Unit 4: Thought Disorders and Medications Schizophrenia in Focus
Schizophrenia: Bleuler’s 4-A’s <ul><li>AFFECT: flat, blunted, inappropriate or bizarre affect </li></ul><ul><li>AMBIVALENC...
Classifying Symptoms: Positive Symptoms <ul><li>“What’s there that shouldn’t be there” </li></ul><ul><li>Hallucinations </...
Thought Alterations <ul><li>Ideas of reference </li></ul><ul><li>Persecutory, grandiose, somatic delusions </li></ul><ul><...
Classifying Symptoms: Negative Symptoms <ul><li>“ What’s not there that should be there” </li></ul><ul><li>Lack of Feeling...
Classifying Symptoms:Cognitive Symptoms <ul><li>Thinking and Decision-making </li></ul><ul><li>Impaired memory </li></ul><...
Phases of Schizophrenia <ul><li>Prodromal: isolation, behavior change, often in adolescence or y. adult </li></ul><ul><li>...
Theories of Causation <ul><li>Many of the psychological theories are now doubted as evidence of a brain disease is more cl...
Neuroanatomical Changes <ul><li>Enlarged lateral cerebral ventricles </li></ul><ul><li>Cortical and cerebellum atrophy </l...
Mechanism of Action of Antipsychotics <ul><li>Phenothiazines: block post-synaptic dopamine receptors giving a decreased do...
Side effects of antipsychotics <ul><li>Extrapyramidal (see H/O in syllabus) </li></ul><ul><li>Tardive dyskinesia: can be p...
Neuroleptic Malignant Syndrome <ul><li>Life threatening: increased temp, decreased consciousness, severely increased muscl...
Nursing Diagnosis: Non compliance <ul><li>Not taking meds or attending therapy is a big factor leading to rehospitalizatio...
Nursing Diagnosis: Potential for violence <ul><li>Usually related to paranoia/perceived threat </li></ul>
Nursing Diagnosis: Impaired social interaction <ul><li>Related to negative symptoms, hard to change! </li></ul>
Nursing Diagnosis: self care deficit <ul><li>No motivation to bathe, lack of recognition of problem, paranoia </li></ul>
Nursing Diagnosis: altered nutrition/FVE <ul><li>Paranoia about eating and drinking </li></ul><ul><li>Excess fluid intake ...
Nursing diagnosis: risk for suicide <ul><li>About 10% schizophrenics commit suicide </li></ul>
Paranoid Schizophrenia <ul><li>Intense, strongly defended irrational suspicions </li></ul><ul><li>Ideas of reference </li>...
Nursing Tactics with Paranoia <ul><li>Calm, matter of fact approach—don’t smother or hover </li></ul><ul><li>Respect perso...
More nursing interventions in Paranoia <ul><li>Help client manage anger and fear through consistent limits, appropriate di...
Disorganized Schizophrenia <ul><li>Regression, increased social impairment, bizarre affect/behavior, incoherent speech </l...
Catatonia: abnormal motor behavior <ul><li>Withdrawn: posturing, waxy flexibility, stupor, mute, unaware of environment </...
Other categories of Schizophrenia <ul><li>Undifferentiated – means doesn’t fit a specific othre group </li></ul><ul><li>Re...
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Thought Disorders

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Thought Disorders and Medications - Schizophrenia in Focus

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  • helpful website that help others. This website has practice exams for various nursing classes as well as videos, presentations, notes, nclex help, and many other tools . Hope they help


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  • This is an excellent slide show! Recommend it to anyone who is lokking for Schiz info.
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  • http://NurseReview.org & http://BookOfTips.BlogSpot.com are sites that i highly recommend you visit if you like this slides!
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Thought Disorders

