PSYCH ASSESSMENT 2
Dystonia
Involuntary muscle contractions that cause repetitive or twisting movements.
This medication, an anticholinergic, is important to administer for EPS side effects (you may want to refer to Chapter 15 for this answer)
benzotropine (COGENTIN)
Anticholinergic effects-what instructions should the client receive?
-Instruct about additive effects of anticholinergic drugs with antipsychotics, dry mouth, need good oral hygiene, *asses and instruct the client to report* urinary retention, tachycardia, tremors, hypertension *(anticholinergic toxicity)*
When patients are taking this medication, they must be reminded to have of fluid intake of 2,000 to 3,000 ml/day.
LITHIUM
is it OK to drink Alcohol with antipsychotics?
NO-- they potentiate each others side effects
This over the counter medication cannot be given when a patient is taking Lithium as it can increase the level of Lithium. (Keep in mind with schizoaffective disorders, a mood stabilizer is given).
NSAIDs -Lithium effects are also increased by Carbamazepine, fluoxetine, haloperidol, loop diuretics, methyldopa, NSAIDs, and thiazide diuretics
EPS symptoms can cause prolactin elevation causing ________1__________. Cholinergic blockade causes___________2________. Blockage of the alpha1-adrenergic receptors produces ________3________. Histamine blockade is associated with ________4__________.
1.) gynecomastia (elevated dopamine causes this) 2.) anticholinergic symptoms 3.) dizziness & tachycardia 4.) weight gain and sedation
can tartive diskonisia become permanent?
YES
Somatic delusions
a belief that he or she has a dysfunctional body part (EX. "my heart is at a standstill. It is no longer beating.")
Control or influence delusions
a belief that his or her behavior and thoughts are being controlled by external forces (EX. "i get my orders from channel 27. I do only what the forces dictate."
persecutory delusions
a belief that someone is out to get him or her in some way (EX. "the FBI will be here at any time to take me away"")
if EPS symptoms occur, what could be a priority nursing intervention?
administer PRN trihexyphenidyl (Artane) [antiparkinsons agent]
Which side effects of antipsychotics are considered as emergent?
agranulocytosis (more common with typical antipsychotics but especially with the atypical antipsychotic agent clozapine)
grandiose delusions
an idea that he or she is all-powerful or of great importance (EX: "I am the king and this is my kingdom ! I can do anything!)
Reference delusions
an idea that whatever is happening in the environment is about him or her (EX: "just watched the movie on TV tonight. It was about my life.")
Agranulocytosis and with what drug?
CLOZAPINE (CLOZARIL) -Agranulocytosis is a potentially fatal blood disorder in which the client's white blood cell (WBC) count can drop to extremely low levels. This can happen with Clozapine (Clozaril), a baseline WBC count and absolute neutrophil count (ANC) must be taken before initiation of treatment with clozapine and weekly for the first 6 months of treatment. Only a 1-week supply of medication is dispensed at a time.
Both cannabis and synthetic cannabinoids can induce what?
"Both cannabis and synthetic cannabinoids can induce many schizophrenia-like symptoms, and in individuals with preexisting psychosis, cannabinoids can exacerbate symptoms."
Note: on page 82, which antipsychotics are very sedating?
*-Clozapine (Clozaril) 5/Atypical* -Chlorpromazine 4/Typical -thioridazine 4/Typical -Asenapine -Illoperidone -Lurasidone -Olanzapine(zyprexa) - Quetetiapine (seroquel) -Ziprasidone (Geodon)
Complete the following statement: One of the identified limitations of medication treatments available for schizophrenia is that there are ________________________________________,,...
"... several cognitive deficits that are core symptoms of this illness, including deficits in working memory, long-term memory, reduced processing speed, verbal fluency, and executive functions."
serious and non serious side effects of anticholinergic drugs
"can't see, pee, or shit" serious effects include *blurred vision or eye pain*, *urinary retention*, confusion and hallucinations, and uncontrollable movements of the patient's eyes, lips, tongue, face, and limbs. less serious effects include dry mouth and *constipation* >> *at times, cognitive impairment*. These symptoms can lead to other problems such as tooth decay or falls,
What is the rationale concerning positive and negative symptoms of schizophrenia? What are the positive and negative symptoms?
