C4 Psych Guide

Schizophrenia, Anxiety, MDD

Positive Symptoms

Symptoms that add to the experience of a disorder

• delusions - fixed beliefs or non bizarre

• hallucinations - perceptual experiences without external stimulus

• disorganized thinking - tangential, incoherent

• Disorganized behavior - psychomotor agitation, catatonic behavior

Schizophrenia

A severe mental disorder characterized by distortions in thinking, perception, emotions, language, and sense of self. Common symptoms include positive and negative symptoms, such as hallucinations, delusions, and emotional flatness.

• over 6 months

• first & second generation drugs

• episode: prodromal —> active —> residual stages

Negative Symptoms

Symptoms that subtract from the experience of a disorder

• avolition - decreased motivation

• anhedonia - inability to find pleasure

• alogia - reduction in use of words

• asociality - lack of interest in socialization

First Generation Antipsychotics

Medications like Haldol that reduce anxiety and agitation but have significant side effects.

• Askasthisa - feeling like you have to move, want to crawl out of your skin

• Tardive Dyskinesia - involuntary movement like grimacing, tongue protrusion

Second Generation Antipsychotics

Medications like Clozaril that reduce both positive and negative symptoms with fewer side effects.

• fatigue, weight gain, decreased libido, high cholesterol

Schizophrenia Interventions

Medication management, exercise/physical activity, lifestyle changes, patient education, identify support networks.

• modify living space to reduce cognitive demand and stress

• organization - checklists, medication dispenser, calendars

Positive presentation

• psychoeducation, minimize stress, develop structure, assess for barriers

Negative presentation

• skill training, highly structured activities with concrete goals

Cognitive-Behavioral FOR

An approach to change dysfunctional thinking and behavior to enhance occupational performance and emotional regulation.

• set goals and action plans to break down overwhelming tasks

• encourage self management and psychoeducation

Self Determination Theory

A psychological theory that emphasizes the role of intrinsic motivation and the basic psychological needs for autonomy, competence, and relatedness in fostering personal growth and well-being.

• patient education to support intrinsic motivation and encourage patient autonomy

Major Depressive Disorder

Depressed mood, anhedonia, weight changes, decrease in appetite, changes in sleeping patterns, psychomotor agitation, impaired concentration, recurrent thoughts of death or suicide

• medication: SSRI, NDRI, MAOI, TCA

• focus on activities of daily living (ADL), sleep hygiene, social participation, and cognitive rehabilitation to address impaired concentration

Avolition

Decreased motivation, commonly observed in negative symptoms of schizophrenia.

Anhedonia

Inability to find pleasure in normally enjoyable activities.

SSRIs

Selective Serotonin Reuptake Inhibitors used to treat Major Depressive Disorder by increasing serotonin availability.

• first line medication

• Drowsiness, nausea, insomnia, diarrhea, weight gain

• Serotonin syndrome: confusion, BP shifts, twitching, fever

Resistant MDD

Medication involves MAOI (monoamine oxidase inhibitor) or TCA (tricyclic antidepressant)

• MOAI - potentially lethal due to dietary and drug interactions

• TCA - seizures, disorientation, drowsiness, headache, drying

MDD Treatment

Strategies include psychotherapy, medication, and lifestyle changes to alleviate symptoms of Major Depressive Disorder.

• Establish daily routine - daily schedule, calendar

• ADL - skills for self care

• Leisure - increase motivation and hobby pursiot

• Stress management - coping mechanisms, guided breathing, PMR

• Art therapy - emotional expression

• Environment - organize space, safety, personalization and comfort (photos)

Generalized Anxiety Disorder

Characterized by excessive anxiety and worry occurring more days than not for at least 6 months.

• Difficulty controlling worry, restlessness, easily fatigued, irritability, sleep disturbance, muscle tension

• Medication: Antihistamine, Beta blocker, SSRI, benzodiapines

GAD Interventions

Include cognitive-behavioral therapy, relaxation techniques, and lifestyle modifications to manage anxiety symptoms.

• Lifestyle/exercise

• Coping mechanisms - guided breathing, PMR, purposeful distraction, mindfulness

• Sensory regulation spaces - soft lighting, weighted blanket, noise cancelling headphones

• Predictable daily routines - sense of control and safety

• Leisure - increase motivation and hobby pursuit

• Environment - calm lighting, organize space, safety

Environmental Adaptations

Modifications made to living or working spaces to reduce cognitive demands and sensory overload.

• organized space

• personalized items for comfort

• calm lighting

• safety - clear pathways, remove rugs