What Is Psychosis?
Psychosis is a condition that affects the way your brain processes information. It
causes you to lose touch with reality. You might see, hear, or believe things that aren’t
real. Psychosis is a symptom, not an illness.
It can be triggered by a mental illness, a physical injury or illness, substance abuse, or
extreme stress or trauma.
Psychotic disorders, like schizophrenia, involve psychosis that usually affects you for
the first time in the late teen years or early adulthood. Young people are especially
likely to get it, but doctors don’t know why. Even before what doctors call the first
episode of psychosis (FEP), you may show slight changes in the way you act or think.
This is called the prodromal period and could last days, weeks, months, or even years.
Sometimes you can lose touch with reality even when you don’t have a primary
psychotic illness such as schizophrenia or bipolar disorder. When this happens, it's
called secondary psychosis.
These episodes stem from something else, like drug use or a medical condition.
Whatever the reason, they tend to disappear in a short time, and they often stay away
if you treat the condition that caused them.
Symptoms of Psychosis
Psychosis doesn’t suddenly start. It usually follows this pattern:

Warning signs before psychosis: It starts
with gradual changes in the way you think about
and understand the world. You or your family
members may notice:
Psychotic disorders are a group of serious illnesses
that affect the mind. They make it hard for someone
to think clearly, make good judgments, respond
emotionally, communicate effectively, understand
reality, and behave appropriately.
What Is a Psychotic Disorder?
Medically Reviewed by Jennifer Casarella, MD on
July 17, 2020
IN THIS ARTICLE
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Types
Symptoms
Causes
Diagnosis
Treatment
Recovery
What Is the Outlook for People With Psychotic
Disorders?
Can Psychotic Disorders Be Prevented?
Psychotic disorders are a group of serious illnesses
that affect the mind. They make it hard for someone
to think clearly, make good judgments, respond
emotionally, communicate effectively, understand
reality, and behave appropriately.
When symptoms are severe, people with psychotic
disorders have trouble staying in touch with reality
and often are unable to handle daily life. But even
severe psychotic disorders usually can be treated.
Types
There are different types of psychotic disorders,
including:
Schizophrenia: People with this illness have changes
in behavior and other symptoms -such as delusions and
hallucinations -that last longer than 6 months. It usually affects them
at work or school, as well as their relationships. Know
the early warning signs of schizophrenia.
Schizoaffective disorder: People have symptoms of
both schizophrenia and a mood disorder, such as
depression or bipolar disorder. Learn more about
the symptoms of schizoaffective disorder.
Schizophreniform disorder: This
includes symptoms of schizophrenia, but the
symptoms last for a shorter time: between 1 and 6
months. Find out more on schizophreniform disorder
symptoms to look for.
Brief psychotic disorder: People with this illness
have a sudden, short period of psychotic behavior,
often in response to a very stressful event, such as a
death in the family. Recovery is often quick -- usually
less than a month. Get more information about
the different forms of brief psychotic disorder.
Delusional disorder The key symptom is having a
delusion (a false, fixed belief) involving a real-life
situation that could be true but isn't, such as being
followed, being plotted against, or having a disease.
The delusion lasts for at least 1 month. Read more on
the types of delusions.
Shared psychotic disorder (also called folie à
deux): This illness happens when one person in a
relationship has a delusion and the other person in
the relationship adopts it, too. Learn more
about shared psychotic disorder and how it develops.
Brief psychotic disorder
Brief psychotic disorder is a sudden, short-term display of psychotic behavior, such
as hallucinations or delusions, which occurs with a stressful event.
Causes
Brief psychotic disorder is triggered by extreme stress, such as a traumatic accident or
loss of a loved one. It is followed by a return to the previous level of function. The person
may or may not be aware of the strange behavior.
This condition most often affects people in their 20s, 30s, and 40s. Those who have
persHallucinations are sensory experiences that appear real but are
created by your mind. They can affect all five of your senses. For example,
you might hear a voice that no one else in the room can hear or see an image
that isn't realonality disorders are at high risk of having a brief reactive psychosis.
About
Schizophrenia spectrum and other psychotic disorders are made up of disorders that
include schizophrenia, other psychotic disorders, and schizotypal personality disorder.
Schizophrenia spectrum diagnoses make up about two-thirds of all psychotic disorders.
People with psychotic disorders experience changes in the way they interpret reality.
Every individual is different and symptoms of psychosis can vary from person to person,
and can also change over time. Some common symptoms of psychotic disorders are:
Emotional changes:

Feeling distanced or detached from one's body or thoughts
Feeling that the surrounding world is strange or not real
Feeling unusually excited or feeling down and depressed, experiencing mood


swings

Finding it hard to show emotions or feeling less emotions than before
Perceptual or sensory changes:

Hallucinations: having the sense of experiencing something that really isn't there
(e.g., seeing, hearing, smelling, tasting or feeling things that do not exist in reality but is
experienced by the person as extremely real)
Cognitive changes:

Delusional thinking or false beliefs, having fixed thoughts about something that
probably isn't true and not accepting any logical arguments that it isn't the case (e.g.,
believing that your thoughts are being controlled by an external force)
Difficulty concentrating, paying attention and remembering things
Everyday thoughts can seem confusing or jumbled, and thoughts might seem
faster or slower than usual
Behavioural changes:
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Social isolation or becoming withdrawn
Problems with work, social or family life
Problems with motivation or problems with increased activity
Laughing at inappropriate times or becoming upset without an identifiable cause
Physical changes:
Problems with sleep (e.g. not sleeping due to preoccupation with thoughts)
Onset, prevalence, and burden of psychotic disorders in young people
Around 3 in every 100 people in the general population will experience a psychotic
disorder at some stage in their lives (1). The lifetime prevalence of schizophrenia
disorder is just under 1 in every 100 people (1). At 21%, schizophrenia is the leading
principal diagnosis of young people in contact with community mental health services in
Australia (2). It is also the third leading contributor to the burden of disease and injury in
Australian males aged 15-24, and the fifth leading contributor for females of the same
age (3).
Psychotic disorders are rare before the age of 14 years, but there is a sharp increase in
its prevalence between the ages of 15-17 years (4). Overall, about 50% of people who
develop a psychotic disorder will do so by the time they are in their early 20s. The mean
age of onset tends to be a little younger in males (18-25 years) than females (25-35
years) (4,5).
Risk factors
A number of factors are known to increase the likelihood that a person will have a
psychotic disorder (6-8) They include:
Early life factors:
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Genetic vulnerability - family history of psychotic disorder
Complications during pregnancy or birth (e.g. fetal hypoxia)
Season of birth (late winter/early spring)
Developmental delay
Traumatic experiences (e.g. abuse or neglect)
Late childhood/adolescent factors:
Substance use, particularly cannabis
Psychosocial stress
Urbanicity
Migration
Cognitive impairments
'Attenuated' or mild psychotic symptoms
It is important to note that psychotic symptoms seem to be part of the continuum of
normal experiences. In the general population, there is a median prevalence rate of
approximately 5% and a median incidence rate of approximately 3%, and 75-90% of
psychotic experiences are transitory and disappear with time (9). Therefore, the presence
of psychotic symptoms does not automatically indicate a diagnosis of a psychotic
disorder, and a comprehensive assessment over time is necessary.
References
1. Perälä, J., Suvisaari, J., Saarni, S. I., Kuoppasalmi, K., Isometsä, E., Pirkola, S., ... &
Lönnqvist, J. (2007). Lifetime prevalence of psychotic and bipolar I disorders in a general
population. Archives of General Psychiatry, 64(1), 19-28.
2. Australian Institute of Health and Welfare 2011. Young Australians: their health and
wellbeing 2011. Cat. no. PHE 140 Canberra: AIHW.
3. Australian Institute of Health and Welfare 2007. Young Australians: their health and
wellbeing 2007. Cat. no. PHE 87 Canberra: AIHW.
4. Kessler, R. C., Amminger, G. P., Aguilar‐ Gaxiola, S., Alonso, J., Lee, S., & Ustun, T.
B. (2007). Age of onset of mental disorders: a review of recent literature. Current Opinion
in Psychiatry, 20(4), 359.
5. Ochoa, S., Usall, J., Cobo, J., Labad, X., & Kulkarni, J. (2012). Gender differences in
schizophrenia and first-episode psychosis: a comprehensive literature
review. Schizophrenia Research and Treatment, 2012.
6. Yung, A. R., Phillips, L. J., Yuen, H. P., & McGorry, P. D. (2004). Risk factors for
psychosis in an ultra high-risk group: psychopathology and clinical
features. Schizophrenia Research, 67(2), 131-142.
7. Pantelis, C., Yücel, M., Bora, E., Fornito, A., Testa, R., Brewer, W. J., ... & Wood, S. J.
(2009). Neurobiological markers of illness onset in psychosis and schizophrenia: the
search for a moving target. Neuropsychology Review, 19(3), 385-398.
8. Phillips, L. J., Francey, S. M., Edwards, J., & McMurray, N. (2007). Stress and
psychosis: towards the development of new models of investigation. Clinical Psychology
Review, 27(3), 307-317.
9. Van Os, J., Linscott, R. J., Myin-Germeys, I., Delespaul, P., & Krabbendam, L.
(2009). A systematic review and meta-analysis of the psychosis continuum: evidence for
a psychosis proneness-persistence-impairment model of psychotic
disorder. Psychological Medicine, 39(02), 179-195.
Assessment
Formal systems for the diagnosis of mental illness (1,2) describe a number of different
types of psychotic disorder, including:

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
Schizophrenia (psychotic illness has been continuing for at least 6 months, with
at least 1 month where symptoms were active)
Schizophreniform disorder (psychotic illness has been continuing for less than 6
months)
Schizoaffective disorder (co-occurring symptoms of psychosis and a mood
disorder, such as depression or bipolar disorder, and were preceded or are followed by at
least 2 weeks of delusions or hallucinations without prominent mood symptoms)
Delusional disorder (having at least one month of delusions but no other
psychotic symptoms)
Brief (or acute or transient) psychotic disorder (psychotic symptoms develop
suddenly in response to major stress - lasts more than 1 day and remits by 1 month)
Schizotypal personality disorder
Assessment Tools
To decide whether a young person may be experiencing a psychotic disorder, a
comprehensive, longitudinal assessment by a mental health professional is required. It is
important to note that assessment must be an ongoing process and aside from gaining
information about symptoms, the purpose of assessment also includes engaging the
young person in order to develop a therapeutic alliance and seeking to understand the
personal context of their symptoms (3).
Providing a thorough assessment should be balanced with the need to develop a
therapeutic alliance with the young person, and techniques to promote engagement
should be incorporated into the assessment (3). This could include interviewing
techniques such as careful listening, taking the young person and their concerns
seriously, providing an optimistic, calm, and supportive environment, ensuring there is
sufficient time for the interview, and using open-ended questions as far as possible (4).
As a first step, the assessment should cover the following domains (3,4):
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Clinical and personal history, including the context for their current symptoms
Mental state examination (in particular, the young person's insight)
Biological assessment (e.g. comorbid medical conditions)
Cognitive assessment, including social cognition
Comorbid psychiatric disorders, including substance misuse
Risk assessment (risk of harm to self or others, risk of neglect or victimisation,
and risk of non-adherence to treatment or disengagement from services)
It may also be beneficial to use a standardized assessment interview such as the
Comprehensive Assessment of At-Risk Mental States (CAARMS) (5) to assist in
assessing symptoms that may indicate imminent development of a psychotic disorder
and to determine if a young person meets criteria for being at ultra high risk for onset of a
psychotic disorder.
References
1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders: DSM-5. Washington, D.C: American Psychiatric Association.
2. World Health Organization. (1992). The ICD-10 classification of mental and
behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World
Health Organization.
3. Early Psychosis Guidelines Writing Group, Australian Clinical Guidelines for Early
Psychosis, 2nd edition. 2010. Orygen Youth Health, Melbourne.
4. Jackson, H. J., & McGorry, P. D. (Eds.). (2009). The recognition and management of
early psychosis: a preventive approach. Cambridge University Press.
5. Yung, A. R., Yuen, H. P., McGorry, P. D., Phillips, L. J., Kelly, D., Dell'Olio, M., ... &
Buckby, J. (2005). Mapping the onset of psychosis: the Comprehensive Assessment of
At‐ Risk Mental States. Australian and New Zealand Journal of Psychiatry, 39(11‐ 12),
964-971
Treatment
Early detection and treatment of psychotic disorders is important for reducing the distress
associated with psychotic symptoms and helping the affected person to retain their dayto-day functioning (eg. at school or work, and their relationships with family and friends).
There is considerable interest in the potential to prevent the onset of psychosis and to
use early, intensive treatment to reduce its short-term damaging effects (such as loss of
work or social functioning) and improve long-term recovery.
Different stages of illness (e.g. ultra high risk, first-episode psychosis) and different
phases of acuity (e.g. acute, recovery, or relapse) might indicate different treatment
approaches. The current Australian clinical guidelines for the treatment of psychosis
provide recommendations according to stages of illness and acuity (1).
Integrated early intervention services for a first episode of psychosis (FEP) have been
developed in Australia and elsewhere, and have been found to have clinically significant
benefits over standard care (2). Common components of an integrated early intervention
FEP service include:

Case management to ensure continuity of care
Psychological therapy (e.g. cognitive behavioural therapy)
Medication and monitoring of metabolic indices and side effects (3)
Family and group programs
Vocational and educational services (e.g. Individual Placement Support program)

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

(4)
A longer duration of untreated psychosis before diagnosis and treatment can worsen the
medium- and long-term outcomes (5). Effective intervention in the early stages of illness
can help reduce long-term disability in work and family, education, and social
relationships.
In areas where such integrated early intervention specialised services do not exist,
general practitioners may need to initiate early treatment and provide ongoing clinical
management (see (6) for a summary of key issues for acute management).
References
1. Early Psychosis Guidelines Writing Group, Australian Clinical Guidelines for Early
Psychosis, 2nd edition. 2010. Orygen Youth Health, Melbourne.
2. Bird, V., Premkumar, P., Kendall, T., Whittington, C., Mitchell, J., & Kuipers, E.
(2010). Early intervention services, cognitive-behavioural therapy and family intervention
in early psychosis: systematic review. The British Journal of Psychiatry, 197(5), 350-356.
3. Curtis, J., Newall, H. D., & Samaras, K. (2012). The heart of the matter:
cardiometabolic care in youth with psychosis. Early Intervention in Psychiatry, 6,347-353.
4. Killackey, E., Jackson, H. J., & McGorry, P. D. (2008). Vocational intervention in firstepisode psychosis: individual placement and support v. treatment as usual. The British
Journal of Psychiatry, 193(2), 114-120.
5. Marshall, M., Lewis, S., Lockwood, A., Drake, R., Jones, P., & Croudace, T.
(2005). Association between duration of untreated psychosis and outcome in cohorts of
first-episode patients: a systematic review. Archives of General Psychiatry, 62(9), 975983.
6. Fraser, R., Berger, G., & McGorry, P. (2006). Emerging psychosis in young peoplepart 2: key issues for acute management. Australian Family Physician, 35(5), 323
Guidelines
The following authoritative guidelines provide evidence-based information about the
practical treatment of schizophrenia and related psychotic disorders:
Psychosis and schizophrenia in children and young people: Recognition and
management. (2013) National Institute for Health and Clinical Excellence (NICE) CG 155,
United Kingdom.
Early Psychosis Guidelines Writing Group, Australian Clinical Guidelines for Early
Psychosis, 2nd edition. 2010. Orygen Youth Health, Melbourne.
McGorry, P., Killackey, E., Lambert, T., Lambert, M., Jackson, H., & Codyre, D.
(2005). Royal Australian and New Zealand College of Psychiatrists clinical practice
guidelines for the treatment of schizophrenia and related disorders. Australian and New
Zealand Journal of Psychiatry, 39(1-2), 1-30.
Schizophrenia. Australian Treatment Guide for Consumers and Carers. (2009). Royal
Australian and New Zealand College of Psychiatrists.
Mental Health First Aid Australia. Psychosis: first aid guidelines. Melbourne: Mental
Health First Aid Australia; 2008.
International Early Psychosis Association Writing Group. (2005). International clinical
practice guidelines for early psychosis. British Journal of Psychiatry, 187(48), s120-s124.
More Information
The following selected articles provide more information about psychosis:
Stafford, M. R., Jackson, H., Mayo-Wilson, E., Morrison, A. P., & Kendall, T. (2013). Early
interventions to prevent psychosis: systematic review and meta-analysis. BMJ, 346, f185.
Crossley, N. A., Constante, M., McGuire, P., & Power, P. (2010). Efficacy of atypical v.
typical antipsychotics in the treatment of early psychosis: meta-analysis. British Journal
of Psychiatry, 196(6), 434-439.
McGorry, P. D., Nelson, B., Amminger, G. P., Bechdolf, A., Francey, S. M., Berger, G., ...
& Yung, A. R. (2009). Intervention in individuals at ultra-high risk for psychosis: a review
and future directions. Journal of Clinical Psychiatry, 70(9), 1206.
McGorry, P. D., Killackey, E., & Yung, A. (2008). Early intervention in psychosis:
concepts, evidence and future directions. World Psychiatry, 7(3), 148-156.
https://www.healthline.com/health/symptom/extrapyramidalsymptoms#:~:text=important%20to%20us,Understanding%20Extrapyramidal%20Symptoms%20and%20the%20Medications%20T
hat%20Cause%20Them,No,-HEALTH%20NEWS
Understanding
Extrapyramidal
Symptoms and the
Medications That
Cause Them

