Onset 18-25

Delusions (false, fixed ideas)

Hallucinations- any of hte 5 senses

Disorganized speech- loose associations, Flight of Ideas, word salad

Grossly disorganized behaviors

Negative symptoms: lack of energy, motivation

Chronic illness

They absolutely believe their delusions

1) Hallucinations

2) Delusions

3) Behavior - bizarre behavior. They're hearing voices and seeing things we don't see or hear and they're responding to them.

What types of hallucinations can you have?

(hint: there are 5)

1. Auditory- (most common in schizophrenia)
2. Visual
3. Tactile
4. Olfactory
5. Taste

• Address feeling and content: ask- are you seeing something? Are you hearing voices?
• Don't pretend to experience the hallucination as well.
• Tell Pt. well I don't see what you're seeing but you seem very upset
• Dont argue with Pt and say "there's nothing there... you're imagining it..."

The paranoid delusion is the most common type.

People have very well formed and complex delusions.

A delusion is a fixed, false idea.

a paranoid delusion is the most common type.

The person may thing they are being controlled by someone outside of the,

They are absolutely convinced of their delusion- you cannot convince them it is not true.

• Provide pre-packaged food (helps with the delusion that some one's trying to poison them)
• Observe for "cheeking" after meds
• Don't stare at them
• Brief one- on one (don't get in their space)
• Recognize that longer group activities are hard to participate in for them

• Neologisms: made up words- made up languages
• Clang Associations: rhyming words
• Word Salad: random words together
• Posturing: holding positions-
• Waxy Flexibility: holding position but you can move their arm like a wax figure
• Ecopraxia: they mimic your mvmt. you fold  , your arms, they fold hteir arms...
• Echolalia: they repeate your words

• Apathy
• Autistic- w/drawn from world
• Affect: flat, blunt
• Ambivalence: hard time making decisions
• Anhedonia: lack of pleasure
• Anergia: lack of energy
• Avolitional: lack of motivation

Often the typical anti psychotic medications can cuse these symptoms b/c they block ALL dopamine

Prodromal- BEFORE the first psychotic break. the signs are: isolated, unusual ideas, preoccupied about religion or something

Acute- their function starts to dip, bizarre behavior

Chronic/Residual- this is what the people are left with after they take their anti psychotic meds. It usually takes a while for the meds ot take effect and the hallucinations to go away.

Hallucinations are something people experience- hear, see, feel, taste, smell. They distort the person's reality and orientation. They often impair memory and disrupt attention and concentration. The person may appear impulsive when they react to the hallucinations.

Delusions are something that people think. They impair judgement and insight, the affect the personality, and they affect relationships with people

They both can impair function, cause unusual behavior they can make the person a danger to self or others (command hallucinations, or the delusion some one's trying to kill you so you act first)

They can both also cause fear and anxiety.

Orientation: thinking, judgment, reasoning and calculation are messed up.

Language: Attention & concentration can be skewed. (clang associations, neologisms..)

Learning- memory is affected

Perception: hallucinations are sensory perception issues...

Impulsivity: May react to voices in head or something they're seeing.

Level of Consciousness (LOC) : generally very alert and very high

1) Paranoid Schizophrenia: the most common

2) Chronic undifferentiated Schizophrenia: not really paranoid, a little disorganized... not specific

3) Disorganized Schizophrenia: these are the most ill Pts. They are hospitalized long term. Starts in late teens, have word salad

4) Catatonic Schizophrenia: waxy--> echolalia--> echopraxia. Pt's usually come out of this after medicaton takes effect.

1. Haldol this has INTENSE side effects. PRN. Very sedating
2. Mellaril
3. Stelazine
4. Thorazone
5. Prolixin
6. Navane
7. Loxitane
8. Trilafon
9. Moban

These all have bad motor side effects. They block ALL of the dopamine which results in the side effects
anagram: Please, Not Too Late To Have Mary Start Meds

Sedation

Anticholinergic: can't see can't pee, can't spit can't shit! :-)

Gynecomastia- breasts start to swell with discharge

Low Libido

Impotence

Photosensitivity- sunburnreally easily

Acute Dystonic Reaction- the muscular system like neck- torso crntract in an involuntary muscle mvmt. Head rolls back and sometimes so do the eyes.

