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Treatment Spring 2024 (Test) > Week 8: Psychotic Disorders > Flashcards

Week 8: Psychotic Disorders Flashcards

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1
Q

Schizophrenia Positive Symptoms

A

Hallucinations, delusion, disorganized speech and/or behavior

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2
Q

How many positive or negative symptoms does one need for a schizophrenia diagnosis?

A

One

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3
Q

Schizophrenia negative symptoms

A

anhedonia, flattening of affect, social isolation, lack of self-care and daily tasks

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4
Q

When do schizophrenia symptoms usually appear

A

late adolescence and early adulthood (16 - 30)

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5
Q

Type of approach, what to assess, what to attend to, and what’s critical?

Schizophrenia Treatment as whole; the counselor’s approach, assessment, attendance to, and outreach

Counselor considerations

Four items listed

A
  1. strength-based approach –> utilize and build on the clients’ strengths
  2. Thoroughly assess symptoms and other life experiences
  3. Attend to physical wellness
  4. Family engagement and support are critical in treatment
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6
Q

What are the ‘three pillars’ of treatment?

A
  1. medications
  2. psychosocial interventions
  3. vocational rehabilitation
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7
Q

What’s so important about the specific phase of schizophrenia

A

Goals and focus of treatment for schizophrenia are dependent on each one.

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8
Q

What are the three phases of schizophrenia treatment?

A
  1. Acute phase
  2. Stabilization phase
  3. Stable Phase
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9
Q

What are the main goals of the acute phase of treatment planning for schizophrenia?

Two of them

What are we working towards?

A

stabilization & crisis management

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10
Q

What types of things would a counselor see during the acute phase of schizophrenia treatment?

A

active symptoms of psychosis

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11
Q

What is the first line of treatment for schizophrenia and how long should it take?

Three Items

What, aproximate time period, and goals

A
  • Psychopharmacology
  • It will take between four and eight weeks
  • Goal to decrease hallucinations, delusions, and agitation
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12
Q

During the acute phase of treatment for schizophrenia, what four things would the counselor focus on or do?

A
  1. Build therapeutic rapport
  2. Connect family and engage with them if they provide support.
  3. Provide psycho-education
  4. Promote medicinal compliance
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13
Q

What would tell us that we have reached the stabilization phase?

Two of them

A
  • Fewer symptoms
  • Renewed self-control
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14
Q

Schizophrenia

What are the goals of treatment planning during the stabilization phase?

Two of them

What are we doing and how are we helping and to what end?

A
  1. Help reduce stress
  2. Provide support

To Promote Recovery

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15
Q

Schizophrenia

Schizophrenia Stabilization Phase: focus on pharmacology

What we want to focus on and what could happen if we didn’t.

A
  • focus on compliance
  • High risk of relapse if discontinued
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16
Q

Schizophrenia

Schizophrenia Stabilization Phase: Counselor’s focus

Goal and risk

What might elicit relapse? What could we do to help prevent relapse?

A

Help the client alleviate or manage stressors.
* Hightened risk of relapse due to stress.

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17
Q

Schizophrenia

Schizophrenia Stabilization Phase: considerations for Psychoeducation

Too whom, for what, and alternative modality

A

For Client and their family.
* To foster understanding of the disorder & symptoms.
* To educate about medications and their side effects.
* To connect them to group modalities.

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18
Q

Schizophrenia

Schizophrenia Stabilization Phase: benefits of group modalities

Two benefits noted

A
  1. Very effective treatment.
  2. Helps with social isolation.
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19
Q

Schizophrenia

Schizophrenia Stabilization Phase: Referral to other supportive services

Three mentioned

A
  1. Peer support
  2. Advocacy groups
  3. Case Management
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20
Q

Schizophrenia

Schizophrenia Stabilization Phase: Beneifts of Case Management

Three points

What kinds of things can a CM link the client to?