Types

Causes

Diagnosis

Treatment

Takeaway
Extrapyramidal symptoms, also called drug-induced
movement disorders, describe the side effects caused by
certain antipsychotic and other drugs. These side effects
include:

involuntary or uncontrollable movements

tremors

muscle contractions
Symptoms might be severe enough to affect daily life by
making it hard to move around, communicate with others,
or take care of your usual tasks at work, school, or home.
Treatment often helps, but some symptoms may be
permanent. Generally speaking, the sooner you get
treatment, the better.
Read on to learn more about extrapyramidal symptoms,
including the medications that might cause them and how
they’re diagnosed and treated.
What are extrapyramidal
symptoms?
Symptoms can occur in both adults and children and may
be severe.
Early symptoms may begin shortly after you start a
medication. They often show up a few hours after your first
dose but can show up anytime within the first few weeks.
Timing may depend on the specific side effect. Delayed
symptoms can happen after you’ve been taking the drug for
some time.
Akathisia
With akathisia, you may feel very restless or tense and have
a constant desire to move. In children, this might show up
as physical discomfort, agitation, anxiety, or general
irritability. You might find that pacing, shaking your legs,
rocking on your feet, or rubbing your face helps ease the
restlessness.
Research suggests risk of akathisia increases with higher
doses of medication. Akathisia symptoms have also been
associated with a higher risk of another condition called
tardive dyskinesia.
Anywhere from 5 to 36 percentTrusted Source of people
taking antipsychotics may develop akathisia.
Some medications, including beta-blockers, may help relieve
symptoms. Lowering the dose of antipsychotic medication
may also lead to improvement.
Acute dystonia
Dystonic reactions are involuntary muscle contractions.
These movements are often repetitive and might include
eye spasms or blinking, twisting head, protruding tongue,
and extended neck, among others.
Movements might be very brief, but they could also affect
your posture or stiffen your muscles for a period of time.
They most often affect your head and neck, though they
can occur in other parts of your body.
Dystonia can cause painful muscle stiffness and other
discomfort. You can also choke or have trouble breathing if
the reaction affects muscles in your throat.
Statistics suggest anywhere between 25 and 40
percentTrusted Source of people taking antipsychotics
experience acute dystonia, though it’s more common in
children and young adults.
It usually begins within 48 hours after you start taking an
antipsychotic but often improves with treatment. Lowering
the dose of antipsychotic medication can help. Dystonic
reactions may also be treated with antihistamines and
drugs that treat symptoms of Parkinson’s disease.
Parkinsonism
Parkinsonism describes symptoms that resemble those
of Parkinson’s disease. The most common symptom is rigid
muscles in your limbs. You could also have a tremor,
increased salivation, slow movement, or changes in your
posture or gait.
Between 20 and 40 percentTrusted Source of people taking
antipsychotics develop Parkinsonian symptoms. They usually
begin gradually, often within a few days after you begin
taking the antipsychotic. Your dose may affect whether this
side effect develops.
Symptoms vary in severity, but they can affect movement
and function. They can eventually go away on their own in
time, but they can also be treated.
Treatment generally involves lowering the dose or trying a
different antipsychotic. Drugs used to treat symptoms of