*Positive symptoms:* things WE can change (w/ meds), tend to reflect an alteration or distortion of normal mental functions...symptoms that are being added to the individual -Content of thought: delusions, paranoia, magical thinking -Form of thought: associative looseness, neologisms, concrete thinking, clang associations, word salad, circumstantiality, tangentiality, mutism, perseveration -Perception: hallucinations, illusions -Sense of Self: describes the uniqueness and individuality a person feels. Individual lacks feeling of uniqueness and experiences confusion regarding his or her identity (weak ego boundaries) ... echolalia, echopraxia, identification (subconscious), imitation (happens at conscious level), depersonalization *Negative symptoms: reflect a diminution or loss of normal function* -Affect: inappropriate (emotional tone incongruent with circumstance), bland/flat, apathy -Volition: inability to initiate goal directed activity aka no motivation...can take form of inadequate interest, motivation or ability to choose a logical course of action in a given situation...emotional ambivalence (coexistence of opposite emotions toward the same object person or situation (can impede making even simple decisions like having coffee or tea with breakfast), deteriorated appearance (neglected personal care) -Interpersonal functioning & relationship to the external world: impaired social intx, social isolation, lack of insight -Psychomotor behavior: waxy flexibility (a condition in which the individual allows body parts to be put in bizarre positions & will remain that way for long pd of time), anergia, posturing (voluntary bizarre posture), pacing/rocking >>Associate features: anhedonia, regression
This over the counter medication cannot be given when a patient is taking Valproic Acid (Depakote) as it can increase the level of Valproic Acid.
*salicylates (aspirin)* -Also, do not take Chlorpromazine, cimetidine, erythromycin, felbamate.
Differentiate between delusions and hallucinations. Give examples of each.
-Delusions (positive symptom) are false personal beliefs that are inconsistent with the person's intelligence or cultural background. The individual continues to have the belief in spite of obvious proof that it is false or irrational. Subdivided according to content. Persecution - they are watching me, want to kill me, etc Grandeur - I am Jesus Reference - the environment is referred to the person i.e. there is a message in the magazine pages meant for me (less rigid are Ideas of reference ex. When around others "they are talking about me") Control or Influence - certain objects or persons are control their body or thoughts Somatic - false idea about functioning of their body Nihilistic - false that self, part of self, others, or the world is nonexistent *Hallucinations (positive symptom) are false sensory perceptions not associated with real external stimuli and may involve the five senses. * Types include: Auditory - voices or noises (most common type of hallucination) Visual - images, lights, etc. Tactile - touch on or under the skin, one specific example is formication (sensation that something is crawling on or under the skin) Gustatory - false perception of taste, most commonly described as an unpleasant taste Olfactory - false perception of sense of smell
What are the advantages of typical vs atypical antipsychotics?
-*Typical antipsychotics* work by blocking postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem and medulla. They also demonstrate a varying affinity for cholinergic, alpha1- adrenergic, and histamine receptors. Anti-psychotic effects may also be related to inhibition of dopamine-mediated transmission of neural impulses at the synapse. (HIGHER chance of EPS) -*Atypical antipsychotics* are WEAKER dopamine receptor antagonists than the conventional antipsychotics but are more potent antagonists of the serotonin type 2A receptors. They also exhibit antagonism for cholinergic, histaminic, and adrenergic receptors.(LOWER chance of EPS) (CONTRAINDICATED IN pts with cardiac issues due to
Atypical antipsychotics
-*better at addressing the negative symptoms of schizophrenia* -Aripiprazole (Abilify) -Asenapine (Saphris) -Clozapine (Clozaril) -Iloperidone (Fanapt) -Lurasidone (latuda) -Olanzapine (Zyprexa) - Paliperidone (Invega) - Quetiapine (seroquel) -Risperidone (Risperdal) -Ziprasidone (Geodon)
APPENDIX B Thought Content: What are the different types of perceptual disturbances?
--Hallucinations (unrealistic sensory perceptions) >auditory, visual, tactile, Olfactory, Gustatory --Illusions (individual misperceives or misinterpret real stimuli within the environment. EX sees something and thinks it is something else) --depersonalization (altered perception of self. EX the individual verbalizes feeling "outside the body"; visualizing himself or herself from afar.) -derealization: (altered perception of the environment EX. individual verbalizes that the environment feels "strange or unreal". A feeling that the surroundings have changed)
Which drug is known for lowering the seizure threshold (antipsychotic)?
