PSYCHE FINALS : TRANS 2

OTHER NEGATIVE SYMPTOMS:

PSYCHOTIC DISORDER: SCHIZOPHRENIA
All this signs & symptoms can also be seen in SAM (Schizophrenia,
Definition: Alzheimer’s & Manic)
Severe impairment of mental & social functioning with 1. Neologism (creating NEW WORDS) vs. Word Salad (incoherent mixture of
grossly impaired reality testing, sensory perception and with deterioration & words)
regression of psychosocial functioning. 2. Flight of Ideas (jumping from one RELATED topic to another): Commonly
THEORIES: seen in MANIC patients, also in Schizophrenia.
1. Increased dopamine –coming from the substancia nigra 3. Verbigeration (meaningless repetition of action words (Verb)) vs.
2. Trauma  PTSD Perseveration
3. Double-bind theory  2 kinds of information/communication e.g. 1st stimulus  correct response
4. Genetics 65% chances- if two parents are diagnose with 2nd & following stimulus  still responding to the 1st stimuli
schizophrenia 4. Circumstantiality (beating around the bush; answers but delayed) vs.
32.5% chances- if 1 parent is diagnosed with Tangentiality (did not answer the stimulus/ question)
schizophrenia 5. Clang association (use of rhymes in sentences) vs. Echolalia/Parroting &
5. Drug addicts and alcoholics: High probability for schizophrenia due to Echopraxia (Commonly seen in AUTISM)
increase Delusions & hallucination B. PRIORITIZED NURSING DIAGNOSES FOR ALL TYPES OF SCHIZOPHRENIA:
DSM V Criteria for Schizophrenia: 1. Risk for violence: Directed toward self or other (priority!!!)
Characterized by both (-) & (+) symptoms & social / occupational 2. Self-care deficit
dysfunction for at least SIX (6) months. 3. Thought process, altered
Patient with 5 admissions in 2 yrs is considered a chronic schizo. 4. Sensory/perceptual alterations ( related to illusion, delusion &
(+) POSITIVE SIGNS OF SCHIZOPHRENIA: Due to EXCESS DOPAMINE hallucination)
Do you know HILDDA PI? 5. Social isolation
Hallucination, Illusion, Looseness of Association, Delusion, 5 (FIVE) TYPES OF SCHIZOPHRENIA:
Disorientation & Agitation 1. PARANOID:
Paranoia & Insomnia Presenting sign is SUSPICIOUSNESS, ideas of persecution
Schizophrenic patient says, “Pretty red dress, tomatoes are red…” is and delusions; sees environment as hostile and threatening. REMEMBER the
showing looseness of association 4 P’s:
(-) NEGATIVE SIGNS OF SCHIZOPHRENIA: Due to LACK OF DOPAMINE Projection (#1 defense mechanism), Proxemics( 7 feet away from
Remember your POOR A’s? the patient), Passive Friendliness (#1 attitude therapy: No touching, , no
Poor judgment, Poor insight, Poor self care whispering & laughing) , delusion of Persecution (#1 delusion of Paranoid
Alogia, Anergia, Anhedonia Schizophrenia) ,
NURSING DIAGNOSIS FOR NEGATIVE SYMPTOMS OF ASSESSMENT FINDINGS (GENERAL SIGNS)
SCHIZOPHRENIA: THE FOUR A’s of SCHIZOPHRENIA ACCORDING TO BLEULER
1. Alteration in Thought Process;  ASSOCIATIONS, LOOSE: Jumping to different topics WITHOUT
association or relevance
2. Alteration in Content of Thought
  AMBIVALENCE (Two opposing feelings toward others at the same
time)
 AUTISM (withdrawal from environment and others) → magical
thinking, neologism, aloofness)
 AFFECT, FLAT (Inappropriate or no display of feelings)
#1 HALLUCINATION of Schizophrenia is Auditory.
A patient who says,” The other staff members are laughing at my back.”
shows a paranoid delusion of schizophrenia.
Schizophrenic says, “Someone has placed a transistor in my
brain,” correct interpretation shows paranoid delusion
Statement like, “I don’t like to eat meat because animal produced foods
are
Poisonous”, shows suspicious paranoid type schizophrenia.
Developmental Stage FIXATION: ORAL PHASE (TRUST vs. MISTRUST)
NURSING CONSIDERATION:
1. Consistency to build trust
2. Food: PACKED OR SEALED foods except canned goods: No
metal
3. Social Isolation – no group session when schizophrenic
Paranoid who is suspicious saying, “This place is meant for bugs &
prison,” In order to encourage trust, the patient should be involved in the
plan of care.
2. CATATONIC: With stereotyped position (catatonia) with waxy flexibility,
mutism, bizarre mannerism.