A

Facilitates linkage to
* mental health
* housing
* rehabilitation agencies/services

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21
Q

Schizophrenia Stable Phase

What is the Stable Phase for Schizophrenia?

outcome and expected duration

A
  • We’d see stability for a significant amount of time
  • Six months to a year
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22
Q

Schizophrenia Stable Phase

Therapeutic Goals for Schizophrenia Stable Phase

Three listed

A
  1. Maintain Recovery
  2. Prevent Relapse of Symptoms
  3. Promote higher levels of functioning in various psychosocial domains
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23
Q

Schizophrenia Stable Phase

Schizophrenia Stable Phase: Counselor’s Focus

Two mentioned

What are we monitoring and what are we providing?

A
  1. Monitor medication compliance
  2. Provide ongoing psycho-education & Skills Training
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24
Q

Schizophrenia Stable Phase

Schizophrenia Stable Phase: Cindy’s components of psychoeducation and skills training

Which type of skills? Which relationships should we promote?

A
  1. Social Skills
  2. Problem Solving
  3. Coping Skills
  4. Foster active engagement with treatment providers (i.e., help list questions to ask their medication provider)
  5. If supportive, keep the family in the loop
  6. Help the client manage weight
  7. Refer to services
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# Schizophrenia Stable Phase Schizophrenia Stable Phase: Referral Services | Three listed ## Footnote Who/what should we consider referring the client to?
1. Peer support 2. Peer delivered services 3. Supportive employment 4. etc.
26
# Schizophrenia Stable Phase Schizophrenia Stable Phase: CBT interventions | Three listed
1. Cognitive Restructuring 2. Behavioral experimentation and reality testing 3. self-monitoring skills
27
# Schizophrenia Treatment for Youth Schizophrenia Treatment for Youth: Psychopharmocology consideration
Despite not approved for youth (poor research), medication prescribers prescribe medications anyway.
28
# Schizophreniform Schizophreniform | Very basic definition ## Footnote The major **symptom *set*** and diagnostically important duration
A mental health condition that causes symptoms of **psychosis**, like hallucinations, delusions and disorganized speech. It **lasts fewer than six months**. ## Footnote https://my.clevelandclinic.org/health/diseases/9571-schizophreniform-disorder
29
# Schizophreniform Schizophreniform: Positive prognosis factors | Four factors listed
* optimal occupational & social functioning **prior to episode** * **rapid** onset of (+) symptoms * **confusion**/distress in relation to symptoms * ➡️ The client may be confused about wtf these symptoms are all about. * absence of (-) symptoms * ➡️ **No negative symptoms**
30
# Schizophreniform According to Cindy--difference between Schizophreniform and schizophrenia re: negative symptoms
* Rapid onset with (+) sxs * Slow deterioration & positive sxs will probably turn into a schizophrenia diagnosis
31
# Schizophreniform The most important elements of **Schizophreniform** recovery | Three listed
1. Medication 2. Family psychoeducation 3. Supported employment * Remember... prior optimal performance *right* before decompensation would imply current employment & trying to work with or about employment will help reduce stress post-recovery (thereby reducing likelihood of relapse)
32
# Schizophreniform Schizophreniform Multidisciplinary Team & integrated approach | Four components
* Medications * Manualized CBT strategies * Individual crisis management * Family counseling and psychoeducation | longer-term reminission & prevention of relapse ## Footnote Pill popping (as per usual); crisis stabilization CM or at least crisis planning with tx (CBT) that wraps family/supports in for psychoedudation purposes
33
# Brief Psychotic Disorder Brief Psychotic Disorder duration requirements
* At least one day * Fewer than one month * Return to premorbid level of functioning ## Footnote Symptoms lasting beyond 30 days are probably schizophreniform disorder
34
# Brief Psychotic Disorder Brief Psychotic Disorder Criterion A
Presence of **at least one** of the following symptoms and **one must be either 1, 2, or 3** 1. delusions 2. hallucinations 3. disorganized speech (frequent derailment or incoherence) 4. grossly disorganized or catatonic behavior
35
# Brief Psychotic Disorder Onset of Brief Psychotic Disorder signs of psychosis
**Sudden** signs of psychosis
36
