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What are the 4 A's of Schizophrenia?
- Affect
- Associative Looseness
- Autism
- Ambivalence
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Diagnoses criteria for schizophrenia
- continuous signs for at least 6 months
- 2 or more of the following each present for a significant portion of time during a 1 month period
- Delusions
- Hallucinations
- Disorganized or catatonic behavior
- Negative symptoms (affective flattening, alogia, avolition)
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Biochemical Influences of Schizophrenia
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what are positive symptoms of Schizophrenia?
- Alterations in thinking
- Alterations in speech
- Alterations in perception
- Alterations in behavior
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what is waxy flexibility?
the extended maintenance of posture, usually seen in catatonia.
The nurse raises the arm of a patient and the patient continues to hold this position in statue like manner
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Tardive Dyskinesia
- Repetitive, involuntary, purposeless movements
- usually involves the toes, neck, trunk, tongue, fingers or pelvis
- caused by dopamine blockage, usually high dose long term therapy
- Tardive continues even after drug is D/C
- Sometimes permanent
- AIMS SCALE
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examples of
1st generation antipsychotics
- Thorazine
- Mellaril
- Loxitane
- Moban
- Trilafon
- Navane
- Prolixin
- Haldol
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Examples of 2nd generation antipsychotics
- Saphris
- Clozaril (may cause AGRANULOCYTOSIS)
- Fanapt
- Latuda
- Zyprexa
- Invega
- Seroquel
- Risperdal
- Geodon
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examples of 3rd Generation antipsychotics
Abilify
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which category of antipsychotics causes weight gain
2nd generation
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which generation of antipsychotic treats which symptoms?
- 1st gen treats positive
- 2nd gen treats positive and negative
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which category of antipsychotics lowers the seizure threshold
1st generation
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which category of antipsychotic cause the most motor side effects?
1st generation
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what are some common Extrapyramidal side effects caused by antipsychotics
- Acute dystonia
- Akathisia
- Pseudoparkinsonism (tremors)
most pts build up a tolerance to the side effects over months / if they don't you will have to decrease the dose or add a anticholinergis or antioarkinsonian drug (to normalize the ratio of dopamine to Ach)
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What is Neuroleptic Malignant Syndrome?
- caused by too much dopamine blockage
- develops over 24-72 hrs, usually early in med therapy
- Sx; muscle rigidity, hyperthermia, altered consciousness, and autonomic dysfunction, tachycardia, HTN, dyspnea
- POSSIBILY DEATH
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what are indications that patients are having hallucinations?
talking to someone that is not really there
- hallucinations involve perceiving a sensory experience for which no external stimuli exists
- (hearing voices, seeing
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types of Schizophrenia include
- Disorganized Schizophrenia
- Catatonic Schizophrenia
- Residual Schizophrenia
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Disorganized Schizophrenia
- onset before 25
- regressive and primitive behavior
- flat or inappropriate affect
- silliness, incongruent giggling, bizarre mannerisms
- poor personal appearance
- social impairment
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what are delusions?
False fixed beliefs that cannot be corrected by reasoning
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catatonic schizophrenia
- marked abnormalities in motor behavior
- WAXY FLEXIBILITY
- stupor and motor agitation
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Residual Schizophrenia
- AKA: Ambulatory schizophrenia
- no longer has active symptoms
- Hx of at least one previous episode of schizophrenia
- CHRONIC FORM OF SCHIZOPHRENIA
- Residual Sx include social isolation, eccentric behavior, impairment in personal hygiene and grooming, inappropriate affect, poverty of speech, illogical thinking, apathy
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Treatment for schizophrenia
- Phase I/Acute: SAFETY!
- inpatient hosp or partial programs
II Stabilization and III maintenance: Medication adherence and community support
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how to communicate with person having hallucinations
- ask about hallucinations
- watch for signs the patient is hallucinating
- do not argue about hallucinations
- focus on reality
- watch for anxiety
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communicate with delusional patient
- be honest
- be matter of fact, but supportive
- ask for info about delusions
- do not argue
- focus on underlying feelings
- observe triggers
- set limits on time talking about delusions
- validate reality in the delusion
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Mnemonic for NMS
- FEVER
- F: Fever
- E: Encephalopathy
- V: Vitals unstable
- E: elevated enzymes
- R: Rigid Muscles
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what is the treatment for NMS
- Stop the drug
- transfer to a medial unit
- parlodel; relieve the muscle rigidity and decrease the fever
- Dantrium: reduce muscle spasms
Nursing: cardiorespiratory support, treat hyperthermia, maintain renal function, ICU
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negative symptoms of schizophrenia
- develop slowly, interfere with ability to cope, have conversations, jobs, decision making, maintain hygiene
- (interfere with the ability to live)
- Affect
- Anergia
- Anhedonia
- Avolition
- Poverty of content of speech
- Poverty of speech
- Thought blocking (can't finish sentences)
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Paranoid Schizophrenia
Preoccupation with one or more systematized delusion, hallucination
patient may be guarded hostile, argumentative
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negative symptoms develops slowly and are those that interfere with a person's adjustment and ability to cope.
Negative symptoms impede one's ability to ___
- initiate and maintain conversations and relationships
- obtain and maintain employment
- Make decisions and follow through on plans
- Maintain adequate hygiene and grooming
Negative symptoms contribute to poor social functioning and social withdrawal
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Positive symptoms of schizophrenia include
hallucinations and delusions
they are categorized as alterations in thought, speech, perception, and behavior
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