Class 4? - Psychosis: Schizophrenia Recovery Model

Question 1

Why is early intervention in psychosis important?

Answer 1

decreases degree of functional impairment

Question 2

Psychobiology

Answer 2

dysregulation of dopamine transport systems between the limbic system and prefrontal cortex

Question 3

Psychosis as a Nursing Concept

Answer 3

a syndrome of neurocognitive symptoms that impairs cognitive capacity leading to deficits of perception, functioning, and social relatedness

Question 4

What is the DSM-5 definition of psychosis?

Answer 4

abnormalities in five different symptomatic domains: delusions, hallucinations, disorganized thoughts/speech, disorganized or abnormal behaviour, negative (and positive) symptoms

Question 5

Prodromal Phase of Psychosis

Answer 5

-early signs may be subtile and not easily identifiable
-vague changes in thoughts, feelings, perceptions

Question 5

Recovery Phase of Psychosis

Answer 5

-psychosis is treatable
-medication can help but doesn’t cure
-relapse not guaranteed, but common

Question 5

Acute Phase of Psychosis

Answer 5

-clear psychotic S&S (hallucinations, delusions)
-functioning deteriorates
-substance abuse is common
-HIGH RISK OF SUICIDE

Question 6

Consequences of Psychosis

Answer 6

-difficulty processing information
-impaired observation and concentration
-easily distracted
-difficulty initiating and completing tasks

Question 7

Individual Psychosis Risk Factors

Answer 7

-temperament
-environment
-genetics

Question 8

Delusions

Answer 8

fixed beliefs that are unlikely to change despite contradictory evidence

Question 9

Hallucinations

Answer 9

perceptions that occur without an external stimulus

Question 10

Does psychosis cause brain damage?

Answer 10

yes it can, but depending how long it lasts

Question 11

Alogia

Answer 11

poverty of speech

Question 12

Avolition

Answer 12

decreased motivation to undertake self-directed activites

Question 13

Anhedonia

Answer 13

inability to feel pleasure

Question 14

Ambivalence

Answer 14

inability to make a decisions

Question 15

Monotony

Answer 15

lack of variety and interest

Question 16

Milieu Therapy

Answer 16

form of psychotherapy that involves the use of therapeutic communities

Question 17

Vocational Therapy

Answer 17

subfield of occupational therapy where work is used as therapy under conditions close to reality

Question 18

Serial Health Monitoring

Answer 18

regularly scheduled monitoring of side effects and general health

Question 19

Case Management

Answer 19

team approach to management

Question 20

What is the first priority in acute interventions?

Answer 20

safety

Question 21

What are acute phase interventions?

Answer 21

-safety
-trust and rapport
-reinforce reality
-reduce stimulation
-create a regular routine
-support adherence

Question 22

What are recovery phase interventions?

Answer 22

-show positive regard
-don’t argue about hallucinations/delusions
-focus on positve-goal activities
-model skills for independence
-connect client with community support, vocational opportunities, support, crisis planning

Question 23

How are first generation antipsychotics administered?

Answer 23

PO or IM

Question 24

What are the side effects of first gen antipsychotics?

Answer 24

-parkinsonism -dystonia -akathisia -tardive dyskinesia -neuroleptic malignant syndrome

Question 25

What type of meds are used to help side effects of first gen antipsychotics?

Answer 25

anticholinergics

Question 26

Akathisia

Answer 26

inability to remain still

Question 27

What does EPS stand for?

Answer 27

extrapyrimidal symptoms

Question 28

Parkinsonism

Answer 28

identical to PD - shuffling gait, tremors, rigidity

Question 29

Dystonia

Answer 29

-abnormal posture of face, tongue, eyes, neck, trunk, limbs -stiffness -distressing -difficulty swallowing

Question 30

Tardive Dyskinesia

Answer 30

impaired voluntary movements, constant movement, lip smacking, tongue protrusion, grimacing, blinking

Question 31

Neuroleptic Malignant Syndrome is a _____________

Answer 31

medical emergency

Question 32

What is NMS?

Answer 32

a rare, potentially fatal adverse effect occurring within 7 days after starting or increasing oral antipsychotics

Question 33

What does NMS involve?

Answer 33

-fever -muscle rigidity -ALOC -fluctuating vitals -diaphoresis -incontinence -leukocytosis -muscle injury -metabolic acidosis

Question 34

How are second gen antipsychotics given?

Answer 34

PO or IM

Question 35

What are the side effects of second gen antipsychotics?

Answer 35

-metabolic syndrome (weight gain, insulin resistance, dyslipidemia, hypertension) -seizures -sialorrhea -agranulocytosis -sedation -orthostatic hypotension -dysrhythmias

Question 36

Are EPS, TD, and NMS more common in first or second gen antipsychotics?

Answer 36

first gen

Question 37

Sialorrhea

Answer 37

excessive saliva flow

Question 38

Dyslipidemia

Answer 38

elevation of plasma cholesterol, triglycerides, HDLs or LDLs

Question 39

hyperprolactinemia

Answer 39

high prolactin levels (stimulates breast milk production)

Question 40

Agranulocytosis

Answer 40

life-threatening condition involving low levels of neutrophils (WBCs)

Question 41

Secondary Psychosis

Answer 41

-toxic psychosis -dementia -medical illness -toxins, drugs, medication

Question 42

What is the prevalence of schizophrenia?

Answer 42

1%

Question 43

What is the age of onset for schizophrenia in women?

Answer 43

18-30yrs or after 40yrs

Question 44

What is the age of onset of schizophrenia for men?

Answer 44

15-25yrs

Question 45

What is the prodromal phase of schizophrenia?

Answer 45

a process of changes in subjective and behavioural symptoms that precede the onset of psychotic symptoms

Question 46

What are some myths about schizophrenia?

Answer 46

-it is uncommon -it is untreatable -they are violent -have multiple personalities -caused by bad parenting -unable to work or go to school

Question 47

____ or more of delusions, hallucinations, disorganized speech, behaviour, and negative symptoms are the diagnostic criteria for schizophrenia

Answer 47

2

Question 48

At least one schizophrenia symptom must be:

Answer 48

delusions, hallucinations, or disorganized speech

Question 49

For schizophrenia to be diagnosed:

Answer 49

-it must last at least 6 months -must affect level of functioning

Question 50

Schizophrenia _____ be attributed to another diagnosis

Answer 50

cannot

Question 51

Schizophrenia diagnostic criteria involves at least 2 of the primary criteria for schizophrenia plus:

Answer 51

-major mood episode -delusions or hallucinations for 2+ consecutive weeks without -mood symptoms

Question 52

What is the CHIME model?

Answer 52

-connectedness (peer support, community, relationships) -hope and optimism (belief in recovery, motivation, positive thinking) -identity (overcoming stigma) -meaning (meaning in experience, social roles) -empowerment (personal responsibility, strenghts)

Question 53

Traditional Biomedical Model

Answer 53

-medical -assess-diagnose-treat -promote clinical recovery -practitioner has control

Question 54

Recovery Model

Answer 54

-wellbeing -individual focused -personal recovery -share control

Question 55

What factors enable recovery?

Answer 55

-accessible -vocational training -shared decision making -respect -spaces for belonging