Ch. 15 Schizophrenia and Other Psychotic Disorders

What is psychosis?

Disorganization of personality, deterioration in social functioning, and loss of contact with or distortion of reality.

Unspecified psychosis

What are the types of psychotic disorders?

Substance Induced Psychosis

Schizoaffective Disorder

Schizophrenia.

What is Schizoaffective Disorder?

A condition characterized by psychosis and mood disorder

requiring symptoms to occur for at least two weeks without a major mood episode.

What are the criteria for diagnosing Schizophrenia?

Two or more positive or negative symptoms must be present

negatively affecting daily functioning and interpersonal relationships for at least 6 months.

Hallucinations = high risk for suicide because they could be telling them to harm themselves

What are positive symptoms of schizophrenia?

"extra" things

abnormal motor behavior

disorganized thinking

delusions

hallucinations.

What is catatonia?

A state of decreased responsiveness characterized by bizarre posture or lack of response to the environment.

sitting and staring out and not responding

What is waxy flexibility?

A condition where body parts can be placed in bizarre or uncomfortable positions and remain there.

DISNEY KNEES

What are delusions?

False fixed beliefs that can include

persecutory/paranoid delusions

- make sure to open meds and food in front of patient

ideas of reference

- they think everything is abt them in a paranoid way

delusions of grandeur

- they think they know someone famous

- they think they have a lot of money

- Intervention: VOICE DOUBT AND DON"T REINFORCE DELUSIONS AND REORIENT

What are the main types of disorganized thinking?

Loose association, preservation, tangential thinking, circumstantial thinking, word salad, neologisms, clang associations, echolalia, and echopraxia.

What is loose association?

shifts from one unrelated topic to another

making it difficult to follow their conversation.

What is preservation?

The persistent repetition of a word or idea in response to different questions.

What is word salad?

A jumble of words that creates a nonsensical sentence

What is tangential?

- going on tangents to get the point across because of the intorduction to new topics

What is circumstantial?

- they get point across or go back to original topic but it takes a long time

What is neologisms?

- creating entirely new words

Ex. meme, spork, brunch

What are clang associations?

- rhyming words

Echolalia

- copying someone's words

Echopraxia

- copying someone's actions

What are negative symptoms of schizophrenia?

Symptoms characterized by a lack of normal behaviors, including affect lacking, avolition, alogia, anergia, and anhedonia.

Affect lacking

- no expression

What is avolition?

A lack of motivation to complete purposeful activities.

Alogia

- decreased speech

Anergia

- decreased energy

What is anhedonia?

A decreased pleasure in activities that were once enjoyable.

What are the two main categories of antipsychotics?

Typical (1st generation)

- which treat only positive symptoms

- MORE POTENT side effects

Atypical (2nd generation)

- which treat both positive and negative symptoms.

What are some common 1st generation antipsychotics?

Haloperidol, Chlorpromazine, Fluphenazine, Loxapine, and Perphenazine.

-azine

- haloperidol

- loxapine

- pimozide

- thiothixene

What are some common 2nd generation antipsychotics?

Risperidone, Olanzapine, Quetiapine, and Clozapine.

-idones

-zapines

-Quetiapine

2nd Gen Special Considerations

Ziprasidone (Geodon): prolonged QT

Quetiapine (Seroquel): orthostatic hypotension

Clozapine (Clozaril)- agranulocystosis (check CBC)

ALWAYS CHECK FOR WEIGHT GAIN AND EPS

What are extrapyramidal side effects (EPS)?

Movement disorders caused by antipsychotic medications tardive dyskinesia: lip smacking, flirty gestures

pseudoparkinsonism: tremors and unsteady gate

akathisia: restlessness

dystonia: jaw locks, screaming (voice box closes), eyes roll back

What is Neuroleptic Malignant Syndrome?

A serious complication of antipsychotic treatment

characterized by:

fever

altered level of consciousness

muscle rigidity

fluctuating blood pressure.

Intervention: GIVE DANTROLENE (reduces muscle rigidity)

Metabolic Syndrome Labs and Symptoms

- lipid panel

- hemoglobin A1C

Symptoms: weight gain and fatigue

What are anticholinergic medications used for in schizophrenia treatment?

They are used to address extrapyramidal side effects caused by antipsychotic medications.

ABCS

trihexyphenidyl (Artane)

diphenhydramine (Benadryl)

benztropine (Cogentin)

What is the significance of assessing hallucinations in patients?

It is crucial to determine if the patient is experiencing command hallucinations that could pose a safety risk.

Hallucination Assessment

- Ask "are you seeing or hearing anything?"

- If no = stop

- If yes = Ask what the voices are telling you (because of command hallucinations for safety)

Also validate their feelings but let them know that you don't hear anything.