Unit 5 Schizophrenia Spectrum Disorders Chapter 12 Flashcards

Question

Why occurs during the Stabilization phase in Schizophrenia?

Answer 1

Sx stabilizing and return to level of functioning if possible I*n this phase, symptoms are stabilizing and diminishing, and there is movement toward a previous level of functioning. This phase can last for months. Care in mental facility for months based on conditions

Answer 2

—In this phase, the condition has stabilized and a new baseline may be established. Pos- itive symptoms (described later) are usually significantly diminished or absent, but negative and cognitive symptoms continue to be a concern.

Answer 3

Table 12.3 Poor Hygiene(foul odor self neglect)  Resistance to treatment(they have the right to consent or refuse treatment)  Cheeking or palming medications(does not swallow medication)  Anosognosia(unable to recognize familiar faces)  Avoiding Peer Interaction  Depression  Poor Self-Esteem  Fall Risk(secondary to first gen antipsychotics, EPS syndrome)  Choking Risk  Restlessness/Agitation  Risk for other directed violence  Risk for self directed violence

Answer 4

D. Haloperidol

Answer 5

*such as eyes tracking an unheard speaker, *muttering or talking to self, appearing distracted, *suddenly stopping conversing as if interrupted, or * intently watching a vacant area of the room.

Answer 6

Ask about the content of the hallucinations and how the patient is reacting to them. Assess for command hallucinations, and assess for resulting fear or distress. ex-What do you see/hear?  Are they commanding you to do anything? (priority) -DO NOT ASK "WHAT ARE THE VOICES SAYING TO YOU" -Do not ask, “What are the voices saying to you?” Ask, “What are you hearing?” *Do not negate the patient’s experience but offer your own perceptions and convey empathy. ***“I don’t hear angry voices that you hear, but that must be very frightening for you.”*** Focus on reality-based “here and now” activities, such as conversations or simple projects. - Promote and guide reality testing. If the patient has frightening hallucina- tions, guide her or him to scan the area to see if others appear frightened; if they are not, encourage the patient to consider that these might be halluci- nations. Teach the patient to compare such beliefs and perceptions to those of trusted others.

Answer 7

**Manage stress and stimulation** * Avoid overly loud or stressful places or activities. * Learn assertive communication skills so you can tell others “no” if they pressure or upset you. ** Find out what is and isn’t real (called promoting reality testing).** * Look at others; do they seem to be hearing/seeing what you are? * Ask trusted others if they are experiencing what you are. ** Engage in activities that can take your mind off what you hear.** * Walk. * Clean. * Take a relaxing bath or shower. **. Talk (if others are nearby, quietly or silently to self).** * Tell the voices or thoughts to go away. * Tell yourself that the voices and thoughts are a symptom and aren’t real. * Tell yourself that no matter what you hear, you will be safe and you can ignore what you hear. **Make contact with others.** * Talk with a trusted friend, relative, or staff member. * Call a help line or go to a drop-in center. * Visit a public place where you are comfortable. **Develop a plan for how to cope with hallucinations; options include** * Any of the activities already mentioned that work for you * Taking extra medication when ordered (call your prescriber) * Using breathing exercises and other relaxation methods

Answer 8

Build trust  Respond in a matter of fact, empathetic, supportive and calm manner  Don’t debate  Validate parts that are real  Focus on feelings and themes  Use reality-based interventions to meet underlying needs  Acknowledge that while the delusion seems real to the patient it doesn’t seem real to others  Don’t dwell on delusion, refocus on reality  Help identify triggers  Promote Reality testing

Answer 9

Focus on the feelings or themes within the delusion. If a patient believes that he is a famous leader, comment: “It would feel good to be more pow- erful.” If the patient believes that others intend to hurt him, comment: “It must feel frightening to believe others want to hurt you.” Use reality-based interventions that help meet underlying needs. If the patient believes that he is powerful, it may represent a sense of power- lessness. Increase the patient’s control, such as asking the patient when he would like to take his medications. Do not dwell excessively on the delusion. Instead, refocus onto reality- based topics. * Help the patient to identify triggers of delusions and find ways to avoid them.

Answer 10

A command hallucination is a particularly concerning symp- tom wherein the person is directed to take an action. **COMMAND HALLUCINATIONS ARE DANGEROUS*** -May need further evaluation that can lead to seclusion

Answer 11

*For example, they may be telling a patient to “jump out the window” or to “hit that nurse.” ***Command hallucinations are often frightening and may be a flag warning of a psychiatric emergency. It is essential to assess what the patient hears, the source to which it is attributed, the patient’s ability to recognize the hallucination as “not real” and resist commands.

