MH Quiz #3

First phase of schizophrenia

Prodromal

• mild changes in thinking, reality testing mood

• not enough criteria for actual diagnosis

• symptoms appear one month to more than 1 years before first full episode

2nd phase of Schizophrenia

Acute

• few and mild to many disabling symptoms: delusions, apathy, social withdrawal

• symptoms are apparent to others

3rd phase of Schizophrenia

Stabilization

• movement toward a previous level of functioning

• care in outpatient setting — group homes

4th phase of schizophrenia 

Maintenance or residual  

• stabilized and new baseline established 

• positive symptoms usually absent or diminished 

• negative and cognitive symptoms are still a concern 

Postive Symptoms

presence of something that should not be present

Associative Looseness

illogical thinking, loosely associate their thoughts

Word Salad

jumble of words that are meaningless

Clang Association

Choosing words based on sounds

Neologisms

Use a known word differently or create new word

Echolalia 

Repeating of another’s words

Catatonia

increase or decrease in rate and amount of movement

Motor Retardation

slowing of movement

Waxy Flexibility

inappropriately maintaining given posture

Stereotyped Behaviors

repetitive behaviors with no purpose

Echopraxia

mimicking of movements of another

Negativism

tendency to resist or oppose requests of others

Negative Symptoms

Serious because absence of essential human qualities, more difficult to treat, contribute to poor social functioning and withdrawal

Anhedonia

Without pleasure

Avolition

Without decision, motivation

Asociality

decreased desire, feel no comfort during social interactions

Affective blunting

decreased or constricted affect

Apathy

decreased interest in things that should be important 

Alogia

reduction in speech

Affect

external expression of a person’s interstate

Flat affect

blank, no expression

Blunted Affect

minimal emotional response

Constricted Affect

decrease in range or intensity

Bizarre Affect

Odd, illogical, inappropriate, or unfounded

anosognosia

inability to realize sickness

Concrete Thinking

An impaired ability to think abstractly, resulting in interpreting or perceiving things in a literal manner 

Treatment for Schizophrenia

antipsychotic medications

Acute dystonia

sudden, sustained contraction of one or several muscle groups

Akathisia

motor restlessness — pacing, repetitive movements, inability to sit still

pseudoparkinsonism

tremor, gait, impairment, decreased facial expressiveness

Tardive dyskinesia

involuntary rhythmic movements

First-Generation Antipsychotic Side Effects

• EPS

• anticholinergic side effects

• orthostatic hypotension

• weight gain

• prolactin release

• sexual dysfunction

Clozaril

2nd generation antipsychotic

• can cause myocarditis and life-threatening bowel emergencies 

• metabolic syndrome

• anticholinergic toxicity 

Lithium

Approved for acute mania + maintenance treatment

• great for bipolar bc it treats mania and depression

• 7-14 days to reach therapeutic blood levels

• monthly levels until stable then every 3 months

Lithium Therapeutic Level

0.8 to 1.2 mEQ/L

Valproate

Treats acute mania better than lithium; anticonvulsant

• monitor liver function and platelet count

• monitor therapeutic levels

Carbamazepine

works with rapid-cycling + severely paranoid angry patients; anticonvulsant

• check liver enzymes

• can cause bone-marrow suppression = monitor CBC

• monitor therapeutic levels

• SE: pruritus, dry mouth

Lamotrigine

For bipolar maintenance; anticonvulsant

• watch for life-threatening rash = SJS (can occur within 8 weeks of starting treatment)

• SE: double and blurred vision

lurasidone and quetiapine

2nd generation antipsychotics

• acute mania — helps with insomnia, anxiety, agitation

• has stabilizing properties

• less EPS and treats positive and negative symptoms 

SSRIs

1st line treatment for depression, can treat OCD and panic

• SE: agitation, anxiety, sexual dysfunction, tension, HA, dry mouth, weight change, tremors

• Toxic effect: serotonin syndrome — abdominal pain, diarrhea, sweating, fever, tachycardia, high BP, delirium, muscle spasms, hostility 

TCAs

depression treatment; dose should start low and increase slowly

• SE: anticholinergic effects, weight gain, severe constipation, postural hypotension

MAOIs

for unconventional depression, panic disorder, OCD, GAD, PTSD, bulimia

• SE: orthostatic hypotension, weight gain, edema, constipation, sexual dysfunction, manic behavior, insomnia

• Toxic effect: increased BP, hypertensive crisis