Psychia 1

What med is prepared pre-ECT to prevent too much erratic
contractions?

Succinylcholine

<20 yrs old [earlier than women; high estrogen delays onset!]

What is the usual onset of schizophrenia in men?

Positive symptoms:
Delusions
Hallucinations
Disorganized speech/behavior

Negative symptoms
Compromised ADLs

Symptoms of schizophrenia

Anhedonia
Avolition
Alogia
Affective flattening
Aphasia

What are the negative symptoms of Schizophrenia?

Anhedonia

a negative symptom of schizophrenia wherein there is a lack of interest/motivation

Alogia

= a negative symptom of schizophrenia wherein there is poverty in speech
= speaking less d/t brain impairment

Affective flattening

a negative symptom of schizophrenia wherein they exhibit little or no affect in face or voice

Anhedonia

a negative symptom of schizophrenia wherein they are unable to experience pleasure

Associality

a negative symptom of schizophrenia wherein they are unable to form close personal relationships

Somatic Delusion
Grandiose Delusion
Nihilistic Delusion
Delusion of Reference
Delusion of Control
Paranoid/ Persecutory Delusion

Types of Delusions in Schizophrenics

Somatic

_ delusion is a type of delusion among schizophrenics wherein they insist of having a disease even though they dont"

Schizophrenia [schizo - split; phrenia - mind/person]

= multifactorial major disturbance in thought, emotion, and behavior
= aka Dementia praecox
= evolution: Dementia praecox > Catatonia > Hebephrenia > Paranoia > ___

Grandiose

_ delusion is a type of delusion among schizophrenics wherein they have exaggerated beliefs related to power/ health"

Nihilistic Delusion

"a type of delusion among schizophrenics wherein they believe that everything is meaningless and they do not exist at all"

Delusion of Reference

"a type of delusion among schizophrenics wherein they believe that things/events/people are referring to them"

Delusion of Control

"a type of delusion among schizophrenics wherein they believe that their thoughts and feelings are being controlled by outside forces"

Paranoid/Persecutory Delusion

"a type of delusion among schizophrenics wherein they believe that someone is going to harm them"

Auditory
Visual
Tactile
Gustatory [taste hallucination]
Olfactory [smell hallucination]

5 Types of Hallucinations in Schizophrenics

Auditory hallucination

"most common and dangerous type of hallucination in schizophrenics"

Command hallucination

"most common type of AUDITORY hallucination in schizophrenics"

Crawling sensation

"most common type of TACTILE hallucination"

Word salad
Echolalia
Palilalia
Perseveration
Neologism
Flight of ideas
Concrete association

7 Types of Disorganized Speech in Schizophrenics

Word salad

"= a type of disorganized speech in schizophrenics
= words have no logical meaning to each other"

Clang association

"= a type of disorganized speech in schizophrenics
= rhyming of random words"

Echolalia

"= a type of disorganized speech in schizophrenics
= echoing, parroting, repeating what is heard"

Palilalia

"= a type of disorganized speech in schizophrenics
= echoing own last word"

Perseveration

"= a type of disorganized speech in schizophrenics
= same response to all questions"

Neologism

"= a type of disorganized speech in schizophrenics
= making own new vocabulary"

Flight of ideas

"= a type of disorganized speech in schizophrenics
= composed of fragmented or unrelated ideas; full sentences"

Concrete associations

"= a type of disorganized speech in schizophrenics
= literal answers"

Waxy flexibility
Cataplexy
Echopraxia
Mutism

4 Types of Disorganized Behavior in Schizophrenics

Waxy flexibility

"= a type of disorganized behavior in schizophrenics
= remains in bizarre, uncomfortable position for very long time regardless of discomfort"

Cataplexy

"= a type of disorganized behavior in schizophrenics
= sudden, brief loss of voluntary muscle tone triggered by strong emotions such as laughter, excitement, anger or fear
= 'helds against gravity' posture"

Echopraxia

"= a type of disorganized behavior in schizophrenics
= imitating another’s movement"

