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Psych - Test 2 > Psychotic Disorders > Flashcards

Psychotic Disorders Flashcards

(54 cards)

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1
Q

Schizophrenia - Physiological Factors

A

Neurotransmitter dysregulation

  • Dopamine Hypothesis
  • Dopamine and Serotonin Dysregulation (more accepted theory)
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2
Q

Schizophrenia - Onset - Prodromal Symptoms

A 
One year prior to diagnosis
Subtle Changes 
-Behavior
-Thinking
-Relating to others
-Caring for self
-Mounting anxiety
-Emotional blunting
-Loss of interest
-Heightened sensitivity to sound
-Neglect of personal hygiene
-Somatic concerns
-Preoccupied with body parts
-Sense of body distortion
-Self-mutilation
-Starving
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3
Q

Schizophrenia communication -

Tangentiality

A

Digressive or irrelevant manner of speech where central idea is never communicated

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4
Q

Schizophrenia communication -

Circumstantiality

A

Digression into unnecessary details and inappropriate thoughts before communicating central idea

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5
Q

Impaired communication - Bizarre Speech (8)

A
  • Echolalia-
  • Concrete thinking
  • Word salad
  • Loose associations
  • Flight of ideas
  • Thought retardation
  • Thought blocking
  • Neologism - invented words
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6
Q

Schizophrenia - Altered Thought Processes

Delusions (5)

A
  • Persecution
  • Paranoia
  • Reference
    • Referential delusion
    • Ideas of reference
  • Grandeur
  • Somatic
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7
Q

Schizophrenia -

Somatic Delusions

A

Somatic - Thinking that your body is diseased in some way. i.e. The idea that one’s body is completely infested with parasites (clearly untrue).

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8
Q

Schizophrenia -

Nihilistic Delusions

A

Nihilistic - Total rejection of values, extreme skepticism or moral and value judgment

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9
Q

Schizophrenia - Negative Symptoms

Alexithymia

A

Alexithymia - Difficulty naming and describing emotions

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10
Q

Schizophrenia - Negative Symptoms

Asociality

A

Asociality - Few friends ~ preference for solitary activities

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11
Q

Schizophrenia - Negative Symptoms

Anhedonia

A

Anhedonia - Inability to experience pleasure

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12
Q

Schizophrenia - Negative Symptoms

Avolition

A

Avolition - Lack of motivation

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13
Q

Schizophrenia - Negative Symptoms

Apathy

A

Apathy - You don’t care

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14
Q

Schizophrenia - Negative Symptoms

Affect changes

A
  • Flat = no affect

- Blunted = not overly animated

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15
Q

Schizophrenia - Negative Symptoms

Anergia

A

Anergia - no energy

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16
Q

Schizophrenia - Negative Symptoms

Ambivalence

A

Ambivalence - having conflicting ideas, wishes and feelings toward a person, thing or situation.

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17
Q

Schizophrenia - Negative Symptoms

Alogia -

A

Alogia - Decreased productivity of thought and speech

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18
Q

Catatonia - Clinical picture is dominated by three (or more) of the following symptoms (12)

A

Stupor - no psychomotor activity

Catalepsy - passive induction of a posture held against gravity

Waxy flexibility - Slight, even resistance to positioning

Mutism - no or very little verbal response

Negativism- oppositional or no response to instructions

Posturing- spontaneous or active maintenance of a posture held against gravity

Mannerisms- Odd, circumstancial caricature of normal actions

Stereotypy- Repetitive, abnormally frequent, non-goal directed movements

Agitation- Not influenced by external stimuli

Grimacing- scowl

Echolalia- Mimicing another’s speech

Echopraxia- Mimicing another’s movement

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19
Q

Schizoaffective Disorder - Period of illness includes

A

Major mood episode (MDD or Mania)
Concurrent with two or more:

  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic
  • Negative symptoms
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20
Q

A homeless psychotic patient tells you that they were attacked by insects “all over me”. What is the first thing you would do?

A

Check for bites or any indication of head lice

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21
Q

Nursing Interventions (4)

A
  • Relapse prevention
  • Maintain psychosocial functioning
  • Provide education
  • Improve quality of life
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22
Q

ACT - Assertive Community Treatment

Study These Flashcards
A

“Kendra’s Law”
Intense case management
-Note: Intense case managemetn should be part of discharge plan for client with multiple psychosocial issues (o.e. homelessness) who have multiple hospitalizations

23
Q

Community/Outpatient care - Personalized Recovery Oriented Services (8)

Study These Flashcards
A
  • Improve functioning
  • Reduce inpatient utilization
  • Reduce emergency services
  • Reduce contact with criminal justice system
  • Increase employment
  • Attain higher levels of education
  • Secure preferred housing
  • Mainstream into the community
24
Q

Meeting Patient’s Psychological Needs -

Relapse Prevention Education (8)

