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schizophrenia Flashcards

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1
Q

spectrum of disorders

A

differ in presentation, disability, QOL

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2
Q

definition

A

structural and functional brain abn with genetic component
psychosis characterized by abn in perception, content of thought, thought process, extensive withdrawal of one’s interest from individual’s in outside world

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3
Q

psychosis

A

state in which individual is experiencing hallucinations, delusions, disorganized thoughts, speech, behavior
s of mental illness, loss of contacts with reality
seen in schizophrenia and mood disorders (bipolar)

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4
Q

dx criteria

A

2+ of following for significat amount of time during 1 mo period: delusions, hallucinations, disorganized speech (need 1 of first 3), disorganized or catatonic behavior, negative s/s
1 + major areas of social/occupational functioning below previously achieved level
continuous s >6 mo
absences or insignificant duration of major dep, manic, or mixed episodes occurring concurrently with active s/s
not physiologic effect of substance/med condition
prominent delusions or hallucinations present when prior hx of autistic disorder or another pervasive dev disorder exists

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5
Q

why is it so devastating

A

interferes with ability to…
think clearly, manage emotions, make decisions, relate to others
cant function to potential without tm
disconnected mind -> confused with multiple personalities

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6
Q

epidemiology

A

higher in M and urban areas
onset usually 15 - 35 (M earlier than F)

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7
Q

etiology

A

genetics -> env and heredity
env -> malN before birth (1 and 2 T), exposure to viruses, autoimmune -> psychosis
brian chem -> NT (dopamine and glutamate)
substance use -> mind altering drugs, marijuana (younger and freq = inc R)

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8
Q

vulnerability stress model

A

genetics and predisposition and stressors can trigger and accelerate

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9
Q

comorbidity

A

substance use, nicotine dependence, anx, dep, suicide, DM, CVD, obesity (meds), malignant neoplasm (dec survival), HIV/AIDS, osteoporosis, hep C

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10
Q

symptoms

A

very btw persons, episodes, some also found in other disorders
positive, negative, cog, affective

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11
Q

positive symptoms

A

exist but should not be there
most common
alterations in perception: paranoia, delusions, hallucinations
disorganized or alterations in speech/ behavior/thought
paranoia
delusions
hallucinations

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12
Q

paranoia

A

irrational fear -> mild to profound
deep mistrust/suspicion of others
can result in dangerous defensive actions
can dev into delusional thoughts

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13
Q

delusions

A

false beliefs despite lack of evidence, not corrected with reasoning
many different types

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14
Q

delusions - persecutory

A

watched, plotted against, ridiculed

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15
Q

delusions - referential

A

events or circumstances are related to you

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16
Q

delusions - grandiose

A

powerful or important

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17
Q

delusions - erotomanic

A

someone romantically desires you

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18
Q

delusions - nihilistic

A

things dont exist

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19
Q

delusions - somatic

A

body is changing

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20
Q

delusions - religious

A

special relationship with god
sinners

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21
Q

delusions - control

A

another person/group is controlling your thoughts, feelings, impulses

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22
Q

delusions - intervene

A

they feel real and are scary
calm, acknowledge, encourage to express, convey empathy, reassure about intentions and present reality, reorient
focus on helping pt feel safe -> focus on fear and causes
build rapport and trust with honesty and genuineness, dec anx
describe delusion, validate and present reality, dont debate or argue (dec trust)
assess intensity, freq, duration
identify trigger
as reality testing (determine what is real) improves, supportively convey doubt where appropriate, prior to this, dont prove delusion is incorrect -> can intensify and dec trust
clarify misinterpretations, gently suggest more reality based perspective as tolerated, focus on present reality and what is real, coping strategies

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23
Q

delusions - doc

A

type, theme, characteristics
use pt words (subjective)
behavior prior and during
actions taken to help, threat, actions for safety

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24
Q

hallucinations

A

alterations in perception, errors in how one interprets perception or perceives reality
sensory experience for which no external source exists: auditory, visual, olfactory, gustatory, tactile
very real, distracting, supportive or terrifying, faint or loud, episodic or constant, varying anx or stress

