[16.1] Psychiatric Nursing (Schizophrenia to Global Cognitive Disorders)

From Sir Kenneth Arzadon's Lecture last 09/02/25

1. YES

2. NO

3. YES

4. NO

Schizophrenia: (YES or NO)

1. Treatable

2. Curable

3. Hereditary

4. Contagious

Less CSF and Brain tissue

Schizophrenia: Describe its neuroanatomy

Increased dopamine and serotonin

Recall

• Low dopamine = Parkinson’s, ADHD

• Low serotonin and norepinephrine = Major Depressive Disorder

• Increased dopamine, serotonin, and norepinephrine = Bipolar Disorder

• Low gamma amino butyric acid (GABA) = Anxiety

Schizophrenia: Which of the following statements describes its changes in the neurochemistry?

a. Increased dopamine and serotonin
b. Low dopamine
c. Low serotonin and norepinephrine
d. Increased dopamine, serotonin, and norepinephrine
e. Low gamma amino butyric acid (GABA)

a. Increased Dopamine

Schizophrenia: Positive Signs

a. Increased Dopamine
b. Decreased Dopamine
c. Increased Serotonin
d. Decreased Serotonin

c. Increased Serotonin

Schizophrenia: Negative Signs

a. Increased Dopamine
b. Decreased Dopamine
c. Increased Serotonin
d. Decreased Serotonin

1. +

2. -

3. -

4. +

5. -

6. -

7. -

Schizophrenia: Identify if each of the following is a positive (+) or negative (-) sign

1. Hallucinations

2. Asociality

3. Avolition

4. Delusions

5. Anhedonia

6. Alogia

7. Catatonia

Eugene Bleuler; 1900s

Schizophrenia: Who identified the 4As of Schizophrenia? When?

1. Autism

2. Ambivalence

3. Associative looseness

4. Abnormal Affect

Schizophrenia: What are the 4As of Schizophrenia?

Autism

Schizophrenia (4As): Indifference; walang pake

Ambivalence

Schizophrenia (4As): Two opposing feelings

Associative looseness

Schizophrenia (4As): Fragmented thoughts

1. Brief psychotic disorder

2. Schizophreniform

3. Shared psychotic disorder

Schizophrenia: What are the related disorders?

Brief Psychotic Disorder

Schizophrenia (Related Disorders): Psychosis (<1 mo.)

Schizophreniform

Schizophrenia (Related Disorders): Psychosis (1-6 mos)

Shared psychotic disorder

Schizophrenia (Related Disorders): Folie a deux

Shared psychotic disorder

Schizophrenia (Related Disorders): Two or more people

Decreased income = Increased stress levels

Schizophrenia: What is its social causation hypothesis?

Two or more symptoms for >/= 1 month

Schizophrenia: What is the diagnostic criteria for Schizophrenia based on the DSM V (not the list)?

4, 5, 7, and 9

Recall

4. Increased talkativeness (Bipolar d/o)

5. Dissociation (PTSD)

7. Hypervigilance (PTSD)

9. Sleeplessness (Initial sign of MDD)

Schizophrenia: Identify which of the following are NOT included in the list of symptoms in DSM V

1. Hallucinations

2. Delusions

3. Disorganized speech

4. Increased talkativeness

5. Dissociation

6. Disorganized behavior

7. Hypervigilance

8. Negative symptoms

9. Sleeplessness

Hallucinations

Schizophrenia: False perception

Delusions

Schizophrenia: False belief

Auditory (Command)

Schizophrenia: What is the most common and most dangerous type of hallucination?

1. Grandiose

2. Persecutory

3. Somatic

4. Nihilistic

5. Erotomania

Schizophrenia (Delusions): Identify the types of delusion being described in the following

1. Superiority and invulnerability

2. “To be harmed by others”

3. Bodily functions are abnormal

4. A part of the body is missing

5. “A person is in love with them”

Ideas of Reference / Referential Delusion

Schizophrenia (Delusion): Giving meaning to events or actions of others

1. Circumstantiality

2. Tangentiality

3. Neologism

4. Schizophasia

5. Clang Association

6. Looseness of association

7. Flight of ideas

Schizophrenia (Formal Thought Disorders): Identify the type of thought disorder being described in the following:

1. Fullness of detail (with answer)

2. Lack of focus (no answer)

3. Coining new words

4. Word salad (mixing without rhyme)

5. Rhyming of words

6. Fragmented ideas (no connection)

7. Jumping from one topic to another (with connection)

1. Echolalia

2. Palilalia

3. Verbigeration

Schizophrenia (Speech abnormalities): Identify the types of speech abnormalities being described in the following:

1. Repeating words of others

2. Repeating own words

3. Repeating phrases

b. Looseness of association

Recall

• Associative looseness is included in the 4As of Schizophrenia by Eugene Bleuler