Mutism

"= a type of disorganized behavior in schizophrenics
= no/very little verbal response"

Stage 1: Premorbid [Pre-symptomatic risk]
Stage 2: Prodromal [Pre-psychotic prodrome]
Stage 3: Onset/Deteriorative [Acute Psychosis]
Stage 4: Chronic/Residual [Chronic Illness]

Stages of Schizophrenia

Stage 1: Premorbid

"= stage of schizophrenia wherein patient is exposed to risk factors
= aka Pre-symptomatic risk"

Stage 2: Prodromal

"= stage of schizophrenia wherein patient manifests non-specific and non-diagnostic symptoms
= aka Pre-psychotic prodrome"

Stage 3: Onset/Deteriorative

"= stage of schizophrenia wherein patient already manifests positive and negative symptoms in 6 months
= aka Acute Psychosis"

Stage 4: Chronic/Residual

"= stage of schizophrenia wherein meds taken by px are taking effect; s/s are weak and infrequent
= aka Chronic Illness"

Brief Psychotic Disorder
Delusional Disorder
Schizophreniform
Schizoaffective Disorder

Clinical subtypes of Schizophrenia [disorders that are similar to schizophrenia]

Brief Psychotic Disorder

"= a clinical subtype of schizophrenia
= sudden onset of psychotic symptoms that may or may not be preceded by severe psychosocial stress
= symptoms last at least 1 day up to <1 month
= followed by remission to Stage 1/premorbid level
= common in females [may follow after childbirth]"

Delusional Disorder

"= a clinical subtype of schizophrenia
= persistently one type of delusion lasting at least 1 month
= Hallucinations = not prominent; behavior = not bizarre"

Schizophreniform

"= a clinical subtype of schizophrenia
= identical to schizophrenia except that the duration is at least 1 month but < 6 months"

Schizoaffective Disorder

"= a clinical subtype of schizophrenia
= Affect → emotions are affected
= Strong symptoms associated with mood disorders
= Hallucinations and/or delusions that occur for at least 2 weeks in the absence of a major episode"

Paranoid Schizophrenia
Disorganized Schizophrenia
Catatonic Schizophrenia
Residual Schizophrenia
Undifferentiated Schizophrenia

5 Types of Schizophrenia

Paranoid Schizophrenia

"= a type of schizophrenia characterized by suspicion toward others
= most prominent manifestation: Persecutory Delusion [believing someone is going to harm them]"

Disorganized Schizophrenia

"a type of schizophrenia characterized by withdrawal from society and very inappropriate behaviors"

Catatonic Schizophrenia

"= a type of schizophrenia characterized by psychomotor agitation or retardation
= either being totally still and mute or being hyperactive for no reason"

Residual Schizophrenia

"= a type of schizophrenia characterized by 2 or more residual
symptoms; usually negative symptoms
= don’t experience hallucinations and delusions anymore, but negative symptoms may persist"

Undifferentiated Schizophrenia

"a type of schizophrenia that is diagnosed when a person meets the criteria for diagnosis for schizophrenia but cannot be classified into any of the subtypes"

Typical antipsychotics [First-generation]

"= dopamine antagonists that decreases only the positive symptoms of schizophrenia
= conventional (older); higher risk for EPS
= ex: Chlorpromazine, Fluphenazine, Perphenazine, Haloperidol
= suffix: -zine and -dol"

Atypical Antipsychotics

"= dopamine + serotonin antagonists that decreases both positive and negative symptoms of schizophrenia
= unconventional (newer); lesser risk for EPS
= ex. clozapine, olanzapine, ziprasidone, risperidone
= suffix: -pine & -done
= Exemption: Aripiprazole (Abilify) - not a PPI!"

