaviour
-communication may be affected:speech is clear but very vague/no context, rambling, delusions (loss of ability to express/experience full range of emotions)
-increased prevelance in first degree relatives with schizophrenia(genetic) but criteria for schizophrenia will not be met
-may lack social supports d/t issues with expression/relationships (lack of trust/suspicious)
-need assistance with social integration

74
Q

treatment for schizotypal personality disorder

A

psychotherapy
social integration
meds for concurrent dx

75
Q

paranoid personality disorder

A

-pervasive distrust and suspiciousness of others at an inappropriate level, will never believe their suspicons are wrong
-psychotic episodes can occur
-difficult to facilitate their making contact with the health care team for fear of being labeled=delayed tx
-increased prevalence in families with history of schizophrenia (genetic)
-creates challenges for establishing therapeutic relationship d/t mistrust
-may lack support systems: impacts outcomes
-medications (atypical antipsychotics) may be helpful
-increasingly common in men
-distinct lack of humour, very serious
-will be on edge/alert

76
Q

schizoid personality disorder

A

-difficulty expressing emotion
-detachment form social relationship
-can become delusional/develop schizophrenia
-lack of social supports & lack of interest in developing
-difficult to establish therapeutic relationship (slow steps)
-self absorbed, introverted, shy, socially withdrawn, “loner”
-lack of nurturing/empathy in childhood
-seek out jobs when they work alone i.e. night shift, computers

77
Q

assessments for type a personality disorders

A

-semi-structured interview: goes beyond self-reported s&s, “how do others” questions d/t lack of insight
-history: genetic & environmental
-nurses self assessment to remove stigma and bias

78
Q

assessment tools for type a personality disorder

A

Minnesota multiphasic personality inventory (MMPI)
-25-45 mins to complete
-10 clinical scales
-dx isnt dependent on this one tool

mental health (10 decks)

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