# Brief Psychotic Disorder Three subtypes of Brief Psychotic Disorder
1. with marked stressor(s) 2. without a marked stressor(s) 3. postpartum onset -- usually within the first four weeks ## Footnote With or without a precipitating stressful event, basically.
37
# Brief Psychotic Disorder Brief Psychotic Disorder: Counselor Considerations | Four components (three of which we *must* do)
* Might not see the diagnosis (especially in private practice) because **symptoms remit quickly** * Counselors *must* **identify the timeline** of stressor/traumatic event connected to the timeline of the symptoms * Counselors *must* identify whether the client has had a previous episode(s) of psychosis * Counselors *must* assess for differential diagnoses ## Footnote Take a recent history that includes potential precursors to symptoms onset, longer term history that accounts for previous events and any potential disorder that has these symptoms
38
# Brief Psychotic Disorder Brief Psychotic Disorder: Assessment for differential diagnoses | Four *Rule Outs*
* Rule out medical conditions by referring to a doctor * Rule out substance-induced... * Rule out personality disorder * Rule out psychotic disorder
39
# Brief Psychotic Disorder Brief Psychotic Disorder Treatment dependencies | Two listed
1. severity of symptoms 2. onset of symptoms ## Footnote Refer clients presenting with severe psychotic symptoms to inpatient setting for stabilization.
40
# Brief Psychotic Disorder Brief Psychotic Disorder Treatment: What a counselor should attend to with a client who has Sudden Onset of psychosis | Three components
Attend to... * clients' **confusion** about their subjective experience * overall **health** and wellbeing (i.e., nutrition & hygiene) * **safety** (as they have hightened risk for self-harm)
41
# Brief Psychotic Disorder Brief Psychotic Disorder: Medication | Type (class) and two examples
Common atypical antipsychotics like... * Zyprexa * Geodon (intramuscular)
42
# Brief Psychotic Disorder Brief Psychotic Disorder counseling goals upon stability | Three components
1. explore the triggering traumatic event / stressor 2. enhance coping skills 3. refer to group counseling for stress management and/or conflict resolution :(
43
# Delusional Disorder A major generality of delusional disorder in light of psychotic disorders
It does not impair functioning & therefore makes diagnosis more elusive
44
# Delusional Disorder Considerations for Delusional Disorder diagnosis and treatment | re: sensitivity and assessment
1. Remain alert to sensitivity, irritability, or hostility when you challenge or question a belief. 2. Attune attention to the client's social relationships as the delusions have probably impacted them. * The client may show distress by their relationships
45
# Delusional Disorder Seven subtypes of Delusional Disorder
* erotomanic type * grandiose type * jealous type * persecutory type * somatic type * mixed type (no one predominant theme) * unspecified type (when the theme does not fit a unique type)
46
# Delusional Disorder Popular treatments for Delusional Disorder | Two listed
1. CBT 2. ACT
47
# Delusional Disorder ACT for Delusional Disorder | Two and a half methods and two benefits (ECT)
* Focus on clients to **accept** disruptive thoughts * **Acknowledge** the situation and increase **mindfulness** about the difficult situation * --> shown to reduce harmful thoughts and feelings * Clients developed better abilities to identify delusional thoughts * Clients reduced need for hospitalization
48
# Delusional Disorder Psychopharmacology and Delusional Disorder
* Mixed research on effectiveness * Might help those with *somatic* and *persecutory* subtypes
49
# Delusional Disorder Psychopharmacology and Delusional Disorder: two medications | Has good results
* Risperidone * Zyprexa ## Footnote Remember, research suggests that medication might help those with *somatic* & *persecutory* type most of all
50
# Schizoaffective Disorder Characteristics of Schizoaffective Disorder | Symptoms and stipulations
1. psychotic symptoms (with stipulations) 2. Symptoms of psychosis experienced without the presence of a manic or depressive episode for at least two weeks ## Footnote Stipulations: experienced concurrently with predominant major depressive episode and/or manic episode
51
Mood disorder with psychotic features.
If someone’s dominant symptoms are mood symptoms but he experiences some periods of psychotic features ## Footnote [https://www.healthyplace.com/thought-disorders/schizoaffective-disorder-information/what-is-schizoaffective-disorder-dsm-5-criteria]
