Unit 2 AH2

Flashcards covering Schizophrenia, Bipolar, Depressive, Anxiety, OCD, Personality Disorders, and Mental Health Pharmacology.

What does the term schizophrenia spectrum refer to?

It refers to a group of severe, chronic, and disabling psychiatric disorders characterized by disturbances in thought, emotion, and behavior.

What are the hallmark signs of schizophrenia spectrum disorders?

Trouble distinguishing reality from fantasy, illogical thinking, delusions, and hallucinations.

What are the three most common types of schizophrenia spectrum disorders?

Schizophrenia, delusional disorder, and schizoaffective disorder.

How many people worldwide are affected by schizophrenia?

Approximately $21\text{ million}$ people worldwide.

How much more likely are schizophrenia patients to die early compared to the general population?

They are $2\text{ to }3\text{ times}$ more likely to die early.

By about how many years does neglecting self-care impact longevity in patients with schizophrenia?

It impacts longevity by about $10\,\text{years}$.

In which gender is the risk of suicide particularly high among schizophrenia patients?

Males.

When does the first psychotic episode typically occur in males with schizophrenia?

Between $18\text{ to }25\,\text{years old}$.

What is the typical age range for the onset of schizophrenia in females?

Between $25\text{ to }35\,\text{years old}$.

When do cognitive alterations and personality changes usually begin to manifest prior to diagnosis?

In late adolescence.

How does the prognosis of schizophrenia change with each acute episode?

The prognosis worsens with the occurrence of each acute episode, becoming more debilitating over time.

Is there a cure for schizophrenia?

No, there is no cure, but early intervention helps in managing the illness.

Has a specific gene been isolated that makes schizophrenia predictable?

No, genes create a predisposition, but no single gene has been isolated that allows prediction.

What maternal prenatal infection during the first trimester shows data of an increased schizophrenia risk in offspring?

The flu (influenza).

In what living environment is schizophrenia more prevalent among single individuals?

Urban areas.

What negative outcomes are associated with substance abuse in patients with schizophrenia?

Nonadherence to prescribed medications, increased psychotic symptoms, repeated relapses, frequent hospitalizations, declining function, loss of social support, and increased risk for suicide.

Under what specific hallucinatory circumstance do patients with schizophrenia pose a real danger of violence?

When they obey hallucinatory voices telling them to attack someone.

Why might a nurse need to interview family, friends, or teachers during an assessment of schizophrenia?

Because cognitive issues may prevent the patient from giving an accurate or complete history.

What are clang associations?

Words that rhyme or sound alike, used in an illogical, nonsensical manner (e.g., 'it's the rain, train, pain').

What is echolalia?

The meaningless repetition of words or phrases.

What is flight of ideas?

A rapid succession of incomplete ideas that are not connected by logic or rationality.

What is word salad?

An illogical or random grouping of words (e.g., 'she had a star, barn, plant').

What are neologisms?

Bizarre words that have meaning only for the patient.

What is overly concrete thinking in a patient with schizophrenia?

The inability to form or understand abstract thoughts.

What is magical thinking?

The belief that thoughts or wishes can control other people or events.

What is thought blocking?

A sudden interruption in the train of thought.

What is ambivalence in schizophrenia?

Coexisting strong positive and negative feelings, leading to emotional conflict.

What is echopraxia?

The involuntary repetition or mimicking of movements observed in others.

What defines positive symptoms in schizophrenia?

Psychotic behavior demonstrating a clear disconnect between actual reality and perceived reality, hallmark signs being hallucinations and delusions.

What is the most common sensory feature of hallucinations in schizophrenia?

Auditory hallucinations (hearing voices and sounds).

What are persecutory delusions?

Beliefs that one is being tormented, followed, tricked, or singled out for harm.

What are delusions of reference?

Believing that environmental cues or passages in periodicals, TV shows, or songs are directed specifically to oneself.

What are grandiose delusions?

Considering oneself a major celebrity or significant figure (e.g., Jesus, Batman).

What are erotomanic delusions?

The false belief that someone wants them romantically.

What are nihilistic delusions?

The belief that a major catastrophe is about to happen (e.g., a natural disaster).

What are somatic delusions?

The belief that one's body is changing inside (e.g., believing lungs are rotting).

What are control delusions?

The belief that another person, group, or external force controls one's thoughts, feelings, or behaviors.

