schizophrenia & psychotic disorders

how long do people have to present with psychotic behavior to be diagnosed with schizophrenia?

6 months

risk for ______ is a main concern with schizophrenia

suicide

psychosis

severe mental condition of disorganization, deteriorating, disorientation, hallucinations, delusions

schizophrenia causes disturbances in what 3 things?

thought processes, perception, and affect

4 phases of schizophrenia

premorbid, prodromal, active psychotic/acute episode, and residual

phase 1: premorbid phase of schizophrenia (4)

shy/withdrawn, poor peer relationships, poor school performance, and antisocial behavior

phase 2: prodromal phase of schizophrenia (5)

deterioration in function/ADLs, depressive, social withdrawal, cognitive impairment, and obsessive-compulsive

at what phase of schizophrenia do we want to intervene?

prodromal

phase 3: active psychotic phase of schizophrenia (4)

dominant psychotic sx, delusions, hallucinations, disorganized speech/behavior, and decreased functioning in work/relationships/self-care

phase 4: residual phase of schizophrenia (5)

absent/diminished psychotic sx, negative sx, flat affect, impaired role functioning, and exacerbation/remission

is schizophrenia more common in males or females?

males

delusional disorder

existence of prominent nonbizarre delusions

persecutory type delusions

believes they will be harmed by others

somatic type delusions

believes they have a medical disorder like cancer

brief psychotic disorder may or may not be preceded by a severe ____________ stressor lasting how long?

psychosocial; <1 month

catatonic disorder (5)

bizarre behavior, stare off into space, akinesia, loss of voluntary motions, and wavy flexibility/hard to move limbs

schizophreniform disorder: sx and duration

same as schizophrenia; 1-6 months

schizoaffective disorder

schizophrenic/psychotic sx and a mood disorder (mania/depression)

magical thinking

ideas that one’s thoughts or behaviors have control over specific situations

nihilistic delusions

believe a part of themselves or a part of the world is missing (ex: continent gone away/missing heart)

loose associations

shift ideas from one unrelated topic to another

neologisms

made-up words that have meaning only to the person who invents them

clang associations

everything they say rhymes

word salad

group of words put together randomly

circumstantiality

delay in reaching point of communication because of unnecessary/tedious details (get an answer after a rabbit trail)

tangentiality

inability to get to the point of communication due to introduction of many topics (going on rabbit trails with no answer)

echolalia

repeating words/phrases spoken by another

echopraxia

imitating your movements

blunt vs flat affect (negative sx)

restricted range of emotions; void of emotional tone

avolition (negative sx)

inability to initiate goal-directed activity

anergia (negative sx)

lack of energy/cannot carry out ADLs

waxy flexibility

placing limbs in strange positions and not moving them

typical (1 gen) vs atypical (2 gen) antipsychotic MOA

block dopamine; weak dopamine blocker

typical (1 gen) antipsychotic examples (3)

enloxapine, haloperidol, and prolixen

atypical (2 and 3 gen) antipsychotic examples (3)

-apine, abilify, and latuda

akinesia (EPS)

slow-no movement

akathisia (EPS)

need to move around

dystonia (5) (EPS)

muscle spasms, tongue protrusions, dysphagia, twist neck and it stays, and dyspnea

oculogyric crisis (EPS)

eyes roll to back of head (emergency)

pseudoparkinsonism (6) (EPS)

shuffling gait, stooped posture, tremors, akinesia, drooling, and pill-rolling

EPS tx (3)

Benadryl, benztropine/Cogentin, and amantadine

antipsychotic SE (16)

anticholinergic effects, GI effects, rash, sedation, orthostatic hypotension, photosensitivity, hormonal effects, ECG changes, hypersalivation, weight gain, hyperglycemia/diabetes, mortality risk in elderly with dementia, seizures, agranulocytosis, EPS, and NMS

NMS

muscle rigidity leading to fever

how do we assess for tardive dyskinesia?

Abnormal Involuntary Movement Scale

cigarette smoking has been identified as a risk for _____________

schizophrenia

drug for smoking cessation? AE?

clozaril; agranulocytosis

assertive community treatment

intensive case management and professional team approach used to assist client with community living needs

catatonic disorder is treated with…

Ativan/lorazepam IM

soft symptoms are aka…

positive symptoms

5 EPS

pseudoparkinsonism, oliguric crisis, akinesia, akathisia, and dystonia

olanzapine AE

metabolic effects