• Flight of ideas is associated with Bipolar Disorder, specifically in the manic state

Schizophrenia

a. Flight of ideas
b. Looseness of association

1. Asociality

2. Avolition

3. Anhedonia

4. Alogia

Schizophrenia (Negative Signs): Identify what is being described in the following:

1. Lack of relationships

2. Lack of motivation

3. Lack of pleasure

4. Lack of speech

Catatonia

Schizophrenia (Negative Sign): Absence of movement

Catatonic Stupor

Schizophrenia (Catatonia): Waxy flexibility (no movement)

Catatonic Excitability

Schizophrenia (Catatonia): Agitation, restlessness (galaw nang galaw)

a. Mood

Internal/Subjective (e.g. happy)

a. Mood
b. Affect

b. Affect

External expression (e.g. smiling)

a. Mood
b. Affect

1. Flat

2. Blunt

3. Restrictive

4. Labile

5. Schizophrenia

Abnormal Affect: Identify the following being described

1. No emotion response (withdrawn)

2. Minimal emotion response (depression)

3. Single emotional response

4. Sudden shift of emotions

5. Emotions don’t match the situation

1st Gen

• -zine

  (except haloperidol, loxapine, and molindone)

Schizophrenia (Anti-Psychotics): Typical/Conventional

• Give the suffix

2nd gen

• -pine, -done

  (e

Schizophrenia (Anti-Psychotics): Atypical

• Give the suffix

3rd gen

• -zole

  (except PPIs)

Schizophrenia (Anti-Psychotics): Dopamine system stabilizers

• Give the suffix

All 1st to 3rd gen

Schizophrenia (Anti-Psychotics): Positive signs

2nd Gen

Schizophrenia (Anti-Psychotics): Negative signs

1st gen

Schizophrenia (Anti-Psychotics): MOA = Decrease dopamine

2nd gen

Schizophrenia (Anti-Psychotics): MOA = Decrease dopamine/serotonin

3rd gen

Schizophrenia (Anti-Psychotics): MOA = Regulates dopamine receptors

1st Gen

Schizophrenia (Anti-Psychotics): Not recommended for elderly patients

2nd Gen

Schizophrenia (Anti-Psychotics): Safe for elderly patients

1st Gen

• d/t decrease in dopamine levels

Schizophrenia (Anti-Psychotics): SE is pseudoparkinsonism

Clozapine

Schizophrenia (Anti-Psychotics): Safest neuroleptic for elderly

3rd Gen

Schizophrenia (Anti-Psychotics): Less side effects in general

1. 1st

2. 2nd

3. 1st

4. 3rd

5. 1st

6. 1st

7. 2nd

8. 3rd

9. 2nd

10. 2nd

11. 2nd

12. 1st

13. 2nd

14. 1st

Schizophrenia (Anti-Psychotics): Identify what gen the following are

1. Chlorpromazine

2. Clozapine

3. Loxapine

4. Aripiprazole

5. Molindone

6. Thioridazine

7. Ziprasidone

8. Brexpiprazole

9. Olanzapine

10. Lorasidone

11. Quetiapine

12. Fluphenazine

13. Risperidone

14. Haloperidol

Haloperidol

Schizophrenia (Anti-Psychotics): Highly potent neuroleptic

Depot treatment / Long term injection (LTI)

Schizophrenia (Anti-Psychotics): Indication = noncompliance

1. Side effects

2. Memory problem

Schizophrenia (Anti-Psychotics): Common causes of noncompliance

IM; 1x to 2x a month

Schizophrenia (Anti-Psychotics): What is the route for decanoates? What is the frequency?

a. ASA

• Anticholinergic

• Sympathetic

• Adrenergic Receptors

Schizophrenia (Anti-Psychotics): Side Effects

a. ASA
b. ChoPa

a. Dry

ASA

a. Dry
b. Wet

b. Wet

ChoPa

a. Dry
b. Wet

CAT DOG PAWS

CAT 🐱

• Constipation

• Agranulocytosis

• Tooth Decay

DOG 🐶

• Dry Mouth

• Orthostatic Hypotension

• Galactorrhea

PAWS 🐾

• Photosensitivity

• Arrhythmia

• Weight Gain

• Sedation

Schizophrenia (Anti-Psychotics): Enumerate ALL the side effects discussed

1. Increase fluid and fiber in the diet

2. Monitor decreased WBC, report any signs of infection (fever, sore throat)

3. Sugar less hard candy or gum

   1. (rurupok kasi ang teeth d/t dryness)

Schizophrenia (Anti-Psychotics): How do you manage the following?

1. Constipation

2. Agranulocytosis

3. Tooth decay

1. Sugarless hard candy or gum to stimulate salivation

2. Change position gradually

3. Use cotton underwear

Schizophrenia (Anti-Psychotics): How do you manage the following?