-Clozapine (Clozaril)
typical antisychotics
-Fluphenazine -Chlorpromazine -Haloperidol (haldol) -Loxapine -Perphenazine -Pimozide (Orap) -Prochlorperazine -Thioridazine - Thiothixene (Navane) -Trifluoperazine
When should a nurse intervene when there are signs of increased anxiety, agitation or verbal or behavioral aggression? What is the empathetic response?
-Intervene at the first sign of increased anxiety, agitation or verbal or behavioral aggression. >>Offer empathetic response to the client's feelings: "You seem anxious (or frustrated or angry) about this situation. How can I help?" -It is important to maintain a calm attitude toward the client. As the client's anxiety increases, offer some alternatives: participating in a physical activity (e.g., punching bag, physical exercise), talking about the situation, taking some anti-anxiety medication. -Have sufficient staff available to indicate a show of strength to the client if it becomes necessary. -If client is not calmed by "talking down" or by medication, use of mechanical restraints may be necessary.
Hyperglycemia-what are symptoms of hyperglycemia?
-Polydipsia- (excessive thirst) -Polyphagia (extreme hunger) -Polyuria (excessive urination) -Weakness -Watch for hyperglycemia in patients taking antipsychotic medication.
Why is concrete communication essential?
-Schizophrenic patients generally cannot abstractly think (regression) so to communicate you have to do so in an easy to understand, concrete way -Abstract phrases or clichés need to be avoided because they will likely be misinterpreted by the client. Concrete communication provides clear and concise explanations with little or no capacity for misinterpretation. Providing this type of communication on the unit, in the way of step-by-step instructions, will aid the client in achieving the ideal goal of internalizing societal norms.
What does it mean to "decode incomprehensible communication patterns."?
-Seek validation and clarification by stating, "Is it that you mean ... ?" or "I don't understand what you mean by that. Would you please explain it to me?" -When schizophrenic pt has impaired verbal communication -These techniques reveal how the client is being perceived by others, while the responsibility for not understanding is accepted by the nurse... instead of saying "you make no sense"
what patient teaching considerations should be made for individuals going home on anti-psychotics?
-Smoking increases the metabolism of antipsychotics, requiring an adjustment in dosage to achieve a therapeutic effect. Encourage the client to discuss this issue with the prescribing physician or nurse practitioner -Advise clients to dress warmly in cold weather and avoid extended exposure to very high or low temperatures. Body temp is harder to maintain with these medications -Encourage clients to avoid drinking alcohol while on antipsychotic therapy. These drugs can potentiate each other's effects -Clients should avoid taking other medications (including over-the-counter products) without the physician's approval. Many medications contain substances that interact with antipsychotics in a way that may be harmful. -A significant number of clients on clozapine report excessive salivation. Sugar free gum and medications (anticholinergic or alpha2 adrenoreceptor agonists) may alleviate symptoms. But client should discuss these options with the prescribing physician. -Advise clients of possible risks of taking antipsychotics during pregnancy. Safe use during pregnancy has not been established. Antipsychotics are thought to readily cross the placental barrier; if so, a fetus could experience adverse effects of the drug. Clients should inform the physician immediately if pregnancy occurs, is suspected, or is planned.
What is "TD?" (also noted in Chapter 4).
-TD aka Tardive Dyskinesia is defined as bizarre facial and tongue movements, stiff neck, and difficulty swallowing; may occur with all classifications but is more common with typical antipsychotics. -The "Abnormal Involuntary Movement Scale" is a rating scale that measures involuntary movements associated with TD. It aids in early detection of movement disorders and provides a means for ongoing surveillance.
Tardive Dyskinesia (TD). What is the screening scale? What are the symptoms? Just a general rule of thumb, Tardive Dyskinesia is usually "tardy" with symptoms that occur later after initiation of the medication. EPS (if you think the letter e is also in the word "early") symptoms are sometimes early in the initiation of the medication. Anticholinergics (e.g.) that are effective for EPS are not given to patients with TD as it can make the symptoms worse.
