N370 Mental Health Schizophrenia

What are some advantages of second-generation antipsychotics?

- Treats both positive and negative symptoms - minimal or no extrapyramidal effects (EPS) side effects are tardive dyskinesia * usually if you see a pt. on first-gen antipsychotics, its because they failed the 2nd generation ones because the 2nd gen has way higher efficacy*

What is psychosis?

- altered cognition - altered perception - impaired ability to determine what is or is not real; break with reality

examples of negative symptoms

- anhedonia - avolition - associality - affective blunting - apathy - alogia

What is the difference in duration between brief psychotic disorder and schizophreniform disorder?

- brief psychotic disorder must last longer than 1 day, but no longer than 1 month - schizophreniform disorder lasts less than 6 months

What does this mean: "a rolling stone gathers no moss"

- concrete thinking: when a stone is rolling down a hill, moss can't grow on it (concrete thinking is an inability to think abstractly which is a symptoms of schizophrenia) - hidden meaning: you have to stay in one place to grow (the moss in the story represents a family, mortgage, life etc.)

third generation antipsychotics

- may improve positive and negative symptoms, AND cognitive function (little risk for EPS or tardive dyskinesia) A newer classification of antipsychotics includes Aripiprazole (Abilify), Brexpiprazole (Rexulti), and Cariprazine (Vraylar) *notice ABC* - a unique antipsychotic known for dopamine system stabilization. increases dopamine in parts of the brain where its too low, and decreases in parts of brain where its too high)

What is the difference in duration between and schizophreniform disorder and schizophrenia?

- schizophreniform disorder lasts less than 6 months - Schizophrenia disorder is continuous disturbance for at LEAST 6 months (ruled out: substance or other disorders)

Comorbities in Schizophrenia

- substance abuse disorders (nicotine dependence ➡ usually gateway drug) - anxiety, depression, and suicide (usually during brief moments of lucidity) - physical illness - polydipsia

What is schizoaffective disorder?

- the umbrella term for all schizophrenic related disorders (ex: brief delusional psychosis and schizophreniform are TYPED of schizoaffective disorders) Symptoms: - Major depressive - manic, or mixed episode, - concurrent with symptoms that meet the criteria for schizophrenia (The patient's disorder meets both the criteria for schizophrenia and depressive or bipolar disorder) - NOT caused by any substance use or general medical condition

examples of cognitive symptoms (5)

1. concrete thinking 2. Impaired memory 3. Impaired information processing 4. Impaired executive functioning 5. Anosognosia

What are the disadvantages of first generation antipsychotics?

1. extrapyramidal effects (EPS) 2. anticholinergic side effects (dry mouth, thirsty) 3. tardive dyskinesia 4. weight gain, sexual dysfunction, endocrine disturbances

___________ is a particularly disturbing symptom that directs the person to take an action.

A command hallucination

Eric becomes anxious and says, "There are worms under my skin eating the hair follicles." How would you classify this assessment finding? A.Positive symptom B.Negative symptom C.Cognitive symptom D.Depressive symptom

ANS: A Positive symptoms: The presence of something that should not be present. Positive symptoms include hallucinations, delusions, paranoia, or disorganized or bizarre thought, behavior or speech. These symptoms usually appear early. Negative symptoms: The absence of something that should be present. Negative symptoms include the ability to enjoy activities, social comfort, or goal-directed behavior. Cognitive symptoms: Subtle or obvious impairment in memory, attention, thinking (e.g., disorganized or irrational thoughts), judgment or problem solving. Affective symptoms: Symptoms involving emotions and their expression.

The nurse is in the psychiatric unit. Which of the following should the nurse see first? A. A patient diagnosed with schizophrenia that is on Abilify, who has a WBC of 1,200. B. A patient who has white pockets in his mouth C. A patient who woke up hearing a new voice in their head that was not previously there D. A patient who has a flat affect and is quieter than normal today

ANS: B. A patient who has white pockets in his mouth - This is an unexpected finding and indicates infection (yeast or thrush maybe) which is something you have to really monitor for pts. on antipsychotics who are already immunocompromised A: A low WBC is an expected abnormal - You would EXPECT the WBC to be low, because the antipsychotic medications cause neutropenia, which is why you would be worried about infection with this patient.

During assessment, Eric has trouble staying on topic, zipping rapidly from one thought to the next, making it hard to follow what he's trying to say. Which speech disturbance is he exhibiting? A.Pressured speech B.Circumstantiality C.Flight of ideas D.Tangentiality

ANS: C Flight of ideas: Moving rapidly from one thought to the next, often making it difficult for others to follow the conversation. Pressured speech: Urgent or intense and resists comments from others. Circumstantiality: Including unnecessary and often tedious details in conversation, but eventually reaching the point. (person goes o Tangentiality: Wandering off topic or going off on tangents and never reaching the point.