52
Most likely has schizoaffective disorder.
Two week period of time with *only* psychotic symptoms but also has a period of time carrying sxs of a mood d/o.
53
# Schizoaffective disorder Subtypes of Schizoaffective disorder | Two
1. Bipolar Type: manic episode 2. Depressive Type: major depressive episode | Determined by mood episode
54
# Schizoaffective disorder Diagnostic Considerations of Schizoaffective disorder & DSM-5 specific instructions | Two sections comprising of five pieces
Debate surrounds the diagnosis * Does it exist? * Where does it belong on the continuum between schizophrenia and mood disorders? Things to consider: * Diagnose as schizophrenia if the psychotic symtoms proportionally dominate over mood. * Consider the timing of symptoms carefully * ➡️ Was there a 2-week period of time with psychotic sxs exclusively (sans mood d/o sxs)? * Remember that diagnoses, symptoms, and client needs can shift over time
55
# Schizoaffective disorder What makes the diagnosis of Schizoaffective disorder difficult?
Observation of two weeks of time when the person does not experience a mood episode & still experiences psychotic symptoms ## Footnote I need to look further into this as I do not understand
56
# Schizoaffective disorder Treatment approach for Schizoaffective disorder
Complicated Treatment course and not thoroughly well researched! * Consider treatment strategies for both schizophrenia and bipolar disorder / major depressive disorder * In severe psychosis? The client should seek inpatient services * Psychoeducation & social skills training * Most likely, we should promote a multi-disciplinary approach
57
# Schizoaffective disorder Medication approach for Schizoaffective disorder Treatment
* **Psychopharmacology** combination of *antipsychotics* & *mood stabilizers*
58
# psychotic disorders Key Treatment Components for psychotic disorders | Five Major components
1. Engagement Strategies 2. Psychoeducation 3. Cognitive Therapy 4. Behavioral Skills Training 5. Relapse Prevention Strategies
59
# Engagement strategies for psychotic disorders Basic counseling strategies ## Footnote Key Tx Components of Psychotic Disorders
* build rapport * patience * transparency * explain the process and why
60
# Engagement strategies for psychotic disorders Importance of therapeutic rapport ## Footnote Key Tx Components of Psychotic Disorders
The client... * may have had adverse interactions with mh professionals, LE, and etc. * may have felt penalized for revealing psychosis to others * ➡️ Radical acceptance * might have active paranoia
61
# Engagement strategies for psychotic disorders Assessment questions about counseling expectations | Three ## Footnote Key Tx Components of Psychotic Disorders
Potential Questions Include: 1. What was it like when you saw a counselor before? 2. What did you do in counseling? 3. What are your ideas about what we will do with our time together?
62
# Engagement strategies for psychotic disorders Getting a clear and shared understanding of the client's symptoms & difficulties ## Footnote Key Tx Components of Psychotic Disorders
* symptoms trump diagnosis * Assessments * Clinical interviews
63
# Engagement strategies for psychotic disorders Assessment considerations ## Footnote Key Tx Components of Psychotic Disorders
They help with diagnosis and reveal the severity of symptoms Make sure to help the client understand * the need for the assessments * how we'll use the information * who will have access to the information
64
# Engagement strategies for psychotic disorders Clinical Interview question examples | Two ## Footnote Key Tx Components of Psychotic Disorders
Open questions like... * What do you think has caused this? * What has your doctor told you about these problems? ## Footnote Get their perspective of their sxs and their perspective of how they view the way others perceive their sxs.
65
# Engagement strategies for psychotic disorders Three considerations in information gathering about AH ## Footnote Key Tx Components of Psychotic Disorders
* Physical characteristics * Content * Beliefs about the voices
66
# Engagement strategies for psychotic disorders Physical characteristics about AH | Five ## Footnote Key Tx Components of Psychotic Disorders
* number of voices * frequency * loudness * clarity * perceived location
67
# Engagement strategies for psychotic disorders Content about AH ## Footnote Key Tx Components of Psychotic Disorders
Assist in generating specifics * What do the voices say? * Does the voice(s) give commands? Do they tell you what to do? * Does it comment about your actions? * Does it criticize, abuse, give advice, or compliment