-Tardive Dyskinesia: is an extrapyramidal side effect that most commonly occurs with antipsychotics. It is characterized by later onset involuntary movement disorders primarily in the tongue, lips, and jaw which can include bizarre facial and tongue movements, stiff neck, and difficulty swallowing. These symptoms are potentially irreversible and the drug should be withdrawn at the first sign (usually 'vermiform' [writhing, wormlike] tongue movements). The screening scale is the Abnormal Involuntary Movement Scale (AIMS). Anticholinergics (e.g. Cogentin, Artane) that are effective for EPS are not given to patients with TD as it can make the symptoms worse. **Review of main bad side effects with antipsychotics: pg.80 -EPS -NMS -Hyperglycemia, weight gain (diabetes pt!!) Hypotension/orthostatic hypotension -Prolonged QT interval -Lower seizure threshold -Anticholinergic effects-Sedation -Photosensitivity -Agranulocytosis (hey which drug ☺)
What substances and general medical conditions can cause psychotic symptoms?
-This diagnosis is made when the symptoms are more excessive and more severe than those usually associated with the intoxication or withdrawal syndrome (for substances) -Medical Conditions? Diagnosis isn't made if symptoms of condition come about during course of delirium...have to exist prior to -Table 15-1 >>Substances: Drugs of abuse (alcohol, cocaine, opioids, hallucinogens)/Medications (antidepressants, CV meds, muscle relaxants, NSAIDs, etc)/Toxins (nerve gases, carbon dioxide, carbon monoxide, fuel, paint, organophosphate insecticides) >>General conditions: CNS trauma, hepatic disease, renal disease, SLE, B12 deficiency, deafness, CNS infections, CV disease)
On page 82, which antipsychotics can increase EPS symptoms?
-Typical antipsychotic agents increase EPS symptoms much more than the atypical. -These typical antipsychotics that increase the EPS symptoms are: Chlorpromazine, Fluphenazine, Haloperidol (Haldol), Loxapine, Perphenazine, Pimozide (Orap), Prochlorperazine, Thioridazine, Thiothixene (Navane), and Trifluoperazine.
What is "voice dismissal"; "reasonable doubt;" "verbalizing the implied"
-Voice Dismissal: With this technique, the client is taught to say loudly, "Go away!" or "Leave me alone!" in a conscious effort to dismiss the auditory perception. -Reasonable Doubt: Expressing uncertainty as to the reality of client's perceptions is a technique often used with clients experiencing delusional thinking... ("I understand that you believe this is true, but I personally find it hard to accept" or "That seems rather doubtful to me") -Verbalized Implied: Putting into words what the client has only implied or said indirectly is a technique that can also be used with clients who are mute or are otherwise experiencing impaired verbal communication. This technique clarifies that which is implicit rather than explicit... (Client: "It's a waste of time to be here. I can't talk to you or anyone'.' Nurse: ''Are you feeling that no one understands?")
According to the joint commission, how often should an individual in restraints be observed?
-every 15 min >> to ensure that circulation to extremities is not compromised (check temperature, color, pulses)
what should the nurse do if you suspect Neuroleptic malignant syndrome (NMS)?
-hold the medication and contact the prescribing physician or nurse practitioner immediately and monitor vital signs as well as I & O's -give parladel and dantreum
common side effects of antipsychotics
-hyperglycemia -EPS(with typical), -orthostatic hypotension, -lower seizure threshold (esp w Clozapine), -prolonged QT interval (esp ziprasidone, thioridazine, pimozide, haloperidol, paliperidone, iloperidone, asenapine, and clozapine) -anticholinergic effects -sedation -weight gain -photosensitivity (severe risk of sunburn) -agranulocytosis (mostly w typical type. But, especially atypical clozapine)
Compare and contrast Schizoaffective Disorder vs Delusional Disorder vs Brief Psychotic Disorder vs Schizophreniform Disorder vs Schizophrenia. Note time frames.