Given the evidence we have so far, if Eric has schizophrenia, which is suspected, which phase is he most likely experiencing? A.Acute B.Residual C.Prodromal D.Stabilization

ANS: C The prodromal stage is characterized by mild changes in thinking, reality testing, and mood, insufficient to meet the diagnostic criteria for schizophrenia. Symptoms appear a month to more than a year before the first full-blown episode of the illness. During this phase speech and thought may be odd or eccentric. Anxiety, obsessive thoughts, and compulsive behaviors may be present. Deterioration in concentration, school- or job-performance, and social functioning are accompanied by distressing thoughts, suspiciousness, memory impairment, and significant disorganization in speech or behavior. The person may feel that they are "not right" or that "something strange" is happening.

Reduced or constricted (flat) affect.

Affective blunting

Reduction in speech, sometimes called poverty of speech.

Alogia

A reduced ability or inability to experience pleasure in everyday life.

Anhedonia

Inability to realize one is ill, caused by the illness itself

Anosognosia - ex: inability to realize you have schizophrenia

Eric's roommate says his speech "... doesn't connect; it doesn't make any sense. He sort of gets derailed." Which of the following symptoms is Eric displaying? A. Avolitional speech B. Delusional speech C. Disorganized speech D.Diminished emotional expression

Answer: C Disorganized speech - disorganized speech is characterized by frequent derailment or incoherence. It is not necessarily always a "negative" symptom (that is, characterized by diminished emotional expression or avolition); nor is it necessarily delusional - Avolition is a total lack of motivation that makes it hard to get anything done. You can't start or finish even simple, everyday tasks.

A decreased interest in, or attention to, activities or beliefs that would otherwise be interesting or important.

Apathy

Decreased desire for, or comfort during, social interaction.

Asociality

Loss of motivation; difficulty beginning and sustaining goal- directed activities reduction in motivation or goal-directed behavior.

Avolition - a slacker to the extreme

The nurse asks the patient about their hallucinations. The patient says "the voices are telling me to send special bombs through the mail that no one can trace". What type of hallucination is this? A. Auditory hallucinations B. Command hallucinations C. Tactile hallucinations D. Visual hallucinations

B. Command hallucinations

Odd, illogical, inappropriate, or unfounded; includes grimacing

Bizarre affect

Reduced or minimal emotional response

Blunted affect - Emotionless

_______ is an impaired ability to sense where one's body or influence ends and another's begins

Boundary impairment

The following patients are experiencing schizophrenic symptoms and are being examined for psychiatric disorders. Which of the following pts. can be considered for schizophrenia spectrum disorder? A. A patient that does mushrooms on the weekends B. A patient that was extremely drunk precipitating the onset of symptoms C. An 18 year old that has no medical conditions and does not drink or do drugs D. A patient who missed their hemodialysis

C. An 18 year old that has no medical conditions and does not drink or do drugs - a pt. with schizophrenia spectrum disorder can not have problems with substance use or medical conditions

_______ is a state of not moving

Catatonia

what is the the term that describes: Including unnecessary and often tedious details in conversation, but eventually reaching the point.

Circumstantiality - ex: you ask a pt. why they didnt take their medicine and the say "well i went to the bathroom and washed my hands for 30 seconds and slowly got some coffee and..." (rambles on until getting to the point)

what is the the term that describes: Generalized slowing of thinking, which is represented by delays in responding to questions or difficulty finishing thoughts.

Cognitive retardation - slow speech (could be from the meds they're on)

Impaired ability to think abstractly, resulting in interpreting or perceiving things in a literal manner. Difficulty responding to concepts like love or humor

Concrete thinking ex: a rolling stone gathers no moss does not mean that moss cant grow if the rock is moving (literal/concrete interpretation), it means in order to grow you have to plant yourself and stay in one spot

Reduced in range or intensity, e.g., shows sadness or anger but no other moods

Constricted affect - acting one way all of the time

_________ is a feeling of being unreal or having lost identity. Body parts do not belong or the body has drastically changed.

Depersonalization - ex: "Someone replaced my arm with someone else's arm. This is not my arm"

What is one example of an affective symptom, that may herald impending relapse, increased substance abuse, increased risk for suicide, and further impairs functioning?

Depression - assessment for depression is crucial - Depression may occur as part of a shared inflammatory reaction affecting the brain, or it may simply be a reaction to the stress and despair that can come from living with a chronic illness.

________ is a feeling that the environment has changed.

Derealization - "this is not the world I grew up in"

______ is the mimicking of movements of another

Echopraxia

What generation of antipsychotics would cause anticholinergic toxicity?

