Ch.24 Schizoprenia

What is the Dx Citeria for Schizoprenia?

Halluncations

Delusions

Disorganized Thinking

Disorganized Behavior

2 + pos/neg s/sx 6 month

Define Delsuions and the 4 types

Fixed false Believe

• Grandiose: believe that one has exceptional powers ex: god like.

• Nihilistic: believe that a calamity is impending or one is dead

• Persecutory: belief that one is being watched or plotted against

  • "The FBI is out to get me".

• Somatic: believes of body changing in unusual ways

  • Growing a third arm.

Define these terms and what does this systoms belong to

• Echolalia

• Circumstantiality

• Paranoia

• Clang association

• Word salad

•  Referral thinking

• Stilted Language

• Neologisms

• Autistic thinking

• Verbigeration

Disorganized speech

• Echolalia (Echo you)

• Circumstantiality (Start with to answer go off topic)

• Paranoia

• Clang association (repeating words that rhythm)

• Word salad → gibberish (coffee lip cat House)

•  Referral thinking Neutral stimuli is talking to them usually a radio or tv

• Stilted Language -> formal language

• Neologisms—words that are made up that have no common meaning and are not recognizable

• Autistic thinking—restricts thinking to the literal and immediate so that the individual has private rules of logic and reasoning that make no sense to anyone else

• Verbigeration -> repeating word salad

Define these terms and what does this systoms belong to

• Aggression

• Catatonia

  • Waxy Flexibility 

• Agitation

• Regressed behavior

• Echopraxia

Disorganized Behavior

• Aggression

• Catatonia →overall Statue like behavior

  • Waxy Flexibility (one a limb or two in a stone state) 

• Agitation -> inability to sit still

• Regressed behavior (baby)

• Echopraxia: automatic imitation of another person’s movements or gestures.

Define these terms and are they neg or pos?

Ambivalence

Anhedonia

Alogia

Avolition

Affect (Blunted, bright, flat, inappropraiate, labile, restricted/constricted)

Anergia

• Ambivalence: difficulty making decisions.

• Anhedonia: lack of pleasure/joy can lead to depression 

• Alogia: poverty of speech

• Avolition: lack of motivation

• Affect: can be blunted (decreased expression) or

• Flat (facial expression never changes) aka mask like behavior

• Anergia: lack of energy

Neg s/sx

What age range is Schizoprenia usally present in men and women?

Men 18-25 years, and Women 25-35

Define these terms

Prodromal

Acute

Stabilization

Recovery

Prodromal

• first seen a change (inc Anxiety, dec Adonia, dec sleep quality,hyper-religiosity, feeling guilty for no reason)

Acute

• Pos and nef S/sx becomes too severe; Aggressive -> Hospitalization and/or substance use

Stabilization

• Begins after diagnosis + starting treatment.

• Goals: reduce substance use, increase social interaction, begin rehabilitation.

Recovery

• Understanding of meds not being a cure + acceptance of illness

• Goal = living as well as possible with illness.

What ventericles are effected in the Schizoprenia and are they larger or smaller?

Is the brain volume larger or smaller?

lateral and third ventricles are larger

total brain volume is less

Whata are some biological indications

Dopamine dysregualtion in the striatal areal (memory and emtions regulation)

Genetics

Enviormetnal

Psychosocial

Antisphooctics meds

What some Generic, trade, Dose for adults → C.F.H.L

Generic	Trade	Dose for adults
Chlorpromazine		30-800mg
Fluphenazine		0.5-20
Haloperidol	Haldol	1-15
Loxapine	Loxitane	20-250

Extrapyramidal Side Effects (EPS) is a major side effects of FGA and SGA. Tell defintion and the 4 types.

Movement problems caused by antipsychotic medications Antipsychotics block dopamine (D2) receptors in the brain -> Dopamine normally helps control movement.

1. Pseudoparkinsonism (Looks identical to Parkinson’s disease)

2. Dystonia (acute dystonic reaction)

3. Akathisia

4. Tardive Syndromes

What are the s/s and which appears after a long time

1. Pseudoparkinsonism (Looks identical to Parkinson’s disease)

2. Dystonia (acute dystonic reaction)

   • Oculogyric

   • Torticollis

   • Torticollis

   • Orolaryngeal-pharyngeal hypertonus

3. Akathisia

4. Tardive Syndromes

1. Pseudoparkinsonism (Looks identical to Parkinson’s disease)

• Symptoms: tremor, rigidity, bradykinesia.

2. Dystonia (acute dystonic reaction)

• Symptoms:

  • Oculogyric crisis: eyes pulled upward.

  • Torticollis: head pulled to side.

  • Retrocollis: head pulled back.

  • Orolaryngeal-pharyngeal hypertonus: difficulty swallowing.

  • Limb contortions.

3. Akathisia

• Symptoms: extreme restlessness, urge to keep moving; very uncomfortable.

4. Tardive Syndromes (Appear after long-term use aka Months to years)

• More common with first-generation antipsychotics but still possible with second-gen.

How to use treat Extrapyramidal Side Effects (EPS)

Tetrabanazine (Xenazine)

Valbenazine (Ingrezza)

lower antipsychotic dose and give anticholinergics (e.g., benztropine, trihexyphenidyl

What are 3 major adverse effects of SGA

• Hyperprolactinemia; increased prolactin levels cause…

  • Gynecomastia -> Inc in breast tissue 

  • Galactorrhea -> inc in milk production

SGA Meds are…

Generic	Trade	Dose for adult	Important info
Clozapine (blk box)	Clorazil	200-600	Last resort b/c Agranulocytosis (dec WBC) interact with antidepressant.
Risperadone (blk box)	Risperdal	4-16	Increased mortality in older patients with dementia-related psychosis
Olanzapine	Zyprex	10-20	interact with antidepressant.
Paliperidone	Invega	3-13
Quetiapine	Seroquel	300-400
Ziprasidone	Geodon	40-160	given with food, high fat meal of 500 cal DRESS: life threatening hypersensitivity. s/s: Really bad allergic reaction
Lurasidone	Latuda	40-80	give with food, 350 cal meal is advised

Propranolol only tx what type of Extrapyramidal Side Effects (EPS)

Akathisia

what are the 2 meds and side effects

Generic	Trade
Benztropine	Congentin
Benadryl	dephenhydramine

Side effects:

• Dry mouth

• Blurred vision

• dec tears

• constipation

• unrinary rentention

• Tachycardia

What is Neuroleptic Malignant Syndrome (NMS)

Tx

Memonic

Define

Tx

STOP medication, give a dopamine agonist (dantrolene), benzodiazepines, and muscle relaxants.

  Remember!! NMS presents as a FEVER

Fever

Encephalopathy (Change in mental stat)

Vital Sign instability

Elevated WBC and CPK

Rigidity

Life threatening reaction to antipsychotics.

define

Schizoaffective Disorder (SAD)

Delusional Disorder

Schizophreniform Disorder

Brief Psychotic Disorder

Psychotic Disorders Attributable to a Substance

Schizoaffective Disorder (SAD)

• The client’s disorder meets the citeria for both schizophenia and depressive/bipolar disorder

Delusional Disorder

• Stable and well-systematized delusions that occur in the absence of other psychiatric disorders presence of one or more delusions for at least 1 month

Schizophreniform Disorder

• Features identical to those of schizophrenia, with the duration of the illness lasting less than 6 months

Brief Psychotic Disorder

• Length of the episode is at least 1 day but less than 1 month

Psychotic Disorders Attributable to a Substance

• Attributable to a substance