68
# Engagement strategies for psychotic disorders Beliefs about the voices/AH | Four Listed ## Footnote Key Tx Components of Psychotic Disorders
* Who do you think these voices belong to? * How much power does it have? How do you know it has such power? * ➡️ What happens when you do not listen to the voice? * ➡️ What would happen if you chose to not listen to the voice?
69
# Engagement strategies for psychotic disorders Cues/Triggers of AH | Three Listed ## Footnote Key Tx Components of Psychotic Disorders
* Some people say they hear more voices some times than other times. Have you noticed this about your voices? * What times or situations do you notice the voices behave more active? * Which times do the voices go away?
70
# Engagement strategies for psychotic disorders AH Emotional and behavioral consequences | Six ## Footnote Key Tx Components of Psychotic Disorders
Voices can have positive, netural, or negative emotional and behavioral consequences. Therefore ask... * How do you end up feeling when you hear the voice? * What do you do when you hear the voice? * Do you willingly listen to the voice or end up hearing it unwillingly? * Have you tried shouting at the voice? * Do you ignore it? * Do you try to stop it from talking?
71
# Engagement strategies for psychotic disorders What do we assess when it comes to AH? | Five ## Footnote Key Tx Components of Psychotic Disorders
1. Physical characteristics 2. Content of the voices 3. Beliefs about the voices 4. Cues / Triggers 5. Emotional and Behavioral Consequences
72
# Engagement strategies for psychotic disorders Assessing Delusions | Method, goals, and suggestions ## Footnote Key Tx Components of Psychotic Disorders
**Clinical Interview** while using a **visual analog scale**. * Goal: understanding predisposing, precipitating, and maintaining factors * Try determining the degree to which the delusions preoccupy the client * Use the words that the client uses * Use words like **beliefs, concerns, worries, & preoccupations**
73
# Engagement strategies for psychotic disorders Three Factors about Delusions to understand ## Footnote Key Tx Components of Psychotic Disorders
1. predisposing 2. precipitating 3. maintaining
74
# Engagement strategies for psychotic disorders Three things to identify re: delusions ## Footnote Key Tx Components of Psychotic Disorders
1. belief 2. worry 3. concern * Rate the degree of **preoccupation** with these beliefs, worries, and concerns along a gradient of zero to 100.
75
# Engagement strategies for psychotic disorders What other areas should we explore? ## Footnote Key Tx Components of Psychotic Disorders
1. disabilities / quality of life (which factors does the client experience more or less difficulty?) 2. associated distress (depression or anxiety going on?) 3. goals to attend to secondary distress 4. motivation
76
# Engagement strategies for psychotic disorders Trying to develop targets for setting goals and trying to alleviate secondary distress | Three ## Footnote Key Tx Components of Psychotic Disorders
* coping skills * relaxation skills * behavioral activation skills
77
# Key Tx Components of Psychotic Disorders Psychoeducation
* Normalize experience of the symptoms * Promote alternative perspective taking about symptoms * Promote understanding of symptoms and context for which they occur * ➡️ Collaborate: identify & create shared understanding of difficulties * You need to pace this * ➡️ structure based on client's level of insight into client's illness * ➡️ ➡️ Start by talking about the **stress vulnerability model** * ➡️ Education about psychosis & symptoms of psychosis
78
# Key Tx Components of Psychotic Disorders (Cognitive Therapy) Cognitive Therapy | Theory, proximity, why
* Verbal Challenges and Behavioral Experiments * When the client has reached stability & only residually symptomatic * Found to reduce believability of delusions & hallucinations
79
# Key Tx Components of Psychotic Disorders (Cognitive Therapy) ABC Model
* Antecedents, Beliefs, & Consequences * Targets thoughts and feelings * Emphasizes the belief ↔️ consequence connection
80
# Key Tx Components of Psychotic Disorders (Cognitive Therapy) Disputing Delusional Beliefs
* Highly dependent on rapport and trust * Help the client recognize feelings when having the belief * Generate alternatives / other possibilities * Examine the evidence about truthfulness
81