>>Schizoaffective Disorder: A disorder manifested by signs and symptoms of schizophrenia, along with a strong element of symptomology associated with the mood disorders depression or mania. The decisive factor in the diagnosis of schizoaffective disorder is the presence of hallucinations and/or delusions that occur FOR AT LEAST 2 WEEKS IN THE ABSENCE OF A MAJOR MOOD EPISODE... but mood disorder is what persists a majority of the time >>Delusional Disorder : presence of delusions that have been experienced for at LEAST 1 MONTH...if present, at all, hallucinations are not prominent and behavior is not bizarre >>Brief Psychotic Disorder : sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor -The individual experiences emotional turmoil or overwhelming perplexity or confusion; evidence of impaired reality testing may include incoherent speech, delusions, hallucinations, bizarre behavior, and disorientation. -LASTS AT LEAST 1 DAY BUT LESS THAN MONTH -With a return to full premorbid level functioning -More common in people with existing personality disorders >>Schizophreniform Disorder : same symptoms of schizophrenia LASTS AT LEAST ONE MONTH BUT LESS THAN 6 MONTHS -Diagnosis changed to schizo if lasts for longer
Nihilistic
A belief that he or she, a part of the body, or even the world does not exist or has been destroyed (EX. "I am no longer alive")
This potentially fatal blood disorder is attributed to the antipsychotic Clozaril (Clozapine).
Agranulocytosis
other considerations: Valproic Acid (Depakote) can cause hepatic failure, resulting in fatality. Liver function tests are required. What liver tests are considered? Carbamazepine (Tegretol) can cause aplastic anemia and agranulocytosis at a rate of 5-8 times greater than the general population.
BUN, albumin, bilirubin, ALT, AST
This is an identified limitation for individuals diagnosed with schizophrenia when taking medication treatment.
Cognitive Deficits
In acute mania, this medication is increased to 1.0 to 1.5 mEq/L.
Lithium
What is the lithium/sodium connection? How does it work? Go to page 72, under Mood-Stabilizing Agents, Lithium is better discussed.
Lithium is a salt. so it is important/relevant to explain some of these interactions. -because lithium is an imperfect substitute for sodium, anything that depletes sodium will make more receptor sites available to lithium and increase the risk for lithium toxicity. This is also the rationale behind trying to maintain usual dietary sodium and fluid intake, since major fluctuations impact lithium levels. EX. significant increase in dietary sodium intake may reduce the effectiveness of lithium because sodium will bind at more receptor sites and lithium will be excreted. Other drugs that increase serum sodium levels will also have an impact on lithium levels
Define Milieu vs Family therapy.
Milieu therapy provides a therapeutic environment, a common area where a patient can interact. They manipulate the environment so that all aspects of the client's hospital experience are considered therapeutic. The client is expected to learn adaptive coping, interaction, and relationship skills that can be generalized to other aspects of his or her life. Family therapy programs treat the family as a resource rather than a stressor, with the focus on concrete problem solving and specific helping behaviors for coping with stress. These programs recognize the biological basis for schizophrenia and the impact that stress has on the client's ability to function. They reduce the likelihood of the client's relapse and the possible emergence of mental illness in previous nonaffected relatives.
This medication would be considered to be administered intravenous or intramuscular in an Emergency room if the patient has uncontrolled rolling back of the eyes due to an antipsychotic.
Oculogyric crisis: uncontrolled rolling back of the eyes...sometimes mistaken for dystonia or seizure activity but emergency bc laryngospasm follow *>> admin IV/IM COGENTIN<<* -Regarding the EPS symptoms of Dystonia and Oculogyric crisis, how are they treated in emergencies? *- ADMIN ANTIPARKINSONISM AGENTS (COGENTIN)*
Pediatrics!! When symptoms of schizophrenia occur before age 17, it is considered EOS (early-onset schizophrenia); when the symptoms occur before age 13, it is considered VEOS (very early-onset schizophrenia). Regarding the pattern of development of schizophrenia, list and define the four phases and characteristics.
