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N222 - Mental Health/Psychiatric > CH 15: Psychotic Disorders > Flashcards

CH 15: Psychotic Disorders Flashcards

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1
Q

Type of Psychotic Disorder

Schizophrenia

A

has psychotic thinking or behavior present for at least 6 months
- areas of functioning, including school or work, self-care, and interpersonal relationship, are significantly impaired.

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2
Q

Type of Psychotic Disorder

Schizotypical Personality Disorder

A

has impariments of personality (self and interpersonal) functioning
- impairment not as severe as with schizophrenia

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3
Q

Type of Pyschotic Disorder

Delusional Disorder

A

experiences delusional thinking for at least 1 month
-self or interpersonal functioning is not markedly impaired

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4
Q

Type of Psychotic Disorder

Brief Psychotic Disorder

A

has psychotic manifestations that last 1 day to 1 month

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5
Q

Type of Psychotic Disorder

Schizophreniform Disorder

A

has manifestations similar to schizophrenia, but duration is 1 to 6 months
- social.occupational dysfuntion might not be present

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6
Q

Type of Psychotic Disorder

Schizoaffective Disorder

A

meets criteria for both schizophrenia and depressive or bipolar disorder

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7
Q

Type of Psychotic Disorder

Substance-Induced Psychotic Disorder

A

experiences psychosis due to substance intoxication or withdrawal
- manifestations are more severn than typically expected

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8
Q

Type of Psychotic Disorder

Psychotic or Catatonic Disorder

not othwise specified

A

exhibits psychotic features (impaired reality testing) or bizarre behavior (psychotic) or significant chand in motor activity behavior (catatonic) but DOES NOT meed criteria for diagnosus with another specific psychotic disorder

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9
Q

Positive symptoms

A

manifestatios of things that are not normally present

most easily identified menifestations

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10
Q

Negative symptoms

A

absence of things that are not normally present

more difficult to treat successfully than positive symptoms

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11
Q

Positive symptoms

of Psychotic Disorders

Expected

A
  • hallucinations
  • delusions
  • alterations in speech
  • bizarre behavior (walking backward constantly)
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12
Q

Negative symptoms

of Psychotic Disorders

Expected

A
  • Affect: blunted and flat
  • Alogia: poverty of thought or speech
  • Anergia: lack of energy
  • Anhedonia: lack of pleasure/joy
  • Avolition: lack of motivation in activites and hygiene
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13
Q

Cognitive findings

of Psychotic Disorders

Expected

A
  • disordered thinking
  • inability to make decisions
  • poor problem-solving
  • difficulty concentration
  • short term memory deficits
  • impaired abstract thinking
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14
Q

Affective findings

of Psychotic Disorders

Expected

A
  • hopelessness
  • suicidal ideation
  • unstable or rapidly changing mood
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15
Q

Alterations in Thought

Delusions

A

false fixed beliefs that cannot be corrected by reasoning and are usually bizarre

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16
Q

Ideas of Reference

Alterations in Thought (Delusions)

A

miscotrues trivial events and attaches personal significance to them

example: believing that others, who are discussing the next meal, are talking about him

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17
Q

Persecution

Alterations in Thought (Delusions)

A

feels singled out for harm by others

example: being hunted down by the FBI

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18
Q

Grandeur

Alterations in Thought (Delusions)

A

believes that they are all powerful and important

like God

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19
Q

Somatic Delusions

Alterations in Thought (Delusions)

A

believes that their body is changing in an unusual way

example: growing a third arm

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20
Q

Jealousy

Alterations in Thought (Delusions)

A

believes their partner is sexually involved with another individual even though there is not any factual basis for this belief

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21
Q

Being controlled

Alterations in Thought (Delusions)

A

believes that a force outside their body is controlling them

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22
Q

Thought Broadcasting

Alterations in Thought (Delusions)

A

believes that their thoughts are heard by others

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23
Q

Thought Insertions

Alterations in Thought (Delusions)

A

believes that others’ thoughs are being inserted into their mind

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24
Q

Thought Withdrawal

Alterations in Thought (Delusions)

A

believes that their thoughts have been removed frpom their mind by an outside agency