First generation because thats the only one with anticholinergic effects

which type of antipsychotics are the following examples: - dopamine (D2 receptor) antagonists - haloperidol [Haldol] - chlorpromazine [Thorazine[)

First-generation

Immobile or blank facial expression

Flat affect - has to do with facial expression (different from blunted because blunted has to do with being emotionless)

what is the the term that describes: Moving rapidly from one thought to the next, often making it difficult for others to follow the conversation.

Flight of ideas - there is no point to what they're saying, they just jump from topic to topic

______ is assuming unusual and illogical expressions (often grimaces), posture or positions

Gesturing or posturing

___________ involve perceiving a sensory experience for which no external stimulus exists.

Hallucinations

________ are misperceptions or misinterpretations of a real experience.

Illusions

Includes difficulty with reasoning, setting priorities, comparing options, placing things in logical order or groups, anticipation and planning, and inhibiting undesirable impulses or actions.

Impaired executive functioning

Delayed responses, misperceptions, or difficulty understanding others; may lose the ability to screen out insignificant stimuli

Impaired information processing

Impacts short-term memory and the ability to learn

Impaired memory

Incongruent with the actual emotional state or situation (e.g., laughing in response to a tragedy)

Inappropriate affect - randomly bursts out into laughter for no reason

Believing that thoughts or actions affect others' consequences.

Magical thinking - the belief that you have magical powers (ex: "I put a curse on that nurse and she's going to trip and get hurt tonight")

What are the names of the phases of Schizophrenia?

P.A.S.M P.rodromal A.ctive S.tabilization M.aintanence or Residual

An irrational fear, ranging from mild (wary, guarded) to profound (believing irrationally that another person intends to kill you).

Paranoia

what is the the term that describes: Urgent or intense speech and resists comments from others (sounds like an auctioneer)

Pressured speech

How would you find out if the voices are giving them command hallucinations? What kind of questions would you ask?

Questions to ask include: 1. Do you recognize the voices? 2. Do you believe the voices are real? 3. Do you plan to follow the command?

Anticholinergic toxicity includes what major symptoms?

Reduced or absent peristalsis (can lead to bowel obstruction); urinary retention

which type of antipsychotics are the following examples: - Serotonin (5-HT2A receptor) & dopamine (D2 receptor) - antagonists: clozapine (Clozaril) and risperidone (Risperdal).

Second-generation ("atypical")

_________ is the repetitive behaviors that do not serve a logical purpose

Stereotyped behaviors

Cognitive symptoms

Subtle or obvious impairment in memory, attention, thinking (e.g., disorganized or irrational thoughts); impaired executive functioning (e.g. impaired judgment, impulse control, prioritization, and problem solving).

How can a patient taking antipsychotic drugs be at risk for neuroleptic malignant syndrome(NMS)?

Suddenly stopping or overdosing medications - Antipsychotics NEED to be slowly stopped

what is the term that describes: Using symbols instead of direct communication. For example, a patient reports "demons are sticking needles in me" when what he means is that he is experiencing a sharp pain (symbolized by "needles").

Symbolic speech

what is the the term that describes: Wandering off topic or going off on tangents and never reaching the point.

Tangentiality - same thing as going on a tangent; keep going off-track (never really get back on-track)

Describe the prodromal phase of schizophrenia

The "pre-stage" before symptoms intensify Before the acute symptoms of schizophrenia occur, people may experience mild changes in thinking, reality testing, and mood. Speech and thoughts may be odd and anxiety (impending doom), obsessive thoughts and compulsive behaviors may present. Concentration, school or job performance, and social functioning can deterioroate. The person may feel that she is "not right" or that "something strange" is happening. - Symptoms typically appear 1-12 months before first full episode of schizophrenia

Negative symptoms

The absence of qualities that should be present. Negative symptoms include the inability to enjoy activities (anhedonia), social discomfort, or lack of goal-directed behavior. - not exhibiting things that are a part of normal behavior

referential themes

This refers to the belief that something like a poster, song, or advertisement has a direct reference to or a hidden meaning for you. A person with this delusion may see a sign that has nothing to do with them, but change their whole life plan as a result.

A reduction or stoppage of thought. Interruption of thought by hallucinations can cause this.

Thought blocking - a pt. could be acting totally normal when they suddenly stop in the middle of a sentence and get distracted by "the voices" or hallucinations

A belief that thoughts have been taken or are missing.

Thought deletion - believe people are taking your thoughts out of you (ex: "that girl took my idea from my memory and is keeping it from me!")

The uncomfortable belief that someone else has inserted thoughts into their brains.

