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2012-05-03 14:54:08
Mental health

miterm ch14
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  1. What is schizophrenia??
    Severe disorder of the brain like epilepsy or multiple sclerosis.

    It is a clinical syndrome, not just one cause

    It is a NO fault illness.

    Acute periods with relapses
  2. What is off in Schizophrenia??
    Perception, judgement, and emotions
  3. Schizophrenia is not due to what the parents did wrong but it is
    it is Highly Genetic
  4. What is Not schizophrenia??
    Does not mean “split personality”.

    Not caused by bad parenting.

    Not caused by personal weakness.
  5. What is the disconnection in pts with schizophrenia
    Disconnect btw what the pt is seeing and the outside world

    (emotions not expressed congruently). Difficult time in relationships
  6. What is a pt with schizophrenia more prone to do when taking thier medications??
    When they are taking drugs they are more prone to think more clearly and able to plan a suicide
  7. What are pts with schizophrenia less likely to commit suicide when not on their meds??
    When not on meds there are so many thoughts they cant distinguish and paln and think clearly
  8. What are the advantages to being diagnosed with schizophrenia later on in your life??
    The later your diagnosed, the better level of functioning overall. Outcomes are greater if you were functional before you were diagnosed

    more likely you will be able to function bc you know what is normal and what is not
  9. What is the disadvantage of getting diagnosed with schizophrenia at a young age??
    • their outcomes are worse bc they didnt have a chance to
    • develop and function well before.

    The earlier your diagnosed the less of a life you will have

    Kids wont know the difference btw normal and not
  10. What is the Dopamine Hypothesis
    • ppl with schizo produce more excess dopamine and they dont have as good things to break it dop down so theres higher concentrations the increased doamine craving cells and a decrease in activity in antagonis (more cells want
    • dopamine and less want to block it )
  11. What are some Selected factors activate genetic vulnerability to schizophrenia
    Winter birth

    Viral infection 28th-30th week of pregnancy

    Rh incompatibility

    Starvation during pregnancy

    Oxygen deprivation at birth
  12. What are the important test used for schizophrenia
    MRI: identifies small changes in brain

    PET: high activity in temporal lobe , metabolism, sugars can be seen

    EEG: just shows pt is alive, and current seizure
  13. What is the Schizophrenia DSM-IV-TR Criteria
    Lasting 6 months

    • Active-phase symptoms lasting at least 1 month include
    • two of the following:



    –Disorganized or catatonic behavior

    • –Disorganized
    • speech
  14. What are the subtypes of Schizophrenia
    • Paranoid
    • Disorganized
    • Catatonic
    • Undifferentiated
    • Residual
  15. what is the paranoid subtype
    • delusional thought.
    • Voices.
    • See the enviroment as threatening and hostile.
    • They can be dangerous.
    • Highest functioning, most successful in recovery
  16. What are people able to do in the Paranoid subtype
    able to work and go to school, just have to manage with the voices, able to functionin life,sees life as threating and hostile enviornment (hypervigulent), want to know whattheir thoughts are (I wonder what its like for you)
  17. Disorganized subtype
    can have hallucinations. Looseness of assoc. disconnection in their affect

    (laughing when talking about someone who died). Harder to understand.
  18. Catatonic Subtype
    walking around, not really talking or have awareness of surroundings. Could be motionless, like a mannequin.

    Look unaware of their environment. They say theres so much going in their head that it immobilizes them. Can be successful
  19. What are we worried about in the Catatonic stage
    • worried about DVT and eating , catatonic can be succesful
    • too,

    they can still hear you even though they may look like they are a maniquien
  20. Undifferentiated subtype
    could be a combo of the other ones. Might not be as successful in recovery.

    little bits and pieces of everything, lots of things going on, a mess and not able to function well
  21. Residual subtype
    don’t have active symptoms but still difficult time in social situations

    left over behaviors after treatment, no active symptom
  22. What are the courses of schizophrenia
    • Prodromal
    • Acute
    • Mainenance
    • Stabilization
  23. Prodromal course
    pre before diagnosis

    –Early symptoms preceding diagnosis: social withdrawal, deterioration in function, perceptual disturbances, magical thinking, and peculiar behavior

