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48 Cards in this Set
- Front
- Back
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What is the most disabling of the schizophrenics and has a major influence on functional outcome, but not a diagnostic criteria?
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Cognitive impairment
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What is the criteria to create a diagnosis of schizophrenia in DSM-IV-TR?
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Presence of two positive or negative symptoms for a significant portion of time during a 1 month.
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Clinical course
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- early to mid-twenties in men
- later in women - steadily progressing symptoms - mild symptoms could be traced back to adolescence - better prognosis = prior psychology sound personality; no family history of schizo; normal neuro status with no brain damage; good funtioning relationships; presence of significant depressive symptoms in association with a family history of mood disorder. - Bleuler found- schizophrenia evolved over 5yrs - severe cognitive deficits were associated with the worst outcomes beyond the 5yrs - socially a devastating disorder - carries a highest suicide risk of any psych. diagnosis - 10% eventually commit suicide - equal frequency in men and women - |
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Explain the Swedish door -to- door cross-sectional survey:
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survey 2,550 persons in a rural community-
- carried out psych. interviews - used added data from the hospital - 21 schizo persons were found - 8.2 per 1000 person in the community - neither been previously diagnosed with schizo nor received treatment - assumed the lifetime risk for schizo in this part of sweden was estimated to be 1.39% |
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Explain the Danish study
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- followed a cohort of persons born during a 4 year period on a small Dains island
- at 11 yrs old were entered in the study and followed for 55 yrs - over the 55 yrs, 38 developed schizo. - comparable to the Swedish study |
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19th century etiology
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Disorder of the brain (organic or biological factors) and not primarily a psych. condition.
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At the end of the 18th century, what were the initial thought of schizo around the time of the European Industrial Revolution?
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Consequence of stress and urbanization
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Whose explanations for the symptoms of schizo view that childhood temper tantrums and other unneutralized aggressions might ultimately lead to psychosis - rising out of inadequate maternal nurturance in early infancy?
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Psychoanalytic theory
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Further etiologies...
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Risk for developing:
- schizo parents - 50% - in a lifetime - 1% - major genetic component - most dramatically through the study of twins - highest of being identical twin - 50% |
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What was the trouble with some of the psychiatrist on finding out what was wrong with the brain?
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no one could finde any structural abnormalities - Dr. Alzhiemer was able to show only mild generalized cell loss and scarring (gliosis) - finding were nonspecific
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Explain teh 1960s, Dopamine hypothesis
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the functional abnormalities in schizo. are due to excessive activity of brain dopamine
- effects the basal ganlia of the brain - drugs effective in the control of positive symptoms of schizo all seem to have significant dopamine receptor blocking activity. - drug reduce the effect of an individual's own dopamine on his or her brain - Amphetamines increase the the brain dopamine concentrations - increase in dopamine receptors in the brains's basal ganglia present at autopsies |
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What are the 3 psychosocial treatments?
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Clinical
- reduce both positive and negative symptoms maximize funtional outcome - involves outpt. management, family community services Rehabilitation - increasing client's capacities both for social interaction and for productive activity (for employment purposes) Humanitarian interventions/public safety - maximize an individual independence, quality of life with the bounds of his or her mental disability - safety involves balancing personal liberty with the recognition that some social control may be needed to preven harm |
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What are the positive signs of schizo.?
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Bizarre, socially disruptive, potentially dangerous behavior
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What so-called root had been used in India to sedate persons with severe psych disorders?
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Rauwolfia
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What is the active ingredient in rauwolfia and was found to have useful properties in the management of schizo.?
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Reserpine
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Which to newly synthesized antihistamine like drugs, were found to have very similar sedative effects as resperine?
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Promethazine and Chlorpromazine
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which drug was found to be effective in controlling both negative and positive symptoms of schizo.?
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Chlorpromazine
- improvement esp. in postive symptoms of paranoia, hallucinations, and agitation |
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What are the two categories of antipsychotics called?
