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68 Cards in this Set
- Front
- Back
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Neurobiological and brain abnormalities: |
Distributions in the pathways of the brain is schizophrenia are thought to be severe. It is possible that structural abnormalities cause such disruptions |
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Structural brain abnormalities: |
Enlargement of the lateral cerebral ventricles, third ventricle dialation or ventricular asymmetry. Reduction in the cortical, frontal lobe, hippocampal or cerebella’s volumes. Reduced cortical thickness and reduced connectivity in various brain regions. Increased dopamine activity in the Mesolithic system. |
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Phase 1 of schizophrenia |
Acute Onset or exacerbation of symptoms * disorganization |
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Phase 2 schizophrenia |
Stabilization *symptoms diminishing - meds by riese hearing *movement towards previous level of functioning. Back to baseline |
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Phase 3 Schozophrenia |
Maintenance after discharge, stay on meds and follow up appointments. *at or near baseline functioning. |
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Psychotic person in ER could mean? |
Establish trust and rapport and then asses to Rule out medical/physical Meth, hypoglycemia, head injury or anxiety. PTSD |
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Psychotic person in ER could mean? |
Establish trust and rapport and then asses to Rule out medical/physical Meth, hypoglycemia, head injury or anxiety. PTSD |
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Schizophrenia onset stage: |
Late teens early 20s |
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Psychotic person in ER could mean? |
Establish trust and rapport and then asses to Rule out medical/physical Meth, hypoglycemia, head injury or anxiety. PTSD |
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Schizophrenia onset stage: |
Late teens early 20s |
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What is schizophrenia? |
Biological disease/dosorder. Brain circuitry and could be caused by too much dopamine |
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SOLER -active listening |
Square up, Opened up, Listening leaning in, eye contact, relax and breathe |
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Biological factors: |
Genetic |
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Neurological: |
Too much dopamine causing positive symptoms like: hallucinations, delusions, |
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Prodromal S/S |
Early onset, disorganized speech, eccentric behavior (bizzarre, odd, unusual) deterioration in concentration. |
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Positive symptoms: |
Delusion, hallucination, grandiose, persecutory, referential(tv talking to me), somatic(organs Inside not there), jealous, nihilistic (lack of hope), erotomanic, mixed |
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The weather man told me a message thru the tv… |
Referential |
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“My significant other has been dating other people so I’ve been watching the account and the odometer” |
Jealous dellusion |
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Pt repeating words… |
Eccholalia |
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Pt saying jumble of words you can’t understand |
Word sala |
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Pt rhyming…. |
Clang associations |
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Pt making up words. Hands turning burkle or a whatchamakalit |
Neologism |
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If you can’t understand what the pt says… what do you say? |
I’m sorry can you please repeat that? |
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I know you can hear my thoughts: |
Thought broadcasting |
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A mental block causing hesitation. Can’t finish thought or sentence |
Blocking |
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Pt says the don’t exist and is nobody and nobody is them |
Depersonalization: loss of identity |
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This room looks a lot larger than normal |
Derealization: a dream like stage changing the environment. |
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A pt is schizoaffective: expretiencing derealixation= |
I feel like I’m in a dream |
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Positive symptom |
Added on. A normal person and add symptoms not normally present. |
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Negative symptom |
The A words. Lacking something. Diminished. Anhedonia: lack of pleasure Avolition: lack of motivation Anergia: lack of energy Alogia: lack of speech Affect: lack of mood |
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First Gen antipsychotics: |
1st: Thorazine/ chloripromazine Dopamine antagonist, most affordable. Target positive symptoms. Palm Springs |
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The patient that is on haloperidol: |
This is a high potency medication and you would expect to see high incedence of EPS, low sedation and - incidence of anticolinérgico effect. |
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The patient that is on haloperidol: |
This is a high potency medication and you would expect to see high incedence of EPS, low sedation and - incidence of anticolinérgico effect. |
