Exam 2 Study Guide - Schizophrenia PDF

Exam 2 Study Guide Chapter 12: Schizophrenia Key Concepts 1. Therapeutic Communication in Psychosis: ○ Establishing trust and rapport: Use a calm, empathetic, and non-judgmental approach. Be patient and understanding, as responses may be slowed or delaye...

Exam 2 Study Guide Chapter 12: Schizophrenia Key Concepts 1. Therapeutic Communication in Psychosis: ○ Establishing trust and rapport: Use a calm, empathetic, and non-judgmental approach. Be patient and understanding, as responses may be slowed or delayed. Use active listening skills, such as reflecting and summarizing. Maintain a consistent and reliable presence. ○ Using clear and concise language: Use simple and direct language, avoiding jargon or complex metaphors. Break down instructions into smaller, manageable steps. Repeat information as needed, and check for understanding. ○ Avoiding arguments or confrontations: Do not argue or challenge delusional beliefs. Validate the person's feelings and experiences, even if they are not based in reality. Redirect the conversation to neutral topics if necessary. Set clear limits on inappropriate behavior, but do so in a calm and respectful manner. 2. 1st Generation Antipsychotics: ○ Common names: Chlorpromazine (Thorazine) Haloperidol (Haldol) Fluphenazine ○ Side effects: Extrapyramidal symptoms (EPS): Dystonia, akathisia, parkinsonism, tardive dyskinesia Neuroleptic Malignant Syndrome (NMS): Fever, muscle rigidity, altered mental status, autonomic instability Anticholinergic effects: Dry mouth, blurred vision, constipation, urinary retention ○ Patient teaching: Importance of adherence to medication regimen Management of side effects, including reporting any concerns to the healthcare provider Regular follow-up appointments to monitor for effectiveness and side effects  Avoidance of alcohol and other CNS depressants 3. 2nd Generation Antipsychotics: ○ Common names: Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Aripiprazole (Abilify) ○ Side effects: Metabolic syndrome: Weight gain, dyslipidemia, hyperglycemia, insulin resistance EPS: Less common than with 1st generation, but still possible Anticholinergic effects ○ Patient teaching: Similar to 1st generation, emphasizing adherence, side effect management, and regular follow-up Additional focus on monitoring for signs of metabolic syndrome, such as weight gain, increased thirst, and frequent urination 4. Management of Violent Command Hallucinations: ○ Prioritize safety: Assess the situation for potential danger to self and others. Ensure a safe environment, with no access to weapons or means of self-harm. Have enough staff available to manage the situation if necessary. ○ Use clear and direct communication: Use a calm and firm voice. Give simple and direct instructions. Avoid arguing or challenging the hallucination. ○ Consider medication adjustments: Consult with the healthcare provider about adjusting medication dosage or type. Rapid tranquilization may be necessary in severe cases. ○ Seclusion or restraints: May be necessary as a last resort to prevent harm to self or others. Use only for the shortest duration necessary, and monitor closely. 5. Hallucinations: ○ Types: Auditory: Hearing voices or sounds Visual: Seeing things that are not there Olfactory: Smelling things that are not there Gustatory: Tasting things that are not there  Tactile: Feeling sensations on the skin that are not there ○ Concern: Persistent or frequent hallucinations Distressing or disturbing content Command hallucinations that instruct the person to do something ○ Interventions: Assess the content, frequency, and impact of hallucinations. Provide reality testing, helping the person to distinguish between hallucinations and reality. Teach coping strategies, such as distraction, relaxation techniques, and positive self-talk. ○ Therapeutic communication: Acknowledge the experience of the hallucination. Focus on the feelings associated with the hallucination. Explore coping strategies and ways to manage the experience. 