# Key Tx Components of Psychotic Disorders (Cognitive Therapy) Behavioral Experiments
* To test the beliefs about the voices/AH * Experiment Log Worksheet * ➡️ Carefully plan this out * ➡️ Promotes experiential learning that combats the delusional belief
82
# Key Tx Components of Psychotic Disorders (Cognitive Therapy) CBT: What is it good for?
* Disputing Voices * ➡️ by disputing *automatic thoughts* we can disarm the power of the voices * ➡️➡️ Look for alternative posibilites
83
# Key Tx Components of Psychotic Disorders (Behavioral Skills Training) Behavioral Skills Training ➡️ purpose and benefits
To improve coping with **residual symptoms** * Relaxation * Activity Scheduling * Distraction & Problem Solving
84
# Key Tx Components of Psychotic Disorders (Relapse Prevention Strategies) Relapse Prevention Strategies
* Identify early warning signs * Develop plans of action in response to indicators
85
# Psychotic Disorders: Psychopharmacology Components that antipsychotic medication effectively treat
* **Positive symptoms** of schizophrenia & other psychotic disorders * Mania * Drug Intoxication * Some medical conditions * Agitation
86
# Psychotic Disorders: Psychopharmacology What antipsychotic meds do not treat so effectively (if at all)
* **negative** symptoms * **cognitive** symptoms
87
# Psychotic Disorders: Psychopharmacology First-Generation antipsychotics | Seven
* Thorazine * Haldol * Prolixin * Loxapine * Compazine * Navane * Mellaril | Contemporarily used minimally; daunted by motor side effects
88
# Psychotic Disorders: Psychopharmacology Second-Generation Antipsychotics | Twelve
AKA: **atypical antipsychotics** * Clozapine * Zyprexa * Risperidone * Seroquel * Geodon * Latuda * Invega * Abilify * Rexulti * Saphris * Vraylar * Fanapt
89
# Psychotic Disorders: Psychopharmacology Term used interchangeably with **antipsychotic** ## Footnote Especially "first generation"
* **neuroleptic**
90
# Psychotic Disorders: Psychopharmacology Other effects of antipsychotics
* Sedating & helpful with **agitation** * Effectively stabilize mood **seroquel, risperidone** * Augment antidepressants **abilify** * Used in **OCD** tx when paired with **SSRI** * Can treat **anxiety disorders** * Sometimes: **Autism** (behavioral problems)
91
# Psychotic Disorders: Psychopharmacology Considered a major breakthrough in schizophrenia treatment
Second-Generation (Atypical) Antipsychotics * Fewer side effects
92
# Psychotic Disorders: Psychopharmacology Risks of Clozapine
* Can provoke the body to stop producing **white blood cells** * Monitored with regular blood tests * ➡️ Monitor weekly for 18 weeks * ➡️ Then every 28 days
93
# Psychotic Disorders: Psychopharmacology -- How they work How do antipsychotics work (generally)?
* Block the D2 dopamine receptor ## Footnote There exist Five Dopamine Receptors (D1 - D5)
94
# Psychotic Disorders: Psychopharmacology -- How they work How many dopamine pathways exist in the brain?
Four Major pathways
95
# Psychotic Disorders: Psychopharmacology -- How they work Blocked by First-Generation Antipsychotics
The four major dopamine pathways
96
# Psychotic Disorders: Psychopharmacology -- How they work Name the four major pathways in the brain that first generation antipsychotics block.
1. Brainstem to Limbic System (mesolimbic pathway) 2. Brainstem to frontal lobe cortex (surface) 3. Brainstem to basal ganglion (nigrostriatal pathway) 4. Dopamine pathway
97
# Psychotic Disorders: Psychopharmacology -- How they work -- Four Pathway 1) Brainstem to Limbic System
**mesolimbic** pathway * medication that **blocks** dopamine in this pathway **decreases psychotic symptoms** * substances that **increase** dopamine here **increases** or **causes** psychotic symptoms
98
# Psychotic Disorders: Psychopharmacology -- How they work -- Four Pathway 2) Brainstem to frontal lobe cortex | Cortex = Surface
Addition of dopamine *stimulates* behavior, thought, expression, & motivation Blocking dopamine here may *exaggerate / exacerbate* schizophrenia's negative symptoms. To block dopamine here is to... * decrease motivation * decrease spontaneity * decreases resiliency * ➡️ the ability to persist and follow through with things
99
# Psychotic Disorders: Psychopharmacology -- How they work -- Four Pathway Brainstem to Basal Ganglion | This one is tricky
* Nigrostiatal Pathway * Control System for the **extrapyramidal motor system** 😳 * To block dopamine here for longer time periods can lead to the development of the extrapyramidal side effects * Second-Gen antipsychotics are *less* risky than First-Gen (not perfect, though) * ➡️ potentially leading to permanent disordered movement
100
