Semester III; Exam V: Schizophrenia

What is schizophrenia?
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Why is glutamate called "the key neurotransmitter"?It's the key neurotransmitter during during development of the CNSWhat does the neurotransmitter acetycholine regulate?Regulates: -mood -memory -learningWhat sort of comorbidities do people with schizophrenia usually have?-Substance abuse -nicotine addiction -depressive -depressive symptoms -anxiety disorders -psychosis-induced polydipsiaIf someone suffers from substance abuse or nicotine addiction, what are key assessments?-Cardiac -Respiratory -Liver labsCan anxiety disorders lead to hallucinations?YESIf someone has psychosis-induced polydipsia, what volume of fluids are they taking in per day?4-10 L/dayWhat is a reason psychosis-induced polydipsia occurs?Lots of meds cause dry mouthWhat is a psychotic episode?A break in realityThe "prodromal period" occurs before schizophrenia is apparent. How long before the first psychotic episode would you expect to see "symptoms" of schizophrenia?Symptoms appear 1 month to 1 yr before 1st psychotic episodeWhat are the symptoms of schizophrenia during the prodromal period?-anxiety -person is socially awkward, lonely, depressed, vague, odd -phobias -obsessions -dissociative features -compulsions -concentration, memory, school/work roles deteriorate -events are misinterpreted -sexuality is altered (fearful of homosexuality is common)During the Acute Phase of schizophrenia (phase I), what's going on?-Periods of positive and negative symptomsIf someone is in the acute phase of schizophrenia (phase one) ,what are the priority nursing interventions?-psychiatric, medical, and neuro eval -meds (psychopharmacological) -education, support, and guidance -supervision and limit setting in the milieuIs hospitalization required during the acute phase of schizophrenia?YESWhat's going on during the stabilization phase of schizophrenia (phase II)?-Symptoms are diminshing, and person is beginning to return to previous level of functioningIs daycare required during the stabilization phase of schizophrenia?YESWhat are your nursing goals when taking care of a patient during the stabilization phase (phase II) of schizophrenia?To prevent relapse by looking for early warning signs and educating patient and family & skills trainingWhen thinking about the long term approach for preventing relapse, what types of interventions are necessary?-medication -administration/adherence to meds and therapy -community resources -psychiatric care -caregiver supportWhat is going on during the maintenance phase of schizophrenia (phase III)?Symptoms are absent, at baseline function prior to episodeExplain what dissociative features means?Nothing makes sense to them. "hard time concentrating"If someone suffers from compulsions, they may have sudden urge to hurt someone. What are some s/s that a schizophrenic may be about to blow up?-clenched fists -restlessness -darty eyes -talking to self (sometimes under breath)According to the DSM-5, what is the list of 5 symptoms we use as a guideline to screen for schizophrenia?-delusions -hallucinations -disorganized speech -grossly disorganized or catatonic behavior -negative symptomsHow many of of the 5 symptoms must be be present, and for how long?Must have at least 2 of the 5 symptoms must e present for at least 1 month.One of the 2 symptoms must be specific. What are the options for 1 of the specific symptoms?-Delusions -hallucinations -disorganized speechDefine "positive symptoms" in regards to schizophreniaExtra feelings that usually are not presentGive examples of positive symptoms-Delusions (distortion in thought content) -Hallucinations (hearing, seeing, tasting, feeling, or smelling) -paranoia -disorganized speech & thinking -bizarre behavior -abnormal movementsDo positive symptoms have an acute onset or a slow onset?AcuteDefine "negative symptoms" in regards to schizophreniaLack of feelings or behaviors that are usually presentGive examples of negative symptoms-losing interest in everyday activities -feeling out of touch w/ other ppl, family, & friends -lack of feeling emotion (apathy) -having inappropriate feelings in certain situations -having less ability to experience joy (adenonia) -loss of motivation (avolition)What are some nursing diagnoses for Negative Symptoms of schizophrenia?-Social isolation -Risk for loneliness -Chronic low self esteem -Self care deficitWhat are cognitive symptoms of schizophrenia?-difficulty w/ attention, memory, decision making, problem solving, and thinkingAre cognitive symptoms evident in most people w/ schizophrenia?YESWhat is dysphoriaflat affect; no emotions, no feelings (Gina)What are affective symptoms of schizophrenia?-dysphoria -suicidality -hopelessnessIf a person w/ schizophrenia has affective symptoms, what are they at risk for?Can lead to relapse, suicide, substance abuse, and functioningWhen assessing a schizophrenic, it is important to assess the TYPE of symptoms they are displaying. What are the different symptom "types"?