Week 8 psychosis Flashcards

(41 cards)

1
Q

What is psychosis?

A

unable to do reality testing

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2
Q

What is schizophrenia?

A

when someone has a break from reality
hallucinations/illusions
grandeur

onset is 15-35 age

affects ADLs, physical health, and QOL

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3
Q

people with schizophrenia tend to have higher risk for what comorbidities?

A

Diabetes
heart disease
etc

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4
Q

What are the causes of schizophrenia?

A

neurotransmitters: (excess)
dopamine
serotonin
glutamate

neurodevelopmental: prenatal exposure to viruses & infections

Neuroanatomic changes - enlarged ventricles, decreased grey matter

Genetic predisposition - first degree relative raises risk 10x

Psychosocial factors - aces, toxins, developmental & social stressors

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5
Q

What makes schizophrenia and mood disorders different with neurotransmitters?

A

schiz- too much neurotransmitters

mood disorders - decreased neurotransmitters

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6
Q

What is the diagnosis criteria for schizophrenia?

A

must have at least 1 of
1. delusions
2. halluciantions
3. disorganized speech

for most of the time for 1 month period

plus one of:
1. stupor/catatonic behaviour
2. negative symptoms
3. social/occupational dysfunction
4. continuous signs for at least 6 months

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7
Q

what are positive symptoms in schizophrenia?

A

something not usually there
- responds well to anti-psychotic meds

  • hallucinations
  • delusions
  • disorganized speech
  • bizarre behaviour
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7
Q

What might someone with schizophrenia experience in the Prodomal stage?

A

-feel strange
- odd beliefs
- odd behaviour
- socially withdrawn
- lose interest in previously enjoyed activities

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8
Q

What are negative symptoms in schizophrenia?

A

develop slowly
interfere with coping
-blunted affect
- poverty of thought (alogia)
- loss of motivation (avolition)
- no joy (anhedonia)

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9
Q

what are cognitive symptoms of schizophrenia?

A
  • inattention/ easily distracted
  • imparied memory
  • poor problem solving
  • poor decision making
  • illogical thinking
  • impaired judgement
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10
Q

What are affective symptoms of schizophrenia?

A
  • dysphoria
  • suicidality
  • hopelessness
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11
Q

what is anosognosia and which disorder is affected by it?

A

lacking insite into your disorder

schizophrenia

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12
Q

What is the goal of phase 1 (acute) for schizophrenia intervention?

A
  1. safety & crisis intervention
  2. drugs
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13
Q

What is the goal of phase 2 (stabilization) for schizophrenia intervention?

A
  1. med follow through
  2. coping with +/- symptoms
  3. promote recovery
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14
Q

What is the goal of phase 3 (maintenance) for schizophrenia intervention?

A
  1. ongoing recovery
  2. health education
  3. encourage family involvement
  4. liase with community supports
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15
Q

What are neuroleptic antipsychotics?

A

1st gen (typical)
- haldol
- chlorpromazine

2nd gen (atypical)
-risperidone
- quetiapine
- clozapine

3rd gen
- aripiprazole

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16
Q

what do the first generation antipsychotics affect?

A

dopamine
positive symptoms

17
Q

what do 2nd generation antipsychotics affect?

A

seratonin
negative symptoms

18
Q

what do 3rd generation antipsychotics affect?

A

dopamine stabilizers

19
Q

which disorder can medications be given by DEPOT?

A

antipsychotics- schitzophrenia

20
Q

What symptoms can occur with antipsychotic medications (usually atypical or 1st gen)

A

EPS - parkinsonism , acute dystonia symptoms, Akathisia
- treatable

Tardive dyskinesia
-irreversible

21
Q

What do we do if someone experiences Akathisia symptoms?

A

decrease dosage
propanolol

22
Q

what med is given to help with EPS (parkinson symptoms?

A

Benztropine mesylate (cogentin)

if acute - cogentin or benadryl IM

23
Q

What is neuroleptic malignant syndrome from?

A

typical or high potency antipsychotics

24
When does NMS usually occur?
within first 30 days of antipsychotic use
25
What are the risk factors for NMS?
dehydration history of NMS recent dose increase switching rapidly from one dopamine receptor agonist to another
26
What is used in NMS to help ?
stop that antipsychotic bromocriptine supportive nursing
27
symptoms of NMS
Incontinence Change in mental status: confusion, delirium, stupor, coma Dehydration Potential renal failure Elevated Creatinine phosphokinase Hyperpyrexia Tachycardia Labile hypertension Tachypnea or hypoxia Diaphoresis Lead pipe muscle rigidity Tremor Drooling
28
what are the typical antipsychotics?
Chlorpromazine (Thorazine) Loxapine (Loxitane) Fluphenazine (Prolixin) Thiothixene (Navane) Haloperidol (Haldol) - "Haloperidol for Hallucinations"
29
what is the MOA of typical antipsychotics (1st gen)
dopamine D2 receptor antagonist in both limbic and motor centers
30
Anticholinergic side effects present with which drug class?
typical antipsychotics (1st gen)
31
what are the main symptoms of NMS?
Fever aLOC rigidity tremors autonomic dysfunction
32
What are serious side effects of clozapine that make it not a first line treatment?
agranulocytosis - loss of neutrophils for fighting infection - need routine CBCs myocarditis - need annual EKGs
32
When is clozapine used?
symptoms of treatment-resistant schizophrenia
33
what are the atypical antipsychotics - 2nd&3rd gen?
Clozapine Olanzapine (Zyprexa) Risperidone (Risperdal) Quetiapine (Seroquel) Lurasidone Paliperidone Ziprasidone Aripiprazole (Abilify)
34
Which drug class is used for both positive and negative symptoms?
Atypical antipsychotics
35
Which drug class is used for positive symptoms only?
typical antispychotics
36
what do we need to monitor in people taking atypical antipsychotics?
agranulocytosis - low WBC, high infection risk
37
what do we need to monitor in someone with clozapine?
sore throat, fever d/t agranulocytosis
38
What antispsychotic do we not give in dementia?
Risperidone
39
At what point might someone with schizophrenia be hospitalized?
- can't do ADLs - safety