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25
Religiosity ## Footnote Alterations in Thought (Delusions)
is obsessed with religious beliefs
26
Magical Thinking ## Footnote Alterations in Thought (Delusions)
believes their actions and thoughts are able to control a situation or affect others ## Footnote example: *weaing a certain hat that makes them invisible to others*
27
Associative Looseness ## Footnote Alterations in Speech
**Unconscious inability to concentrate on a single thought** - can progress to flight of ideas in which the client's speech moves so rapidly from one thought to another that it is incoherent
28
Neologisms ## Footnote Alterations in Speech
made-up words that have meaning only to the client ## Footnote example: *"I trangled and flittled."*
29
Echolalia ## Footnote Alterations in Speech
client repeats the words spoken to him
30
Clang Association ## Footnote Alterations in Speech
meaningless rhyming of words | often forceful ## Footnote example: *"Oh fox, box, and lox."*
31
Word Salad ## Footnote Alterations in Speech
words jumbles together with little meaning or sugnificance to the listener ## Footnote example: *"Hip hooray, the flip is cast and wide-sprinting in the forest."*
32
Alterations in Perception | Hallucinations
sensory perceptions that do not have any apparent external stimulus
33
Auditory ## Footnote Alterations in Perceptions (Hallucinations)
hearing voices or sounds
34
Auditiory Command ## Footnote Alterations in Perceptions (Hallucinations)
voice instructs the client to perform an action | (to hurt self or others)
35
Visual ## Footnote Alterations in Perceptions (Hallucinations)
seeing persons or things
36
Olfactory ## Footnote Alterations in Perceptions (Hallucinations)
smelling odors
37
Gustatory ## Footnote Alterations in Perceptions (Hallucinations)
experiencing tastes
38
Tactile ## Footnote Alterations in Perceptions (Hallucinations)
feeling bodily sensations
39
Personal Boundary Difficulties
disebfranchisement with one's own body, identity, and perceptions
40
Depersonalization ## Footnote Personal Boundary Difficulties
nonspecific feeling that a client has lost their identity | self is different ot unreal
41
Derealization ## Footnote Personal Boundary Difficulties
perception that the environment has changed ## Footnote example: *believing that objects in their environment are shrinking*
42
Illusions ## Footnote Personal Boundary Difficulties
misperceptions or misinterpretations of a real experience
43
Extreme agitation ## Footnote Alterations in Behavior
pacing and rocking
44
Stereotyped Behaviors ## Footnote Alterations in Behavior
motor patterns that had meaning to client but nit are mechanical and lack purpose | (sweeping the floor)
45
Automatic Obedience ## Footnote Alterations in Behavior
responding in a robot-linke manner
46
Waxy Flexibility ## Footnote Alterations in Behavior
maintaining a specific position for an extended period of time
47
Stupor ## Footnote Alterations in Behavior
motionless for long periods of time | coma-like
48
Negativism ## Footnote Alterations in Behavior
doing the opposite of what is requested
49
Echopraxia ## Footnote Alterations in Behavior
purposeful imitation of movements made by others
50
Catatonia ## Footnote Alterations in Behavior
pronounced decrease or increas in the amoung of movement - may be so severe that limbs remain in whatever position they are placed
51
Motor Retardation ## Footnote Alterations in Behavior
pronounced slowing of movement
52
Impaired Impulse Control ## Footnote Alterations in Behavior
reduced ability to resist impulse
53
Gesturing or Posturing ## Footnote Alterations in Behavior
assuming unusual and illogical expressions
54
Boundary Impairment ## Footnote Alterations in Behavior
impaired ability to see where one person's body ends and another begins
55
Abnormal Involuntary Movement Scale | (AIMS) ## Footnote Standardized Screening Tool
used to monitor involuntary movemnets and tardive duyskinesia in clients who take antipsychotic medication
56
World Health Organization Diability Assessment Schedule | (WHODAS) ## Footnote Standardized Screening Tool
helps to determine the client's level if global functioning
57
What therapy is used for clients who have a psychotic disorder? | (used both in acute and community facilities)
Milieu therapy - provides structure, safe environment to decrease anxiety and constant thinking about hallucinations
58
Manifestation Management techniques include:
- using music to distract from "voices" - attending activities - waling - talking to a trusted person when hallucinations are most bothersome - interacting with an auditory or visual hallucination by telling them to stop or go away | used to cope with deptessive finding and anxiety
59
Client education | for Psychotic Disorders
- develop social skills and friendships - participate in group work and psychoeducations - comply with the medication