-positive -negative -cognitive -affectiveOnce you figure out what types of symptoms are being displayed, you must assess what phase they are in. What are the different phases of schizophrenia?-Acute -Stabilization -MaintenanceIt is important to monitor for early warning signs of relapse of psychotic episodes. What are early warning signs?-insomnia -social withdrawal -difficulty concentrating -irritability -loss of interest -increasing paranoia -hallucinationsHow can relapse of psychotic episodes be prevented?-Monitor for early warning signs -Administer antipsychotics -Encourage participation in psychotherapy (helps with coping and life skills -Educate patient and family -Offer supplemental essential fatty acidsGive some examples of fatty acids-salmon -tuna -nuts -green leafy vegetables -whole grainsAre delusions a positive symptom or negative symptom of schizophrenia?POSITIVEDefine delusionsA false belief that cannot be clarified/corrected. The person is convinced that his/her belief is realWhat percentage of people with schizophrenia have delusions?75%What precipitates delusions in schizophrenics?It is a response to anxiety or concernIf a person is having a delusion, do you tell them it is not real?NO! Do NOT try to tell the pt that it is a delusion and that it is not real. -Look for and address the underlying theme or need (sometimes the person just has to use the bathroom or eat)What are delusions of persecution?The feeling that someone is always out to get them (Ex: "The doctor is trying to kill me")What are delusions of grandeur?They think they are responsible for saving the world (Ex: "I am Jesus", or "Jesus talks to me")What are ideas of reference?"The street lights go on because I walk toward them"If you are communicating with someone with delusions, what do you NOT do?-Do NOT touch the patient -Do NOT get too physically close -Do NOT ask closed ended questions (yes/no questions) -Do NOT argue about the content of the delusion, but explain misinterpretations of the environment -Avoid being drawn into the content of the delusionWhat are things you SHOULD do when communicating with someone who is delusional?-Present the reality of the experience and empathize with the apparent experience and feelings of fear -Talk about the persons feelings, NOT the delusional material -Engage patient in reality based activities or with peopleWhat is an example of a command hallucination?A voice in their head that says, "Go up on the roof and jump off". "Drown your children- (Andrea Yates)Are auditory hallucinations always negative?No, voices can be supportive and pleasant OR demeaning & terrifyingIf someone is hearing voices, what should you find out about the voices?Find out what the voices are saying or telling the person to doIf someone is having hallucinations, how should you approach them?Approach patient in a nonthreatening and nonjudgmental mannerWhen speaking to a person having hallucinations, you should make eye contact, and call the patient by name. Do you speak in a louder voice or softer voice than usual?LOUDER VOICE THAN USUALShould you react to someone's hallucinations as if they are real?No. Do not negate the patient's experience, but offer your own perceptionsWhat types of diversions should you use when dealing with someone who is having hallucinations?Focus on reality based diversionsWhat are some examples of bizzare behavior?-inappropriate clothing/appearance (lots of layers in summer) -innapropriate social/sexual behavior -aggressive/agitated behavior -catatonia (one position for prolonged period) -waxy flexibilityAre disorganized speech and behaviors positive symptoms or negative symptoms?POSITIVEWhat is associative looseness?Jumbled, illogical speech. (in psychiatry) a disturbance of thinking in which the association of ideas and thought patterns becomes so vague, fragmented, diffuse, and unfocused as to lack any logical sequences or relationship to any preceding concepts or themes.What are neologismsMade up wordsWhat is echolalia?Repeating anothers wordsDefine echopraxiaMimicking movementsWhat is clang association?Rhyming words that don't necessarily even have to have true meaning.What is word salad?Jumble of words that are meaninglessIs paranoia considered a "positive" behavioral symptom?YESIf someone has associated looseness, how should you respond?Do NOT pretend that you don't understand. Tell the patient you are having difficulty understanding the communication. Ex: "I'm having difficulty understanding you"If you don't understand someone who has associated looseness, should you blame the your not understanding on yourself, or on the patient?Blame it on yourself, not on the patient. Make sure you tell the patient what you DO understand though. (Sometimes you might understand part of what they're saying)How can you try to figure out what the person with associative looseness is trying to talk about?Look for recurring topics and themesHow can you reorient a person with associative looseness?Emphasize what is going on in the patient's immediate environmentWhat are some nursing diagnoses for Positive Symptoms of schizophrenia?