Answer 12

Stay in contact with support systems  Physical Health is important, self care and hygiene  Healthy Diet, Weight and regular exercise  Regular sleep pattern  Stress reduction – Self-care  Support Groups (NAMI)  Educate yourself about the Dx  Minimize tobacco and caffeine, as they may make your medicines less effective and hurt your health. -Read books about severe mental illness, such as the following: * Surviving Schizophrenia  Trusted sources -National Institute of Mental Health: -National Alliance on Mental Illness: -Living with Schizophrenia

Answer 13

D.Extrapyramidal Side Effects

Answer 14

Acute dystonia Pseudoparkinism Akathisia Tardive dyskinesia

Answer 15

Neuroleptic malignant syndrome (NMS) RARE but DANGEROUS *Severe muscle rigidity(LEAD PIPE), *Dysphasia(TROUBLE SPEAKING), *flexor-extensor posturing, *reduced or absent speech and movement, decreased respon- siveness. *Hyperpyrexia is the main feature: temperature over 103°F Autonomic dysfunction: hypertension, tachycardia, diaphoresis, incontinence, Delirium(onset and sudden confusion), *stupor(near unconsciousness), *coma - rhabdomyolysis (protein in the blood from muscle breakdown), which can cause organ failure (30%), acute respiratory failure (16%), acute kidney injury (18%), sepsis (6%), and other systemic infections. Respiratory failure is the strongest predictor of mortality.

Answer 16

*Acute painful contractions of limited muscle groups (e.g., tongue, face, neck, and back; usually tongue and jaw first) *Spasm of the muscles causing backward arching of the head, neck (torticollis), and spine *Eyes roll back (oculogyric crisis) Laryngeal dystonia: could threaten airway (rare)

Answer 17

*Masklike face, *stiff and stooped posture, *shuffling gait, *bradykinesia, *drooling, *tremor, *“pill-rolling” finger movements, *dysphagia or reduction in spontaneous swallowing

Answer 18

Motor restlessness (e.g., pacing, patient unable to stand still or stay in one location, rocking while seated or shifting from one foot to other while standing)

Answer 19

protruding or writhing tongue; blowing, smacking, licking; facial distortion Limbs: Chorea: rapid, purposeless, and irregular movements Athetoid: slow, complex, and serpentine movements Trunk: neck and shoulder movements, hip jerks and rocking, or twisting pelvic thrusts

Answer 20

-ingrezza drug can cause QT prolongation which can cause death. Prolongation of the QT interval is a delay of ventric- ular repolarization. This condition may result in tachycardia, fainting, seizures, and even sudden death.

Answer 21

Benztropine and Benadryl

Answer 22

● Haloperidol, high potency ● Fluphenazine, high potency ● Loxapine, medium potency ● Thioridazine, low potency ● Thiothixene, high potency ● Perphenazine, medium potency ● Trifluoperazine, high potency ●Chlorpromazine, high potency

Answer 23

*Clozapine *Aripiprazole *Quetiapine *Risperidone *Ziprasidone

Answer 24

Sedation, Orthostatic Hypotension, Lowered seizure threshold, photosensitivity, cataracts or other visual changes  Increased prolactin levels – sexual dysfunction, galactorrhea, gynecomastia

Answer 25

A. second gen Clozapine Aripiprazole Quetiapine Risperidone Ziprasidone

Answer 26

A. Positive -Positive symptoms include -hallucinations -delusions, -paranoia, -disorganized -bizarre thoughts, behavior, or speech.

Answer 27

A. Clozapine

Answer 28

Both Positive symptoms hallucinations -delusions, -paranoia, -disorganized -bizarre thoughts, behavior, or speech. Negative Symptoms *inability to enjoy activities (anhedonia), *social discomfort, or * lack of goal- directed behavior.

Answer 29

Dopamine & Serotonin (some have antidepressant properties)  Newer Medications  Positive and Negative Symptoms  Less likely to cause Tardive Dyskinesia or EPS  Side Effects are usually fewer and milder  Metabolic Syndrome  Weight gain (specifically in abdominal area)  Increased lipids  Increased blood glucose and insulin resistance

Answer 30

C. Metabolic syndrome

Answer 31

Weight gain, dyslipidemia (abnormal lipid levels), and increased insulin resistance leading to increased risk of cardiovascular disease, diabetes, and other serious medical conditions

Answer 32

*Teach the patient how to minimize weight gain through proper nutrition and physical activity (e.g., help the patient to identify low-calorie snacks that he enjoys, engage the patient in regular physical activity, and help the patient to identify and pursue enjoyable physical activities, such as walking or cycling. *Teach the patient and family about the importance of regular medical evaluation and care to identify and correct possible changes that could lead to this syndrome, which can increase the risk of premature illness and death. *Metformin has been used off label to reduce diabetes in patients with metabolic syndrome.