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25
hallucinations - command
auditory, instruct pt, serious to innocuous assess and monitor
26
hallucinations - intervene
introduce self, rapport, trust approach in non threatening and calm manner (non verbal actions as well) reassure safety
27
hallucinations - indicators
can ask pt darting eyes, muttering/talking, distracted, suddenly stopping convo, intently watching vacant area
28
hallucination - assess
type and content -> ask directly began, what pt feels -> distress, comfort what are you hearing, is it telling you to do something (command), do you believe it is real (yes = inc r/o acting on it) dont respond to them like they are real or deny their experience offer own perceptions, convey empathy, present reality after: identify triggers, worse/better, how they respond, cope
29
hallucinations - help
name, clearly speak, simple sentences, loud enough support, eye contact, redirect focus alert for anx -> may be intensifying engage in reality based activities
30
hallucinations - doc
type, theme, characteristics use pt words (subjective) behavior prior and during actions taken to help, threat, actions for safety
31
hallucinations - educate
manage stress and stim, use other sounds to compete, check with others for reality activities to distract, contact others (friend, fam, staff, help line), dev plan to cope talk: self = symptom, not real, tell voices to go away, tell yourself you are safe
32
disorganized or alterations in speech -circumstantiality
extremely detailed and lengthy convo, eventually gets to point
33
disorganized or alterations in speech - tangentiality
going on tangents, never reach point
34
disorganized or alterations in speech - loose associations
absence of normal connectedness of thoughts, ideas, topics
35
disorganized or alterations in speech - flight of ideas
topic of convo changes repeatedly and rapidly with superficial associative connections, difficult to follow
36
disorganized or alterations in speech - echolalia
repeat others words
37
disorganized or alterations in speech - clang association
choose words based on sound rather than meaning, often rhyme or similar beginning sound
38
disorganized or alterations in speech - symbolic speech
using words based on what they symbolize
39
disorganized or alterations in speech - pressured speech
urgent/intense, reluctant to allow comments from others
40
disorganized or alterations in speech - word salad
string of words totally unconnected, jumble of words meaningless to listener
41
disorganized or alterations in speech - neologisms
made up words, pt meaning only
42
disorganized or alterations in thought - thought blocking
dec or stoppage of thought, usually ralking about something importnat
43
disorganized or alterations in thought - thought insertion
someone else inserted thoughts into brain
44
disorganized or alterations in thought - thought delusion
thoughts have been taken or are missing
45
disorganized or alterations in behavior - paranoia
previously defined
46
disorganized or alterations in behavior - catatonia
pronounced inc or dec in rate and amount of movement, excessive motor activity is purposeless
47
disorganized or alterations in behavior - echopraxia
invol imitation of anothers movements and gestures
48
disorganized or alterations in behavior - motor retardation
pronounced slowing of movement
49
disorganized or alterations in behavior - motor agitation
excited behavior, running or pacing rapidly, often in response to internal or external stim
50
disorganized or alterations in behavior - negativism
tendency to resist or oppose requests or wishes of others
51
disorganized or alterations in behavior - stereotyped behavior
repetitive purposeless movements, peculiar, serve no purpose
52
disorganized or alterations in behavior - gesturing or posturing
posture held in fixed position
53
disorganized or alterations in behavior - impaired impulse control
they have it
54
disorganized or alterations in behavior - boundary impairment
impaired ability to sense where one's body or influence ends and another's begins
55
negative s/s
should be there but arent -> absense of essential human qualities dec social functioning tm more difficult, frustration, disabling, dec function, persistent
56
negative s/s - affective blunting
can sometimes be caused by meds reduced affect (flat, blunted, constricted, inappropriate, bizarre) dec spont movement, poor eye contact, no vocal inflection
57
affect - flat
immobile or blank facial expression
58
affect - blunted
reduced or minimal emotional response
59
affect - constricted
reduced in range or intensity
60
affect - inappropriate
incongruent with the actual emotional state or situation
61
affect - bizarre
odd, illogical, inappropriate, unfounded, includes grimacing
