Psychiatry Chapter: Antipsychotic Medications

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Questions and Answers

Which of the following antipsychotic medications is considered first-generation (typical)?

Ziprasidone

Olanzapine

Risperidone

Haloperidol (correct)

Atypical antipsychotics are often preferred over typical antipsychotics because they have a lower incidence of what side effect?

Extrapyramidal symptoms (EPS) (correct)

Sedation

Weight gain

Metabolic syndrome

Clozapine is an atypical antipsychotic with a black box warning for which of the following?

Agranulocytosis (correct)

Increased risk of diabetes

Hypertension

Hypothyroidism

Which of the following patient populations is specifically contraindicated for clozapine?

Elderly patients with dementia-related psychosis (C) Signup and view all the answers

Which of the following is NOT a typical symptom of schizophrenia?

Anxiety (C) Signup and view all the answers

Which of the following factors is NOT associated with an optimal prognosis?

Family history of schizophrenia (C) Signup and view all the answers

What is one characteristic of 'residual' symptoms described in the context?

Flat affect (A) Signup and view all the answers

Which condition is linked to a better prognosis according to the stated factors?

Female gender (D) Signup and view all the answers

What contributes to the sense of self according to the assessment?

Uniqueness and individuality of a person (B) Signup and view all the answers

Which symptom is associated with a minimal residual state?

Absence of neurological dysfunction (A) Signup and view all the answers

What are characteristics of Phase I: Pre-Morbid of schizophrenia?

Social maladjustment and poor peer relationships (C) Signup and view all the answers

Which symptom is most likely to indicate the onset of overt psychosis during Phase II: Prodromal?

Perceptual abnormalities and ideas of reference (B) Signup and view all the answers

During which phase of schizophrenia do overt symptoms like hallucinations and delusions first become evident?

Phase III: Schizophrenia (C) Signup and view all the answers

Which of the following is a common symptom during Phase II: Prodromal?

Anxiety and impaired concentration (A) Signup and view all the answers

What best describes the symptoms in Phase IV of schizophrenia?

Similar symptoms to the prodromal phase (B) Signup and view all the answers

What is a key characteristic of Neuroleptic Malignant Syndrome (NMS)?

Hyperthermia and muscle rigidity (B) Signup and view all the answers

Which generation of antipsychotics is more likely to lead to Neuroleptic Malignant Syndrome?

Only first generation antipsychotics (C) Signup and view all the answers

Which symptom is NOT associated with Neuroleptic Malignant Syndrome?

Weight gain (A) Signup and view all the answers

What action should be taken immediately if a patient shows signs of Neuroleptic Malignant Syndrome?

Contact the healthcare provider and hold dosage (C) Signup and view all the answers

Which medication is specifically used in the treatment of Neuroleptic Malignant Syndrome?

Bromocriptine (C) Signup and view all the answers

Which of the following is NOT recommended for the treatment of Neuroleptic Malignant Syndrome?

Psychotherapy (A) Signup and view all the answers

What is a common misconception about Neuroleptic Malignant Syndrome symptoms?

It can be mistaken for Serotonin Syndrome (C) Signup and view all the answers

What should patients NOT do with their medication when managing the risk of Neuroleptic Malignant Syndrome?

Stop taking medication abruptly (A) Signup and view all the answers

What is a common symptom that indicates a client may need to be transferred to an intensive care environment?

Severe muscle rigidity (D) Signup and view all the answers

Which of the following antipsychotic medications is classified as atypical (2nd generation)?

Olanzapine (C) Signup and view all the answers

What is a key feature of atypical antipsychotics compared to typical ones?

Fewer extrapyramidal side effects (C) Signup and view all the answers

What potential risk is associated with antipsychotics, especially in elderly patients?

Cerebrovascular accidents (CVA) (B) Signup and view all the answers

Which of the following is an adverse effect of combining antihypertensives with antipsychotics?

Additive hypotension (A) Signup and view all the answers

Which nursing diagnosis is relevant for a patient taking antipsychotic medications?

Risk for other-directed violence (B) Signup and view all the answers

What is a negative symptom of schizophrenia?

Emotional withdrawal (A) Signup and view all the answers

Which antipsychotic medication is specifically indicated for treating depression with psychotic features?

Olanzapine (C) Signup and view all the answers

How do atypical antipsychotics generally affect blood pressure and obesity?

Exert less influence on hypertension and obesity (D) Signup and view all the answers

What should be monitored closely when administering drugs that prolong QT intervals with antipsychotics?

Additive effects (C) Signup and view all the answers

Which of the following is NOT considered a positive symptom in schizophrenia?

Flat affect (B) Signup and view all the answers

What behavior might indicate impaired interpersonal functioning in a patient?

