thought disorders
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Thought Disorders and Medications - Schizophrenia in FocusTRANSCRIPT
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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)