Psychology Chapter on Antipsychotics

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Questions and Answers

What type of symptoms do antipsychotics typically help alleviate?

Cognitive symptoms

Negative symptoms

Behavioral symptoms

Positive symptoms (correct)

Patients can be forced to take antipsychotic medication against their will without any legal parameters.

False

What type of hallucination involves hearing voices?

auditory hallucinations

Patients may exhibit __________ delusions, where they believe they possess extraordinary powers or a divine status.

grandiose Signup and view all the answers

Match the type of psychotic symptom with its description:

Hallucination = A sensory experience without external stimuli Delusion = A false belief held despite contradictory evidence Paranoia = An irrational fear of being harmed or persecuted Dopamine = A neurotransmitter associated with movement and reward Signup and view all the answers

Which of the following is a potential reason a patient might refuse to take antipsychotic medication?

All of the above Signup and view all the answers

Long-lasting antipsychotics are typically recommended for short-term treatment.

False Signup and view all the answers

What is a common treatment approach for managing psychotic disorders?

setting honest limits and boundaries Signup and view all the answers

Which of the following is a common psychological symptom associated with antipsychotic use?

Auditory hallucinations Signup and view all the answers

What is a noted consequence for patients who are mandated to take antipsychotic medication?

They may experience heightened paranoia. Signup and view all the answers

What can be a significant barrier for patients in adhering to antipsychotic treatment?

Lack of supportive environment Signup and view all the answers

Which type of delusions involves believing one has extraordinary abilities or a divine role?

Grandiose delusions Signup and view all the answers

What term is used to describe the persistent false beliefs held by a patient?

Delusions Signup and view all the answers

Which scenario exemplifies a patient possibly experiencing a negative symptom of psychosis?

Not showing interest in social interactions Signup and view all the answers

What is the potential effect of dopamine dysregulation related to antipsychotic medication?

Development of Parkinson's-like symptoms Signup and view all the answers

Which treatment option is typically recommended for managing long-term medication in psychotic disorders?

Long-acting injectable antipsychotics Signup and view all the answers

Study Notes

Schizophrenia Overview

Schizophrenia is a mental illness characterized by psychotic symptoms, impaired relationships, and odd or bizarre behaviors.
It affects 1% of the US population.
Prevalence is equal in men and women, though men typically have an earlier age of onset.
It's seen in all cultures and typically emerges in early adulthood.
Life expectancy is decreased due to medical co-morbidities and suicide.

Schizophrenia Demographics

Affects 1% of the US population equally in men and women.
Men experience the condition earlier than women in most cases.
Seen in all cultures.

Clinical Manifestations of Schizophrenia

Positive Symptoms: These are additions to normal experiences and include delusions, hallucinations, abnormal movements, and formal thought disorder.
Negative Symptoms: These represent diminished affects and behaviors, such as flat or blunted affect, thought blocking, avolition, poverty of speech, and social withdrawal.
Cognitive Symptoms: These include memory deficits, attention deficits, language difficulties, and loss of executive function.

Positive or Negative Symptoms?

Auditory hallucinations and bizarre behaviors are considered positive symptoms.
Disorganized thoughts and lack of facial expressions are considered negative symptoms.
Lack of speech is considered a negative symptom.

Hallucinations vs. Delusions

Hallucinations: Experiencing external stimuli with no physical cause; can be auditory, visual, tactile, olfactory, or gustatory.
Delusions: Fixed false beliefs, with common types including paranoid, grandiose, and delusions of reference.

Hallucination or Delusion?

Hearing voices: hallucination
Seeing bugs on the wall: hallucination
Feeling bugs on skin: hallucination
Mafia is after them: delusion
Talking to someone who isn't there: hallucination
Prophet from God: delusion

Focus on Diversity and Culture

Some cultures may view hearing voices or seeing visions as normal. Nurses report delusions and hallucinations within the client's cultural context.

Practice Question - Genetic Causes of Schizophrenia

Genetic factors increase the client's vulnerability to schizophrenia, but there is no specific gene that directly causes it.

Practice Question - Nursing Diagnosis Priority

Social isolation is the priority nursing diagnosis when a client refuses to bathe/dress, remains in the room most of the day, and speaks rarely to others.

Video Focus Questions

Themes of voices: The video does not specify the themes of the voices being experienced by the person.
Positive environment impact: The video starts with a beautiful morning; the impact on the person's internal experience is not directly addressed.
Perception of news/delivery man: Nurses should understand how the client perceives external figures.
Caregiver impact: Nurses should know how caregivers impacts the client.

Management of Hallucinations

Safety is paramount
Be direct with questions and validate feelings, but stay in reality.
Avoid perpetuating or joking about hallucinations.
Minimize stimuli; should not occur in groups.
Monitor for worsening symptoms (increased fear, anxiety).
Administer PRN medications when appropriate.

Management of Delusions

Safety
Ask for details, but don't engage in arguing.
Focus on feelings and reality.
Be honest.
Set clear limits and boundaries.