#1 Defense mechanism: Autism & mutism
#1 Cardinal Sign of Catatonia – waxy flexibility (cerea
flexibilitas)
-Similar in children with autism
- Most dangerous/serious type of schizophrenia– may die
from dehydration
CATATONIC CHARACTERISTICS:
 Catatonic stupor – markedly slowed movement.
 Catatonic posturing- bizarre or weird positions
 Catatonic rigidity – cementation/stone-like position
 Catatonic negativism – resistance towards flexion & extension
 Catatonic hyperactivity or excitability
PRIORITIZED NURSING DIAGNOSIS:
1. Fluid & Electrolyte Imbalance
2. Altered Nutrition less than body requirement
3. Self Care Deficit
3. DISORGANIZED: Another word is Hebephrenic. Characterized with
inappropriate behavior: Silly crying, laughing, regression, transient
hallucinations (Auditory).
All behaviors are similar with toddlers since they are anal fixated.
Developmental Stage FIXATION: Anal Fixation
#1 Defense Mechanism: Regression & Fixation
4. UNDIFFERENTIATED or MIXED : Symptoms of more than one type of
schizophrenia
has delusions & disorganized behavior but DOES NOT meet the criteria for
the above sub types alone. The #1 drug of choice is Fluphenazine (Prolixin
decanoate)
5. RESIDUAL: No longer exhibits overt symptoms, no more delusions but still
has negative
Undifferentiated type chronic schizophrenia must be referred to a program
promoting social skills due to functional loss deficit.
PRINCIPLES OF CARE
1.Maintenance of safety: Protect from altered thought processes. Respond
to feelings, and not to delusions; Do not argue; Validate reality; remove
from areas of tension
Suspiciousness & paranoid patient is threatening to the staff, the
action of an RN that shows a need for further teaching is when she goes to
the room of a pt. who yells, “Everyone, out of here,”
Appropriate action of RN to a Schizophrenic who yells loudly, talks to wall
and saying “Don’t talk to me, bastard.” includes walking towards the pt &
ask him who he is talking to.
2. Meeting of physical needs: May have to be fed / bathe initially
3.Establishment and maintenance of therapeutic relationship: Engage in
individual therapy; Promote trust; Encourage expression by verbalizing the
observed; Offer presence-Tolerate long silences
4.Implementation of appropriate family, group, social or diversional
therapies
Patients with schizophrenia need activities that do not require interaction,
so solitary activities are preferred over team activities.
Admission assessment of a Schizophrenic client reveals auditory
hallucination, and drinking more than 6 L of water daily for past weeks,
priority focus should be hyponatremia.
 Desired efficacy of treatment in schizophrenic patient who is mute & “I will need to monitor my blood level to continue my medication.”
immobilized includes standing up when RN enters the room. shows a correct understanding of a patient while taking Clozaril.
Loxapine (Loxitane)
ANTIPSYCHOTICS Risperidone (Risperidone) #1 drug for Korsakoff’s psychosis
Another word: Neuroleptic / Major Tranquilizers Molindone (Moban)
USES: Schizophrenia, acute mania, depression and organic conditions; Non- Aripiprazole (Abilify) newest antipsychotic drug
psychiatric cases: Nausea and vomiting, pre-anesthesia, intractable hiccups.
Antipsychotics can only decrease the positive symptoms of schizophrenia, SIX COMMON ANTICHOLINERGIC SIDE EFFECTS OF ANTIPSYCHOTICS
but not the negative symptom such as ambivalence. (Anticholinergic effects are drug actions of antipsychotic drugs because they
Action: ↓ delusion, hallucinations, looseness of association to BLOCK MUSCARINIC CHOLINERGIC RECEPTORS)
decrease levels of dopamine in the substantia nigra CODE: BUCO PanDan – anticholinergic S/Es
I. Phenothiazine Code: AZINE 1. Blurring of Vision - ↑ sympathetic reaction (don’t operate
Fluphenazine (Prolixin)* machinery);
Acetophenazine (Tindal) Mydriatic – pupil dilate  sympa  ↑ IOP  don’t use in glaucoma
Pherphenazine (Trilafon) 2. Urinary Retention – (Post Partum, Autonomic Dysreflexia,
Promazine (Sparine) paraplegia)
Chlorpromazine (Thorazine)*#1 that causes Nursing Interventions:
photosensitivity/photophobia; 1. Provide Privacy – give bed pan
Side effects: Causes also red orange urine 2. Sounds of dripping water – faucet