# Psychotic Disorders: Psychopharmacology -- How they work -- Four Pathway extrapyramidal motor system side-effects | Re: Brainstem to Basal Ganglion
Can occur with antipsychotics (espeically first gen), lithium, and antidepressants * ➡️ Parkinson-like tremors * ➡️ muscle spasms (**dystonia**) * ➡️ motor restlessness (**akathisia**) * ➡️ involuntary facial movements (**tardive dyskinesia**)
101
# Psychotic Disorders: Psychopharmacology -- How they work -- Four Pathway Pyramidal System | Re: Brainsgtem to Basal Ganglion
**voluntary** muscle movement
102
# Psychotic Disorders: Psychopharmacology -- How they work -- Four Pathway Extrapyramidal Motor System | definition-ish
System involved with making muscles move smoothly by setting muscle tension correctly.
103
# Psychotic Disorders: Psychopharmacology -- How they work -- Four Pathway 4) Dopamine pathway
Blocking dopamine raises prolactin * Leads to gynecomastia development * ➡️ ♂ breast enlargement & milk-like liquid secretion * ➡️ ➡️ Can happen in women, but not referred to as gynecomastia * can lead to other sexual side effects such as decreased libido
104
# Psychotic Disorders: Psychopharmacology -- How they work -- Four Pathway Prolactin
One of the sex-related hormones
105
# Psychotic Disorders: Psychopharmacology -- How they work - 2nd gen Serotonin
Messages the dopamine-containing nerve cells to **stop** producing and releasing dopamine. *they put the brake on dopamine release*
106
# Psychotic Disorders: Psychopharmacology -- How they work - 2nd gen 2nd generation antipsychotic medications | What do they do?
* Block the D2 receptors in the limbic pathways and leave the other three pathways largely unaffected * Utilizes the **serotonin neurotransmitter system** * ¡Getting the right **balance** of the serotonin and dopamine blockade **reduces** psychotic symptoms while leaving the other pathways intact, thereby causing fewer **side effects**!
107
# Psychotic Disorders: Psychopharmacology -- How they work - 2nd gen Unique effect of 2nd generation antipsychotics
Unique effects on a variety of receptors including... * D2 * 5HT2A (Serotonin) * ➡️... which leads to differences in effects of medication and side-effects
108
# Psychotic Disorders: Psychopharmacology -- How they work - 2nd gen 2nd generation antipsychotics affect various receptors in different ways...
* on/off state rather than consistent blockade * partial agonists * ➡️ partially block and stimulate the receptors
109
# Psychotic Disorders: Psychopharmacology -- Common Side Effects Re: 1st gen antipsychotics, potency, and side effects
Side effects have relation to potency * Low-Potency (100 mg Thorazine) * High-Potency (2 mg Haldol)
110
# Psychotic Disorders: Psychopharmacology -- Common Side Effects Low-Potency example provided
100 mg Thorazine * More sedating, more anticholinergic side effects, weight gain * dry mouth, constipation, blurred vision, drop in blood pressure * Fewer (bot not entire) motor side effects
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# Psychotic Disorders: Psychopharmacology -- Common Side Effects High-Potency example provided
2 mg Haldol * Less sedating, less weight gain, fewer anticholinergic side effects * commonly cause extrapyramidal effects or motor effects (EPS) * ➡️ tremor, stiffness, severe muscle cramps (dystonia), motor restlessness (akathisia)
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# Psychotic Disorders: Psychopharmacology -- Common Side Effects Medication to control extrapyramidal side-effects
Cogentin | used also in Parkinson's
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# Psychotic Disorders: Psychopharmacology -- Common Side Effects Overall difference between 1st and 2nd gen side effects
2nd Gen... * less likely to cause **motor effects** * less likely to make people **feel drugged** * *more likely* to cause significant **weight** gain, elevated **cholesterol**, predispose people towards **diabetes**
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# Psychotic Disorders: Psychopharmacology -- Common Side Effects 2nd gen antipsychotics that tend to cause prolactin elevation
**Risperdal** & **Invega** prolactin elevation: sexual side-effects and gynecomastia
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# Psychotic Disorders: Psychopharmacology -- Common Side Effects 2nd gen antipsychotics most likely to cause **akathisia**
**Geodon** & **Abilify** movement disorder / inability to sit still
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# Psychotic D/o: Psychopharmacology - Common Side Effects Four broad categories of *general side effects*