Phase I: The Premorbid Phase - includes premorbid signs that present before there is definitive and clear evidence of the illness. The premorbid signs may include distinctive personality traits and behaviors such as being very shy and withdrawn, having poor peer relationships, poor school performance, and antisocial behavior. Adolescents who may be considered pre-schizophrenic frequently have no close friends and enjoy solitary activities, rather than team sports. *Phase II: The Prodromal Phase* - This phase can last for a few weeks to a few months, but the average length of the Prodromal Phase is 2 to 5 years. The Prodromal Phase lasts until the onset of frank psychotic symptoms. Prodromal signs manifest more clearly as signs of schizophrenia than premorbid signs, and individuals suffer a significant deterioration in functioning. Common signs and symptoms include depressive symptoms and social withdrawal, sleep disturbance & anxiety. Individuals may also begin to exhibit signs of cognitive impairment. Some adolescents develop a sudden onset of obsessive-compulsive behavior. Interventions that take place during the Prodromal Phase allow for the possibility of improvement in long-term outcomes. -Perceptual abnormalities, ideas of reference and suspiciousness *herald onset of psychosis* *Phase III: Schizophrenia* - this is the active phase of the disorder. Psychotic symptoms are prominent. The diagnostic criteria are as follows: 2 or more of the following, each present for a significant portion of time during a 1-month period: -delusions -hallucinations -disorganized speech (frequent derailment or incoherence), -grossly disorganized or catatonic behavior -negative symptoms (diminished emotional expression, avolition) >>>For a significant portion of the time since onset, the level of functioning in work, relationships, or self-care is markedly reduced from the level prior to onset. >>>Continuous signs of the disturbance persist for at least 6 months, with at least one month of active phase symptoms & may include prodromal or residual symptoms (prodromal or residual symptoms in this may be negative or an attenuated version of criteria A (odd beliefs...but not so psychotic as delusional beliefs)) >>>Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out. >>>The disturbance is not caused by substance use or another medical condition. >>>Among individuals with a history of autism spectrum disorder, the diagnosis of schizophrenia is made only if symptoms of schizophrenia (including delusions and hallucinations) have been present for at least one month. *Phase IV: the Residual Phase* - a period of remission that follows the active phase of the illness. Symptoms of the active phase are absent or no longer prominent, though negative symptoms may remain. Individuals may still experience an impairment in role functioning.
A baseline EKG is necessary to begin treatment with some antipsychotics due to this cardiac dysrhythmia.
Prolonged QT Interval. (is a heart rhythm disorder that can cause serious irregular heart rhythms (arrhythmias). ... In long QT syndrome, your heart muscle takes longer than normal to recharge repolarize) between beats.)
a baseline EKG is necessary to begin treatment with some antipsychotics due to this cardiac dysrhythmia.
QT prolongation (takes longer for the heart to recharge/repolarize in between beats)
Clozapine (Clozaril)
anticholinergic antipsychotic (used to treat schizophrenia) -classified as an ATYPICAL antipsychotic -RISK for agranulocytosis -med is only given 1 week at a time -LOW risk for EPS (1) -HIGH risk for sedation (5) -POTENT anticholinergic (5) -HIGH risk for orthostatic hypotension (4) -HIGH risk for weight gain (5) -high/increased salivation >>numbers are on a 1-5 scale w/ 5 being the highest & 1 being the lowest.
what is the etiology of schizophrenia?
Schizophrenia spectrum disorders may have several causative factors, including genetic predisposition, biochemical dysfunction, physiological factors, and psychosocial stress. Although it is possibly studied more than any other mental disorder, its causes are still unknown.
This syndrome can be life threatening if patients are taking this anti-seizure medication for mood stabilization.
Steven's-Johnson Syndrome
Schizophrenia uses a lot of "A" words to describe symptoms and side effects. Define: Anergia, Affect, Anhedonia, Apathy, Associative looseness, Ambivalence, Anosognosia and Avolition. (Avolition is usually not always discussed but you need to know the definition). Is therapy beneficial?
Symptoms AAAAAAAAA Schizophrenia uses a lot of "A" words to describe symptoms and side effects. >Anergia: deficiency in energy >Affect: what WE see...behavior associate with pt feelings, emotions (flat/blunted) >Anhedonia: lack of pleasure >Apathy: indifference, disinterest in environment >Associative looseness: ideas shift from one unrelated subject to another >Ambivalence: refers to the coexistence of opposite emotions toward the same object, person, or situation. >Anosognosia: lack of being aware of there being any illness/disorder even when symptoms appear obvious to others (they don't know it/realize it) -Severe deterioration of social and occupational functioning
It is considered an important screening tool to assist with early detection of movement disorders and encourage surveillance.
The Abnormal Involuntary Movement Scale (AIMS)
Which medication is incorrectly paired with its side effect? Lithium-hypothyroidism Oxcarbazepine-Agranulocytosis Valproate-Hepatic necrosis Lamotrigine-Steven-Johnson syndrome
The drug most associated with agranulocytosis would be clozapine (Clozaril).
This population is at risk for stroke and sudden death while taking this type of medication.
