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Tuesday, September 18, 2007

Thought Disorders

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Thought Disorders Slideshow Transcript

Slide 1: Unit 4: Thought Disorders and Medications Schizophrenia in Focus

Slide 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

Slide 3: Classifying Symptoms: Positive Symptoms “What’s there that shouldn’t be there”  Hallucinations  Delusions  Bizarre Behavior  Disorganized speech, word salad,  echolalia

Slide 4: Thought Alterations Ideas of reference  Persecutory, grandiose, somatic  delusions Thought blocking, insertion, withdrawl,  broadcasting Command/control hallucinations 

Slide 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) 

Slide 6: Classifying Symptoms:Cognitive Symptoms Thinking and Decision-making  Impaired memory  Poor problem solving and poor  judgment Illogical thinking  Inattention, distractability 

Slide 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

Slide 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

Slide 9: Neuroanatomical Changes Enlarged lateral cerebral ventricles  Cortical and cerebellum atrophy  Third ventricle dilation and asymmetry  Changes in blood flow and glucose  metabolism patterns

Slide 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 

Slide 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 

Slide 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)

Slide 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

Slide 14: Nursing Diagnosis: Potential for violence Usually related to paranoia/perceived  threat

Slide 15: Nursing Diagnosis: Impaired social interaction Related to negative symptoms, hard to  change!

Slide 16: Nursing Diagnosis: self care deficit No motivation to bathe, lack of  recognition of problem, paranoia

Slide 17: Nursing Diagnosis: altered nutrition/FVE Paranoia about eating and drinking  Excess fluid intake 

Slide 18: Nursing diagnosis: risk for suicide About 10% schizophrenics commit  suicide

Slide 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

Slide 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 

Slide 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

Slide 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.

Slide 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

Slide 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)

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