wk 7: schizophrenia & friends

ch 15

psychosis and factors (3)

disorganized personality

• deterioration in social functioning

• loss of contact

• distortion of reality

unspecified psychosis

“starter” for schizophrenia

ex: admit to unit

main dx is they dont know what mental state they’re in

3 types of psychosis

• substance induced psychosis

• schizoaffective disorder

• schizophrenia

schizoaffective disorder, what u need to have it

schizophrenia traits with mood disorders (bpd/mdd)

• must occur for at least two weeks in the absence of a major mood episode

can’t just be mood, must also have psychotic TRAITS

schizophrenia requirements

• two or more POSITIVE or NEGATIVE sx must be present

• sx negatively affect ADLs and relationships

• sx are continuous and persist for at leats 6 months

schizophrenia is high risk for what

suicide

• it’s debilitating

• may be d/t hallucinations

positive symptoms

“extra” things we don’t see in a normal person

• change in behavior/thoughts

ex: having hallucinations or delusions

negative symptoms

“lack of” normal behaviors

ex: ppl are withdrawn

symptoms that typically have an A in the beginning “ahedonia”

positive symptoms — abnormal motor behavior (2)

• catatonia

• waxy flexibility

catatonia

bizarre posture or decreased responsiveness to things around them

waxy flexibility

body parts are placed in bizarre or uncomfortable positions

disney knees

delusions

false fixed beliefs

persecutory/paranoid

pt thinks someone is out to get them/watching them/out to kill them

how do you care for someone with paranoia

• take lunch lid off in front of them

• with meds they think they are poisonous so they have to watch when you open it

ideas of reference

they think everything is about them and it scares them

ex: accident billboards pointing at you, thinks it’s pointing at them

delusions of grandeur

• pt thinks that they own a mansion and knows celebs

• pt is proud to say it, but doesn’t know it’s not real

general delusion interventions

• don’t deny belief

  • reasonably doubt them

• redirect them to reality especially towards persecutory delusions

“you are a pt at ___ at ____ and you are safe here.”

loose association

• shifting from one unrelated topic to another

• topics do not connect 

  • out of pocket, no flow

  • like “flight of ideas”

preservation

preoccupied with something or topic

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

• somewhat like being preoccupied with something

tangential

not being able to get a point across because of the introduction to new topics

establish thoughts and then goes off topic

circumstantial

they get the point across or go back to the original topic, but it takes a long time for them to get there

keeps going back on the topic

word salad

a group of words put together to make a sentence

that doesn’t make sense

neologisms

creating an entirely new word

clang associations

rhyming words together for every sentence

echolalia

copying someone’s words

like right after they say it

echopraxia

copying someone’s actions

hallucinations

sensing things that are not there

• can be any sense/tactile

• ex: ants crawling on skin

hallucination assessment

“are you seeing or hearing anything that’s not there?”

• if no stop there

• if yes ask to describe

  • if there are voices, ask what the voices are telling you

    • when described, validate their feelings but let them know you don’t hear anything

affect lacking

blunted affect

avolition

no motivation to complete purposeful activities

alogia

decreased verbal communication

anergia

decreased energy

anhedonia

decreased pleasure in doing things

typical antipsychotics

treats only positive symptoms, more potent side effects

• 1st generation

atypical antipyschotics

treats positive AND negative symptoms, less potent side effects

• 2nd generations

antipsychotics side effects (EPS)

• tardive dyskinesia

• pseudoparkisonism

• akathisia

• dystonia

1st generation antipsychotics

• haloperidol

• chlorpromazine

• fluphenazine

• loxapine

• perphensazine

• pimoside

• prochlorperazine

• thioridazine

• thiothixene

• trifluoperazine

2nd generation antipsychotics

• ziprasidone

• risperidone

• paliperidone

• lurasidone

• olanzapine

• quetiapine

• clozapine

• aripiprazole * (depot)

different routes can increase.. and what are the two different routes

med compliance

• orally disintegrated tablets

• depot formulation

  • long acting IM

tardive dyskinesia

flirting, winking, lip smacking

• EPS

pseudoparkinsonism

• EPS

• parkinson traits, but drug induced 

• “pill rolling” tremor and shuffling gate

akathisia

• EPS

• restless, jittery

• ex: acting like you drank 8 cups of coffee a day

dystonia

• EPS

• MEDICAL EMERGENCY

• airway compromised, eye roll, jaw locks, and starts screeching

• causes voice box to close (airway)

which medications help with EPS

anticholinergic meds

Anticholinergics: ABCs (TBDs)

• trihexyphenidyl (Artane)

• benztropine (Cogentin)

• diphenhydramine (Benadryl)

neuroleptic malignant syndrome

• antipsychotic complication

manifestations:

• fever

• ALOC

• muscle rigidity

• fluctuating BP

what do you give for neuroleptic malignant syndrome?

dantrolene

labs to look at

• lipid panel

  • HDL, LDL, Cholesterol

weight fain, fatigue from meds

• A1C

metabolic syndrome