NUR 401 Schizophrenia Questions and Answers 2024 with complete solution

"CANS" -> Toxins Affecting Efficacy of Psychotropic Meds: Caffeine - Alcohol -> 2 things it can cause? - Nicotine -> what does it increase? what does this mean? - Sugar -> 2 things it increases? - - Caffeine - Alcohol - sedation & neurotoxicity - Nicotine - increases liver metabolism -> means we have to increase dosage of antipsychotic - Sugar - weight gain, increase risk of diabetes Anosognosia: - what is this? what causes it? - what 2 things may it result in? - what is it often combined with? why is this bad? - - Inability to realize they are ill - Caused by the illness itself - May result in resistance to or cessation of treatment (not taking meds) - Often combined with paranoia so that accepting help is impossible Antipsychotic Medications (Third Generation): - what are 3 common TGA meds? - 1. aripiprazole (Abilify) 2. brexpiprazole (Rexulti) 3. cariprazine (Vraylar) Atypical Antipsychotics (Second Generation): - name 6 common meds for SGA - 1. clozapine (Clozaril) 2. olanzapine (Zyprexa) 3. quetiapine (Seroquel)4. respiridone (Respiradol) 5. Respiradol Consta 6. ziprasidone (Geodon) Atypical Antipsychotics (Second Generation): - why are these first line of choice? - what symptoms do they treat? - what 2 SE do we have minimal of? - 2 disadvantages of these? - - These are first-line of choice bc equally effective for positive & negative symptoms - Serotonin (5-HT2A receptor) and dopamine (D2 receptor) antagonists, e.g., clozapine (Clozaril) - Treat both positive and negative symptoms - Minimal to no EPS or tardive dyskinesia - Disadvantage—tendency to cause significant weight gain; risk of metabolic syndrome Brief Psychotic Meds: - what is the essential feature of a brief psychotic disorder? - how long do symptoms last? with what expectation? - why do these patients have psychosis? - - The essential feature of a brief psychotic disorder is a disturbance that involves the sudden onset (change from a non-psychotic state to a clearly psychotic state within 2 weeks) of at least one of the following positive symptoms: delusions, hallucinations, disorganized speech, or grossly abnormal psychomotor behavior including catatonia. Symptoms must last longer than 1 day but no longer than 1 month with the expectation of a return to normal functioning - Psychosis due to a medical disorder or substance induced -> medical disorder could be hepatic renal disease, drugs are a danger bc we don't know what's in themChallenges of Treating Schizophrenia: - there are 5 challenges, think about all the aspects of a medication to consider - 1. adherence to meds 2. efficacy of med for patient 3. adverse side effects 4. Stigma 5. high cost of medication Clozaril: - what does this have an effective history for treating? what is this MI? what is this population prone to? -> why? - this med has resulted in a decrease of what? increase of _______, reduced ____________________, & improved _____________ - what fatal SE does it have? - what is this med considered to be? - - Has been effective in treating Refractory Schizophrenia, or schizophrenia that doesn't respond to normal treatment. People with Refractory Schizophrenia make up approximately 30 % of the thought disorder population. This population is prone to violence and suicide bc they've had trouble finding meds that help. The use of Clozaril has resulted in decreased negative symptoms, increased impulse control, reduced violence to self and others, and improved quality of life. Clozaril has the potentially fatal side effect of agranulocytosis. - This med is last resort Cognitive Symptoms: - what is concrete thinking? how can the patient NOT think? - impaired memory -> what 2 things does it impact? - impaired information processing -> what is delayed & what is difficult? - impaired executive functioning -> patient has difficulty with 4 things - - Concrete Thinking = inability to think abstractly -> interprets things in a literal manner - Impaired memory = impacts short-term memory and the ability to learn- Impaired information processing = delayed responses, misperceptions or difficulty understanding others - Impaired executive functioning = difficulty with reasoning, setting priorities, comparing options, planning... Command hallucinations - what are "command hallucinations"? - what can these range from? why do we need to monitor this type of hallucination? - Knowing they are hearing voices is more important than what the voices are saying EXCEPT _________________________ - how do we need to approach the patient in terms of figuring out these hallucinations? - can this patient be alone? - what 3 questions could we ask to help distinguish if the hallucinations they are having are command hallucinations? - - Command hallucinations = command hallucinations are auditory hallucinations in the form of commands. - The contents of the hallucinations can range from the innocuous to commands to cause harm to the self or others. This type of hallucination must be monitored carefully because they may be dangerous. - Knowing they are hearing voices is more important than what the voices are saying EXCEPT w/ commands - Need to be direct & ask -> patients are concrete thinkers -> are the voices telling you to hurt yourself or someone else? - Patients with this need a 1:1 - Need to distinguish if hallucinations they are having are command hallucinations: 1. Are you hearing a voice that is telling you to do something? 2. Do you plan to follow the command?3. Do you believe the voices are real? Definitions: - define schizophrenia, where are abnormalities? - what is psychosis? what is the individual experiencing? - - Schizophrenia = defined as a psychosis characterized by abnormalities in perception, content of thought, and thought processes, & extensive withdrawal of one's interest from people and the outside world -> it's a disease of the brain - Psychosis = a state in which the individual is experiencing hallucinations, delusions or disorganized thoughts, speech or behavior. -> this is symptoms Delusional Disorder: - what type of delusions are present here? - how long do people with this problem live with their delusions? do they seek treatment? - what can bring them to the attention of health care providers? - do these patients function normally? - give an ex of these delusions & why pt wouldn't come into treatment? - - Is characterized by non-bizarre, logical, stable and well-systematized delusions that can occur in the absence of other psychiatric disorders. The delusions are characterized by adherence to possible situations that could occur in real life and are plausible; being followed, poisoned... People with this disorder usually live with their delusions for years, rarely receiving psychiatric treatment. Somatic delusions are usually the only thing that brings them to the attention of health care providers. They function normally except when the focus is on their delusion. - Ex: Could think someone is following them or has delusions BUT these don't impact their quality of life - > usually don't come into treatment bc they believe the delusions they have are not real Disorganized Behavior: 1. aggression -> basic what is this? give 2 ex of why patient would get aggressive 2. agitation -> inability to do what? what could pt be doing? 3. catatonic excitement -> hyperactivity characterized by what (2)? what is catatonia? 4. echopraxia -> what is this? is it on purpose?5. regressed behavior -> how does the patient present? 6. stereotype -> what does this patient do? how does this make him feel? 7. what is hypervigilance? 8. waxy flexibiltiy -> what does the patient look like? explain how it works when you interact with them - 1. Aggression = behaviors or attitudes that reflect rage -> get frustrated bc paranoid or people don't understand them 2. Agitation = inability to sit still or attend to others, pacing 3. Catatonic Excitement = hyperactivity characterized by purposeless activity & abnormal movements - Catatonia can be a patient is mute or can't move 4. Echopraxia = involuntary imitation of another's movements & gestures 5. Regressed Behavior = childlike/immature 6. Stereotype = repetitive purposeless movements that are peculiar to the person 7. Hypervigilance = sustained attention to external stimuli 8. Waxy Flexibility = posture held in fixed position -> pt has catatonia & you put them in position & they stay there -> you could put a pt arm above their head and they never move it!! Shock treatment helps Disorganized Speech: - what is circumstantiality? - define tangentiality - explain loose associations -> absence of something - what is flight of ideas? think about what makes it different from loose associations - define echolalia