62
negative s/s - apathy
dec interest in activities or beliefs that would otherwise be interesting or important or little attention to them
63
negative s/s - alogia
dec speech
64
negative s/s - avolition
dec or loss of motivation or goal directed behavior apathy and avolition cause deficits in basic activities
65
negative s/s - anhedonia
dec ability to experience pleasure or joy
66
negative s/s - asociality
dec desire for social interaction or discomfort while doing it
67
cog symptoms - concrete thinking
cant think abstract, interpret or percieve thoughts in literal manner
68
cog symptoms - impaired mem
short term, impact ability to learn
69
cog symptoms - impaired info processing
delayed reponse, misperceptions, difficulty understanding others
70
cog symptoms - impaured executive functioning
difficulty with reasoning, setting priorities, compare options, planning
71
cog symptoms - anosognosia
freq relapse dont believe ill, resist/cease tm, often combo with paranoia, impossible to accept help
72
affective s/s
altered experience and expression of emotion mood unstable, erratic, labile, incongruent
73
schizoaffective disorder
schizophrenia and serious mood s/s (mania, dep)
74
schizoaffective disorder - tm
antipsychotics and mood stabilizing mes, fam, psychosocial strategies, self care, psychotherapy, integrated care if substance abuse rx meds: combo antipsych, mood stabilizing, anti dep CBT: long term recovery, recognize, understand, change behaviors group therapy: feel alone and misunderstood, supportive env
75
schizoaffective disorder - what is it
uninterrupted, either major dep, manic, or mixed episode with s/s schizophrenia, many experience major mood episodes day or weeks while s/s schizophrenia persist after often mis dx with bipolar or schizophrenia rare, M and F same rate, M earlier manage with meds and therapy
76
schizoaffective disorder - types
bipolar: dep and manic and schizo s/s depressive: no highs and lows, just low, psychotic s/s of schizo and dep
77
schizoaffective disorder - dx criteria
major mood and schizo affective hallucinations and delusions 2+ wk w/o major mood s/s of mood episode present for most of duration disturbance not from substance or med
78
schizoaffective disorder - depressive s/s
lethargy, dont want to do anything, no pleasure form fav activities, no sleep or excessive sleep, dec appetite, feel you will never be happy again constant or eb and flow of these feelings
79
schizoaffective disorder - schizophrenia s/s
near constant delusions, hallucinations, difficulty holding work or staying enrolled in school, problems with hygiene or taking care of self, difficulty comm with individuals, not being understood by those around you
80
nursing
assess (holistically) metnal status, phys health, social support systems identify priority problems -> hct dev care plan with goals and interventions implement interventions that address pt s/s, promote safety, support recovery continuously eval effectiveness and adjust prn
81
potential priority problems
safety, violence, suicide, self harm, disturbed thought processes, disturbed sensory perception, treatment non adherence, ineffective coping, social isolation, self care deficits, knowledge deficits, hopeless or powerless
82
potential outcomes
short and long term goals, SMART goals slide 56
83
potential interventions
slide 57 utilize priority problems -> s/s management, enhance function, inc QOL need variety to help meet goals, may need to adjust
84
eval
adjust prn, identify progress, dec helpless safety in all settings phys care of pt stabilize on meds pt and fam edu on illness and tm psychosocial support of pt and fam smart goals inc buy in and coop
85
treatment facts
failure of prescribed meds: relapse, suicide, self harm, violence, inc mortality, readmit, dec qol, social and occupational difficulty antipsych crucial in short and long term early intervention with med dec some associated long term co morbid or co existing conditions
86
relapse
at any time, v high rate longer recovery period with each relapse combo med and psychotherapy diminishes severity and freq of recurrent relapse one of major reasons for relapse in non adherence with med stopping med almost certainly leads to relapse (anosognosia) recovery is process, not outcome anosognosia, paranoia, auditory hallucinations, persecutory delusions: long acting injectable antipsych and family psychosocial edu cbt, social skills
87
antipsychotics
2-6 wk for effectiveness, pt specific dosages -> effective and SE balance not addictive, routes per risks (cheeking, mouth, nonad) typical = first gen atypical = 2nd gen monotherapy recommended IM = more intense and less easily managed SE
88
typical