Social isolation (B) Signup and view all the answers

Which of the following symptoms is characterized by a lack of initiative in goal-directed activities?

Avolition (D) Signup and view all the answers

Echolalia is best described as which of the following?

Imitating the speech of others (B) Signup and view all the answers

Which nursing diagnosis might be appropriate for a client exhibiting extreme suspiciousness?

Risk for Violence (C) Signup and view all the answers

Which symptom is characterized by a person's inability to perceive the environment correctly?

Hallucination (C) Signup and view all the answers

Which of the following refers to the interaction of inappropriate emotional expression?

Inappropriate affect (D) Signup and view all the answers

What is the primary concern when assessing a client for command hallucinations?

The client may harm themselves or others. (A) Signup and view all the answers

Which negative symptom may resemble depression or apathy?

Anergia (C) Signup and view all the answers

What symptom involves talking in an incoherent or nonsensical manner?

Word salad (C) Signup and view all the answers

Which nursing diagnosis is linked to severe panic anxiety and withdrawal?

Impaired verbal communication (B) Signup and view all the answers

Which intervention should a nurse NOT perform when working with a client exhibiting disturbed thought processes?

Argue against their delusions (C) Signup and view all the answers

What is the purpose of recognizing distortions of reality in a client?

To assist in managing their anxiety. (B) Signup and view all the answers

Which of the following symptoms involves movement that appears purposeless or abnormal?

Waxy flexibility (B) Signup and view all the answers

Study Notes

Introduction

Schizophrenia is thought to be caused by a combination of factors, including genetic predisposition, biochemical dysfunction, and physiological factors.
Schizophrenia requires comprehensive treatment presented in a multi-disciplinary manner.
Of all mental illnesses, schizophrenia causes the most lengthy hospitalizations, family stress and chaos, and exorbitant costs to families, third-party payers, and government.
Schizophrenia causes disturbances in thought processes, perception & response to stimuli, affect (mood), sleep, occupational and other role functions.

Predisposing Factors

Biological influences include viral infections, anatomical abnormalities, and histological changes in the brain.
Biochemical influences include an excess of dopamine activity in the brain, and abnormalities in other neurotransmitters like serotonin and norepinephrine.
Genetics plays a crucial role in the development of schizophrenia.

Varying Degrees of Deterioration

Varying degrees of severe deterioration in social and occupational functioning are observed.
The lifetime prevalence of schizophrenia is about 1 percent of the population in the USA.

Phases of Schizophrenia

Phase I (Pre-morbid): Social maladjustment, antagonistic thoughts and behaviors, shy and withdrawn, poor peer relationships, doing poorly in school, and antisocial-like behaviors.
Phase II (Prodromal): Duration from weeks to years. Further deterioration in role functioning, social withdrawal, functional impairment, sleep impairment, anxiety, irritability, depression, impaired concentration, and fatigue. Perceptual abnormalities, ideas of reference, and suspiciousness herald the onset of overt psychosis.
Phase III (Schizophrenia): Active phase of disease with overt symptoms that may comprise of delusions, hallucinations, illusions, gross impairment in work/occupation, social relationships, and ADLs (self-care).
- Phase IV (Residual): Symptoms similar to the prodromal phase, with flat affect and impairment in role functioning prominent.

Prognosis

Factors associated with an optimal prognosis are good premorbid functioning, older age at onset of symptoms, female gender, abrupt onset precipitated by a stressful event, associated mood disturbance, and brief duration of active phase symptoms.

Assessment

Sense of Self: Assessing the uniqueness and individuality a person feels about themselves. How does the patient see him/herself? How does their sense of self play a role in the assessment of de-personalization?
Positive and Negative Syndrome Scale (PANSS): Measures positive and negative symptoms in schizophrenia
- Positive Symptoms: Delusions, Religiosity, Paranoia, Magical thinking, also shared with the Schizotypal Personality Disorder, Form of Thought (loose associations, neologisms, concrete thinking, clang associations, word salad, circumstantial, tangentiality, mutism, and perseveration), and Perception (hallucinations and illusions).
- Negative Symptoms: Affect (inappropriate, bland, flat, or apathetic emotional tone), Avolition (inability to initiate goal-directed activity), Emotional ambivalence, deterioration in appearance, and impaired ADLs (Activities of Daily Living). Inappropriate social interactions, Social isolation, Anhedonia, and Regression.

Nursing Diagnosis/Outcome Identification

Disturbed Sensory Perception (auditory and visual), related to panic anxiety, extreme loneliness, and withdrawal into oneself.
Social Isolation r/t inability to trust, panic anxiety, weak ego development, delusional thinking, and regression.
Disturbed Thought Processes related to inability to trust, panic anxiety, or other issues.
Risk for violence: Self-directed or Other-directed related to extreme suspiciousness, panic anxiety, catatonic excitement, rage reactions, or command hallucinations.