1) Metabolic problems .....➡️ weight gain & diabetes 2) EPS (muscle related side-effects) 3) Common non-muscle-related side effects .....➡️ not life threatening, but quite uncomfortable 4) Rare & dangerous problems
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# Psychotic d/o: Psychopharmacology - Four Common Side Effects 1. Metabolic side-effects: Weight Gain & Diabetes
* Weight gain seems related to carbohydrate cravings * .....➡️ BTW: This is a side-effect of SSRI's, too! * Antipscyhotics can also change how the body handles glucose & insulin. * .....➡️ Development of diabetes sans weight gain
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# Psychotic d/o: Psychopharmacology - Four Common Side Effects 2) Extrapyramidal Side Effects (EPS)
* Dystonia * Pseudo-Parkinsonism * Akathisia * Akinesia * Tardive Dyskinesia ## Footnote Less likely in Second Generation
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects--EPS Distonia
Sudden spasms of head, neck, lips, and tongue ## Footnote EPS related
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects--EPS Psuedo-Parkinsonism
* muscular rigidity * mask-like face * stiff-walk * shuffling gait ## Footnote EPS related
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects--EPS Akathisia
Persistent & very uncomfortable motor restlessness ## Footnote EPS Related
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects--EPS Akinesia
* Motor and emotional woodenness * lack of spontaneity in facial expression or gesturing * .....➡️ similar in appearance to negative symptoms ## Footnote EPS related
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects--EPS Tartive Dyskinesia
Repetitive movement of... * fingers * lips * tongue * other body areas ## Footnote EPS related
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects 3) Common, uncomfortable, & usually temporary / reversible side-effects
* Toxic side-effects that can occur with any medication * Psychotoxic effects * Anticholinergic effects * Prolactin Elevation
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects-Temp. & Rvsble Psychotoxic Effects
Feeling *drugged* or out of it * depersonalization * depression * confusion
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects-Temp. & Rvsble Anticholinergic Effects
* Dry mouth * Dry eyes & blurred vision * Constipation * Hypotension * .....➡️ Drop in blood pressure as the Client stands up
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects Rare & serious side-effects
* Blood dyscrasia * Neuroleptic Malignant Syndrome (NMS) * Fatal Heat Stroke * Seizures
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects- Rare/Serious Blood Dyscrasia
* Blocking white blood cell production * .....➡️ Requires monitoring (too low WBC count can threaten life
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects- Rare/Serious Neuroleptic Malignant Syndrome (NMS)
High Fever and Muscle Stiffness * Significant threat of hypothermia (105° F) without immediate & vigorous treatment
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects- Rare/Serious Fatal Heat Stroke
All antipsychotics can interfere with temperature regulation system while in hot weather * Requires the client to seek an air conditioned or cool space * Drink fluids to stay hydrated
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# Psychotic d/o: Psychopharmacology - 4 Common Side Effects- Rare/Serious Seizures
Rare but potential side effects of any medication
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# Psychotic d/o: Psychopharmacology: Know Know the medications your client takes and the med's common side effects
* The Client's psychiatrist or other prescriber depends on you to alert them to problems. * You may have to refer the Client to seek medical attention
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# Psychotic d/o: Psychopharmacology: Know Take a sympathetic approach to the side-effects your Clients report
Help educate Clients about their medications and potential side-effects * Depends on your Client's capacity/capability * Lead them to uncover knowledge on their own. Show them how to research these medications * Help generate questions for their prescriber(s) and trouble-shoot ways to remember them.
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# Psychotic d/o: Psychopharmacology: Know Remain aware of drug interactions
Refer the Client to their prescriber or bring it to their prescriber's attention * The Client can also take questions to their Pharmacist

Treatment Spring 2024 (Test) (1 decks)

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