Study These Flashcards
A
  • Poor nutrition
  • Lack of sleep
  • Infection
  • Hostile environment
  • Social isolation
  • “Hopeless” attitude
  • Poor social skills
  • Medication issues
    * How will client get meds?
    - Order, finance, pick up
25
Meeting Patient's Psychological Needs - | Relapse Prevention Education
- Self monitoring - Recognition of triggers - Events, time, place, stimuli - Identify HIGH RISK times
26
Family Needs - Provide Education on the Disease Process
- Need to understand that schizophrenia has many presentation for different clients - Should NOT compare client's symptoms to other schizophrenics in the family, relatives, friends, etc.
27
Strategies for working with Psychotic patients
Re-orient to reality -"I know that you believe you (hear voices) but I want you to know that I do not hear any voices (except yours)." Acknowledge feelings -"I believe you are safe here, but it must be very frightening to believe that the CIA is after you."
28
Pharmacologic Intervention - Long acting injections
``` Given every 4 weeks Check for allergy before administering LAI -Prolixin Decanoate -Haldol Decanoate -Risperdal Consta -Invega Sustenna -Zyprxa Relprevv ```
29
Zyprexa Relprevv - Precautions / Implications
- Post injection delirium/sedation syndrome (PDSS) | - Client must stay for 3 hour observation after injection
30
Zyprexa Relprevv - Symptoms (9)
- Sleepy - Dizzy - Disoriented - Stiff - Shaky - Weak - Increased Blood Pressure - Seizures - Unconsciousness
31
Alternatives to PO Meds
- Orally disintegrating anti-psychotics OR - Long Acting Injections *We need to know alternatives to standard PO meds
32
Orally disintegrating anti-psychotics (3)
- Zyprexa Zydis - Risperdol-M Tab - Abilify Discmelt
33
Long Acting Injectables (5)
- Prolixin Decanoate - Haldol Decanoate - Risperdol Consta - Invega Sustenna - Zyprxa Relprevv
34
Patient Education for Antipsychotic Side Effects
- Photosensitivity - Stay out of the sun or wear sunscreen - EPS - Various movement disorders - Pregnancy - Risk vs. benefits - Avoid antacids - Diet teaching - Rise slowly - hypotension (orthostatic)
35
Anti-psychotics Adverse Side Effects - | Agranulocytosis
- May occur with any anti-psychotic - Most common with CLOZARIL - May occur at any time during treatment
36
Anti-psychotics Adverse Side Effects | Agranulocytosis - Symptoms (4)
- Sore throat - Mouth sores - Increased temperature - "Flu Like" symptoms
37
Anti-psychotics Adverse Side Effects | Agranulocytosis - Nursing interventions (4)
- Check WBCs - Hold dose of Clozaril - Notify health care prescriber - Monitor patient for increased and worsening symptoms
38
Clozaril Protocol
* Not for patient who dislikes needles! * Initially - Weekly WBC.CBC for 6 months After 6 months - WBC/CBC bi -weekly for next 6 months After first year - Month for the duration of medication
39
Anti-psychotic Adverse Side Effects | Neuroleptic Malignant Syndrome - AM FM (4)
- Autonomic Instability - Increased BP/P - Muscle Symptoms - "lead pipe rigidity" - Fever up to 107 - Mental status changes - confusion to COMA
40
Extrapyramidal Side Effects -
KNOW
41
Extrapyramidal Side Effects - | Psuedoparkinsonism
"Pill rolling"
42
Extrapyramidal Side Effects - | Akathesia
--MOST COMMON SIDE EFFECT-- Extreme restlessness "Ants in the pants"
43
Extrapyramidal Side Effects - | Dystonia
"Neck to the side" - Muscular rigidity - Stiff or thick tongue - Difficulty swallowing - Spasms in face/neck
44
Extrapyramidal Side Effects - | Tardive Dyskinesia
"Permanent lip smacking" - abnormal, involuntary skeletal movements - facial grimacing - finger movement - jaw swinging - repetitive chewing - tongue thrusting * *-IRREVERSIBLE**
45
Extrapyramidal Side Effects - | Bradykinesia
"SLOW movement"
46
Extrapyramidal Side Effects - | Akinesia
"No movement"
47
Extrapyramidal Side Effect ASSESSMENT
Observe and measure involuntary movements - Face - Trunk - Extremities - Abnormal, involuntary skeletal movements
48
** Extrapyramidal Side Effects ** (4)
- Pseudo parkinsonism - Pill rolling - Drooling - Shuffling gait
49
Anticholinergics - Indications for use | EPS
Used for - Dystonias (decrease drooling) - Pseudo-parkinsonism (less of a shuffle) - Initiate when symptoms arise - Use may become unnecessary after several months - Some potential for abuse * *-DO NOT USE with TARDIVE DYSKINESIA** -WILL MAKE IT WORSE
50
Anticholinergics - ABC (3)
Artane (trihexohenidyl) Benadryl (diphenhydramine) Cogentin (benzotropine) *MOST COMMON*
51
Anticholinergic Side Effects
Can't See (blurred vision) Can't Pee (urinary retention) Can't Spit (dry mouth) Can't Shit (constipation)
52
Anticholinergic Syndrome (4)
Increased Temp - Hot as a Hare Dilated Pupils - Blind as a Stone Agitation - Made as a Hatter Hot, dry, flushed skin - Dry as a Bone
53
Non-Compliance (6)
Find out WHY patient is non-compliant -Insensitivity to patient's challenges Wishes - opposition of idea of taking meds Complaints - poorly controlled side effects Ability to buy medications after discharge Ability to follow up - transportation, insurance
54
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Mood Disorders!

Psych - Test 2 (4 decks)

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