    • Usually before pt has their first break there are SOME symptoms. Start disconnecting social-wise. Magical thinking , change in behavior usually don’t act like this
    • is a sign
  24. Acute course
    when postive symptoms occur crack and start to be schizophrenic
  25. Maintenance course
    Acute symptoms decrease, especially positive symptoms

    When meds and treatment are given
  26. Stabilization
    Symptoms are in remission

    Even in remission, pts will have some type of delusional thinking but it might not prevent them from functioning
  27. Positive Symptoms of Schizophrenia-Excess or distortion of normal functions
    Hallucinations-distortion of perceptions

    Delusions-distortion of thought content

    Disorganized speech

    Grossly disorganized or catatonic behaviors
  28. Negative Symptoms of Schizophrenia- Loss of Normal Functions
    • Apathy
    • Alogia
    • Lack of motivation
    • Blunted flat affect
    • Loss of emotional warmth
    • Impaired social skills

    • Treatment:
    • Atypical antipsychotics-newer. They help these
  29. thought blocking is associated with what disease
  30. Flight of ideas is associated with what disease
  31. What are the Thought Disturbances with Schizophrenia
    • Delusions
    • Circumstantially
    • Tangentiality
    • Thought blocking
    • Losse association
  32. Circumstantially
    somebody who doesn’t know what is more important.

    You ask them about a movie and they tell you everything (the parking spot, etc) THE WHOLE STORY
  33. Tangentiality
    start talking about something then going off on tangent (refocus pt)
  34. Loose association
    • might not be a connection.
    • They go from one topic to another.
    • (random, I cant follow you)
  35. When a pt says I Am Jesus what is that
    A delusion
  36. When a person says they Hear Jesus and they Can see him what is that
    A Hallucination
  37. What are the Objective data in the Assessment
    Mental status examination

    Positive and negative symptoms

    Assessment scales

    –PHATS (Bp, HDL (good cholesterol), Abdominal obesity, Triglycerides, sugar) how they are reacting to the atipical drugs

    Newer bc a lot of the newer drugs cause these
  38. What happens if the pt is not doing their ADLs
    Then they will not be discharged
  39. What will the nurse do in the Planning stage of the nursing process in the Acute phase
    planning strategies to ensure patient safety and stabilize symptoms
  40. What will the nurse do i the Planning stage of the nursing process in the Maintenance phase
    planning strategies to provide patient and family education
  41. What will the nurse do in the planning stage of the nursing pocess in the stabilization phase
    planning strategies to prevent relapse
  42. If they ask you if you think they are jesus christ, you say
    i find it hard to believe but i believe that you think youre jesus christ”
  43. which diagnosis would be highest priority for client with catatonic schizophrenia?
    Imbalanced nutrition:less than body requirements
  44. Typical Antipsychotic block what
    Block D2 receptors in limbic region
  45. When a Typical Antipsychotic blocks dopamine it reduces what symptoms
    Positive symptoms
  46. What are the Typical Antiphsychotic drugs for Schizophrenia
    Haldol, Prolixin, Thorazine, trilafon
  47. What are the Major side effects with Typical Antipsychotics
    dopamine blockage (EPS), noradrenergic (Alpha 1)blockage, cholinergic blockage
  48. What are the Adverse effects to Cholinergic blockade in low-potency Typical Antipsychotics
    Atropine-like Side Effects

    •Dry mouth

    •Blurred vision

    •Sinus tachycardia

    •Urinary retention


    •Nasal congestion

    •Treatment: Supportive measures
  49. What are the HIGH potency Typical Antipsychotics
    • Haldol
    • Stelazine
    • Prolixin
    • Navane
  50. What are the MEDIUM potency Typical Antipsychotics
    • Loxaprin (loxitane)
    • Moban
    • Trilafon
  51. What are the LOW potency Typical Antipsychotics
    • Thorazine
    • Taractan
    • Mellaril
  52. Haldol hase a low _____affect
    los sedative affect
  53. Haldol can be given IM every
    3-4 wks
  54. Prolixin IM can be effective when given
    every 2-4 wks
  55. Which Typical Antipsychotic drug has an increase sensitivity to the sun??
  56. Which Typical Antipsycotic drug has the Highest sedative and hypotensive effect
  57. What Typical Antipsychotic cna can irreversible retinitis pigmentosa at 800 mg
  58. Adverse Side Effects Related to Alpha1 Blockade Low-Potency Typical Antipsychotics
    Orthostatic hypotension-risk of falling and monitor blood pressure

