psych exam 1

schizophrenia means…

split mind

— is a hallmark of schizophrenia

psychosis

what are the hallmarks of psychosis

altered cognition (disorganized thoughts), altered perception, impaired reality testing (ability to tell what is real and not real), loss of contact with or distortion of reality, hallucinations or delusional thinking

schizophrenia disturbs…

thought processes, perception, affect/behavior

late onset schizophrenia has — phases

4

what is the phase of schizophrenia called where there is milder symptoms months or years before full onset

prodromal phase

what are the hallmarks of the prodromal phase of schizophrenia

lasts few weeks-few years, deterioration role functioning and social withdrawal, substantial functional impairment, sleep distrubance/anxiety/irritability, depressed mood, poor concentration, fatigue

what are the hallmarks of the late prodromal phase of schizophrenia

perceptual abnormalities, ideas of reference/suspiciousness, imminent onset of psychosis

what are the requirements for the diagnosis of acute phase of schizophrenia

2 or more symptoms (delusion, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms), decreased level of functioning in one or more major areas (social/occupational dysfunction), must last at least 6 months (or less if successfully treated)

what must be ruled out to diagnose schizophrenia

schizoaffective and mood disorders, substance abuse, medications, medical condition; if hx autism, must have prominent delusions or hallucinations to diagnose

what are positive symptoms of schizophrenia

things that the typical person does not experience

what are negative symptoms of schizophrenia

things that the typical person experiences that the diagnosed lack

the believe that people are out to get you

persecutory delusions

see themselves as someone with great importance

grandiose delusions

the belief that everything pertains to you

referential delusions

the belief that someone else has control over you

control or influence delusions

body based delusions

somatic delusions

the belief that the end of days are coming

nihilistic delusions

obsessive over religion

religiosity delusions

the belief that someone loves you when they may not even really know you

erotomantic delusions

language that jumps all over the place

associative looseness

real words, but jumbled up and do not make sense

word salad

talking, but use words that rhyme

clang associations

made up words, but make sense to them

neologisms

parrot, repeat words

echolalia

a lot of details but eventually gets to the point

circumstantiality

goes off on a tangent and never gets to the point

tangentiality

fast talking and you can’t get a word in

pressured speech

rapid speech where nothing really makes sense

flight of ideas

slowing of thoughts

cognition retardation

forget what you were saying

thought blocking

the belief that other people are putting thoughts in your head

thought insertion

the belief that other people took thoughts out of your head

thought deletion

normal in children, the belief that if you think something it could affect someone

magical thinking

something about yourself feels of

depersonalization

what are the most dangerous form of hallucinations

command hallucinations (telling you to do something)

the environment feels weird and off

derealization

pronounced increase or severe decrease in movement

catatonia

what things usually occur in catatonia

catalepsy (muscles rigid), wavy flexibility (example- take BP and they keep their arm like that until you physically put it down)

less severe than catatonia, slowed movement

motor retardation

less severe than catatonic excitement, frigidity, just can’t relax well

motor agitation

repeatedly does a movement

stereotyped behaviors

repeating someones movement

echopraxia

resistant to advice

negativism

act before thinking

impaired impulse control

holds body in an odd way

gesturing/posturing

stands too close, invades personal space

boundary impairment

inability to experience pleasure

anhedonia

hard time with motivation

avolition

don’t have a lot of words to say

alogia (poverty of speech)

doesn’t seek out people

asociality

doesn’t care what happens

apathy

minimal response

affective blunting

what are the cognitive negative symptoms of schizophrenia

concrete thinking, impaired memory, impaired information processing, impaired executive functioning, anosognosia (don’t believe that you are sick), impaired social interaction, social isolation, thermoregulation issues

what are the hallmarks of the maintenance or residual phase of schizophrenia

symptoms of acute phase are absent, symptoms of prodromal phase are present (the new baseline), flat affect and impairment in role functioning, residual impairment increases between episodes

what are the biological risk factors of schizophrenia

genetic, dopamine theory (increased dopamine), theory involving norepinephrine, serotonin, GABA, acetylcholine, and glutamate levels, toxins (tetrachloroethylene), prenatal stressors, viral (HSV 2, retrovirus, flu), yeast, father > 35 yrs, marijuana use, enlarged ventricles, cerebellar atrophy, increased size of fissures, reduced connectivity