Nursing Process: Diagnosis/Outcome Identification

Ineffective Health maintenance related to disordered thinking or delusions.
Impaired ADL related to regression, withdrawal, lack of knowledge or resources, impaired physical or cognitive functioning, self-care deficits, and coping related to difficulty coping with the client's illness.

Clinical Outcomes - The client will...

Demonstrate ability to perceive the environment correctly while maintaining a manageable anxiety level.
Relinquish the need for delusions or hallucinations while demonstrating the ability to trust others in their interactions with others. Appropriate use of verbal communication.
Recognize distorted reality, self-perception, self-care independence, and demonstrate an ability to relate to others in a socially appropriate manner.

Nursing Process: Planning/Implementation

Disturbed Sensory Perception: Observe signs of hallucinations, help clients recognize and understand the anxiety and hallucinations connection, distract the client from hallucinations.
Disturbed Thought Processes: Avoid arguing or denying client's beliefs, reinforce reality based focus.
Risk for Violence: Observe clients' behavior, maintain calm attitude, ensure staff sufficient.

Client/Family Education

Nature of Illness: What to expect as a progression. Symptoms associated with illness. How clients can respond to behaviors associated with illness.
Management of Illness: Connection of exacerbation of symptoms to times of stress. Importance of medication, side effects of medications, when to contact their health care provider, relaxation techniques, social skills training, and ADL skills training.
Support Services: Financial and legal assistance. Caregiver support groups, respite care, and home health care.

Evaluation

Has the client established trust? Are altered perceptions prevalent? Is anxiety level maintained at a manageable level?

Recovery Model

Discusses the concept of healing and transformation enabling a person with mental illness to have a meaningful life in the community while striving to achieve their full potential.
Research is provided as supporting recovery as an achievable objective for individuals with schizophrenia.

Treatment

Individual psychotherapy
Family psychotherapy
Group Psychotherapy
Cognitive behavioral therapy
Social skills training/ADL skills training
Psycho-Pharmacology
PACT (Program of Community Treatment)

Antipsychotics

Preparations (oral, IM, decanoate, inhalant versions).
Common Side Effects (Cardiovascular: Orthostatic hypotension, weight gain; Endocrine and Sexual; Blood Dyscrasias: Agranulocytosis (clozapine); Anticholinergic).
Positive Symptoms: Thioxanthenes, Phenothiazines, Butyrophenones, other mixed subclasses, and treatment of positive schizophrenia symptoms.
Extrapyramidal side effects and adverse drug reactions.
Conventional/typical versus atypical antipsychotics.
Contraindications/Precautions (hypersensitivity, severely depressed patients, elderly patients with dementia-related psychosis).
Specific antipsychotics
NMS (Neuroleptic Malignant Syndrome): Treatment (Including Bromocriptine, Dantrolene, Acetaminophen, Na Bicarbonate), Benzodiazepines, Mannitol, etc.).
Side effects (Weight gain, Hyperglycemia/diabetes, Increased risk of mortality in elderly clients with dementia, seizures, reduction in seizure threshold, agranulocytosis, Extrapyramidal symptoms (EPS), Tardive dyskinesia, Neuroleptic malignant syndrome (NMS)).

Nursing Diagnoses

Risks for other-directed violence.
Risks for injury, activity intolerance, and noncompliance,
Need to monitor blood counts regularly and have interventions in place to prevent complications from treatment.

Elderly and Antipsychotic Medications

Reports of CVA, sudden deaths, neurocognitive disorder, and increased risks of death with antipsychotic use in elderly patients.
Risk factors (Fall precautions, Aspiration risk, EPS and tardive dyskinesia, other side effects).
Patient-centered, collaborative team approach.

Antipsychotic Planning/Implementation

Monitor clients for side effects (anticholinergic, skin rash, sedation, orthostatic hypotension, photosensitivity, hormonal, electrocardiogram changes, hypersalivation, etc.)
Educate about medication management.

Antipsychotic Medications: Atypical (2nd Generation)

Lower incidence of extrapyramidal side effects (EPS).
Target both positive and negative symptoms.
Also indicated for treatment of mood disorders, particularly mood stabilizers (helpful in those with psychotic features).

Clozapine

Black Box Warnings and associated risks

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Description

Test your knowledge on antipsychotic medications, including typical and atypical types, their side effects, and specific patient considerations. This quiz covers key concepts related to schizophrenia and its prognosis. Enhance your understanding of the therapeutic implications of these medications.