In liquid form is usually put in a chaser  Chaser: 60- 100 ml juice (prone 3. Intermittent cold & warm compress
or tomato); to prevent constipation & contact dermatitis; taken with straw 3. Constipation
(bite straw & sip) Nursing Interventions:
Mesoridazine (Serentil) 1. Prevent constipation ↑ fiber (residue) AG or roughage,
Thioridazine (Mellaril)* ceiling dose/day: 800 mg  Adverse Effect: prune/pineapple/papaya juice/ fruits
Retinitis pigmentosa 2. ↑ OFI
Prochlorperazine (Compazine)* #1 commonly used anti emetic 3. ↑exercise
Compazine causes anticholinergic side effects 4. Orthostatic Hypotension/Postural Hypotension
Trifluoperazine (Stelazine) - take BP in supine, Fowler’s & standing position. Difference of BP 15-20 mm
II. Butyrophenones Code: PERIDOL Hg below
Haloperidol (Haldol, Serenase)* #1 drug used for extreme violent S/Sx: Pallor, dizziness
behavior Nursing consideration: Slowly change position. Told patient
Instruct patient taking Haldol to wear sunscreen to dangle feet first before standing
Droperidol (Inapsine) 5. Pan Photosensitivity (photophobia)
III. Thioxanthenes Code: THIXENE Nursing Intervention:
Chlorprothixene (Taractan 1. Use sun glasses, sun block, long sleeves or/and umbrella
Thiothixene (Navane) Patients taking antipsychotic should be instructed to wear wide brimmed
IV. Atypical Antipsychotics Code: DONE / ZAPINE or APINE hat when going outside
Olanzapine (Zyprexia) 6. Dan Dry mouth/ Xerostomia
Clozapine (Clozaril) #1 that causes Agranulocytosis & Blood Prioritized Nursing Intervention:
Dyscrasia Give (1) ice chips, (2) chewing gum, (3) sips of water
 - Usually they are anticholinergic &
antiparkinsonian drugs
ACUTE/COMMON SIDE-EFFECTS FOR PROLONGED USED OF Procyclidine (kemadryl, kemadrin)
ANTIPSYCOTICS Artane ( trihexyphenydyl)
Extrapyramidal Symptoms (EPS) Common Signs & Symptoms: Cogentin (Benztropine mesylate)
Definition of EPS: Reversible side effect (except TARDIVE DYSKINESIA), which Akineton (biperiden Hcl)
is a result of neurological dysfunction of the Extrapyramidal System. Bromocriptine (Parlodel)
Patients taking with prolonged antipsychotic medications should always be Benadryl (Diphenhydramine)
assessed for symptoms of extrapyramidal symptoms. Amantadine (Symmetrel)
1. Akathesia –another word: Motor restlessness  1-6 wks
Signs of motor restless: Foot tapping, finger fidgeting, can’t sit down ADVERSE EFFECT OF ANTIPSYCHOTIC DRUGS:
for more than 15 minutes and pacing back & forth.
Neuroleptic Malignant Syndrome RARE, LIFE-THREATENING :
Patient is unable to remain still
(EXTREME EMERGENCY):
Drug of Choice: CODE: CBA
#1 Cardinal Sign is High fever, tremors, tachycardia, tachypnea,
#1 Cogentin (Benztropine Mesylate)
sweating, hyperkalemia, stupor, incontinence, renal failure, muscle rigidity
#2 Benadryl (Diphenhydramine Hcl)
(Discontinue all drugs STAT; ventilation; hydration; nutrition; renal dialysis;
#3 Akineton (Biperiden Hcl)
hydrotherapeutic measures).
3.Pseudoparkinsonism - another word: Drug-induced Parkinsonism – #1
Elevated blood pressure and diaphoresis are indicative of Neuroleptic
sign: Pill-rolling tremors. Other signs: Mask-like face, flat affect, shuffling gait
malignant syndrome, which is a medical emergency.
or festinating gait, cogwheel rigidity.
ANTIDOTE: Dantrolene (Dantrium) or Bromocriptine (Parlodel)
DRUG OF CHOICE:
Bromocriptine is both an Antiparkinsons & Anti prolactin
#1 Artane (trihexyphenydyl)
#2 Amantadine ( Symmetrel) can also be used in Chicken pox, also
an ANTI VIRAL
2.Dystonia – #1 cardinal Sign: Oculogyric crisis = involuntary rolling of
eyeballs, neck shoulder, jaw and throat spasm (dysphagia)  2-5 days
Drug of Choice: CODE: CBA
#1 Cogentin (Benztropine Mesylate)
#2 Benadryl (Diphenhydramine Hcl)
#3 Akineton (Biperiden Hcl)
4.Tardive Dyskinesia – Starts with T: TONGUE (tongue rolling & tongue
protrusion) lip smacking, tongue rolling, protrusion of the tongue,
vermicular or vermiform tongue rolling  irreversible. This is an
EMERGENCY!!!
Symptoms of tardive dyskinesia include fly catcher’s mouth, tongue
thrusting, facial grimacing, puckering of cheeks, and drooling of saliva.
--administer Artane, Benadryl, Cogentin, Antiparkinsonian drug
5. Akinesia – absence of kinetic movements
ANTI- EPS MEDICATION
CODE: PACABBA