Psychiatric Medications and Client Care Quiz

Schizophrenia Spectrum & Psychotic Disorders

• Schizophrenia is thought to involve a combination of factors, including genetic predisposition, biochemical dysfunction, and physiological factors.
• Comprehensive treatment is necessary and requires a multidisciplinary approach.
• Schizophrenia often results in lengthy hospitalizations, family stress, and significant financial burdens that impact families and the government.
• Stigma surrounding the illness is a major concern.

Schizophrenia Symptoms

• Disturbances in thought processes, perception, response to stimuli, affect (mood), sleep, occupational, and other roles are common characteristics.

Predisposing Factors

• Biological influences, such as viral infections, anatomical abnormalities, and histological changes to the brain, are implicated.
• Biochemical influences might include an excess of dopamine activity and abnormal neurotransmitter function.
• Genetics plays a critical role in the development of schizophrenia.

Prevalence of Schizophrenia

• The lifetime prevalence of schizophrenia is estimated to be around 1% within the population of the USA.

4 Phases of Schizophrenia

• Phase I (Pre-morbid): Characterized by social maladjustment, antagonistic thoughts and behaviors, social withdrawal, poor peer relationships, and poor academic performance.
• Phase II (Prodromal): This phase involves a deterioration in role functioning, social withdrawal, impairments in daily activities, sleep disruption and mood disturbances (anxiety, irritability).
• Phase III (Schizophrenia): Marked by prominent delusions, hallucinations, illusions, and a significant decrease in occupational, social, and daily functioning (ADLs).
• Phase IV (Residual): Characterized by symptoms similar to the prodromal phase, with prominent flat affect and impairment in role functioning.

Prognosis Factors

• Good premorbid functioning, older age at the onset, female gender, acute onset, precipitated by stressful events, and the presence of associated mood disturbances are beneficial for a positive prognosis.

Assessment (Schizophrenia)

• Sense of self: Recognizing personal uniqueness, understanding how the patient perceives themselves, and how personal sense of self plays a role in the assessment.
• Assessment tools: Tools like the PANSS (Positive and Negative Syndrome Scale) can be useful for measuring the presence and severity of symptoms.

Assessment: Positive Symptoms

• Content of thought: Delusions, religiosity, paranoid ideation, and magical thinking.
• Form of thought: Associative looseness, neologisms, concrete thinking, clang associations, word salad, circumstantial speech, tangentiality, and mutism.
• Perception: Hallucinations (auditory, visual, somatic), illusions, and depersonalization.

Assessment: Negative Symptoms

• Affect: Inappropriate emotional tone, flat effect, blandness, and apathy.
• Avolition: Inability to initiate goal-directed behavior, ambivalence, and deterioration in appearance.

Nursing Diagnoses/Outcomes for Schizophrenia

• Disturbed Sensory Perception, Social Isolation, Disturbed Thought Processes, Risk for Violence, Impaired Verbal Communication, and Ineffective Health Maintenance.

Nursing Process: Planning/Implementation

• Specific interventions are tailored to the identified nursing diagnoses (e.g. Observe for signs of hallucinations, reinforce reality, help client recognize anxiety, manage and maintain calm).

Client/Family Education

• Educate patients and families about illness progression, symptom management, behavioral response, medication management, support services, and effective communication strategies.

Recovery Model

• A healing and transformation concept empowering people with mental illness to live meaningful lives in the community.

Treatment

• Individual psychotherapy, family therapy, group therapy, cognitive behavioral therapy, social skills training, and psycho-pharmacology are important components in treatment.

Antipsychotics: Types and Uses

• The treatments are categorized into 1st and 2nd generation, with different side effects and mechanisms of action. Specific medications such as Clozapine (1st generation) and others have more severe side effects, such as agranulocytosis or other blood disorders, while those in the 2nd generation tend to have fewer of these side effects.

Antipsychotic: Preparations, Common Side Effects, and Cross Interaction

• Oral preparations, intramuscular (IM) shots or Decanoates, and inhalants are available
• Side effects include but are not limited to hypotension, dyskinesia, weight gain, endocrine effects, and many other side effects.
• Cross interactions with other medications exist and should be considered

Antipsychotics: Nursing Diagnoses for Schizophrenia

• Risk for other-directed violence, risk for injury, risk for activity intolerance, and noncompliance are important considerations when managing antipsychotics for schizophrenic patients.

Elderly and Antipsychotic Medications

• Issues of increased mortality, cerebrovascular accidents (CVAs), sudden deaths, and neurocognitive disorder (NCD) risks need special consideration for older adults.

Extrapyramidal Side Effects (EPS) and Other Adverse Effects

• Dystonia, AKATHISIA, Tardive dyskinesia and Neuroleptic Malignant Syndrome (NMS) are all possible adverse effects.

Serotonin Syndrome and Neuroleptic Malignant Syndrome (NMS)

• Both are serious syndromes with specific symptoms, necessitating prompt interventions.
• Specific causes and prevention strategies are relevant for NMS.

Other relevant factors

• Evaluation, assessment, follow-ups, and care planning are necessary within the various treatment phases discussed.