Block 4+5 of Mod 1

Overview of Psychotic Disorders

• Introduction to psychotic disorders

  • Distinction from depression and bipolar disorders.

  • Emphasis on the breadth and depth of the topic of psychotic disorders.

  • Purposeful superficiality in introductory discussions to prepare for deeper exploration in psychiatric nursing class.

Understanding Psychosis

• Definition of psychosis

  • Combination of positive and negative symptoms.

  • Clarification that "positive" and "negative" do not refer to good or bad but to the nature of the symptoms.

• Description of symptoms:

  • Positive symptoms

  • Definition: Additional experiential symptoms exaggerating normal experiences.

  • Examples:

    • Hallucinations:

    • Types: Visual, auditory, bodily sensations.

    • Description: Experiences that others do not perceive.

    • Delusions:

    • Examples: False beliefs of having power or being in danger.

    • Paranoia: A type of delusion involving irrational fear of harm.

  • Negative symptoms

  • Definition: Symptoms that take away from everyday experiences.

  • Examples:

    • Blunted Affect: Lack of emotional expression.

    • Social Withdrawal: Avoidance of social interaction.

Observing Symptoms in Nursing

• Importance of recognizing both positive and negative symptoms in clinical practice.

• Observability considerations:

  • Negative symptoms like social withdrawal are often more easily observable than positive symptoms.

  • However, positive symptoms can be overtly observable, and severe agitation is a clear sign.

  • Insight into the variable nature of symptom presentation among patients and the need for nonjudgmental attitudes from healthcare providers.

Neurotransmitter Dysregulation in Psychosis

• Discussion of brain chemistry and psychosis.

• Current limitations in distinguishing between psychotic and non-psychotic brains using diagnostic imaging.

• Knowledge of neurotransmitter involvement:

  • Dopamine Dysregulation:

  • Hypothesis that there is excessive dopamine in some areas and insufficient in others.

  • Serotonin Imbalance: Mention of potential serotonin dysregulation.

Antipsychotic Pharmacology

First Generation Antipsychotics (FGAs)

• Overview of first-generation antipsychotics developed in the 1950s and 60s.

• Prototype: Haloperidol.

  • Mechanism of action: Strong dopamine blockade, effective against positive symptoms of schizophrenia.

  • Usage in acute agitation scenarios.

• Other first generation drugs: Chlorpromazine, fluphenazine, parfenazine.

• Adverse effects associated with FGAs:

  • Extrapyramidal Symptoms (EPS):

  • Dystonia: Characterized by involuntary muscle contractions; treated using anticholinergics.

  • Parkinsonism: Rigidity symptoms; managed similarly to Parkinson's disease.

  • Akathisia: Restlessness; may respond to beta blockers.

  • Tardive Dyskinesia (TD): Irreversible involuntary movements; progressive monitoring suggested.

• Neuroleptic Malignant Syndrome (NMS):

  • Serious and potentially lethal reaction combining muscle rigidity, fever, autonomic instability.

Nursing Implications for FGAs

• Monitoring EPS symptoms post-administration of FGAs.

• Prompt management for early symptoms like dystonia.

• Importance of monitoring for NMS, especially with increased temperature and rigidity.

Second Generation Antipsychotics (SGAs)

• Development motivation: Reduced adverse effects compared to FGAs.

• Prototype: Risperidone.

  • Mechanism: Blocks serotonin more than dopamine; lower risk of EPS.

  • Common use: Treating psychotic disorders with complex neurochemical profiles.

• Adverse effects of SGAs:

  • Metabolic Effects:

  • Significant weight gain, diabetes, elevated cholesterol levels.

  • Monitoring for metabolic syndrome.

  • Clozapine: Notable for agranulocytosis risk; monitoring of absolute neutrophil counts essential.

  • Other notable SGAs: Olanzapine, Quetiapine, Ziprasidone, Lurasidone, Aripiprazole.

Specific Drug Characteristics and Implications

• Olanzapine: Known for sedation and use in palliative care to manage weight gain and appetite.

• Quetiapine: Sedative properties; used in some contexts as a sleep aid.

• Ziprasidone and Lurasidone: Must be taken with food for proper absorption; pharmacokinetic importance discussed.

• Aripiprazole: Activating properties; caution advised in agitated patients due to potential for exacerbating symptoms.

Special Considerations for Elderly Patients

• Increased risk of side effects in older adults.

• Caution with sedating psychotropics in dementia-related psychosis due to mortality risk.

• Non-pharmacological interventions suggested before resorting to medication for behavioral management.

Key Safety Principles

• Identifying severe syndromes that pose high risk:

  • Serotonin Syndrome: Neuromuscular changes and flu-like symptoms resulting from serotonin excess.

  • Neuroleptic Malignant Syndrome (NMS): Associated with dopamine blockage and persistent symptoms; imperative to monitor vitals closely.

• Lithium Toxicity:

  • Commonly arises from prerenal injury affecting lithium clearance; importance of monitoring renal function emphasized.

• Special attention to drug interactions, especially SSRIs and MAOIs, to prevent hypertensive crises.

Conclusion and Future Directions

• Closing remarks emphasizing ongoing vigilance in pharmacological management in psychiatric care.

• Recap the importance of patient assessment to catch potential complications early before they escalate.