Psych EXAM IV Schizo

cdunbar4's version from 2017-02-04 21:27

Antipsychotic Drug Classes

Question Answer
FGA Typical/Conventional: class/prototypephenothiazines: chlorpromazine
FGA Typical/Conventional: MOAblocks dopamine & serotonin receptors in brain, blocks excitement of + s/s
What adverse effects of FGA's limit therapy?EPS may develop & be permanent in order to control s/s. Also, takes 7-8 weeks for symptoms to improve.
FGA nonphenothiazine drug examplehaloperidol (Haldol), also blocks dop & sero receptors in brain with somewhat fewer SE & less sedation than phenos
Patient Education FGA'sreport s/s of EPS/NMS ASAP! Inform about anticholinergic effects; report dizziness, falls ↓LOC, continued or ↑ sx of psychosis
SGA/Atypical "pines and dones, 2 pips and a rip": why are these the drugs of choice?controls both + and - s/s. MOA is unknown, blocks dop & sero receptors.
SGA/Atypical generic drug name examples:risperidone, clozapine, clanxapine, ziprasidone
SE of SGA'swt. gain, DM, ↑trigylcerides, CVA risks (these SE can ↓ adherence)
patient education SGA'stake as prescribed, report SE ASAP, but continue meds; change positions slowly; avoid; ETOH, caffeine, tobacco, ↑ fiber & fluids to prevent constipation
SGA: dopamine stabilizeraripiparzole (Abilify): blocks alpha 1 receptors, does not block cholinergic receptors

Non-schizo disorders

Question Answer
schizotypical personality disorderimpairment in self & interpersonal functioning
delusional disorderexperience delusional thinking at least once a month
brief psychotic disorderpsychotic manis that lasts b/t 1day to a month in duration.
schizophreniform disordersimilar to shizophrenia, but duration is from 1 to 6 months, social & occupational dysfunction may or may not be present.

+ & - Sx's & phases of Schizo

Question Answer
positive symptoms of schizophreniahallucinations; delusions; disorganized speech (associative looseness); bizarre behavior
negative symptoms of schizophreniablunted affect; poverty of thought (alogia); loss of motivation (avolition); anhedonia; anergia; apathy;
premorbid phase 1 characteristics (usually younger age)Social maladjustment Antagonistic thoughts and behavior; Shy and withdrawn; Poor peer relationships; Doing poorly in school; Antisocial behavior
Prodromal phase 2 (lasts about 1-2 years)↓ in role functioning & social w/drawal; substantial functional impairment; sleep disturbances/anxiety/irritability; depressed mood/poor concentration/fatigue; perceptual abnormalities, ideas of reference & suspiciousness herald onset of psychosis
Phase 3: Schizophrenia DHSA & 6A'sdelusions, hallucinations, impairment in work, social relations & self-care
Phase 4: Residualno positive symptoms, some of the prodromal & 6 A's; flat affect & impairment in role functioning are prominent
Delusionsfalse personal beliefs that are inconsistent with the person’s intelligence or cultural background.
Hallucinationsfalse sensory perceptions not associated with real external stimuli and can include any of the 5 senses→ auditory (voices), visual, tactile, gustatory (unpleasant tastes), olfactory.
Neologismsnew words that an individual invents that are meaningless to others, but have symbolic meaning to them.
Echolaliaparrot-like repetition, by an individual with loose ego boundaries, of the words spoken by another.
Clang associationpattern of speech in which the choice of words is governed by sounds, often takes the form of rhyming.
Word saladgroup of words put together in a random fashion w/o any logical connection.

Nursing Care for Schizo clients

Question Answer
Factors to consider during assessment r/t symptoms of schizophreniano clinical symptom is pathognomonic for schizo & every s/s seen occurs in other psychiatric & neuro disorders as well. Symptoms change over time.
Can a mental status examination diagnose schizophrenia?No
Other factors to take into account during the assessment phase?Edu. level, intellectual ability, cultural & subcultural membership. Religious organizations & cults may have customs that seem strange & out of context.
Nurse actions during hallucinationslet the client know you do not see or hear what they do, be honest.
Use reasonable doubt, example?“I understand that you believe this is true, but I personally find it hard to accept.”
What should the nurse do at the first sign of anxiety, agitation or verbal/behavior aggression?Offer empathetic response to client's feelings: “You seem anxious, how can I help?” Validate client’s feelings.
Attempt to decode incomprehensible communication patterns, seek validation/clarification, example?“Would you please explain that to me, I do not understand what you mean by that.”
If client becomes unable to speak, verbalize the implied. Example?“That must be very difficult for you when your mother left, you must have felt very alone.” Conveys empathy & trust.
Speak plainly & in words that cannot be misinterpreted, example?“Pick up the spoon, scoop some potatoes & put them in your mouth.”

Pt./Family Teaching & Goals of Treatment

Question Answer
Nature of illnessteach what to expect as illness progresses; sx associated; ways for family to respond to behaviors associated with the illness.
Mgmt. of illnessconnect exacerbations of sx’s to times of stress; med. mgmt.; do not stop meds; when to call PCP; relaxation techniques; social skills training; daily skills training
Support servicesfinancial & legal assistance; caregiver support groups; respite care; home health care.
Auditory/Visual: Goals of treatmentclient will discuss content of hallucinations with nurse or therapist w/in 1 wk (short-term). Client will be able to define & test reality, reducing or eliminating the occurrence of hallucinations (long-term).
Disturbed thought process: Goals of treatment by end of 2 wks., client will recognize & verbalize that false ideas occur at times of increased anxiety (short-term). Client’s verbalizations will reflect reality-based thinking w/ no evidence of delusional ideation and will differentiate b/t delusional thinking & reality.
Risk for violent behavior: goals of treatmentclient will be able to recognize signs of increasing anxiety & agitation & report to staff for help. Long-term goal-client will not harm self or others.
Impaired verbal communication: goals of treatmentclient will be able to remain on one topic, using intermittent eye contact for 5 minutes with nurse or therapist. Client will be able to carry on a conversation in a socially acceptable manner with health care providers & peers.


Question Answer
Describe extrapyramidal symptomsa variety of responses that originate outside the pyramidal tracts & in the basal ganglion of the brain. *Side effect of antipsychotic meds: pseudoparkinsonism; akinesia (muscle weakness);
dystonia (part of EPS sx's)involuntary muscular movements (spasms) of face, arms, legs, & neck. >M & <25y.o.
akathisia (part of EPS sx's)continuous restlessness & fidgeting >F
Treatment for EPS benedryl *1st line choice for acute dystonia; benztropine; biperiden; trihexyphenidyl; amantadine; levodopa. Common SE: dry moth, sedation, blurred vision, constipation. Serious SE: psychosis, toxicity.
Tardive dyskinesiabizarre facial & tongue movements, stiff neck & difficulty swallowing. Potentially irreversible, stop drug at 1st sight of this!
Neuroleptic Malignant Syndrome (NMS) s/s?rare, but can be fatal. Sx: severe muscle rigidity, high fever, tachy, fluctuations in BP, diaphoresis & rapid deterioration of mental status to stupor & coma.

Recent badges