60
Haloperidol Loxapine Chlorpromazine Fluphenazine | 1st Generation/Conventional Antipsychotic
**used to treat mainly positive psychotic symptoms; reduces dopamine** - *Nursing actions:* monitor for EPS, including dystonia, akathisia, pseudoparkinsonism, and tardive dyskinesia - *Client education:* chew sugarless gum, eat food high in fiber, 2-3L of fluids/day - *Postural hypotension:* lightheadedness and dizziness (sit or lie down)
61
Risperidone Olanzapine Quetuapine Ziprasidone Clozapine | 2nd Generation/Atypical Antipsychotic
**treat both positive and negative symptoms; preferred choice for psychotic disorders** - *Client Education:* follow a healthy, low-calorie diet, regularly exercise, and monitor weight (weight gain) - *Adverse effects:* agitation, dizziness, sedation, and sleep disruption (report to provider) - blood tests needed to monitor for agranulocytosis
62
Aripiprazole | 3rd Generation Antipsychotic
**treats both positive and negative symptoms while improving cognitive function** - decreased risk of EPSs or tardive dyskinesia - lower risk for weight gain and anticholinergic effects
63
Acute Dystonia ## Footnote 1st Gen Complications: EPS
sustained muscle contraction - spasm of tongue, face, neck, back - requires immediate treatment - occurs within 1-5 days
64
Akasthisia ## Footnote 1st Gen Complications: EPS
body restlessness - inability to sit/stand still; pacing; agitation - occurs within 5 to 60 days
65
Pseudoparkinsonism ## Footnote 1st Gen Complications: EPS
drooling, facial masking, bardykinetic, flat affect - tremors, shuffling gait, stooped posture/hump/hunch, pill rolling, muscle rigidity - occurs withing 5 to 30 days
66
Tardive Dyskinesia ## Footnote 1st Gen Complications: EPS
unnatural; bizarre - late onset - subtle, gets worse - can't dress; difficulty eating - sometimes irreversible - monitor for 12 months, then every 3 months
67
Neuroleptic Malignant Syndrome | (NMS) ## Footnote 1st and 2nd Gen Complications
*Manifestations:* sudden high fever, BP fluctuations, diaphoresis, tachycardia, mucle rigidity, decreased LOC, coma - life-threatening medical emergency *Nursing Actions:* 1) stop med, 2) monitor vitals, 3) apply cooling techniques, 4) antipyrectics, 5) increase fluids, 6) admin meds for arrythmias, 7) admin dantrolene for muscle relaxation, 8) transfer to ICU - wait 2 weeks before resuming therapy
68
Contraindications for 1st Gen Antipsychotics
- liver issues - parkinson's - severe hypotension - dementia
69
Haloperidol and Fluphenazine Depot ## Footnote 1st Generation Antipsychotics
IM every 2-4 weeks
70
Metabolic Syndrome ## Footnote 2nd Gen Complications
new onsent of DM or loss of glucose control in those with DM *Education:* healthy, low-calorie diet; regularly exercise; monitor weight
71
Risperidone | Contraindication ## Footnote 2nd Gen Contraindications
pregnancy risk category C - depot injection: IM every 2 weeks
72
Aripiprazole ## Footnote 2nd Gen Side Effects
- headache - anxiety - GI upset - insomnia - depo injection: monthly | low risk of DM, weight gain, dyslipidemia, OH, & anticholinergic effects
73
Clozapine ## Footnote 2nd Gen Antipsychotic
- risk for agranulocytosis (monitor WBC) - notify provide of signs of infection - hypersalivation
74
Olanzapine ## Footnote 2nd Gen Antipsychotic
- after ER injection, monitor for 3 hours
75
Quetiapine ## Footnote 2nd Gen Side Effects
- cataracts
76
Pre-assaultive Category | Signs of Escalation ## Footnote Anger Management
client becomes angry and exhibits anxiety, tension, hyperactivity, and verbal abuse - argumentative, increased profanity - stone silence, newly isolative - alcohol or drug intoxication - possesion of weapons - pacing, restlessness - frowning or grimacing - clenching fists, waving arms - leaning forward - loud, rapid talking; yelling and shouting - rapid breathing
77
Steps to handle aggressive behavior
- respond quickly - remain calm/in control - encourage client to express feelings - give space - maintain eye contact - avoid accusatory/threatening - calmly and directly state what the client must do - use physical activity - inform consequences of behavior - use pharm interventions is pt does not respond to calm limiting-setting - plan 4-6 members to be available and insight of client if appropriate
78
Following an aggressive/violent episode
- discuss ways for client to keep control - reassess milieu and identify potential and actual stressors that may have contributed - encourage client to talk about the incident, what triggered and escalated the aggression - debrief staff to evaluate effectiveness - document the entire incident (behaviors leading up, behaviors observerd throughout, nursing interventions implemented, and the clients response

N222 - Mental Health/Psychiatric (7 decks)

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