Parkinson’s disease may also be used specifically to treat
symptoms.
Neuroleptic malignant syndrome (NMS)
This reaction is rare, but very serious.
Generally, the first signs are rigid muscles and fever, then
drowsiness or confusion. You could also experience seizures,
and your nervous system function may be affected.
Symptoms commonly appear right away, often within a
few hours after you begin taking the antipsychotic.
Research suggests no more than 0.02 percentTrusted
Source of people will develop NMS. This condition can lead
to coma, renal failure, and death. It’s most often associated
with starting an antipsychotic, but it’s also been linked to
suddenly stopping or switching medications.
Treatment involves stopping the antipsychotic immediately
and providing supportive medical care. With prompt
medical care, full recovery is usually possible, though it may
take two weeks or longer.
Tardive dyskinesia
Tardive dyskinesia is a late-onset extrapyramidal symptom.
It involves repetitive, involuntary facial movements, such as
tongue twisting, chewing motions and lip smacking, cheek
puffing, and grimacing. You might also experience changes
in gait, jerky limb movements, or shrugging.
It usually doesn’t develop until you’ve been taking the drug
for six months or longer. Symptoms may persist in spite of
treatment. Women are more likely to have this side effect.
Age and diabetes can increase risk, as can
negative schizophrenia symptoms or symptoms that affect
typical function.
Among people taking first-generation antipsychotics, up to
about 30 percentTrusted Source may experience this side
effect.
Treatment involves stopping the drug, lowering the dose, or
switching to another drug. Clozapine, for example, can help
relieve tardive dyskinesia symptoms. Deep brain
stimulation has also shown promise as a treatment.
Subtypes of tardive dyskinesia

Tardive dystonia. This subtype is more severe than
acute dystonia and usually involves slower twisting
motions across the body, such as extension of the neck
or torso.

Persistent or chronic akathisia. This refers to akathisia
symptoms, such as leg movements, arm movements,
or rocking, that last for one month or longer while
you’re taking the same dose of medication.
Both of these have a later onset and may persist in spite of
treatment, but types of movement associated with these
symptoms differ.
Children who stop taking medication suddenly may also
have withdrawal dyskinesias. These jerky and repetitive
movements are generally seen in the torso, neck, and limbs.
They usually go away on their own in a few weeks, but
starting the drug again and gradually reducing the dose can
also reduce symptoms.
What causes extrapyramidal
symptoms?
Your extrapyramidal system is a neural network in your
brain that helps regulate motor control and coordination. It
includes the basal ganglia, a set of structures important for
motor function. The basal ganglia need dopamine for proper
function.
Antipsychotics help improve symptoms by binding to
dopamine receptors in your central nervous system and
blocking dopamine. This may prevent the basal ganglia from
getting enough dopamine. Extrapyramidal symptoms can
develop as a result.
First-generation antipsychotics commonly caused
extrapyramidal symptoms. With second-generation
antipsychotics, side effects tend to occur at lower rates.
These drugs have less affinity for dopamine receptors and
bind loosely and block some serotonin receptors.
First-generation antipsychotics include:

chlorpromazine

haloperidol

levomepromazine

thioridazine

trifluoperazine

perphenazine

flupentixol

fluphenazine
Second-generation antipsychotics include:

