Mental Health Week 2
Course of Schizophrenia
- Continuous without temporary improvement - Episodic with progressive or stable deficit - Episodic with complete or incomplete remission
Serious Mental Illness (SMI)
-difficulty with a wide range of functions -at risk for multiple physical, emotional, and social problems
temporal lobe function
-language comprehension -stores sounds into memory -allows expression of emotions
pt has symptoms of fever, muscle rigidity, and confusion what will you suspect is happening as the nurse?
-neuroleptic malignant syndrome (NMS)
frontal lobe function
-planning -decision making -insight -motivation -social judgement -voluntary motor ability starts here
disorganized behavior
-positive sign -decline is overall daily function -unpredictable and inappropriate emotions -lack of impulse control
parietal lobe
-receives and identifies sensory information -concept formation -body awareness -reading, math -right and left orientation
Other side effects of antipsychotics
-sedation -orthostatic hypotension -weight gain -photosensitivity -hormonal effects (sexual dysfunction) -seizures -extrapyramidal symptoms (EPS) -neuroleptic malignant syndrome (NMS) -blocks activity of dopamine receptors -reduces positive symptoms -tardive dyskinesia -anticholinergic effects (dries up) -serotonin syndrome (diarrhea)
Boundaries violations
-self disclosure (discussion personal info) -dual relationships (friend/family relationship) -becoming friends (seeing client outside of hospital) -physical contact (hugs, kisses, holding hands) -gift giving (do not accept money) -sexual contact *Don't reveal personal information to psych pt, no physical contact, don't see them outside of the hospital (Report to nurse supervisor if you see this)
Stages of Schizophrenia
1. Prodromal phase: impaired function before onset of active psychotic phase 2. Active/Acute phase: delusions, hallucinations, disorganized speech, disorganized behavior and negative symptoms such as flat affect (no expressions), avolition (lack of motivation), alogia (lack of conversation) ^^(these s/s must be present for a least 1 month) 3. Residual: functional impairment, abnormalities of affect, cognition, communication
Schizophrenia, how many die by suicide? %?
10%
These are the first line tx due to lower EPS risks
2nd gen antipsychotic drugs -these block serotonin and dopamine -target both - and + s/s -SE: hyperglycemia, wt gain, dizziness, sedation, sleep disruption
Mental Health Team checks on pt how many days a week?
7
jealously delusion
A person with this type of delusional disorder believes that his or her spouse or sexual partner is unfaithful.
Anger vs. Aggression
Anger is a feeling Aggression is a behavior or action
3rd Gen antipsychotic drug
Aripiprazole -lower metabolic effects than 2nd gen -hypotension MOA: decreases dopamine SE: insomnia, akathisia (can't sit still)
Anticholinergics are used for what in pts w/ psychotic disorders
Benztropine and Diphenhydramine ^^ (can be given as an IM injection) -treat side effects -treat EPS
Examples of disorganized behavior
Catatonia (unable to move) Motor retardation (slow down of thought and movement) Motor agitation (movements that serve no purpose) Waxy flexibility (patient's limbs retain any position into which they are manipulated by another person) Echopraxia (imitation of the movements of another person) Negativism (negative thoughts) Stupor (near-unconsciousness) Impaired impulse control Gesturing or posturing (sitting odd or bizarre postures) Boundary impairment (impaired ability to sense where ones body or influence)
1st generation schizophrenia tx drugs
Chlorpromazine (Thorazine) (Strong like THORazine) monitor RR on this med because it can make it very low Haloperidol (Haldol)
This antipsychotic the pt needs to have weekly blood draws first 6 months due to risk of agranulocytosis (need WBC @ 5-10K)
Clozapine *Have to taper off, if ATI asks tho we want to discontinue this med if WBC are low^^^ *If pt gets flu like symptoms on this meds, they need to tell us since we stop doing blood draw after 6 months, they might be getting agranulocytosis
2nd gen antipsychotics
Clozapine (last resort drug) Risperidone Olanzapine Ziprasidone Asenapine (dissolves in mouth, absorbs fast) Paliperidone
FEVER mnemonic for neuroleptic malignant syndrome (NMS)
F: Fever E: encephalopathy V: vital sign E: elevated blood enzyme levels R: muscle rigidity
Delusion of control:
False belief that another person, group of people, or external force controls one's general thoughts, feelings, impulses, or behaviors.
Serotonin, what happens when this is high/low?
Low: Depression High: Anxiety -plays a role in sleep, hunger, mood, pain -hormonal activity -aggression and sexual behavior
Dopamine, what happens when this is high/low?
Low: Depression, Parkinson's Disease High: Schizophrenia, Mania -involved in fine muscle movement -integration of emotions and thoughts -decision making -stimulates the release of hormones (sex, thyroid, adrenal)
This antipsychotic med lowers BP, over time pt will gain weight "Obese starts with O"
Olanzapine
This is the 2nd gen go to tx for schizophrenia
Paliperidone
We use this antidepressant for pts with psychotic disorders
Paroxetine
This can happen when they body becomes tolerant to meds
Relapse
Tardive Dyskinesia:
SE of antipsychotic meds, weird movements and the pt is unaware
These 2 defense mechanisms are always healthy
Sublimation and Altruism
Deutetrabenazine and Valbenazine treat/prevent what?
Tardive Dyskinesia
We don't want to remove restraints all at the same time T/F?