The elderly who take antipsychotics
Tangentiality
The inability to get to the point of a story. The speaker introduces many unrelated topics, until the original topic of discussion is lost
This therapeutic range is critical for patients on Lithium (maintenance).
The therapeutic range for maintenance for patients on lithium is 0.6-1.2 mEq/L
What is the dopamine hypothesis?
This theory that suggests schizophrenia (or symptoms like schizophrenia) may be caused by an excess of dopamine-dependent neuronal activity in the brain. This excess activity may be related to increased production or release of the substance at nerve terminals, increased receptor sensitivity, too many dopamine receptors, or a combination of these mechanisms. Pharmacological support exists for this hypothesis: -Amphetamines (increase levels of dopamine; psychotomimetic symptoms) -Antipsychotics (such as Chlorpromazine or haloperidol, lower levels of dopamine and reducing schizophrenic symptoms) >>Positive symptoms of schizophrenia (delusions and hallucinations) may be related to increased numbers of dopamine receptors in the brain and respond to antipsychotic drugs that block these receptors.
This medication may required weekly blood levels and a weekly supply of the medication (refer to Chapter 15).
clozapine (Clozaril) {antipsychotic; can treat schizophrenia} >> pts on this need blood levels drawn because of the risk for agranulocytosis. *agranulocytosis is* a potentially fatal blood disorder in which the client's white blood cell (WBC) count can drop to extremely low levels. A baseline WBC count and absolute neutophil count (ANC) MUST be taken before initiation of treatment with this med and weekly for the first 6 months of treatment. >> pts are only given a one week supply at a time in order to help maintain the WBC count. if WBC counts are maintained with in the normal levels ( at least 3,500 mm3 and ANC at least 2,000/mm3) for the first 6 months, then the blood counts can be monitored biweekly and a 2 week supply of the medication may then be dispensed.
What are the hormonal side effects of antipsychotics and why do they occur?
decreased libido, retrograde ejaculation, gynecomastia (increase in prolactin levels), amenorrhea
Mutism
does not speak (either cannot or will not)
what can you do if you are having problems communicating with someone who has schizophrenia?
give them a piece of paper to write on ! sometimes thats easier for them to communicate with !
Circumstantiality
in speaking, the delay of an individual to reach the point of a communication, owing to unnecessary and tedious details
echotaxia
movement identification/ mimicking
Akinesia
muscular weakness
part of the nurse's continual assessment of the client taking antipsychotic medications is to observe for EPS. what are 3 examples?
muscular weakness, rigidity, tremors, facial spasms
Neologisms
new words that an individual invents that are meaningless to others, but have symbolic meaning to the psychotic person
How do atypical antipsychotics work?
partial dopamine block (lower probability of EPS)
Preservation
persistently repeating the last word of a sentence spoken to the client (EX. nurse: "george, it's time to go to lunch." George: "lunch, lunch, lunch, lunch, lunch")
Echolalia
persistently repeating what another person says
Neuroleptic Malignant Syndrome (NMS). FYI: A video to assist with NMS
rare but potentially fatal side effect...high BP, very hot, delusional, tachycardia, muscle rigidity, sweating --Compare and contrast Serotonin Syndrome and Neuroleptic Malignant Syndrome. -serotonin shivers (shivers, hyperreflexia, increased temp, unstable vitals, encephalopathy, restlessness, sweating) >> caused by tooooooo much serotonin -NMS is side effect & has muscle rigidity and high BP (as opposed to unstable) *-difference is what type of med causes it!!! Present similarly....* *CAUSE:* Neuroleptic malignant syndrome (NMS) is a severe disorder caused by an adverse reaction to medications with dopamine receptor-antagonist properties or the rapid withdrawal of dopaminergic medications.
akathisia
restlessness
Associative looseness
sometimes called loose associations, a thinking process characterized by speech in which ideas shift from one unrelated subject to another. The individual is unaware that the topics are unconnected
Clang associations
speaking in puns or rhymes; using words that sound alike by have different meanings
poverty of speech
speaks very little; may respond in monosyllable labels
Echolilia
speech identification/ mimicking
Concrete thinking
thinking is literal; elemental. Absence of ability to think abstractly, unable to translate simple proverbs
How do typical antipsychotics work?
total dopamine block (high probability of causing EPS)
signs of anticholenergic toxicity
urinary retention, tachycardia, tremulousness, or hypertension