-Disturbed sensory perception -Risk for violence -Disturbed thought processes -Defensive coping -Impaired verbal communicationWhat does "affect" mean (word pronounced w/ short a sound)?Affect is the observable behavior that indicates a person's emotional state.What are some different examples of types of affect?-affective blunting; Blunted affect refers to a reduction in the intensity of an individual's emotional response -anergia; abnormal lack of energy -thought blocking; will completely stop talking mid sentenceMilieu therapy is an intervention. What is milieu therapy?A structured environment that is safe and nonthreatening for patients with schizophreniaWhat are some patient benefits of milieu therapy?Offers valuable activities and resources for resolving conflicts, and provides learning opportunities for social and vocational skills. It also increases social competence/esteem.Good communication is an intervention. Why is communication beneficial when taking care of a schizophrenic?-lowers patient's anxiety -decreases defensive patterns -increases patient's level of self worthPatient and family health teaching is important. Why is it so important?It reduces exacerbation of psychotic symptomsWhy is case management an important intervention when taking care of someone with schizophrenia?Case management offers community resources and information to patient and family membersHow long does it take for antipsychotic medication to start working?Antipsychotics take effect in 2 to 6 weeksIf a patient isn't responding to antipsychotics alone, what medications do we augment (use in congunction) to help patient?Anticonvulsants and antiparkinsonian drugsWhat drug class do first-generation antipsychotics belong to?Dopamine antagonists (they work to decrease dopamine)What "type" of symptoms do first gen antipsychotics have an affect on?They decrease POSITIVE symptoms (Ex: hallucinations, delusions, disorganized thinking)What are names of the first generation antipsychotic meds?-chlorpromazine (Thorazine) -haloperidol (Haldol)What are adverse reactions of first gen antipsychotics?-anticholinergic toxicity -extrapyramidal side effects (EP's)Is anticholinergic toxicity a medical emergency?YES! It can be fatalWhat are the signs and symptoms of anticholinergic toxicity?-dry mucous membranes -diminished peristalsis -mydriasis (dilation of pupils) -non reactive pupils -hot red skin -hyperpyrexia -tachycardia -urinary retention -deliriumWhat are your nursing interventions for anticholinergic toxicity?-Call HCP immediately -Hold all meds -Apply cooling measures -Insert Indwelling catheter (for retention) -Administer benzodiazepines as orderedWhat are extrapyramidal side effects (EP's)?-Akathisia: psychomotor restlessness -Dystonia: sustained contraction of muscles, usually the head and neck -Tardive dyskinesia (TD); involuntary tonic muscular contractions, i.e. smacking of lipsIf someone is having extrapyramidal side effects, what are your nursing interventions?-Administer benztropine (Cogentin) and diphenhydramine (Benedryl) -Lower dosage of antipsych med to decrease EPS's as ordered -MONITOR AIRWAY!What are the drug classifications of benztropine and diphenhydramine?benztropine (Cogentin) is an antiparkansonian diphenhydramine (Benedryl) is an anticholinergicWhat is the drug classification of second gen antipsychotics?seratonin-dopamine antagonistsWhat type of symptoms do second gen antipsychotics have an effect on?Both positive and negative type symptomsSecond gen antipsychotics have minimal side effects. What is a side effect of 2nd gen antipsych meds?Weight gainBesides having minimal side effects, what is another benefit of second generation antipsych meds?Greater adherence to treatmentWhat is a downfall as far as cost when it comes to second gen antipsychotics?Second generation antipsych meds are expensiveName the second generation antipsych meds-risperidone (Risperdol) -quetiapine (Seroquel) -clozpine (Clozaril)What is a possible side effect of both first generation and second generation antipsychotics?Neuroleptic Malignant Syndrome (NMS)Is Neuroleptic Malignant Syndrome (NMS) a medical emergency?YES! It can be fatalWhat are signs and symptoms of neuroleptic malignant syndrome (NMS)?-Reduced conciousness -muscular rigidity -autonomic dysfunction (ex: breathing, heartbeat)If someone presents with neuroleptic malignant syndrome, what are your nursing interventions?-Hold antipsychotics -Manage fluid balance -Apply cooling measures -Administer dantrolene (Dantrium) to reduce muscle rigidityWhat types of symptoms do third generation antipsychotics help with?Improves both positive and negative symptoms AND improves cognitive functionIs there a smaller risk of extrapyramidal side effects and tardive dyskinesia with third gen antipsych drugs?YESWhat is the third generation antipsych drug?aripiprazole (Abilify)