Answer 33

A. White blood cells 500 is a finding of agranulocytosis, the patient may have difficulty fighting off infections which can lead to death Intervention -"monitor temperature" -Advise clients to observe for indications of infection (fever, sore throat), and to notify the provider if these occur. - If indications of infection appear, obtain a CBC. Medication should be discontinued if laboratory test indicates the presence of infection. Risk of myocarditis, life-threatening bowel emergencies, agranulocytosis Agranulocytosis is a condition in which the absolute neutrophil count (ANC) is less than 100 neutrophils per microlitre of blood

Answer 34

Liver impairment may also occur during antipsychotic therapy, particularly with first-generation agents. Second- generation drugs also lead to serum enzyme elevations but rarely to injury or jaundice. Liver impairment usually occurs in the first weeks of therapy. -Monitoring of liver function values is essential. Signs of liver problems include jaundice, abdominal pain, ascites, vomiting, lower extremity edema, dark urine, pale or tarcolored stool, and easy bruising. The patient may complain of itchy skin, chronic fatigue, nausea, and decreased appetite

Answer 35

**Neuromalignant Syndrome** Rare but dangerous. Severe muscle rigidity, dysphasia, flexor-extensor posturing, reduced or absent speech and movement, decreased respon- siveness. Hyperpyrexia is the main feature: temperature over 103°F Autonomic dysfunction: hypertension, tachycardia, diaphoresis, incontinence Delirium, stupor, coma **SEROTONIN SYNDROME** * Hyperactivity or restlessness * Tachycardia → cardiovascular shock * Fever → hyperpyrexia * Elevated blood pressure * Altered mental states (delirium) * Irrationality, mood swings, hostility * Seizures → status epilepticus * **Myoclonus, incoordination, tonic rigidity** * Abdominal pain, diarrhea, bloating * Apnea → death

Answer 36

Types of hallucination include the following. * Auditory: Hearing voices or sounds * Visual: Seeing people or things * Olfactory: Smelling odors * Gustatory: Experiencing tastes * Tactile: Feeling bodily sensations (e.g., feeling an insect crawling on one’s skin)

Answer 37

associative looseness, Word salad, Clang association Neologisms Echolalia Circumstantiality Thought insertion Thought deletion Magical thinking:

Answer 38

One, associative looseness, or looseness of association, results from haphazard and illogical thinking where concentration is poor and thoughts are only loosely connected. For example: “My friends talk about French fries but how can you trust the Bacon?”

Answer 39

The most extreme form of associative looseness, is a jumble of words that is meaningless to the listener (e.g., “agents want strength of policy on a boat reigning supreme”). -mixed up words with no sense

Answer 40

rhyming choosing words based on their sound rather than their meaning and often involves words that rhyme or have a similar beginning sound (“On the track ... have a Big Mac” or “Click, clack, clutch, close”).

Answer 41

Neologisms Making your own words words that have meaning for the patient but a different or nonexistent meaning for others. A patient may use a known word differently than others or create a completely new word that others do not understand (e.g., “His mannerologies are poor”).

Answer 42

repetition of what is heard repetition of another’s words, occurring perhaps because the patient’s thought processes are so impaired that she is unable to generate speech of her own. **EXAMPLE** Nurse: Mary, come get your medication. Mary: Come get your medication.

Answer 43

Including unnecessary and often tedious details in conversation but eventually reaching the point. ex- Nurse: what is your mothers name, Patient: She was born in the 1980's in a small town on Bahamas called free port . She lived on the fourth street of little haiti back in the 1990's she came to live in the united States in the 2000's. My mom's name is Kimberly Joe.

Answer 44

Wandering off topic or going off on tangents \and never reaching the point. ex- Nurse: what is your mothers name, Patient :She was born in the 1980's in a small town on Bahamas called free port . She lived on the fourth street of little haiti back in the 1990's she came to live in the united States in the 2000's.

Answer 45

rapid speech. speaking without pauses. talking even when interrupted -Urgent or intense speech; reluctance to allow comments from others.

Answer 46

Thought insertion: The often uncomfortable belief that someone else has inserted thoughts into the patient’s brain.

Answer 47

Thought deletion: A belief that thoughts have been taken or are missing.

Answer 48

Magical thinking: Believing that reality can be changed simply by thoughts or unrelated actions. This thinking is common in children (e.g., “Because I was mad at him, he fell down”).

Answer 49

Paranoia: An irrational fear, ranging from mild (being sus- picious, wary, guarded) to profound (believing irrationally that another person intends to kill you). Fear may result in dangerous defensive actions, such as harming another per- son before that person can harm the patient.