Thought Disorders

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Unit 4: Thought Disorders and Medications Schizophrenia in Focus

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Thought Disorders and Medications - Schizophrenia in Focus

Transcript of Thought Disorders

Page 1: Thought Disorders

Unit 4: Thought Disorders and Medications

Schizophrenia in Focus

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Schizophrenia: Bleuler’s 4-A’s AFFECT: flat, blunted, inappropriate

or bizarre affect AMBIVALENCE: holding opposing

opinions or attitudes at the same time

ASSOCIATIVE LOOSENESS: Jumbled, illogical thinking

AUTISM: living in one’s own fantasy world—turned in to the self

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Classifying Symptoms: Positive Symptoms “What’s there that shouldn’t be

there” Hallucinations Delusions Bizarre Behavior Disorganized speech, word salad,

echolalia

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Thought Alterations Ideas of reference Persecutory, grandiose, somatic

delusions Thought blocking, insertion,

withdrawl, broadcasting Command/control hallucinations

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Classifying Symptoms: Negative Symptoms “What’s not there that should be

there” Lack of Feeling and affect including

positive emotion (anhedonia) Poverty of thought (alogia) Loss of motivation (avolition)

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Classifying Symptoms:Cognitive Symptoms

Thinking and Decision-making Impaired memory Poor problem solving and poor

judgment Illogical thinking Inattention, distractability

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Phases of Schizophrenia Prodromal: isolation, behavior change,

often in adolescence or y. adult Acute/Active Phase: Evident psychosis.

Periods of fluctuation, but symptoms are evident

Chronic/Residual: Long term outcome is that the intensity of the psychosis may diminish, leaving more of the negative symptoms

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Theories of Causation Many of the psychological theories are

now doubted as evidence of a brain disease is more clear.

Genetic transmission is evident Dopamine theory—excess dopamine

(does not explain all) Glucomate theory—regulation of

glucomate (NMDA) receptor in brain r/t PCP psychosis

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Neuroanatomical Changes Enlarged lateral cerebral ventricles Cortical and cerebellum atrophy Third ventricle dilation and

asymmetry Changes in blood flow and glucose

metabolism patterns

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Mechanism of Action of Antipsychotics Phenothiazines: block post-synaptic

dopamine receptors giving a decreased dopamine response. Works on + symptoms only

Atypical antipsychotics: Antagonizes both serotonin and dopamine receptors giving a decreased dopamine and serotonin response. Works on + and – symptoms both

See supplemental info on Oncourse

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Side effects of antipsychotics Extrapyramidal (see H/O in syllabus) Tardive dyskinesia: can be permanent, See AIMS test, don’t raise dose of med Anticholinergic side effects (go over) Blood dyscrasias Photosensitivity, excess prolactin

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Neuroleptic Malignant Syndrome Life threatening: increased temp,

decreased consciousness, severely increased muscle tonicity, HTN, tachycardia, drooling sweating

Stop the antipsychotic, treat symptoms in a monitored setting (ICU), fluids, cooling blanket, dantrolene, parlodel (a dopamine agonist)

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Nursing Diagnosis: Non compliance Not taking meds or attending

therapy is a big factor leading to rehospitalization

Why? Denial, hate being in sick role, lack of judgment, side effects of meds

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Nursing Diagnosis: Potential for violence Usually related to

paranoia/perceived threat

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Nursing Diagnosis: Impaired social interaction Related to negative symptoms,

hard to change!

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Nursing Diagnosis: self care deficit No motivation to bathe, lack of

recognition of problem, paranoia

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Nursing Diagnosis: altered nutrition/FVE Paranoia about eating and drinking

Excess fluid intake

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Nursing diagnosis: risk for suicide About 10% schizophrenics commit

suicide

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Paranoid Schizophrenia Intense, strongly defended irrational

suspicions Ideas of reference Behaving with anger, sarcasm,

hostility Projection of feelings Often paranoid ideas are intricate

and complex

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Nursing Tactics with Paranoia Calm, matter of fact approach—don’t

smother or hover Respect personal territory Verbal indication of nursing measures

before intervention Be honest, trustworthy, consistent Don’t feed delusions or challenge directly

—cast reasonable doubt and focus on reality

Look at underlying themes in delusions

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More nursing interventions in Paranoia Help client manage anger and fear

through consistent limits, appropriate diversion, and not taking bx personally

“When in doubt, check it out” strategy

Talk about dealing with food and med. paranoia

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Disorganized Schizophrenia Regression, increased social

impairment, bizarre affect/behavior, incoherent speech

Nursing measures: help with grooming, eating. Routine, consistent and structured. Understanding milieu. Plus all the general nsg measures.

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Catatonia: abnormal motor behavior Withdrawn: posturing, waxy flexibility,

stupor, mute, unaware of environment Nsg care in Withdrawn state: complete

hygiene, nutrition, mobility, bathroom assist

Excited: Gross hyperactivity-running striking out

Nsg with Excited: preserve milieu, keep client safe

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Other categories of Schizophrenia Undifferentiated – means doesn’t

fit a specific othre group Residual—means most of the

active symptoms are gone (mostly negative symptoms remaining)