schizophrenia spectrum disorders Flashcards
(58 cards)
1
Q
psychosis
A
altered cognition and perception, reality base could be medical or substance (15-28y)
2
Q
dsmv criteria: highlights
A
Two or more of the following for a significant portion of time in 1 month:
- Delusions
- Hallucinations
- Disorganized speech
- Gross disorganization or catatonia
- Negative symptoms (diminished emotional expression or avolition)
- Functional impairment of some kind
Continuous disturbance for at least 6 months
3
Q
delusions
A
fulse beliefs, held despite a lack of evidence to support them
4
Q
hallucinations
A
sensory experiences that are not real
ex) visual, auditory
5
Q
phases of schizophrenia
A
Prodromal
- Onset; mild changes
Acute
- Exacerbation of symptoms
Stabilization
- Symptoms diminishing
- Movement toward previous level of functioning
Maintenance or residual
- New baseline is established
6
Q
prodormal
A
onset; mild changes
- early onset (warning signs)
- disroganized thoughts
- not answering questions correctly
- auditory hallucinations
- magical thinking
7
Q
acute
A
exacerbation of s/s
- s/s get worse, harm to self/others, greatly need help
- hearing voices to kill others
- ask what they are telling you
8
Q
stabilization
A
Symptoms diminishing
Movement toward the previous level of functioning
- not completely gone, positive s/s go away, negative are residual
- making an effort to not to listen to them
- don’t need acute care but maybe partial hospitalization
9
Q
maintenance or risdual
A
new baseline is established
- back at baseline
- know how to control symptoms
10
Q
assessment
A
- During the prodromal phase
General assessment
- Positive symptoms
- Negative symptoms
- Cognitive symptoms
- Affective symptoms
11
Q
positive symptoms
A
- hallucinations
- delusions
- disorganized speech
- bizarre behavior (talking to self)
12
Q
negative symptoms
A
- blunt affect
- no expression
- alogia- the poverty of thoughts
- avolition- lack of motivation
- anhedonia- lack of pleasure
13
Q
cognitive symptoms
A
- thought process
- memory
- locx4
- distracted
- memory impaired
- trouble problem solving
14
Q
affective symptoms
A
- thoughts of suicide
- hopeless
- ysphoria: s/s of uneasiness
- depression and anxiety
15
Q
alterations in speech
A
- associative losseness
- clang association
- neologisms
- echolalia
16
Q
associative looseness
A
Word salad—most extreme form; jumble of words meaningless to a listener
17
Q
clang association
A
Words chosen based on sound
18
Q
neologisms
A
Meaning for the patient only
19
Q
echolalia
A
Pathological repetition of another’s words
20
Q
circumstantiality
A
trying to have a convo and going in a circle, say a lot of other things than go back to the question
21
Q
tangentiality
A
talking on a tangent, does not get back to question
22
Q
cognitive retardation
A
delay in response
23
Q
pressured speech
A
word vomit, talking so fast cant get a word in
24
Q
flight of ideas
A
- one thought to next thought, transfentile
“sunny, grandma coming over, pet died”
25
symbolic speech
- symbols to describe what they say
| - " needs are pinching me"
26
Disorders or Distortions of Thought
```
Thought blocking
Thought insertion
Thought deletion
Magical thinking
Paranoia
```
27
thought blocking
reduction/stopage of thought
28
thought insertion
inserted thoughts not there own
29
thought deletion
deleted their thoughts
30
magical thinking
dont step on a crack
| - what there doing will curse someone
31
paranoia
irrational fear but believes it
| - dont trust or believe
32
alterations in perception
- Depersonalization
- Derealization
Hallucinations
- Auditory: voices and sounds
- Visual: spots, animals, people
- Olfactory: smell something not there
- Gustatory: taste something not there
- Tactile: begs crawling on them
- Command: need interventions, voices telling them to hurt them/someone
Illusions: spiders crawling on wall, black dots
33
depersonalization
unreal
loss of idenity
arm not part of body
34
derealization
environment has changed
| "everything tiny"
35
alterations in behavior
- Catatonia: very expressive or no movement
- Motor retardation: don't move: atican challenge
- Motor agitation
- Stereotyped behaviors
- Waxy flexibility: arm stuck in strange way of motion
- Echopraxia: copy movement
- Negativism
- Impaired impulse control
- Gesturing or posturing
- Boundary impairment
36
cognitive symptoms
- Concrete thinking: inability to think obstractly