clozapine

risperidone

olanzapine

quetiapine

paliperidone

aripiprazole

ziprasidone
How are extrapyramidal
symptoms diagnosed?
It’s important to watch out for these symptoms if you or a
loved one is taking an antipsychotic. Drug side effects
sometimes resemble the symptoms of the condition a drug
is being used to treat, but a doctor can help diagnose
symptoms.
Your doctor may ask you or a family member about your
symptoms. They may be able to see difficulties you’re having
with movement or coordination during an office visit.
They might also use an evaluation scale, such as the DrugInduced Extrapyramidal Symptoms Scale (DIEPSS) or the
Extrapyramidal Symptoms Rating Scale (ESRS). These
scales can provide more information about your symptoms
and their severity.
How are extrapyramidal
symptoms treated?
Treatment for extrapyramidal symptoms can be difficult.
Drugs can have varying side effects, and they affect people
differently. There’s no way to predict the reaction you
might have.
Often the only method of treatment is to try different
drugs or lower doses to see which provide the most relief
with the fewest side effects. Depending on your symptoms,
you may also be prescribed another type of drug along with
your antipsychotic to help treat them.
You should never adjust or change the dose
A client comes to the mental health clinic saying that he feels so
down and
lacking in energy with “loss of interest in everything.” He tells the
nurse that he
received some samples of a new medication from his primary care
physician last week
to relieve his depression. The nurse recalls that this client has a
history of bipolar I
disorder with hospitalization for a significant manic episode. With
this knowledge, the
nurse would have special concern if he is taking which of the
following categories of
medication?
1.
Atypical antipsychotics.
2.
Mood stabilizers/antimanics.
3.
Antianxiety agents (benzodiazepines).
4.
Selective serotonin reuptake inhibitor (SSRI) antidepressant.
51. In a predischarge program to educate clients with bipolar
disorder and their
family members, the nurse emphasizes that the most significant
indicators for the onset
of relapse include which of the following symptoms?
1.
A sense of pleasure and motivation for new endeavors.
2.
Decreased need for sleep and racing thoughts.
3.
Self-concern about increase in energy.
4.
Leaving a good job to start a new business.
52. A client has just been admitted to the hospital for medication
adjustment after
outpatient treatment failure of his bipolar disorder and returning
mania. He tells his
primary nurse about his medications and treatment. Which of his
following statements
would raise the most urgent need for more medication instruction
about his lithium
therapy?
1.
“My doctor tells me that my lithium level is 1.0 so I don't have to
worry about my
levels.”
2.
“I've been getting a lot of good exercise playing on a local soccer
team.”
3.
“I'm trying hard to watch my diet and eat healthy.”
“I have learned to take my lithium even when I'm not feeling well,
like when I had the
stomach flu.”
53. A young woman comes to the mental health clinic for her
routine medication
follow-up. She has been married for 2 years and reports that she and
her husband are
ready to start a family. She has a diagnosis of bipolar I disorder and
has been well
managed on divalproex sodium (Depakote) for at least 3 years. What
is the most
essential counsel for the nurse to give her?1.
“Schedule an appointment for a complete gynecological exam if you
have not had
one in the past year.”
2.
“Pay careful attention to eating healthy from this point on in order to
maximize
the health of both mother and baby.”
“Check with your prescriber today as Depakote carries an increased
risk for birth
defects, especially during the first 3 months of pregnancy.”
4. “It is very important for you to take steps to reduce your stress
and this will help
you to stay in balance during your pregnancy and reduce your
chances of
developing post-partum depression.”
54. A health care provider has prescribed valproic acid for a client
with bipolar
disorder who has achieved limited success with lithium carbonate.
The nurse should
instruct the client about which of the following?
1.
Follow-up blood tests are necessary while on this medication.
2.
The extended-release tablet can be crushed if necessary for ease of
swallowing.
3.
Tachycardia and upset stomach are common side effects.
4.
Consumption of a moderate amount of alcohol is safe if the
medication is taken in
the morning.
55. A young adult client diagnosed with bipolar disorder h