What is waxy flexibility in catatonia?

Maintaining a posture inappropriately for a prolonged period (e.g., raising an arm and leaving it elevated).

What is negativism in disorganized behavior?

Resisting or opposing the requests of others.

What are stereotyped behaviors?

Repetitive behaviors that serve no purpose.

What is boundary impairment?

Impairment in understanding one's own physical or personal boundaries, such as invading another's personal space.

What defines negative symptoms in schizophrenia?

An absence of normal characteristics, such as lack of emotion, decreased motivation, delayed speech, and social withdrawal.

What does the negative symptom 'avolition' mean?

Impairment in motivation and the ability to start and follow through with activities.

What does the negative symptom 'alogia' mean?

Poverty of speech; speech that is brief, terse, and lacks content.

What does the negative symptom 'anhedonia' mean?

Diminished capacity to experience pleasure.

What does the negative symptom 'asociality' mean?

Avoidance of relationships and social interactions.

What occurs during the prodromal phase of schizophrenia?

Mild functional changes, social withdrawal, neglect of personal hygiene, and lack of energy occurring months or years before hospitalization.

What occurs during the acute phase of schizophrenia?

Exacerbation of acute psychotic symptoms (hallucinations, delusions, incoherence, catatonic behavior), often triggered by stress.

What occurs during the stabilization phase of schizophrenia?

Symptoms begin to diminish and the patient moves toward their previous level of functioning.

What characterizes the residual phase of schizophrenia?

Positive symptoms resolve, but negative symptoms can become more pronounced as the overall illness pattern stabilizes.

How is a mild course of schizophrenia described?

Usually stable, adheres to drug treatment, with $1\text{ to }2$ major relapses by age $45$.

How is a severe, unstable course of schizophrenia described?

No drug adherence, frequent relapses, brief stability between relapses, requires assistance with ADLs, bothersome symptoms, and coexisting substance abuse.

What DSM-5 criteria must be met for a schizophrenia diagnosis?

Two or more key symptoms (delusions, hallucinations, disorganized speech, gross disorganization/catatonia, negative symptoms) for a significant portion of $1\,\text{month}$, with continuous disturbance for at least $6\,\text{months}$.

What physical lab tests are followed up to rule out physiological causes of psychotic symptoms?

Vitamin deficiencies, uremia, thyrotoxicosis, and electrolyte imbalances.

What is the mechanism of action of First-Generation Antipsychotics?

Dopamine antagonists ($D_2$ receptor antagonists).

What symptoms do First-Generation Antipsychotics target?

Positive symptoms of schizophrenia.

What is an advantage of First-Generation Antipsychotics over Second-Generation?

They are less expensive.

Name three examples of First-Generation Antipsychotics.

Chlorpromazine, fluphenazine, and haloperidol.

What is the primary mechanism of action of Second-Generation Antipsychotics?

Serotonin ($5\text{-HT}_{2A}$ receptor) and dopamine ($D_2$ receptor) antagonists.

Why are Second-Generation Antipsychotics often chosen as first-line agents?

They are equally effective for positive symptoms while also treating negative symptoms with minimal to no EPS or tardive dyskinesia.

What major metabolic side effects are associated with Second-Generation Antipsychotics?

Significant weight gain and metabolic syndrome (abdominal weight gain, dyslipidemia, elevated blood glucose, and insulin resistance).

What life-threatening side effect is associated with clozapine (Clozaril)?

Agranulocytosis, a severe blood disorder marked by low WBC count and pronounced neutrophil depletion.

What blood monitoring protocol is required for patients taking clozapine?

Regular blood monitoring to detect agranulocytosis early.

What pharmacological classification is given to Third-Generation Antipsychotics?

Dopamine system stabilizers.

Name three examples of Third-Generation Antipsychotics.

Aripiprazole (Abilify), brexpixprazole (Rexulti), and cariprazine (Vraylar).

What are the three most common extrapyramidal side effects (EPS)?

Dystonia, drug-induced parkinsonism, and akathisia.

What is dystonia?

Prolonged, repetitive muscle contractions causing twisting or jerking movements, especially of the neck, mouth, and tongue.

What are the clinical signs of drug-induced parkinsonism?

Bradykinesia, muscle rigidity, shuffling gait, stooped posture, flat facial affect, tremors, and drooling.