dec positive s/s little effect on negative s/s used less often, less expensive SE: eps, antichol, sedation, weight gain, met syndrome, neuroleptic malignant syndrome, sexual dysF, endocrine disturbances, CV issues (orthostatic hypoT and arrhythmias), inc r/o seizure SE often lead to nonadherence and stigma chlorpromazine, haloperidol, fluphrenazine, thioridazine, perpherazine
89
atypical
+ and - s/s, fewer and better tolerated SE same potential SE but usually milder and better tol clozapine, risperidione, olanzipine, quetiapine, ziprasidone less TD or EPS more weight gain, met syndrome, costly
90
antipsychotics: common SE
extrapyramidal -> motor control and coordination, cause discomfort, social stigma, poor adherence; acute dystonic, akathisia, pseudoparkinsonism, tadrive dyskinesia (first 3 w/n few weeks of starting or inc dosage antichol neuroleptic malignant syndrome metabolic syndrome
91
EPS - acute dystonic rxns
sudden sustained contraction of 1+ muscle groups, usually head/neck painful, scary, uncomfy, anx -> only dangerous if airway muscles (emergency!) torticollis = head pulled to 1 side oculogyric crisis = eyes roll back laryngeal dystonia = spasm of throat, impair breathing and swallowing
92
EPS - akathisia
restless: pace, rock, shift distressing, mistaken for anx or agitation -> give more drug and make worse -> assess! tardive form can persist despite treatment treatment: dec dose, change med, antichol (benztropine), add med - short term (BB, lorazepam, diazepam), relaxation exercise can persist 6+ mo after dose or med change or become tardive
93
EPS - pseudoparkinsonism
stiff and stooped posture, shuffling gait, bradykinesia, pill roll, rest tremor, dysphagia, drool tm: identify med, slow and safe d/c (not always possible), dec dose, add antichol (benztropine, trihexyphenidyl)
94
EPS - tardive dyskinesia
invol rhythmic movement with long term meds, severity varies, F > M usually oral and facial muscles, progress fingers, toes, neck, trunk, pelvis, tongue protrudes, lip smack, mouth move gradual change, can miss signs -> AIMS q3 mo tm: d/c or dec dose based on severity, switch to 2nd gen (opposite taper), s/s usually persist, meds to manage s/s (valbenazine, deutetrabenazine)
95
anticholinergic SE
dry mouth, blurred vision, dry eyes, c, urinary retention/hesitancy, drowsy, dizzy, confusion, hallucinations, tachy, skin flush, dec sweat can progress to tox
96
neuroleptic malignant syndrome
rate but serious and fatal usually early SE, early detection through hx improves survival muscle rigid, altered mental status temp >103, htn, tachy, tachypnea, diaphoresis, incont complications: rhabdomylosis (P in blood, organ fail), acute resp fail (strongest predictor of mortality), AKI, sepsis, systemic infection
97
neuroleptic malignant syndrome - tm
detect with prompt and freq assessment, stop all antipsych, supportive tm, ICU supportive = oral and IV hydration -> e imbalance, VS, monitor for comp dantrolene Na, bromocriptine mesylate for muscle rigidity and fever lorazepam for agitation cool body for fever -> blanket, OH bath, water/ice bath dysR treat
98
3rd gen antipsychotics
subset of 2nd improve positive and negative and cognitive function little r/o EPS or TD aripiprazole, brexpiprazole, cariprazine
99
2nd gen SE
sedation major weight gain, met changes, endocrine problems (DM, hyperprolactinemia, dyslipidemia), cancers, htn, CV disease cardiac dysR/sudden death sexual dysF less likely: antichol, orthohypoT, seizures, eps
100
met syndrome
monitor weight and girth, initial glucose tolerance test, monitor BG, provide nutrition and activity support, consider lifestyle
101
clonzapine
I: refractory schiz, unresponsive schiz (2+ meds), eps with other drugs prone to violence and suicide when untreated/other treatment methods dont work dec negative, inc impulse control, dec violence, inc QOL not 1st line -> agranulocytosis
102
agranulocytosis
potentially fatal SE a dec in # of circulatory granulocytes and dec production of granulocytes, limit ability to fight off infeciton inc r during first months: monitor wbc weekly for 18 wks, continue based on orders, d/c med if <3.06 leukopenia or neutropenia (<1.56) reversible with early tm
103
long acting injectable meds
r/o nonadherence q2-4 wk or months need transportation typical: fluphenazine decanoate, haloperidol decanoate atypical: risperidone microspheres, paliperidone palmitate, olazipine pamoate, aripiprazole
104
additional tm
ect -> catatonia cbt, group, fam, social skills, case management, support gorups
105
prognosis
most have s improve and good QOL doesnt always respond to tm some need lengthy or repeated inpt -> slow onset 2-3 yrs, younger onset, delayed tm, long periods untreated, more negative s/s

psych 329 (28 decks)

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