6. CBT for Delusions: ○Identify and challenge delusional beliefs: Explore the evidence for and against the delusion. Gently challenge the logic and plausibility of the delusion. ○ Develop alternative explanations: Help the person to develop alternative explanations for their experiences. ○ Improve coping strategies: Teach coping strategies to manage the distress associated with the delusion. 7. Management of Delusions: ○ Similar to hallucinations, focus on the feelings associated with the delusion. ○ Do not try to disprove the delusion or argue with the person about it. ○ Validate the person's feelings and experiences. ○ Explore coping strategies and ways to manage the distress associated with the delusion. 8. Types of EPS and causative medications: ○ Dystonia: Sudden, sustained contraction of muscles, causing twisting or abnormal postures. Can be painful and frightening. ○ Akathisia: Motor restlessness, causing an inability to stay still or remain in one place. Can be very distressing and lead to agitation. ○ Parkinsonism:  Temporary group of symptoms that resemble Parkinson's disease, such as tremor, rigidity, and bradykinesia. ○ Tardive dyskinesia: Involuntary rhythmic movements of the face and tongue, such as lip smacking, chewing, and tongue protrusions. Can be irreversible. ○ Medications: Typical antipsychotics (1st generation) are more likely to cause EPS. Atypical antipsychotics (2nd generation) can also cause EPS, but generally less frequently. Chapter 13: Bipolar Disorder 1. Bipolar I vs. II: ○ Bipolar I: At least one manic episode May also have hypomanic or depressive episodes ○ Bipolar II: At least one hypomanic episode At least one major depressive episode No history of manic episodes 2. Evolution to Mania: ○ Gradual onset, with subtle changes in mood, sleep, and behavior ○ Increased energy, decreased sleep, racing thoughts, impulsivity ○ May progress to a full manic episode, with psychotic symptoms 3. Features of Mania and Nursing Management: ○ Features of mania: Elevated or irritable mood Grandiosity Decreased sleep Pressured speech Racing thoughts Impulsivity Distractibility Psychotic symptoms (in severe cases) ○ Nursing management: Safety: Prevent harm to self and others Limit setting: Set clear limits on behavior Medication adherence: Encourage adherence to medication regimen Mood stabilization: Monitor for mood changes and intervene as needed  Patient and family education: Teach about bipolar disorder and its management 4. Therapeutic Communication: ○ Similar to psychosis, focus on establishing trust and rapport, using clear and concise language, and avoiding arguments or confrontations. ○ Be patient and understanding, as responses may be rapid or impulsive. ○ Redirect the conversation if necessary. ○ Set clear limits on inappropriate behavior. 5. Safety Precautions in Bipolar I: ○ Assess for suicide risk. ○ Prevent harm to self and others. ○ Manage impulsive behaviors. ○ Monitor for signs of agitation or aggression. ○ Provide a safe environment. 6. Lithium: ○ Therapeutic range: 0.6-1.2 mEq/L ○ Signs of toxicity: Tremor Nausea and vomiting Diarrhea Confusion Seizures Coma ○ Patient teaching: Regular blood tests to monitor lithium levels Maintain consistent fluid and salt intake Avoid alcohol and other CNS depressants Report any signs of toxicity to the healthcare provider Chapter 14: Depressive Disorders (Continued) 1. MDD and Suicidal Ideation: ○ Assessment: Use a standardized suicide risk assessment tool, such as the Columbia-Suicide Severity Rating Scale (C-SSRS). Ask directly about suicidal ideation, plans, and intent. Assess for risk factors, such as hopelessness, previous attempts, and access to means. ○ Interventions: Prioritize safety. Provide one-on-one observation if necessary.  