Thought Disorders

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Thought Disorders - Presentation Transcript

  1. Unit 4: Thought Disorders and Medications Schizophrenia in Focus
  2. 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
  3. Classifying Symptoms: Positive Symptoms
    • “What’s there that shouldn’t be there”
    • Hallucinations
    • Delusions
    • Bizarre Behavior
    • Disorganized speech, word salad, echolalia
  4. Thought Alterations
    • Ideas of reference
    • Persecutory, grandiose, somatic delusions
    • Thought blocking, insertion, withdrawl, broadcasting
    • Command/control hallucinations
  5. 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)
  6. Classifying Symptoms:Cognitive Symptoms
    • Thinking and Decision-making
    • Impaired memory
    • Poor problem solving and poor judgment
    • Illogical thinking
    • Inattention, distractability
  7. 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
  8. 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
  9. Neuroanatomical Changes
    • Enlarged lateral cerebral ventricles
    • Cortical and cerebellum atrophy
    • Third ventricle dilation and asymmetry
    • Changes in blood flow and glucose metabolism patterns
  10. 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
  11. 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
  12. 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)
  13. 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
  14. Nursing Diagnosis: Potential for violence
    • Usually related to paranoia/perceived threat
  15. Nursing Diagnosis: Impaired social interaction
    • Related to negative symptoms, hard to change!
  16. Nursing Diagnosis: self care deficit
    • No motivation to bathe, lack of recognition of problem, paranoia
  17. Nursing Diagnosis: altered nutrition/FVE
    • Paranoia about eating and drinking
    • Excess fluid intake
  18. Nursing diagnosis: risk for suicide
    • About 10% schizophrenics commit suicide
  19. 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
  20. 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
  21. 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
  22. 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.
  23. 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
  24. 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)

+ jben501jben501, 2 years ago

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