Antidote: Benadryl

Akathisia- motor reslessness. This is where their limbs need ot move all of the time (old lady in video :-()

Antidote: take off meds

Pseudoparkinsonism- Cogwheeling. Their arms move in a jerky motion like cogs on a truening wheel. Antidote: Anti-parkinsons meds.

Tardive Dyskinesia (TD) slight involuntary muscles contractions that become progressively more severe.

These muscle contrations manifest in: lip smacking (like a chewing motion) blinking, eyebrows up and down.

You can stop meds completely, but side effects will remain.

AIMS: Abnormal Involuntary Movement Scale

it's a neurological test: Get patient's to touch their fingers together, pronate and suponate hands. WHile they do this, watch their mouths- they'll exhibit lip smacking, like they're chewing, blinking their eyes. moving eyebrows ↑&↓. 

I think the instructions for hand movmnts is just so they don't focus on their mouths and eyes and try to control symptoms they may have,

What are some dangerous physiologic side effects from taking antipsychotic meds?

(specifically Dopamine blocking meds)

What are the symptoms?

Neuroloplectic Malignant Syndrome (NMS)

• It begins with fever, it progresses quickly through your system and you can have:

diaphoresis, HTN, elevated pulse, cardiac irregularities, muscle rigidity, incontinence, unconsciousness, coma, death.

1) STOP antipsychotic medications

2) Start IV access for fluids & electrolytes

3) cooling blankets for fever

4) Cardiac meds, and anti HTN meds.

1. Abilify
2. Clozaril
3. Geodon
4. Zyprexa
5. Seroquel
6. Risperdal
7. Invega

anagram: Atypical Zyprexa Can Get Really Soothing Instantly

• They treat the positive symptoms (hallucinations, voices) and the negative symptoms (lack of motivation, motor functioning)
• They have fewer side effects (they don't block all of the dopamine)
• There is much less EPS and Pt's rarewly if ever have TD

1) What are some side effects from taking atypical side effects?

2) What happens with Clozaril specifically?

1) Some side effects are:

hyperlipidemia, hyperglycemia, weight gain, decreased libido, impotency, Geodon prolonged QT complex ( affects heart at QT complex must get Pt EKG)

2) With Clozaril, your granulocytes (WBC) dip way down which can lead to easy infection.  SO you must get baseline WBC count and monitor WBC's closely

What are Depot Medications? Why might they work well for some patients?

The goal is to have:

↓ less conviction with the delusions

↓ reduced numbers of hallucinations

↑Improved function

↑Improved interaciton

What characteristics are we hoping improve after someone with schizophrenia takes meds?

(I think it's referred to as residual schizophrenia.)

We hope for better:

• Orientation
• Thinking- judgement, reasoning, calculation
• Language
• Attention & Concentration
• Learning
• Memory
• Perception
• Impulsivity

LOC stays the same- generally schizophrenics have a good LOC. They can make treatment decisions for themselves.

Most people have:
repeated psychotic episodes

Medication doesn't PREVENT episodes or psychosis, but it makes it less severe

Early treatment is the key. Remember kindling.

If you're diagnosed and treated early, your illness may be less severe, less disabling and you'll have a better return to baseline.

Millie starts to now hears voices telling her to protect herself. When her boss asks her a question, she think it's some sort of accusation or code in the plot to put her away. She may try to punch her boss and scream at him/her that "... you'll never get away with your diabolical plan..."

Then she get EP'd and admitted to local psych hospital.  That's when we meet her. :-)

Nurse can say:

I know this is upsetting but you're in a hospital where we're trying to help you. We are going to make sure you're safe.

• Make sure Pt will not harm self or others
• Give meds and hope for decreased conviciotn about delusions
• With time hope she can increase her interact with others (even if only briefly)
• Watch to see if meds reduce frequency of hallucinations/voices.

Long term goals for "Millie" :

• Hallucinations and delusions decreased
• Pt is compliant with treatment
• Pt maintains safety
• Patient able to function in least restrictive setting
• Pt will have increased insight about symptoms

Mental health centers

Psychosocial rehab

Supervised living program

Financial aid, SS disability

Insurance coverage & medical assistance

A Case Manager

A Therapist

Psychiatrist

A Vocational training program