what are the psychological risk factors of schizophrenia

stress, childhood trauma, ACE events, downward shift hypothesis (low socioeconomic status is more likely to have epigenetic turn on)

what are the comorbidities with schizophrenia

substance abuse, nicotine dependence, anxiety, depression, suicide, physical illnesses, polydipsia (can lead to fatal water intoxication, hyponatremia, confusion, coma)

combination of bipolar and schizophrenia, less negative symptoms, responds better to medications

schizoaffective disorder

one specific delusion and nothing else

delusional disorder

one person has the psychotic disorder and someone close to them starts to experience it as well

folie a deux

what is the goal of individual psychotherapy for those with schizophrenia

not insight oriented- reality oriented, improve compliance, enhance social/occupational functioning and prevent relapse

what is the goal of behavior therapy for those with schizophrenia

reduce bizarre, disturbing, deviant behaviors/increase appropriate behaviors

what are the hallmarks of typical/1st generation antipsychotics

dopamine antagonists (inhibits dopamine, mediated transmission of neural impulses at synapses), gets rid of positive symptoms, almost no relief of negative symptoms

what are some examples of typical/1st generation antipsychotics

chlorpromazine, fluphenazine, haloperidol, haloperidol decanoate (long acting injectable)

what are the hallmarks of atypical second generation antipsychotics

weaker dopamine receptor antagonists, more potent antagonists of serotonin, antagonism for cholinergic/histaminic/adrenergic receptors, helps with negative symptoms

what are some examples of atypical second generation antipsychotics

risperdone, clozapine, olanzapine, quetiapine, ziprasadone, brexpiprazole, aripiprazole, sasenapine, illoperidone, lurasidone, cariprazine, paliperidone

what are the contraindications/cautions with antipsychotics

CNS depression, blood dyscrasia (neutropenia- no clozapine with myloproliferative disorders), parkinson’s disease, liver and renal problems, poorly controlled seizure disorders, BLACK BOX (elderly with neurocognitive disorders- increased risk of death from stroke), cardiac alert (QT prolongation, cardiac arrhythmias, recent MI, uncompensated HF), QTC > 500 NO haloperidol/ziprasidone/risperidone/paliperidone

what are the side effects of antipsychotics

blocks cholinergic receptors- drys up mouth, eyes, blurred vision, constipation, urinary retention, female sexual dysfunction, anticholinergic toxicity (altered mental status), blocks alpha adrenergic receptors- orthostatic hypotension, reflex tachycardia, tremors), histamine blockers- weight gain and sedation (olanzapine), nausea, GI upset, photosensitivity, reduction in seizure threshold, agranulocytosis, liver failure, prolactin elevation (decreased libido, retrograde ejaculation, gynecomastia, possible reduce fertility, amenorrhea (STILL NEED CONTRACEPTIVE)

what are the extrapyramidal symptoms of antipsychotics (worse with 1st gen meds)

pseudoparkinsonism (tremor, shuffling gait, pill rolling dingers, drooling, rigidity, give antiparkinsonian (benztropine mesylate-cogentin given for prevention), akinesia (muscle weakness, give carbidopa/levodopa), akathisia (continuous restlessness- give antiparkinsonian and propranolol and lorazapam), acute dystonia (emergency- sudden sustained contraction of muscles- tx stop med and five cogentin or Benadryl), oculogyric crisis (emergency- uncontrolled rolling back of eyes, tx stop med and five cogentin or Benadryl), tardive dyskinesia (emergency, bizarre facial and tongue movements, difficult swallowing, potentially irreversible, stop drug at first sign, IV cogentin, Benadryl, symmetrel, ingrezza)

how do you prevent EPS symptoms of antipsychotics

prophylactic treatment with an anticholinergic agent (benztropine or diphenhydramine)

what are the neuroleptic malignant syndrome symptoms of antipsychotics

rare, fatal, severe parkinsonian muscle rigidity, very high fever, tachycardia/tachypnea/fluctuations in BP, diaphoresis, rapid deterioration of mental status to stupor and coma, treat (stop med, give parlodel, dantrium, muscle relaxant to counteract, cooling blankets, IV fluids)

what are the second generation side effects of antipsychotics

metabolic syndrome (weight gain-abdominal, dyslipidemia, insulin resistance- increased blood glucose), increased risk = DM, HTN, CVD, cancer, teach physical activity/diet/regular follow ups with provider to monitor