Blurred vision
Urinary retention
Constipation
Orthostatic hypotension
Photosensitivity
Amnesia
Nausea
Dryness of mouth
Apraxia
Night discomforts

Side Effects of Antipsychotics [BUCOPANDAN]

"Akathisia [restlessness]
Dystonia [involuntary muscle contraction]
Pseudoparkinsonism [tremor, difficulty finishing thoughts, stiff facial muscles]
Tardive dyskinesia [involuntary facial/jaw movements]"

4 Extrapyramidal Symptoms (EPS)

Acute dystonia

"= earliest EPS that can be caused by antipsychotics
= occurs 2-4 weeks after med is started
= appearance of torticollis [wry neck], opisthotonus [arching of back and extending of legs], oculogyric crisis [eyeballs rolling upward]
= second most fatal EPS"

Akathisia [makathi sia]

"= most common EPS that can be caused by antipsychotics
= inability to sit or stand still
= “Ants in the pants” sensation
= #1 reason for drug non-compliance
= DOC: Propranolol"

Propranolol

What is the DOC for Akathisia?

Tardive Dyskinesia

"
= manifests after 6 months to 1 year of therapy
= late onset but irreversible manifestation
= tongue protrusion, lip smacking, and facial grimacing
= most effective antidote: Benztropine
= last option d/t sedative fx: Diazepam (Valium)
= other antidotes: Trihexyphenidyl, Diphenhydramine, Amantadine"

Pseudoparkinsonism

"= drug-induced parkinsonism
= EPs that is generally reversible and can be treated by stopping the med
= tremor, cogwheel rigidity, shuffling gait"

Neuroleptic Malignant Syndrome
Agranulocytosis

2 Adverse Effects of Antipsychotics

Neuroleptic Malignant Syndrome

"= an adverse effect of antipsychotics characterized by distinctive clinical syndrome of mental status change:
> Rigidity of muscles
> Fever
> Dysautonomia
= most common cause: Typical antipsychotics (Chlorpromazine)"

Chlorpromazine

a typical antipsychotic that may cause the adverse effect of Neuroleptic Malignant Syndrome

Agranulocytosis

"= an adverse effect of antipsychotics wherein the body doesn’t make enough of neutrophils → risk for infection
= Initial manifestation: sore throat
= most common cause: Atypical antipsychotics (Clozapine)
= ttt: Hold medication"

Clozapine

an atypical antipsychotic that may cause the adverse effect of Agranulocytosis

Electroconvulsive Therapy (ECT)

"= a SOMATIC therapy for schizophrenia [LAST RESORT!]
= duration of shocking: 0.2-0.8 s
= duration of seizure: < 1 minute
= 6-12 sessions (2-3x a week)
= MOA: delivers electrical current to balance neurotransmitters in the brain"

"Bilateral ECT has more memory loss but is more effective; unilateral ECT has less memory loss yet is less effective"

What differentiates Bilateral ECT from Unilateral ECT?

> Atropine sulfate [prevent aspiration]
> Succinylcholine [muscle relaxant]
> Phenobarbital [tranquilizer]

Before ECT, what meds do we prepare?

Atropine sulfate [minimizes secretion within RT]

What med is prepared pre-ECT to prevent risk for aspiration?

Succinylcholine

What med is prepared pre-ECT to prevent too much erratic contractions?

Respiratory depression

What should we look out for when giving succinylcholine?

Phenobarbital

What med is prepared pre-ECT to induce sleep/deep coma?

NPO for 6-8 hours
Half bath only
Position: Supine with raised side rails
Obtain V/S (check RR)
*Priority after the procedure: Check RR

How do we prep the px before ECT?

"> Denial - unable to accept the loss
> Anger - intense emotion expressing the frustration of not being able to do something
> Bargaining - negotiates for more chances
> Depression - dwells into the sadness attributed loss
> Acceptance - accepts the loss"

Stages of Grieving (Kubler-Ross)

Assist the client to achieve the acceptance of the loss

What is the most important role of the nurse in a grieving patient?

listening, offering self, silence, therapeutic touch, outlet for frustration

How can the nurse help client to accept a loss?

Mood = feeling
Emotion = summary of what you feel
Affect = outward behavioral expression

What is the difference between mood, emotion, and affect?