1. Dry mouth

2. Orthostatic hypotension

3. Galactorrhea

1. Avoid direct sunlight, use umbrella and sunglasses, apply SPF 25 lotion

2. Immediately report abnormal heart beat

3. Lessen intake of sugary food and beverages

4. Avoid driving and operating machines

Schizophrenia (Anti-Psychotics): How do you manage the following?

1. Photosensitivity

2. Arrhythmia

3. Weight Gain

4. Sedation

Decreased Dopamine → increased acetylcholine → Increased muscle strength

Schizophrenia (Anti-Psychotics): What is the cause of extrapyramidal syndrome, or how do they develop?

1st and 2nd (they decrease dopamine)

Schizophrenia (Anti-Psychotics): What gens usually cause EPS?

DAP

• Dystonia

• Akathisia

• Pseudoparkinsonism

Schizophrenia (Anti-Psychotics): What are under the extrapyramidal syndrome?

Dystonia

Schizophrenia (Anti-Psychotics: EPS): Uncontrollable muscle spasms

Akathisia

Schizophrenia (Anti-Psychotics: EPS): Agitation; intense need to move

Pseudoparkinsonism

Schizophrenia (Anti-Psychotics: EPS): Tremors and unstable gait

DOT

• Dysphagia

• Oculogyric crisis (Tumirik ang mga mata)

• Torticollis (Stiff neck)

Schizophrenia (Anti-Psychotics: EPS): What are the effects of dystonia?

ABC + Artane

• Akineton (Biperidine)

• Benadryl (Diphenhydramine)

• Cogentin (Benztropine)

• Artane (Trihexyphenidyl)

They are Anticholinergics

Schizophrenia (Anti-Psychotics: EPS): What are the medications to address EPS? What is their drug classification?

Notify the physician. DO NOT discontinue to prevent relapse

• Decrease the dose; shift to another gen

Schizophrenia (Anti-Psychotics: EPS): What should be the nursing action?

• What will be the intervention?

a. EPS

Schizophrenia (Anti-Psychotics): First

a. EPS
b. NMS
c. TD

b. NMS

Schizophrenia (Anti-Psychotics): Most Fatal

a. EPS
b. NMS
c. TD

c. TD

Schizophrenia (Anti-Psychotics): Last/Late (After 6 months)

a. EPS
b. NMS
c. TD

Neuroleptic Malignant Syndrome

Schizophrenia (Anti-Psychotics): What are the following under?

• Muscle spasms

• Hyperthermia

• Hypertension

Tardive Dyskinesia

Schizophrenia (Anti-Psychotics): What are the following under?

• Tongue protrusion

• Tongue twisting

• Teeth grinding

• Lip smacking

Muscle spasms → Laryngeal Spasms → Airway obstruction → Death

Schizophrenia (Anti-Psychotics: NMS): Why is this the most fatal?

Supportive

• Antipyretic

• Antihypertensives

Schizophrenia (Anti-Psychotics: NMS): How do you manage hyperthermia and hypertension?

1. Discontinue the medication

2. Dantrolene, Baclofen [Muscle relaxants]

   1. Recall:

      1. Dantrolene Sodium is also indicated for malignant hyperthermia post-op from general anesthesia

      2. Baclofen is also indicated for multiple sclerosis

3. Hydrate the patient

Schizophrenia (Anti-Psychotics: NMS): For NMS, what should be the

1. Nursing Action

2. Intervention

3. Prevention

Tardive Dyskinesia (TD)

Schizophrenia (Anti-Psychotics): Delayed involuntary movements (after 6 mos.)

1. Notify the physician

2. Ingrezza (Valbenazine) → Anticholinergics

   1. Recall: Anticholinergics are also used for EPS

3. Start with the lowest dose

Schizophrenia (Anti-Psychotics: TD): For TD, what should be the

1. Nursing Action

2. Intervention

3. Prevention

c. Tardive Dyskinesia

Schizophrenia (Anti-Psychotics): Could be permanent/irreversible

a. EPS
b. NMS
c. TD

1. Exogenous

2. Endogenous

Major Depressive Disorder: What are the two classification of causes?

b. Exogenous

Major Depressive Disorder: Loss, self-reproach, self-depreciation

a. Endogenous
b. Exogenous

Decreased serotonin and norepinephrine

Major Depressive Disorder: What is the endogenous cause of MDD?