- Impaired memory: short term memory
- Impaired information processing: delayed response, misperception
- Impaired executive functioning: difficulty with reasoning
37
affective symptoms
- Assessment for depression is crucial
- May herald impending relapse
- Increases substance abuse
- Increases suicide risk: ask if they have a plan
- Further impairs functioning
38
anosognosia
- Inability to realize they are ill
- Caused by the illness itself
- May result in resistance to or cessation of treatment
- Often combined with paranoia so that accepting help is impossible
39
nurses self assessment
Anxiety or fear
Frustration
Expectations
- give them space
- look for waning s/s
- hat I'm injection
- haldol give w another med to prevent epis s/s
40
assessment guidelines
- Any medical problems
- Medical problems that mimic psychosis
- Drug or alcohol use disorders
- Mental status examination
- Include cognitive assessment (e.g., reality testing)
41
what to assess for
```
Assess for hallucinations
Assess for delusions
Assess for suicide risk
Assess ability to ensure personal safety and health
Assess prescribed meds
Assess symptoms’ impact on functioning
Assess family knowledge
```
42
nursing diagnosis: postive symptoms
Disturbed sensory perception
Risk for self-directed or other-directed violence
Impaired verbal communication
43
nursing diagnosis: negative symptoms
Social isolation
Chronic low self-esteem
risk for succide
44
outcomes and planning phase 1
phase 1- acute
- Patient safety and medical stabilization
Best strategies to ensure patient safety and provide symptom stabilization
45
outcomes and planning phase 2
- stabilization
- Help patient understand illness and treatment
- Stabilize medications
- Control or cope with symptoms
46
outcomes and planning phase: maintenance
maintenance
Maintain achievement
Prevent relapse
Achieve independence, satisfactory quality of life
Provide patient and family education
Relapse prevention skills are vital
47
implementation
Acute phase
- Psychiatric, medical, and neurological evaluation
- Psychopharmacological treatment
- Support, psychoeducation, and guidance
- Supervision and limit setting in the milieu
- Monitor fluid intake
- Working with aggression
+ Regularly assess for risk and take safety measures
- basic eating, urinating, drinking, safety
48
interventions
Stabilization and maintenance phases
- Medication administration/adherence
- Relationships with trusted care providers
- Community-based therapeutic services
- Teamwork and safety
- Activities and groups
Counseling and communication techniques
- Hallucinations
- Delusions
- Associative looseness
- Health teaching and health promotion
- silence
- base them back to reality
49
psychobiological intervention
Antipsychotic medications
- First-generation
- Second-generation
- Third-generation
Injectable antipsychotics
- Short-acting
- Long-acting
50
first gen antipsychotics
```
Dopamine antagonists (D2 receptor antagonists)
Target positive symptoms of schizophrenia
```
51
first gen antipsychotics advantage
Less expensive than second generation
52
disadvantange of first gen
- Extrapyramidal side effects (EPS)
- Anticholinergic (ACh) side effects
- Tardive dyskinesia
- Weight gain, sexual dysfunction, endocrine disturbances
53
second gen
- Serotonin (5-HT2A receptor) and dopamine (D2 receptor) antagonists, e.g., clozapine (Clozaril)
- Treat both positive and negative symptoms
- Minimal to no EPS or tardive dyskinesia
54
2nd gen disadvantage
tendency to cause significant weight gain; risk of metabolic syndrome
55
3rd gen
- Really a subset of the SGAs
- Aripiprazole (Abilify), brexpiprazole (Rexulti), and cariprazine (Vraylar)
- Dopamine system stabilizers
- May improve positive and negative symptoms and cognitive function
+Little risk of EPS or tardive dyskinesia
56
Potentially Dangerous Responses to Antipsychotics
- ACh toxicity
- Neuroleptic malignant syndrome (NMS)
- Agranulocytosis
- Prolongation of the QT interval
- Liver impairment
57
Advanced Practice Interventions
```
Individual and group therapy
Psychoeducation
Medication prescription and monitoring
Basic health assessment
Cognitive remediation
Family therapy
```
58
evaluation
- Reevaluate progress regularly and adjust treatment when needed
- Even after symptoms improve outwardly, inside the patient is still recovering.
- Set small goals; recovery can take months.
- Active, ongoing communication and caring is essential.