True
Need baseline EKG before giving this antipsychotic med because it can cause QT prolongation
Ziprasidone
Thought withdrawal delusion
a delusion that occurs when a person believes that a person or entity has removed thoughts from his or her mind.
neuroleptic malignant syndrome
a life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) agents and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia
negative symptoms of schizophrenia
absence of appropriate behaviors these are more difficult to treat than positive symptoms
3 phases of tx for schizophrenia
acute phase, stabilization, maintenance phase *Most pts experience improvement with antipsychotic meds
What is the best first response by the nurse to a agitated pt who threatens to assault the staff?
address pt with simple directions and a calming voice
pharmocogenetics
an individuals response to therapeutics based on genetics makeup -pt who metabolizes drug poorly, will have increased adverse reactions -pt who metabolizes drug extensively may have a less therapeutic response to tx
Delusions of persecution
believes people want to kill them
Pharmacodynamics
biochemical and physiological effects of drugs on the body -MOA and its effects
sign of disorganized speech Word Salad:
confused or unintelligible mixture of seemingly random words and phrases
Pt says he can receive radio waves from aliens because they put a computer chip in his brain is this a hallucinations or delusion?
delusion
Religiosity delusion
delusion where pt believe they are religious entity
Ideas of reference-
delusion where pt thinks someone is laughing at them anytime someone laughs
cognitive symptoms of schizophrenia
disordered thinking ambivalence poor problem solving difficulty concentrating memory deficit (long term memory, working memory such as inability to follow directions)
sign of disorganized speech - Circumstantiality:
disturbed pattern of speech or writing characterized by delay in getting to the point because of the interpolation of unnecessary details and irrelevant remarks
cognitive enhancement therapy (CET)
evidenced based practice designed to help people with schizophrenia and related cognitive disorders improved brain and cognitive development, social cognition, and increase vocational capabilities
somatic delusion
false belief that a person's internal or external bodily functions are abnormal ex: they think a worm is in their belly
Warning signs of violations
favoring client staying late to speak with client sharing personal info swapping assignments dressing for client receiving gifts
Examples of negative symptoms in schizophrenia
flat affect (no expressions) avolition (lack of motivation) alogia (lack of conversation) anergia (chronic state of lethargy and low energy) anhedonia (inability to experience pleasant emotions) ambivalence (mixed feelings)
cognitive-behavioral therapy (CBT)
help pt understand their own thoughts and feelings and how these influence their own behavior
Thought insertion delusion
in schizophrenia involves somehow experiencing one's own thoughts as someone else's.
sign of disorganized speech Mutism:
inability or unwillingness to speak
Magical thinking delusion
is the belief that one's own thoughts, wishes, or desires can influence the external world
sign of disorganized speech - Loose associations:
jump from one idea to another, with increasingly more fragmented connections between the thoughts.
We use these anxiety meds for pts with psychotic disorders
lorazepam clonazepam (these also treat some - and + disorders)
Echolalia
meaningless repetition of another person's spoken words as a symptom of psychiatric disorder common with kids that have schizophrenia
Pharmocokinetics
movement of drugs within the body absorption, distribution, metabolism, excretion
transinstitutionalization
movement of people with severe mental illness from large psychiatric hospitals to smaller group residences usually due to community care policies and they end up in a different institution vs their own home
Neologisms: sign of disorganized speech
new word or phrase of the patient's own making often seen in schizophrenia (for example, headshoe to mean hat), or an existing word used in a new sense;
Thought broadcasting delusion
patient has the experience that his or her thoughts are being broadcast aloud so that people around can hear the thoughts.
sign of disorganized speech Thought Blocking:
person stops speaking suddenly and without explanation in the middle of a sentence.
sign of disorganized speech - perseveration:
repetition of a particular response (such as a word, phrase, or gesture) regardless of the absence or cessation of a stimulus.
What is always the first nursing intervention?
self awareness then: -establish trusting relationship -therapeutic communication -encourage medication compliance -encourage development of social skills -don't argue or challenger hallucination -provide safety -protect from harm -avoid physical contact (risk of them hitting you)
hallucinations
sounds or other sensations experienced as real when they exist only in the person's mind -positive symptom of schizophrenia -can involve any of the 5 senses (auditory is the most common, along with visual) -auditory is usually when the pt sees their own self talk as coming from an outside source
sign of disorganized speech - Clanging:
speech pattern where people put words together because of how they sound instead of what they mean.
Nihilistic (delusion)
the belief that oneself, a part of one's body, or the real world does not exist or has been destroyed.
Ideas of influence (delusion)
the false belief that one's intentions or actions directly control external events or the thoughts and behavior of other people.
Tactile Hallucination:
the feeling of touch or movement ex: bugs crawling on you
Delusions of grandeur -
they are all powerful
Erotomania
type of delusion where pt believes people love them or want to have sex with them
Schizophrenia
usually results from a complex interaction between genetic and environmental factors including: - genetic causes - environmental causes -abnormal brain structure *often manifests right at time of transition from adolescence to adulthood *these pts display the highest rate of genetic mutation that affect their CNS affecting neuron communication
Assertive Community Treatment (ACT)
utilizes evidence-based practice that improves outcomes for people with severe mental illness who are most at-risk of psychiatric crisis and hospitalization and involvement in the criminal justice system.
Delusions
very common symptoms in Schizophrenia pt (90%) and involve illogical or bizarre ideas or fantasies
Occipital lobe:
vision and language formation ex: trauma on back of head, vision changes and hallucinations might occur
Social Skills Training (SST)
works well for kids with autism or schizophrenia ex: kids playing with other kids, learning social cues
pt with schizophrenia is OK to work?
yes, they might be limited on tasks they can do