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First and second generation
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Side effects of antipsychotics
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- rare suddent death after injection
- serious side effects involve the nervous system resulting for the dopamine receptor blockade - Dystonia was readily treated - painful muscle spasm lasting form few seconds to days - contractions of the (torticollis) and facial muscles are most common - head drawn forcefully to one side - fixed tongue protrusion - typically occur within few hours of days of starting - stop when med is given and instantly to IV diphenhydramine or to other anticholinergics - Benzodiazepines (diazepam or clonazepam) are also effective in treating dystonia - acute dystonia - occurs in 2-3% pts. give chlorpromazine and more common in haldol and Fluphenazin, long acting injectable neuroleptice Akathisia - common side effect - affect motor and behavior - become restless unable to sit sit - upper extremities and face are rarely involve - develop emotional changes - unable to concentrate along with euphoria - malaise - depression - worsening psychosis - begins later with treatment compare to that of dystonia, but rarely after 6 mos. - goes away sometime before with treatment and totally when stopped Symptoms of parkinsonism - older clients are affected more than younger - like akathisia, occur within the first month - akinesia - poverty of movement - initiate very slowly any movement - symptoms resolve even w/o stopping med, but only 1% of individuals to continue to have despite withdrawal - pts. may have had underlying "idiopathic" parkinsonism that was unmasked by treatment (maybe reduction in dopamine) - drug induced parkinsonsim respond well to anticholinergic med. treatment Tardive dyskinesia - trouble some movements - found when pts. are on med for a long time - highest in older clients esp. women - repetitive and commonly involve the face - repetitive smacking, chewing, grimacing, cheek puffing, tongue protrusion - grunts and ticlicke move - increasing dosage supress the TD - TD often resistent to treatment - early diagnosis/treatment: drug holidays, decrease dosages Neuroleptic Malignant Syndrome - most serious side effect - also the rarest - untreated = rapid death - when on hight or increasing doses; after a dosage increase - symptoms: confusion, decrease LOC, high fever (106 F+) - acutely develop parkinsonian of rigidity and akinesia - fever doesn't have to be present and not required to make a diagnosis - serum creatinin kinase (ck) is the definitive diagnostic test due to muscle damage - indications myoglobinuria - vigorous hydration - cooling - antipsych. med is stopped - give meds to increase cns dopamine levels - overlooked at time for mistake of an infection |
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Why are thioridizine and clozapine regarded as atypical antipsychotics?
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Because they do not seem to cause movement disorders
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Why is thioridizine less effective than other antipsychotics?
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Atypical such as, clozapine, has been shown more effective and produce improvements in clients resistant to classical antipsychotics.
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Which drug causes reduction in mumbers of white blood cells?
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Clozapine
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why clozapine is very difficult to employ in community outpatient settings?
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B/c the careful monitoring of WBC is difficult to ensure compliance
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What are some 1st and 2nd generation drugs?
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quetiapine (seroquel), olanzapine (zyrexa) and risperidone (risperdal)
- all significantly decrease risk of tardive dyskinesia than haloperidol - "First line" treatments - Olanzapine and resperidone b/c better side effects; better at relieving neg. and post. symptoms - Weight gains of 40 pound is not unusual with most 2nd generation drugs. - diabetes may accompany longterm use - diabetic ketoacidosis - OC symtoms is seen with the inhibition of serotonin pathway - no treatment programis uniformly successful or equally alters the course of the disease |
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What is the likely course of action for clients who do not improve with second gen. drugs?
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switched to either first generation or to clozapine
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What is the preferential treatment in clients with the highes levels of functioning, despite its risk of life threatning bone marrow supression?
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Clozapine
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Who are candidates for injectable medicines?
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clients who relapse due to failure of compliance
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What disorder sometimes accompanies schizo, often lead to a diagnosis of schizoaffective disorder?
