Used in treatment of schizophrenia
antipsychotic agents - major tranquilizers, neuroleptics
Chloropromazine (Thorazine) , Haldol (Haloperidol)
“Typical” / conventional antipsychotics ; first generation
Clozapine (Clozaril) , Risperidone (Risperdal)
“Atypical”, new generation
Contraindicated in clients with known hypersensitivity, comatose state, CNS depression, clients with Parkinson’s disease …
Typical antipsychotics
Contraindicated in patients with hypersensitivity, comatose, severe depression, dementia-related psychosis , lactation…
Atypical antipsychotics
exact mechanism is not known; thought to work by blocking postsynaptic dopamine receptors …
Antipsychotics action
Extrapyramidal symptoms (EPS) Tardive dyskinesia Neuroleptic malignant syndrome (NMS) Agranulocytosis are side effects of ...
Typical antipsychotics and Clozarile (Clozapine ) - atypical
S/s: 1. Pseudoparkinsonism - tremor, shuffling gait, drooling, rigidity;
2. Akinesia - muscle weakness
3. Akathisia - restlessness
4. Dystonia - involuntary muscle movements
5. Oculogyric crisis - uncontrolling rolling back of the eyes
TX: antiparkinsonian drugs - Benztropine (Cogentin) - anticholinergic
EPS - extrapyramidal symptoms
Bizarre facial and tongue movements , stiff neck , difficulty swallowing
Tardive dyskinesia
Rare but potentially fatal
S/s: 1. severe parkinsonian muscle rigidity
2. high fever
3. Tachycardia, tachypnea
4. fluctuations in BP
4. mental deterioration, stupor, coma
TX: Dantrolene (Dantrium) - skeletal muscle relaxant
NMS - neuroleptic malignant syndrome
failure of bone marrow to make enough WBC
Agranulocytosis
- Reduced seizure threshold (tx: anticonvulsants)
- Onset DM
- ECG changes - HOT heart
are side effects of …
Atypical antipsychotics
Planning of environment for therapeutic purposes ; stresses patients rights to goals and to have freedom of movement and informal relationship with stuff
Mileu Therapy
Symptoms that tend to reflect an excess or distortion of normal functions ;
- Content of though - delusions, paranoia
- Form of thought - associative looseness, concrete thinking , circumstantiality, perseveration
- Perception - hallucinations, illusions
- Sense of self - confusion regarding identity
Positive symptoms of schizophrenia
Speech in which idea shifts from one unrelated topic to another; unaware that topics are unconnected
Associative looseness
Missing point, too many details
Circumstantiality
False sensory perceptions : auditory (most common), visual, tactile (touch), gastatory (taste), olfactory
Hallucinations
Symptoms that reflect the diminution or loss of normal functions
- Affect - emotional tone - inappropriate, bland or flat, apathy
- Volition - emotional ambivalence (oposite emotions), impaired goal-directed activity
- Impaired interpersonal functioning and relationship to the external world (withdrawal) - autism, deteriorated appearence
- Psychomotor behavior - anergia, waxy flexibility, posturing, pacing and rocking.
Negative symptoms of schizophrenia
- Disorganized
- Catatonic - stupor or excitement
- Paranoid - delusions, hallucinations …
Types of schizophrenia
Disorganization of the personality, deterioration in social functioning, distortion of reality; hallucinations and delusional thinking - …
Psychosis - schizophrenia
- Disturbed thought process
- Disturbed sensory perception
- Social isolation
- Risk for violence :self-directed or other-directed
- Impaired verbal communication
- Self-care deficit
Nursing diagnoses for schizophrenia
Reissue new order every 4 hours for adults; 1-2 hours for children; observe every 15 min (check T, color, pulses)
JCAHO - restraints
- Dry mouth
- Blurred vision
- Constipation
- Memory impairment
- Urinary retention
- Confusional states
Anticholinergic effects
