s/s
Early Signs
Social withdrawal, Flat/expressionless gaze, Depressed mood, Oversleeping or insomnia, Forgetful, Unable to concentrate, Inability to cry or express joy
key diagnostic factor
Psychosis
(Psychosis not a DX it’s a symptom)
Antipsychotics
most common
Effective in treating negative and positive symptoms
Agranulocytosis
Antipsychotics
Clozapine; 2nd gen
May discontinue
what is anticholinergic Crisis
Life-threatening condition:
Overdose or sensitivity to drugs with anticholinergic properties
Onset
late teens to mid 30’s
Rarely DX before adolescence
Delusions
Thoughts that are erroneous, fixed, false beliefs, cannot be changed by reasonable argument
Beliefs that are not real or correct.
ziprasidone
Antipsychotics-2nd-gen (a-typical)
give with food
Neuroleptic malignant syndrome
1st generation Antipsychotics.
[Haloperidol: high doses=increased risk]
Life-threatening condition
check CK
Anticholinergic Crisis
Signs and symptoms
mnemonic
Hot as a hare (flushed)
Blind as a bat (blurry vision)
Mad as a hatter (confused)
Dry as a bone (urinary retention)
POSITIVE SYMPTOMS
Hallucinations
Delusions
Abnormal behaviors, thoughts, or perceptions
Hallucinations
Sensory experiences of things that are sensed but not real without actual external sensory stimuli
(usually visual/auditory. Can be tastes/smells, or feeling something that isn't there)
lurasidone
Antipsychotics-Second-gen (a-typical)
give with food
Tardive dyskinesia
Antipsychotics 1st gen
Anticholinergic Medication
Effects & Abuse
Toxic dosages: mild delirium with disorientation & hallucination
Lesser doses possible experience greater sociability & euphoria
Some find effects pleasurable (high feeling)
NEGATIVE SYMPTOMS
Absence or decrease of normal behaviors, thoughts, or reactions.
(Flat affect, Anhedonia, Alogia, Apathy)
“low key”
THERAPEUTIC RELATIONSHIP
Must develop trust, accept person as a worthy human being, & infuse relationship with hope.
Be consistent (enforce rules, don’t leave room for negotiation)
Keep promises
Clozapine
Antipsychotics-Second-generation (a-typical)
only when other second-generation agent not effective
(s/e: agranulocytosis)
Extrapyramidal side effects
Antipsychotics
Parkinsonism, Dystonic reactions, Akathisia, Tardive dyskinesia.
Cholinergic Rebound
cause & symptoms
Abruptly stop taking anticholinergic agent
Symptoms: Vomiting, Excessive sweating, Altered dreams & nightmares
NEGATIVE SYMPTOMS
vs
POSITIVE SYMPTOMS
Positive symptoms: Presence of abnormal behaviors, thoughts, or perceptions
Negative symptoms: Absence or decrease of normal behaviors, thoughts, or reactions
PRIORITY OF NURSING CARE
during psychosis episode
Safety
In group setting may need to clear room 1st
More dangerous to try to remove pt
Antipsychotics
Effective timeline
1st few days: diminish hallucinations & illusions
1 to 2 weeks: change in symptoms start
6 to 12 weeks: for full effects
NEUROLEPTIC MALIGNANT SYNDROME
treatment
Early recognition: withhold med
Dopamine agonists (bromocriptine)
muscle relaxants (dantrolene or benzodiazepine)
Supportive measures: stay with pt & seizure precautions
Anticholinergic Crisis
treatment
Life-threatening:
d/c med (usually self-limiting, 3 days after drug dc)
Gastric lavage, charcoal (rare)