What is akathisia?

Restlessness, pacing, and an inability to rest or sit still.

What are the key clinical manifestations of Neuroleptic Malignant Syndrome (NMS)?

Fever, extremely rigid muscles, and altered consciousness.

What is the primary benefit of Long-Acting Injectable (LAI) antipsychotics?

Promoting medication adherence to prevent or delay illness relapses.

What residential option provides 24-hour supervision and treatment during acute episodes or stabilization?

Brief respite or crisis homes.

What residential option provides daily in-house training in living skills with 24-hour coverage by paraprofessionals?

Transitional group homes.

What residential option features an on-site residential manager to assist autonomous long-term recovery?

Supported or supervised apartments.

What is the primary diagnostic criterion for Delusional Disorder according to DSM-5?

The presence of $1\,\text{month}$ of delusions without other psychotic symptoms.

What percentage of the US population is affected by Delusional Disorder?

$0.02\%$ of the total US population.

What proportion of patients diagnosed with Delusional Disorder will have delusions for life versus remission?

$2/3$ of diagnosed individuals have delusions for life, while $1/3$ achieve remission.

What diagnostic scale evaluates the ability of mental health patients to perform ADLs and function independently?

Global Assessment of Functioning (GAF) Scale.

What primary class of medications is used to manage Delusional Disorder?

Atypical antipsychotics such as aripiprazole or ziprasidone.

What two disorder features combine to define Schizoaffective Disorder?

Schizophrenia combined with a mood disorder (depression or acute mania).

What percentage of the population is affected by Schizoaffective Disorder?

$0.3\%$ of the population.

How is 'mood' distinguished from 'affect'?

Mood is a pervading internal feeling or emotional state, whereas affect is the outward expression of emotion attached to ideas.

What is Bipolar Disorder?

A mood disorder marked by severe, pathological mood swings ranging from extreme highs (mania/hypomania) to extreme lows (depression).

What is the typical age of onset for Bipolar Disorder?

Between ages $18\text{ to }20\,\text{years}$.

What defines Bipolar I Disorder?

Classic and most severe form consisting of manic or mixed episodes that alternate with major depressive episodes.

What defines Bipolar II Disorder?

Mild episodes of hypomania alternating with major depressive episodes, without severe manic episodes.

What defines Cyclothymic Disorder?

Numerous hypomanic episodes intermingled with numerous depressive episodes that do not meet full criteria for major depressive episodes.

What is hypomania?

An expansive, elevated, or agitated mood that resembles mania but is less intense, lacks psychotic symptoms, and does not cause severe social/occupational impairment.

How much higher is the suicide risk in bipolar patients compared to the general population?

It is $20\text{ to }30\text{-fold}$ higher.

What defines rapid cycling in Bipolar Disorder?

Four or more distinct periods of depression, mania, hypomania, or mixed states occurring within a $12\text{-month}$ period.

What clinical manifestations increase during the manic phase of Bipolar Disorder?

Agitation, elation, euphoria, hyperactivity, impulsivity, rapid thought and speech, and sexuality.

What clinical manifestations decrease during the manic phase of Bipolar Disorder?

Attention span, awareness of illness, eating, and sleep.

Which medication is highly effective for preventing and relieving manic episodes without causing sedation?

Lithium.

Which medication is prescribed for bipolar patients who cycle rapidly or cannot tolerate lithium?

Valproic acid (Depakote).

Why must antidepressants be used with extreme caution in bipolar patients?

Because they can trigger a manic episode.

What dietary nursing priority is essential for a manic bipolar patient?

Provide high-calorie finger foods because the patient may be too hyperactive to sit down to eat.

What attitude should nursing staff maintain when interacting with a manic bipolar patient to avoid power struggles?

Maintain a neutral, nonjudgmental attitude ('be Switzerland') while setting firm limits.

What is the narrow therapeutic blood level range for lithium taken 10-12 hours after the last dose?

$0.8\text{ to }1.2\,mEq/L$.

How frequently should blood levels be monitored when initiating lithium therapy?

Checked $8\text{ to }12\,\text{hours}$ after first dose, $2\text{ to }3\text{ times}$ weekly for the first month, then weekly to monthly.

What physiological condition contraindicates the administration of lithium?

Renal impairment, because lithium is excreted by the kidneys.