Introjection (Blaming self)

Major Depressive Disorder: Defense mechanism

Sleeplessness

Major Depressive Disorder: Initial sign

Hopelessness, Helplessness, Worthlessness

Major Depressive Disorder: Hallmark sign

>/= 5 symptoms lasting for >/= 2 weeks which impairs educational, social, and occupational functioning

Major Depressive Disorder: What is the diagnostic criteria based on the DSM V? (Not the symptoms)

DIWAGAS

• Difficulty thinking

• Insomnia/Hypersomnia

• Weight Gain/Loss (5%)

• Anhedonia

• Guilt feeling

• Anergia

• Suicidal thoughts

Major Depressive Disorder: What are the symptoms being referred to in the DSM V? (DIWAGAS)

1. Monoamine Oxidase Inhibitors (MAOI)

2. Tricyclic Antidepressants (TCA)

3. Selective Serotonin Reuptake Inhibitors (SSRI)

4. Serotonin Norepinephrine Reuptake Inhibitors (SNRI)

5. Atypical Antidepressants

Major Depressive Disorder: What are the classifications of antidepressants?

1. MAOI

2. SSRI

3. TCA

4. SNRI

5. TCA

6. SSRI

7. MAOI

8. SSRI

9. MAOI

10. TCA

11. Atypical Antidepressant

12. Atypical Antidepressant

13. SNRI

14. SSRI

15. TCA

16. SSRI

17. MAOI

18. Atypical Antidepressant

19. TCA

20. SSRI

Major Depressive Disorder: Identify what type of antidepressant each of the following is (Generic Name):

1. Tranylcypromine

2. Sertraline

3. Imipramine

4. Venlaflaxine

5. Clomipramine

6. Paroxetine

7. Isocarboxazid

8. Fluvoxamine

9. Phenelzine

10. Nortriptyline

11. Mirtrazapine

12. Trazodone

13. Duloxetine

14. Fluoxetine

15. Amitriptyline

16. Escitalopram

17. Selegiline

18. Bupropion

19. Doxepin

20. Citalopram

1. MAOI

2. SSRI

3. TCA

4. SNRI

5. TCA

6. SSRI

7. MAOI

8. SSRI

9. MAOI

10. TCA

11. Atypical Antidepressant

12. Atypical Antidepressant

13. SNRI

14. SSRI

15. TCA

16. SSRI

17. MAOI

18. Atypical Antidepressant

19. TCA

20. SSRI

Major Depressive Disorder: Identify what type of antidepressant each of the following is (Brand Name):

1. Parnate

2. Zoloft

3. Tofranil

4. Cymbalta

5. Anafranil

6. Paxil

7. Marplan

8. Luvox

9. Nardil

10. Elavil

11. Remeron

12. Desyrel

13. Effexor

14. Prozac

15. Pamelor

16. Lexapro

17. Eldepryl

18. Wellbutrin

19. Sinequan

20. Celexa

BONUS: Mnemonic for antidepressants

• MAOI = → Money → PaMaNa → Tip + Sell

• TCAs = 3 magkakapatid na nataTAE (Tofra, Ana, Pamela) + Anak sa labas (Pamela) → Tinanong, “Sino ka?” (Sinequan)

  • Mga praning at may tililing kasi pina-ASA

• SSRIs = Sing brand names and generic names

Tyramine

• The older, the higher the level in the food

Major Depressive Disorder: What food component should those taking MAOIs avoid?

Hypertension

• Occipital headache

Major Depressive Disorder: What will happen if the patient taking MAOI ate food with tyramine? What is the sign to watch out for?

1. NO

2. NO

3. YES

4. NO

5. NO

6. NO

7. NO

8. YES

9. NO

10. NO

11. NO

12. YES

13. YES

14. YES

15. NO

16. NO

17. NO

18. NO

19. YES

20. NO

Major Depressive Disorder (MAOIs): Identify if the patient can eat each of the following (YES or NO):

1. Frozen, fermented, preserved

2. Raisin

3. Grapes

4. Dried, pickled, overripe fruits

5. Pizza

6. Pepperoni

7. Avocado

8. Orange

9. Aged-cheese

10. Atsara

11. Cheddar

12. Cottage Cheese

13. Ricotta Cheese

14. Mozzarella Cheese

15. Parmesan

16. Salami

17. Lasagna

18. Tocino

19. Grilled Chicken

20. Kimchi

a. ASA

Major Depressive Disorder: TCA

a. ASA
b. ChoPa

a. Dry

Major Depressive Disorder: TCA

a. Dry
b. Wet

Tachycardia

Major Depressive Disorder: What is the adverse effect of TCAs?

Bradycardia

Major Depressive Disorder: What is the sign of toxicity of TCAs?

b. TCA

• Causes Arrhythmia → Death

• ECG every 2 weeks

Major Depressive Disorder: Which is the most fatal? Why? How should it be monitored?

a. MAOI
b. TCA
c. SSRI
d. SNRI
e. Atypical antidepressants

c. SSRI

Major Depressive Disorder: Which is the safest?

a. MAOI
b. TCA
c. SSRI
d. SNRI
e. Atypical antidepressants