Clinical depression
Bipolar Disorder

2 DSM-5 Diagnosis of Mood Disorders

Clinical Depression

"= aka “Common cold” of Psychiatry
= different from regular depression
= has 5 clinical types"

Major depressive disorder [MDD]
Seasonal affective disorder [SAD]
Persistent Depressive Disorder [PeDD]
Premenstrual Dysphoric Disorder [PrDD]
Substance Induced Depressive Disorder [SIDD]

5 Types of Clinical Depression

Major depressive disorder

"= a clinical depression that has a single or recurrent episode of unipolar depression of at least 2 wks
= symptoms: depressed mood, insomnia/hypersomnia, indecisiveness, decreased ability to concentrate, anhedonia, weight gain/loss
= inability to perform ADLs, increase/decrease in motor activity
= most dangerous manifestation: Suicidal ideation"

Seasonal Affective Disorder

"= a clinical depression that usually occurs during cold/dark seasons [PH: June-Dec]
= formerly known as ""Cyclothymic disorder""
= symptoms are the same as MDD"

Light therapy (20-30 minutes/day)

What is the mgmt for Seasonal Affective Disorder?

Persistent Depressive Disorder

"= a clinical depression that only has 3 manifestations of MDD mostly present throughout the day; does not impair ADLs
= persists for 2 years
= does not need somatic therapy [ECT]"

Premenstrual Dysphoric Disorder

"= a clinical depression that usually occurs among women in the childbearing age
= happens during the luteal phase of the menstrual cycle
= more severe & debilitating than PMS
= Exaggerated emotional manifestations: irritable, mood swing, overwhelmed feeling "

Hormonal assessment & hormonal therapy

What is the mgmt for Premenstrual Dysphoric Disorder?

Substance-Induced Depressive Disorder

a clinical depression that is related to substance use and withdrawal [alcohol, opioids]

Acute phase

"= phase of depression that lasts bet. 6-12 mos
= severe clinical findings
= need for hospitalization, first line ttt
= assess suicide ideation"

Continuation phase

"= phase of depression that starts after success of ttt and aversion of suicide
= this is where we do RELAPSE PREVENTION"

Maintenance phase

"= phase of depression where we check for remission of manifestations
= here we PREVENT FUTURE EPISODES of depression
= antidepressants are LOW-DOSE
= duration: can last months to years [depends on doctor's orders]"

Selective Serotonin Reuptake Inhibitor (SSRI)

"= FIRST LINE of med for depression [lesser side fx, lesser SEDATIVE fx, newest form of antidepressant]
= suffix: -oxetine, -line, -talopram
= prototype: Fluoxetine (Prozac)
= other meds: Sertraline (Zoloft), Citalopram, Escitalopram, Paroxetine
= pregnancy category C [can be given as long as benefits outweight the risks]"

Selective Serotonin Reuptake Inhibitor (SSRI)

"= an antidepressant med that elevates serotonin by stopping reuptake/elimination of serotonin
= takes effect within 2-4 weeks
= best given in the AM [can cause insomnia]"

"Sexual dysfunction (low libido) - #1 reason for drug non-compliance
Insomnia
Excessive weight loss"

Side effects of SSRIs

"MAOI + SSRI = leads to Serotonin syndrome > mental confusion, GI symptoms, agitation, hallucination, tremor"

Adverse effects of SSRIs

hold next dose

Priority action for SEROTONIN SYNDROME?

Antidepressant

_ has to be flushed out of system before using another one

Serotonin syndrome

"= characterized by mental confusion, GI symptoms, agitation, hallucination, tremor
= happens when MAOI and SSRI is taken w/o interval between
= mgmt: Hold next dose"

MAOI - Serotonin syndrome
Lithium - decreased therapeutic effect of each other
Warfarin - severe bleeding
NSAIDs - GI bleeding

Drug interactions of SSRIs

lithium

Taking _ with SSRIs decreases both their therapeutic effects.

Warfarin

Taking _ with SSRIs causes severe bleeding.