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Depression
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When is suicide more likely to occur in schizo?
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when positive symptoms are improving, but overall suicide risk may be decrease in clients taking clozapine
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Which movement disorder frequently cannot be reversed by withdrawing medication?
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Tardive dyskinesia
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Antipsychotic med
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- they do not cure
- 22% complete remission when treated with 1st generation drugs - in some clients positive symptoms remain highly resistant to antipsychotic med - negative symptoms frequently remain socially incapcitating - significant AE - seems as if only clozapine and olanzapine is more effective than the rest - all block dopamine from interacting with brain dopamine receptors |
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What kind of therapy is normally used for persons in catatonic states?
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Electroconvulsive (shock) therapy
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Disturbed thought processes
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- client is unable to easily follow verbal speech, think rationally
- must speak clearly to client - do not enter in to the delusion when client is delusional - learn the meaning of the delusion; express doubt over the reality; redirect conversation |
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Impaired verbal communication
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- disordered speech
- take time to understand the clients needs - maintain a calm and peaceful enviroment to help the client center and express himself - speak in clear, short phrases - interventions aimed at developing and maintaining social skills |
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Ineffective role performance
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- cause problems for the client is society
- loss of job, freinds, and support - inability to care for himself - dependence on others - evaluate the living situations and procure appropriate safe arrangements - assist clients in activities that foster socially acceptable interactions with others |
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Disturbed sensory perceptions due to hallucinations
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- frightening to client and family
- understand hallucinations are very real to client and will respond to their hallucinations - acute care - provide quiet and nonstimulate environment - talk to client - maintain safety - tell the client you dont see or heare the their hallucination,but you know its real to them - given prescribed meds - goal: safety and attune them to reality |
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Impaired social interactions
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- result from negative symptoms of the disease
- social support/training - 1st. begin one on one and build on the relationship |
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What are negative symptoms of schizo?
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- flat effect (dampening of emotions
- poverty of speech - lack of motivation - symptoms of depression |
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Outcome ID
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Acute Phase
- IMMEDIATE GOAL: bring symptoms under control: not thinking rationally, delusional, hallucinating - collaborative effort - use of meds - help client to sleep w/o interferenc (established through safe and trusting environment) Rehabilitative Phase - assist client and family to make best judgement - help maintaing client's independence - planned by nurse and client together - help to find volunteer work in his community - encourage interactions - work w/ family to monitor med. compliance - assist fam with keeping acute symptoms under control |
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What are sensory experiences not perceptible to other?
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Hallucination
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hallucinations
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- hearing voices
- threatning or negative nature - voices come from inside the body or from the sky - occur whil fully awake - hear two or more voices - |
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Symtoms
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postive symptoms - bizarre behaviors
- disordered thoughts - delusions - hallucination negative symptoms- socially debilitating - flattened affect loss of expressiveness, extreme emotional distance Alogia - speak very little - when speaking openly, they use brief and empty phrases Avolition - lack motivation for work or other activities Anhedonia - inability to find enjoyment in activites that would have been fun to another individual - major part of the experience of depression |
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the loss of rational thought and or reality
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psychotic
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The word schizo does mean splitting of the mind, but this name was chosen to relflect what?
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the effects of schizophrenia on thought and language, not personality
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neologisitic word
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newly invented words by schizophrenics.
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Schizophrenic speech
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derailment
- going off the point tangetiality - failure to reach a goal or stick to the original point incoherence - speech not logically connected word salad - group of disconnected words |
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What is the most striking psychotic manifestations - bizarre postures; decrease in reactivity to the environment; extreme degree of complete awarenenss?
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Catatonia
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Delusions
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- false beliefs that misrepresent either perceptions
- defining characteristics of psychosis - Grandiose delusions have special powers, religious Messiahs, perceptions of importance - persecutory delusions paranoid, others intend to do them harm - referential delusions common event - passages in songs, patterns in the cloud in the sky refer to them |