Thought insertion - belief that people are inserting thoughts in your head (ex: "that girl told me in my head that I should kill myself")

what symptoms do you need for schizophrenia according to the DSM-V? How long do you need them?

Two or more of the following for a significant portion of time in 1 month: Positive symtoms: 1. delusions 2. hallucinations Negative symptoms: (diminished emotional expression or avolition - things that should be there, that aren't) 3. Disorganized speech (frequent derailment or incoherence) 4. gross disorganization 6. Functional impairment of some kind - can't do everyday things like pay the bills, remember to eat etc. *Avolition is a total lack of motivation that makes it hard to get anything done. You can't start or finish even simple, everyday tasks.*

what is the the term that describes: word salad - most extreme form; jumble of words meaningless to a listener

associative looseness (flight of ideas)

What disease displayed in childhood is similar to schizophrenia, given that that schizophrenia does not generally occur in young children?

autism

how can you tell the difference between autism and schizophrenia in children?

autism does not have halluncinations or delusions

persecutory delusions

beliefs of being targeted by others - feeling like everyone is against you - victim mind set

What are you going to do if a pt. starts exhibiting neuroleptic malignant syndrome (NMS)?

call 911 or transfer to the ER - This is a medical emergency (no longer a psychiatric issue) pt. needs to be stabilized - Provider might tell you to give Bromocriptine (Parlodel) and Dantrolene (Dantrium, Ryanodex) can relieve muscle rigidity and reduce the heat (fever) generated by muscle contractions.

Second-generation antipsychotics treat positive symptoms and can also help _____________

can also help negative symptoms.

what is the the term that describes: words chosen based on sound

clang association

what describes a disorder characterized by false thoughts or beliefs that have lasted 1 month or longer?

delusional disorder - includes gradiose, persecutory, somatic, and referential themes - are not severe enough to impair functioning

what is the the term that describes: pathological repetition of another's words (mimicking)

echolalia

When a nurse describes a patient as blunt, what does he/she mean?

flat affect, not much emotion being displayed verbally or in manner

disorganized speech

frequent derailment or incoherence

somatic delusions

his definition: believes that his body is changing in an unusual way, such as growing a third arm - Like a hypochondriac

Gradiose delusions

individuals are convinced they have special powers, talents, or abilities, or may believe they are a famous person

shizophreniform disorder

meets criteria for schizophrenia but has lasted less than 6 months

excited behavior such as running or pacing rapidly, often in response to internal or external stimuli

motor agitation

slowing of movement

motor retardation

How long does a person have to be exhibiting symptoms to be classify as brief psychotic disorder?

must last longer than 1 day, but no longer than 1 month, with the expectation of a return to normal functioning - most return to normal function

what is the the term that describes: words/language has meaning only to the patient (like a made-up language)

neologisms

First-generation antipsychotics primarily work by doing what?

reducing positive symptoms (e.g., hallucinations and delusions) but have little effect on negative symptoms.

repeated motor behaviors that do not serve a logical purpose

stereotyped behaviors - repetitive nonsensical behavior or purpose

what two things should always be ruled out before a primary diagnosis of schizophrenia spectrum disorder is made?

substance use and medical conditions

what are the behaviors exhibited by brief psychotic disorder?

sudden onset of at least one of the following (more than a day but no longer than a month): - Delusions, hallucinations, disorganized speech, and disorganized or catatonic behavior

The most important thing to know about the affective disorder of depression, is that it puts people at increased risk for __________.

suicide

Affective symptoms

symptoms involving emotions and their expression - cant express anything, blunt, no emotion or facial affect

positive symptoms

symptoms that are present that should not be there - Positive symptoms include hallucinations, delusions, paranoia, or disorganized or bizarre thoughts, behavior, or speech.

What are the disadvantages to second-generation antipsychotic drugs?

tendency to cause significant weight gain; risk of metabolic syndrome *Metabolic syndrome—includes weight gain (especially in the abdominal area), dyslipidemia, increased blood glucose, and insulin resistance*

feature of catatonic schizophrenia in which people rigidly maintain the body position or posture in which they are placed by others

waxy flexibility

Risk factors for schizophrenia (isnt going to test a lot on this but good to know)

•Biological factors (Genetics ➡ usually runs in families) •Neurobiological •Glutamate, dopamine, and serotonin •Acetylcholine •Brain structure abnormalities •Prenatal stressors •Environmental factors •Prognostic variables

What are some symptoms of neuroleptic malignant syndrome (NMS)?

•Severe muscle rigidity, dysphasia •Flexor-extensor posturing •Reduced or absent speech and movement •Decreased responsiveness. •Hyperpyrexia: temperature over 103°F •Autonomic dysfunction: hypertension, tachycardia, diaphoresis, incontinence Delirium, stupor, coma