what are the risks of IM antipsychotics and long acting injectables (detonate, maintena, Sustenna)

injection site reactions, risk of cerebrovascular adverse rxn (CVA/TIA in elderly patients with dementia/neurocognitive disorder related psychosis)

what are the antipsychotic teaching points

not stop taking abruptly (only with EPS symptoms), use sunscreen, report weekly (for clozapine) for blood levels and get weekly supply, women of child bearing age need contraception, no ETOH/nicotine/substances, no other meds, caution driving, need regular follow up, get up slowly, use gum/ice, watch body temp

what are the risks for suicide with schizophrenia

highest risk < 45 yrs, 1st 10 years of illness, male, hx suicide attempt, family history of suicide, comorbid substance misuse, comorbid depression, high education, paranoid, active hallucinations/delusions, presence of insight

what is the only consistent protective factor for suicide with schizophrenia

identifying those at risk, treating comorbid depression and substance misuse, providing best available treatment for psychotic symptoms, delivery of and adherence to effective treatment

how do you help patients with hallucinations

assess content, don’t reinforce the hallucinations, don’t negate, focus on reality, distract them

how do you help clients with associative looseness

don’t pretend or allow patient to think you understand- say you don’t (place difficulty understanding on yourself), look for recurring topics and themes, summarize or paraphrase communication to role model clearer communication, reduce stimuli, speak clear, concisely, concretely, and in short sentences

how can schizophrenia be prevented?

avoid malnutrition/ infection/tobacco use during pregnancy, no marijuana/substance abuse, promote resiliency/coping, supplemental essential fatty acids (omega 3-6. tuna, salmon, sardines), early treatment with antipsychotic medications at onset of early s&s

what are the general risk factors for suicide

previous attempts, attempts or completed suicides in family or in others with whom the patient identifies, significant losses, hopelessness, despair, sadness or depressed mood, social isolation, little support, substance abuse, chronic illness, young white males

what are psychiatric illnesses influences by

genetics, epigenetic (environment), neurophysiological, neurochemical (neurotransmitters), endocrine, psychoimmunology

what lobe of the brain is responsible for the personality

frontal

which brain system is responsible for emotions

limbic system

junctions between 2 neurons, how neurons talk to each other

synapses

small space between 2 neurons

synaptic cleft

conduct impulses toward synapse

presynaptic neurons

conduct impulses away from synapse

postsynaptic neurons

binds with receptor sites on postsynaptic neuron to determine if another impulse will be generated

neurotransmitters

excitatory neurotransmitters, key turned- get response

agonist

inhibitory neurotransmitters, key sits and takes up space, allows no response

antagonist

what are the hallmarks of acetylcholine

memory, learning and big movement; triggers muscle contractions-movement, involved in sleep/arousal/pain perception/memory/cognition, mood/sexual aggression, destroyed or inhibited by acetylcholinesterase

what are the hallmarks of norepinephrine

motivation/vigilance, executive function, cardiovascular functioning, sleep, arousal, metabolized/inactivated by MAO and COMT

what are the hallmarks of dopamine

reward and fine movement and coordination, decision making, judgment, regulation of emotional responses, inhibits the release of prolactin, implicated in schizophrenia and mania, metabolized/inactivated by MAO and COMT

what are the hallmarks of serotonin

derived from tryptophan (from the diet), mood/agression/appetite/libido/sleep/arousal/pain/SI/judgment/coordination, role in anxiety, mood disorders, schizophrenia, metabolized/inactivated by MAO

what are the hallmarks of histamine

allergic and inflammatory reactions, role in CNS (limited info- wakefulness/alertness), medications that block this cause weight gain, sedation, hypotension, metabolized/inactivated by MAO

what are the hallmarks of GABA

inhibitory- prevents postsynaptic excitation (slows down body, reduces aggression/anxiety), decreased levels r/t anxiety disorders/mania, enhancing GABA is how anti anxiety meds work, catabolized by GABA transaminase

what are the hallmarks of glutamate (NMDA)

excitatory/relay sensory info- learning memory, increased levels are neurotoxic and are related to Alzheimers disease, decreased levels are related to schizophrenia and psychosis

what are the hallmarks of endorphins and enkephalins (opioids)

pain/peristalsis, alter release of dopamine- may link to schizophrenia

what are the hallmarks of substance p

pain/sensory transmission (like in fibromyalgia), increased levels relate to depression