  1. 1. Unit 4: Thought Disorders and Medications Schizophrenia in Focus
  2. 2. Schizophrenia: Bleuler’s 4-A’s <ul><li>AFFECT: flat, blunted, inappropriate or bizarre affect </li></ul><ul><li>AMBIVALENCE: holding opposing opinions or attitudes at the same time </li></ul><ul><li>ASSOCIATIVE LOOSENESS: Jumbled, illogical thinking </li></ul><ul><li>AUTISM: living in one’s own fantasy world—turned in to the self </li></ul>
  3. 3. Classifying Symptoms: Positive Symptoms <ul><li>“What’s there that shouldn’t be there” </li></ul><ul><li>Hallucinations </li></ul><ul><li>Delusions </li></ul><ul><li>Bizarre Behavior </li></ul><ul><li>Disorganized speech, word salad, echolalia </li></ul>
  4. 4. Thought Alterations <ul><li>Ideas of reference </li></ul><ul><li>Persecutory, grandiose, somatic delusions </li></ul><ul><li>Thought blocking, insertion, withdrawl, broadcasting </li></ul><ul><li>Command/control hallucinations </li></ul>
  5. 5. Classifying Symptoms: Negative Symptoms <ul><li>“ What’s not there that should be there” </li></ul><ul><li>Lack of Feeling and affect including positive emotion (anhedonia) </li></ul><ul><li>Poverty of thought (alogia) </li></ul><ul><li>Loss of motivation (avolition) </li></ul>
  6. 6. Classifying Symptoms:Cognitive Symptoms <ul><li>Thinking and Decision-making </li></ul><ul><li>Impaired memory </li></ul><ul><li>Poor problem solving and poor judgment </li></ul><ul><li>Illogical thinking </li></ul><ul><li>Inattention, distractability </li></ul>
  7. 7. Phases of Schizophrenia <ul><li>Prodromal: isolation, behavior change, often in adolescence or y. adult </li></ul><ul><li>Acute/Active Phase: Evident psychosis. Periods of fluctuation, but symptoms are evident </li></ul><ul><li>Chronic/Residual: Long term outcome is that the intensity of the psychosis may diminish, leaving more of the negative symptoms </li></ul>
  8. 8. Theories of Causation <ul><li>Many of the psychological theories are now doubted as evidence of a brain disease is more clear. </li></ul><ul><li>Genetic transmission is evident </li></ul><ul><li>Dopamine theory—excess dopamine (does not explain all) </li></ul><ul><li>Glucomate theory—regulation of glucomate (NMDA) receptor in brain r/t PCP psychosis </li></ul>
  9. 9. Neuroanatomical Changes <ul><li>Enlarged lateral cerebral ventricles </li></ul><ul><li>Cortical and cerebellum atrophy </li></ul><ul><li>Third ventricle dilation and asymmetry </li></ul><ul><li>Changes in blood flow and glucose metabolism patterns </li></ul>
  10. 10. Mechanism of Action of Antipsychotics <ul><li>Phenothiazines: block post-synaptic dopamine receptors giving a decreased dopamine response. Works on + symptoms only </li></ul><ul><li>Atypical antipsychotics: Antagonizes both serotonin and dopamine receptors giving a decreased dopamine and serotonin response. Works on + and – symptoms both </li></ul><ul><li>See supplemental info on Oncourse </li></ul>
  11. 11. Side effects of antipsychotics <ul><li>Extrapyramidal (see H/O in syllabus) </li></ul><ul><li>Tardive dyskinesia: can be permanent, </li></ul><ul><li>See AIMS test, don’t raise dose of med </li></ul><ul><li>Anticholinergic side effects (go over) </li></ul><ul><li>Blood dyscrasias </li></ul><ul><li>Photosensitivity, excess prolactin </li></ul>
  12. 12. Neuroleptic Malignant Syndrome <ul><li>Life threatening: increased temp, decreased consciousness, severely increased muscle tonicity, HTN, tachycardia, drooling sweating </li></ul><ul><li>Stop the antipsychotic, treat symptoms in a monitored setting (ICU), fluids, cooling blanket, dantrolene, parlodel (a dopamine agonist) </li></ul>
  13. 13. Nursing Diagnosis: Non compliance <ul><li>Not taking meds or attending therapy is a big factor leading to rehospitalization </li></ul><ul><li>Why? Denial, hate being in sick role, lack of judgment, side effects of meds </li></ul>
  14. 14. Nursing Diagnosis: Potential for violence <ul><li>Usually related to paranoia/perceived threat </li></ul>
  15. 15. Nursing Diagnosis: Impaired social interaction <ul><li>Related to negative symptoms, hard to change! </li></ul>
  16. 16. Nursing Diagnosis: self care deficit <ul><li>No motivation to bathe, lack of recognition of problem, paranoia </li></ul>
  17. 17. Nursing Diagnosis: altered nutrition/FVE <ul><li>Paranoia about eating and drinking </li></ul><ul><li>Excess fluid intake </li></ul>
  18. 18. Nursing diagnosis: risk for suicide <ul><li>About 10% schizophrenics commit suicide </li></ul>
  19. 19. Paranoid Schizophrenia <ul><li>Intense, strongly defended irrational suspicions </li></ul><ul><li>Ideas of reference </li></ul><ul><li>Behaving with anger, sarcasm, hostility </li></ul><ul><li>Projection of feelings </li></ul><ul><li>Often paranoid ideas are intricate and complex </li></ul>
  20. 20. Nursing Tactics with Paranoia <ul><li>Calm, matter of fact approach—don’t smother or hover </li></ul><ul><li>Respect personal territory </li></ul><ul><li>Verbal indication of nursing measures before intervention </li></ul><ul><li>Be honest, trustworthy, consistent </li></ul><ul><li>Don’t feed delusions or challenge directly—cast reasonable doubt and focus on reality </li></ul><ul><li>Look at underlying themes in delusions </li></ul>
  21. 21. More nursing interventions in Paranoia <ul><li>Help client manage anger and fear through consistent limits, appropriate diversion, and not taking bx personally </li></ul><ul><li>“ When in doubt, check it out” strategy </li></ul><ul><li>Talk about dealing with food and med. paranoia </li></ul>
  22. 22. Disorganized Schizophrenia <ul><li>Regression, increased social impairment, bizarre affect/behavior, incoherent speech </li></ul><ul><li>Nursing measures: help with grooming, eating. Routine, consistent and structured. Understanding milieu. Plus all the general nsg measures. </li></ul>
  23. 23. Catatonia: abnormal motor behavior <ul><li>Withdrawn: posturing, waxy flexibility, stupor, mute, unaware of environment </li></ul><ul><li>Nsg care in Withdrawn state: complete hygiene, nutrition, mobility, bathroom assist </li></ul><ul><li>Excited: Gross hyperactivity-running striking out </li></ul><ul><li>Nsg with Excited: preserve milieu, keep client safe </li></ul>
  24. 24. Other categories of Schizophrenia <ul><li>Undifferentiated – means doesn’t fit a specific othre group </li></ul><ul><li>Residual—means most of the active symptoms are gone (mostly negative symptoms remaining) </li></ul>
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