Practice Question - Group Therapy for Clients with Auditory Hallucinations

The nurse should encourage the client to participate in group therapy when the client is experiencing a decrease in voice influence.

Lifespan Considerations

Schizophrenia typically emerges in early adulthood, following a classic course.
Prodromal symptoms precede the full-blown disorder and often arise several years prior.
Stressful events can trigger preexisting vulnerabilities (diathesis-stress model).
Positive symptoms often lessen with age.
Early and late onset schizophrenia is less common.

Pharmacologic Therapy for Schizophrenia (Antipsychotics)

Typical (Conventional): Older meds often used in emergencies or when other medications fail; more potent with more side effects.
Atypical: Newer meds generally preferred for long-term treatment, with fewer side effects.

Examples of Antipsychotics

Typical: Chlorpromazine (Thorazine), haloperidol (Haldol), fluphenazine (Prolixin).
Atypical: resperidone (Risperdol), olanzapine (Zyprexa), clozapine (Clozaril), ziprasidone (Geodon), quetiapine (Seroquel), paliperodone (Invega), aripiprazole (Abilify).

Antipsychotics Mechanism of Action

All reduce dopamine in the brain, and typically affect only dopamine.
Atypicals affect dopamine and other neurotransmitters.

Nursing Considerations for Antipsychotics

Monitor for side effects. Some are common (and manageable) while others are rare but life-threatening.
Teach importance of adherence; and clients struggle to follow regimens.

Medication Adherence

Compliance is lower with psychotropic medications (65-58%) than physical medications (76%).

Factors Affecting Medication Adherence

Anosognosia: Denial of illness.
Stigma: Shame and discrimination from mental illness.
Drug and alcohol use.
Cost: Difficulty affording medications.
Poor relationship with the doctor: Lack of trust and understanding.
Dislike taking meds: Difficulty accepting treatment regimens.
Forgetting: Forgetfulness that impacts medication schedules.
Side effects: Negative experiences or sensations due to the treatment.

Practice Question - Refusal to Take Psychotropic Medications

Ask the client about previous experiences with psychotropic medications. This helps the nurse understand the client's reason behind the refusal and how to properly address it.

Medication Administration

Cheeking (hiding pills in the cheek to be swallowed later) is a common diversion tactic that nurses should be mindful of.
Observe appropriate swallowing, and assess adherence to prescriptions.

Health Messaging about Psychotropic Medications

Nurses should carefully consider how messages are conveyed to clients and significant others about the importance of adherence.

Extrapyramidal Symptoms (EPS)

Pseudoparkinsonism: Tremors, shuffling gait, stooped posture.
Acute dystonia: Muscle spasms of the face, neck, arms, or legs, and upward eye movement.
Akathisia: Restlessness, pacing, difficulty standing still.
Tardive dyskinesia: Slow, involuntary movements of the face, mouth, and tongue.
Oculogyric crisis: Continuous involuntary upward eye movement.

Assessment of EPS

Abnormal Involuntary Movement Scale (AIMS): Nurses use the scale to track severity of movements.

Drugs to Treat EPS

Anticholinergics: Benztropine (Cogentin), diphenhydramine (Benadryl).

Rare/Life-Threatening Side Effects of Antipsychotics

Neuroleptic malignant syndrome (NMS): Severe muscle rigidity, high fever, and altered mental status.

Side Effects of Metabolic Syndrome

High blood pressure, high triglycerides, low HDL cholesterol, and insulin resistance are common.

Other Side Effects

Agranulocytosis (clozapine): Low white blood cell count. This one warrants more frequent blood monitoring and caution.
Sexual dysfunction: Very common side-effect with many antipsychotics, such as risperidone.
Reduced glucose control and gynecomastia: These side-effects can impact health.

Practice Question - Weight Gain and Antipsychotic Medication

Assess potential side effects, such as weight gain or other issues linked to treatment.

Nursing Care of Clients with Schizophrenia

Prevent injury.
Provide symptomatic treatment.
Educate clients and significant others.
Advocate for patients.

Therapeutic Communication

Nurses should communicate effectively with people with schizophrenia, actively listening and validating feelings, while maintaining boundaries for therapeutic conversations.

Practice Question - Evaluating Schizophrenia Care

Frequent reassessment and attention to the client's response to treatment is essential for improving patient care. The family's involvement in treatment is vital.

Family Communication

Family-to-Family is an NAMI educational program that supports family members of people with mental health conditions.

Evaluation

Client adherence to medications, utilization of community resources, clear communication, absence of hallucinations/delusions, and ability to perform ADLs and work in a structured setting are key assessment criteria.

The End

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Description

This quiz explores the effects and implications of antipsychotic medications. It covers symptoms they alleviate, patient rights regarding medication, types of hallucinations, and treatment approaches for psychotic disorders. Test your knowledge on key concepts in psychology and antipsychotic treatment.