Terminology
What is the difference between clang associations and word salad?
Clang Association: rhyming of words that don't have any connection
(Ex: he rained the train brain strain gain the crane)
Word Salad: group of words put together without any logical connection
(Ex: blue I rain the cat car smelly house walked ghostly food swimming)
Fill in the blank.
1st Gen antipsychotics are more likely to cause _______ symptoms, whereas 2nd Gen antipsychotics are more likely to cause ________ and ________ symptoms.
1st Gen antipsychotics are more likely to cause positive (+) symptoms, whereas 2nd Gen antipsychotics are more likely to cause positive (+) and negative (-) symptoms.
Presence of one or both of the following-
Delusions and/or Hallucinations
What is dystonia?
1. Definition
2. When do symptoms occur?
3. What do we want to monitor?
4. Treatment
1. Definition: severe spasm of tongue, neck, face and back
2. Symptoms occur 1-5 days after administration (could be after discharge - educate!)
3. AIRWAY! (think about location of spasms)
4. Antiparkinson's agents, Benztropine (Cogentin), Benadryl
What is the #1 priority?
SAFETY (assuming ABCs are stable)
What is grandeur?
Exaggerated feelings of importance, power or superiority
(Ex: I own this hospital, I hold all the power)
What are some benefits to long-acting antipsychotics?
Administration is not daily
Improved medication adherence
Reduced symptoms
ANY OTHERS??
How is schizophrenia diagnosed? (hint: 2 or more symptoms must be present)
Delusions
Hallucinations
Disorganized speech
Grossly disorganized/catatonic behavior
Negative symptoms (the A's)
What is Parkinsonism?
1. Definition
2. When do symptoms occur?
3. What do we want to monitor?
4. Treatment
1. Definition: bradykinesia, rigidity, shuffling gait, tremor, drooling, stooped posture, instability
2. Symptoms occur 5+ hours after administration.
3. FALL RISK! (unstable gait)
4. Antiparkinson's agents, Benztropine (Cogentin), Trihexyphenidyl
Describe the difference between positive and negative symptoms. Give examples of each.
Negative: DIMINISHED effects and behaviors (the 5 A's - alogia, anhedonia, blunt affect, avolition, asociality)
What is the difference between flight of ideas and loose association??
Flight of Ideas: Changing topics very quickly or statements that don't have any flow of thought. Can be erratic and not make a lot of sense.
(Ex: I like tea, your shoes are black, that lady likes sugar, I want to sleep)
Loose Association: Lack of connection between ideas, similar theme, fragmented connections
(Ex: We want to take the bus, but the airplane took all the traffic)
1st Gen or 2nd Gen? Match the med.
Haldol (haloperidol)
Thorazine (chlorpromazine)
Vraylar (cariprazine)
Prolixin (fluphenazine)
Clozaril (clozapine)
Risperdal (risperidone)
Abilify (aripiprazole)
1st Gen: Haldol (haloperidol), Thorazine (chlorpromazine), Prolixin (fluphenazine)
2nd Gen: Vraylar (cariprazine), Clozaril (clozapine), Risperdal (risperidone), Abilify (aripiprazole)
Abilify (aripiprazole) can be classified as 2nd Gen or 3rd Gen
Positive symptoms of substance-induced psychosis are directly related to what 4 things?
Substance intoxication
Substance withdrawal
Exposure to medication
Exposure to toxin
What is akathisia?
1. Definition
2. When do symptoms occur?
3. What do we want to monitor?
4. Treatment
1. Definition: inability to sit or stand still
2. Symptoms occur 2 hours after administration. Symptoms can occur within the first 2 months of taking med.
3. SUICIDE RISK! (d/t uncontrolled restlessness)
4. Antiparkinson's agents, beta blockers, Ativan, Valium
What is psychosis?
A change in the brain that disrupts a person's interpretation or experiences of the world secondary to complex neurobiological changes
Describe the differences in the following hallucination terms: tactile, olfactory, somatic
Tactile: Sensation of touch w/o any physical stimulus
(Ex: I feel bugs crawling on me)
Olfactory: Detect smells that aren't actually present
(Ex: Do you smell smoke?)
Somatic: Internal bodily sensations in the absence of objectifiable cause or false belief that the person has a physical/medical problem
(Ex: Parasites are eating at my organs)
Which generation of antipsychotics are more likely to cause EPS, QT prolongation and gynecomastia?
1st Gen
What is catatonia?
Abnormality of movement and behaviors arising from a disturbed mental state
May be repetitive or purposeless overactivity or resistance to movement
What is tardive dyskinesia?
1. Definition
2. When do symptoms occur?
3. Assessment tool
4. Treatment
1. Definition: Involuntary movements of the tongue, face, lip smacking, fasciculations, involuntary movement of arms, legs and truck
2. "Late EPS" symptoms can occur at any time during course ot taking an antipsychotic
3. Assessment tool: AIMS scale
4. Change antipsychotic, Ingrezza
What does SADPERSONS assess?
What does it stand for?
Lethality
Sex, Age, Depression, Previous attempts, Excessive alcohol/drug use, Rational thinking loss, Separated/divorced/widowed, Organized attempt, No social supports, Stated future intent
What is the difference between paranoia and persecution?
Paranoia: extreme suspiciousness
(Ex: all of the nurses are out to get me)
Persecution: suspicion that a specific person/group of people are out to get them; accusatory
(Ex: the pharmacy is poisoning my medication)
What does Vraylar target?
What is the side effect of Clozaril? What does this necessitate?
Vraylar targets negative symptoms.
Clozaril causes agranulocytosis. Necessitates frequent CBCs
What are the 5 A's of schizophrenia? Describe them.
Alogia - reduction in quantity of words spoken
Avolition - reduced goal-directed activity d/t decreased motivation
Asociality - lack of motivation to engage in social interaction
Anhedonia - reduced experience of pleasure
Affect (flat/blunt) - nonexistent expression of emotion
What is Neuroleptic Malignant Syndrome (NMS)?
1. Definition
2. What are the defining characteristics of NMS?
3. True or False: this is a medical emergency
4. When do symptoms occur? List some.
5. Is it more common with 1st or 2nd gen?
6. What is the FIRST intervention if NMS develops?
7. What 2 meds are used to reduce rigidity and spasms?
8. What interventions do we want to anticipate?
1. Definition: life-threatening neurologic emergency associated with the use of antipsychotics
2. FALTER - Fever, Altered mental status, Labs, Tremors, Elevated CPK, Rigidity
3. TRUE!
4. Can occur within first week of drug therapy, but often later. Symptoms: muscle ridigity, dysphagia, hyperpyrexia, tachycardia, incontinence, coma
5. More common with 1st gen antipsychotics
6. STOP antipsychotic!!
7. Dantrolene and Bromocriptine (don't want to mask symptoms though...)
8. Cool the body, hydrate via IV fluids, heart monitor
State and describe the 4 stages of mental illness.
Stage 1: premorbid phase (personality traits of behavior start to appear, may be overlooked)
Stage 2: Prodromal symptoms (1mo-1yr prior to diagnosis, noticeable symptom changes)
Stage 3: Active psychotic phase/first psychotic episode (clear deterioration from baseline, can expand across lifespan, might only have 1 episode w/ proper treatment)
Stage 4: Residual phase w/ recurrent exacerbations (inpatient, managed not cured, road to recovery)