    Dysrhythmias, palpitations
  59. Adverse Side Effects Related to D2 Blockade High-Potency Typical Antipsychotics
    Extrapyramidal Side Effects
  60. What are the Extrapyramidal Side Effects??
    • Dystonia
    • Pseudoparkinsonism
    • Akathisia
    • Tradive Dyskinesia
  61. Dystonia
    (stiffness)(see this right away)

    IM diphenhydramine (benadryl) or benztropine (cogentin, artane) followed by oral antiparkinsonism drug, eyes rolling back
  62. What are the Two Typical Antipsychotics that have more EPS
    Haldol and Prolixin
  63. Pseudoparkinsonism
    Change to low-potency drug

    Oral antiparkinsonism (symmetrel) drug
  64. Akathisia
    (see this a lot. Movements uncontrolled. Pacing, moving legs) (they look agitated)

    Decrease antipsychotic dose

    Propranolol (Inderal)
  65. Tardive Dyskinesia
    chronic result) (involuntary movement of facial area a lot of times) tongue might be moving. feeling of caramel stuck in your mouth

    Change to atypical antipsychotic make comment of what you are seeing
  66. Other Side effect with Typical Antipsychotics
    Photosensitivity( doesn’t matter what your skin color is)wear sunscreen

    Poikilothermia (Temperature Regulation Affected)-body isnt telling them if theyre hot or cold. Could be sweating but wont know to take their coat off

    Galactorrhea and Gynecomastia
  67. What are the Atypical Antipsychotics??
    Clozapine (Clozaril)-agranulocytosis,wt gain

    •Risperidone (Risperdal)

    •Olanzapine (Zyprexa)-wt gain

    •Quetiapine (Seroquel)

    •Ziprasidone (Geodon)

    •Aripiprazole (Abilify)
  68. What are the Side Effect for Atypical Antipsychotic
    fewer EPS, fewer anticholinergic effects, may have sedation and hypotension

    Dopamine side effects much weaker

    Histamine is blocked: results in weight gain, sedation
  69. What happens metabolically with Atypical Antipsychotics
    Hyperlipidemia, Hyperglycemia and weight gain may occur over time, esp. with Olanzapine

    •May improve TD
  70. What Atypical Antipsychotic may cause Agranuloctyosis??
    Clozaril-requires weekly WBC counts
  71. Clozapine takes up a high amount of what??
    D4 and 5HT2
  72. Clozapine has a risk for
  73. What are the Side effects for Clozapine
    –Anticholinergic, extrapyramidal

    –Neuroleptic malignant syndrome (NMS)

    –Tachycardia, postural hypotension

    –Weight gain

    –Fever, seizures
  74. What the side effects of Neuroleptic Malignant Syndrome Reaction to Antipsychotic Medications
    •Potentially fatal

    •Decreased Level ofbconsciousness

    •Inceased Muscle tone

    •Autonomic dysfunction

    –Hyperpyrexia-high temp.

    –Labile hypertensions





    •Myoglobinuria-large molecules that block your kidneys
  75. What is the treatment for NMS
    •D/C antipsychotics




    •Dantrolene- antidote for hyperthermia


    –Bromocriptine, amantadine
  76. What can be used for early recognition of EPS
    Use Abnormal Involuntary Movement Scale (AIMS) for early recognition of EPS
  77. What meds can be used for treatment of EPS
    Anticholinergic meds
  78. Deopt Meds
    • Risperdal Consta atypical antipsychotic
    • –IM
    • q2weeks

    • Fluphenazine (Prolixin)decanoate typical antipsychotic
    • –IM or SC

    • •Haloperidol decanoate typical antipsychotic
    • –IM
  79. What things will cause relapse
    •Denial of illness


    •Lack of family support

    •Inability to cope with health system

    •Medication failures