Remove any means of self-harm. Encourage the patient to express their feelings. Instill hope and encourage treatment adherence. ○ Therapeutic communication: Use empathetic and non-judgmental language. Validate the patient's feelings. Express concern and offer support. Instill hope for recovery. Chapter 24: Personality Disorders (Continued) 1. Nursing Interventions/Approach: ○ Establish clear boundaries: Define acceptable and unacceptable behavior. Be consistent in enforcing limits. ○ Maintain consistency: Provide a predictable environment. Avoid reacting emotionally to provocative behavior. ○ Promote self-awareness and coping skills: Encourage journaling and reflection. Teach relaxation techniques and stress management skills. Support the development of healthy coping mechanisms. Chapter 25: Suicide (Continued) 1. Assessing Suicide Risk: ○ Risk factors: Previous suicide attempts Family history of suicide Mental health disorders Substance abuse Access to means Hopelessness Social isolation ○ Suicidal ideation: Frequency, intensity, and duration of thoughts Presence of a plan ○ Lethality of plan: Specificity of the plan Availability of means Likelihood of rescue 2. Cues for Impending Suicide:  ○ Changes in behavior: Increased withdrawal, agitation, or impulsivity ○ Mood changes: Sudden shift from sadness to happiness ○ Communication: Giving away possessions, making final arrangements, saying goodbye ○ Giving away possessions ○ Making final arrangements 3. Priority Nursing Interventions: ○ Safety is paramount. ○ One-on-one observation ○ Remove means of self-harm. ○ Establish a therapeutic relationship. ○ Encourage expression of feelings. ○ Instill hope. 4. Indications for Inpatient Hospitalization: ○ High suicide risk ○ Lack of support system ○ Need for intensive treatment ○ Medical or psychiatric instability 5. Suicide Survivors' Management: ○ Provide support and resources. ○ Address grief and trauma. ○ Promote healing and coping. ○ Encourage connection with others. Chapter 32: Serious Mental Illness (Continued) 1. Neuroleptic Malignant Syndrome: ○ Symptoms: High fever Muscle rigidity Altered mental status Autonomic instability (tachycardia, labile blood pressure, sweating) ○ Nursing interventions: Stop the causative medication immediately. Provide supportive care, such as cooling measures and hydration. Monitor for complications, such as respiratory failure and renal failure. Administer medications as ordered, such as dantrolene or bromocriptine. 2. Life Expectancy with SMI: ○ Reduced by 10-20 years compared to the general population.  ○ Due to higher rates of physical health problems, such as cardiovascular disease, diabetes, and respiratory disease. ○ Suicide is also a leading cause of death in people with SMI. Miscellaneous (Continued) 1. Types of Therapies: ○ Psychotherapy: Individual therapy Group therapy Family therapy Cognitive behavioral therapy (CBT) Dialectical behavior therapy (DBT) ○ Milieu therapy: Creating a therapeutic environment that supports recovery Includes safety, structure, support, and validation Involves patients in decision-making and promotes social interaction Miscellaneous (Continued) 1. Definitions: ○ Pressured speech: Rapid and excessive speech that is difficult to interrupt. Often seen in mania. (See your Bipolar Disorder presentation for examples) ○ Circumstantiality: Indirect speech that includes unnecessary and tedious details before getting to the point. The person eventually answers the question but only after a long, roundabout explanation. ○ Delusions: Fixed, false beliefs that are not based on reality and are not amenable to change in light of conflicting evidence. (Refer to your Schizophrenia presentation for examples like delusions of grandeur, persecution, etc.) ○ Tangentiality: Similar to circumstantiality, but the person never returns to the central point and never answers the original question. ○ Erotomanic: A delusion that another person, usually of higher status, is in love with the individual. ○ ○ Echolalia: The pathological repeating of another's words by imitation. Often seen in catatonia. ○ Psychosis: A state in which a person experiences a loss of contact with reality, characterized by hallucinations, delusions, and disorganized thinking. (Review the "Phases of Schizophrenia" slide in your Schizophrenia presentation) ○ Clang associations: Meaningless rhyming of words, often in a forceful manner. ("On the track...have a Big Mac...attack the sack") ○ Grandiose delusions: Exaggerated beliefs about one's importance, power, knowledge, or identity. (Refer to the "Positive Symptoms" section of your Schizophrenia presentation) ○ Anosognosia: Lack of awareness of one's illness or the need for treatment. This can be a significant barrier to treatment adherence in SMI (See your Serious Mental Illness presentation).