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Pts taking Thorazine/ chloripromazine |
This is a low potency medication and you would expect to see - incedence of EPS, high sedation and high incidence of anticolinérgico effect. |
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What do you see with muscle dystonia? |
Lick jaw, stiffness, torticolis, tight muscles. Arching back |
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What do we give for EPS? |
Anecdote: A: artane/hexaphinodile or B:benedryl/ or Cogentine IM only. |
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What do we give for EPS? |
Anecdote: A: artane/hexaphinodile or B:benedryl/ or Cogentine IM only. |
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Pt on first Gen medications starts being irritable and agitated passing around. |
Acathesia: occurs in 3-4 weeks. Can’t stay still, toe tapping, rocking, swaying Reversible |
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What reverses effects of acastesia. |
A or B or C |
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Psudoparkinsonism |
Slow movement, Brady kinesia, pull rolling, shuffling gate, tremors, fall risk. Revirseible symptom |
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Tardivediskonesia |
Excessive blinking, facial grimacing, lip smacking. You fue. Rocking of hips, twisting, thrusting Irreversible |
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First Gen high potent medications are: |
haloperidol, fluphenazine, thiothixene,loxapine. High EPS, low sedation, low anticholinergic effect |
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Second Gen antipsychotics: |
Treat positive and negative symptoms. Weight gain. Less EPS. |
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Second Gen antipsychotics: |
Treat positive and negative symptoms. Weight gain. Less EPS. |
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Metabolic syndome |
Lipids, hypertension, weight, diabetes (sugar) |
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Which are second Gen medications? |
Clozapine, Olanzapine, quetiapine, risperidone, ziprasidone |
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Hyperprolactemia |
Breast tenderness. Depression in men’s. |
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Chlozapine |
Strongest. Paralytic illeus. Risk for seizures, weight gain, sedation and hyper salivation. Lab draws every 6 months. WBC and ANC (absolute neutrophil count) |
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WBC and ANC are 6 |
Do nothing. Normal limits. Give meds. |
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WBC 5 ANC 3 |
Give meds |
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WBC 3 ANC 1 |
Hold meds |
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Chlozapine side effects |
Flu like symptoms. Sore throat |
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Before taking ziprasidone do a |
EKG and give with Atleast 350 calories of food. |
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Before taking ziprasidone do a |
EKG and give with Atleast 350 calories of food. |
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Anticolinergic toxicity |
Hyperthermia, fry red hot skin, diminished bowel sounds, coma, death, no reactive pupils |
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NMS (neuroleptic malignant syndrome) |
Dantrolene can be used. Fever always. High BP. Cool down patient. Stop the medication. |
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Agranulocytosis |
Chlozapine |
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Neurological and brain abnormality theory: |
Enlarged lateral ventricles, increased dopamine activity in the mesolimbic system, ventricle asymmetry, third ventricle dialation |
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Schizophrenia DSM-5criteria |
Symptoms Atleast 6 months Active phase symptoms for Atleast 1 month: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms |
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First Gen low potent medication: |
Chlorpromazine/ thorazine High sedative, photosensitive, high anticholinergic systems |
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EPS means: |
Extrapyramidal side Effects |
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Reversible EPS |
Acute dystonia: bizzare muscle contractions Akathisia: inner restlessness Pseudoparkinsonism: pillrolling, movementvat rest, Brady kinsesia, |
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What are the ABCs |
Artane - trihexyphenidyl Benadryl- diphenhydramine Cogentin- benstropine |
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Irreversible EPS |
Tardive dyskinesia. Grimacing, sticking out tongue, smacking lips, rapid jerking. |
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Long acting first Gen antipsychotics depot therapy |
Haloperidol decanoate. 50-100mg q4 weeks. 16g needle thick |
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Second Gen depot therapy |
Risperidone consta Q2 weeks Paliperidone sustenna Q4 weeks Zyprexa relprevv Q2-4 monitor 3 hrs post injection |
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Third generation antipsychotic |
Aripiprazole (abilfy): quick dissolve, long acting injection, dopamine stabilizer, minimal risk EPS, minimal sedation, SE insomnia alathisia. +/- symptoms. No weight gain. |
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Dangerous response to antipsychotics: |
Fever, autonomic, renal, muscle rigidity. |
