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Thought Disorders

Outline

I. Thought Disorders

    1. Definition

Thought disorders affect the person’s perceptions, thinking, language, emotion, volition, and social behavior. Schizophrenia and other psychotic disorders interfere with peoples ability to interpret reality, to communicate to others, and form relationships, to perform simple tasks, and do ADL’s.

 

Caption on a photograph in LACMA ( Los Angeles County Museum of Art )

 

" The schizophrenic body appears as a kind of body sieve… As a result the entire body is nothing but depth…as there is no surface, interior or exterior, container and content no longer have percise limits"

o        Jean Baudrillard 1979

 

Incidence: 1 in every 100 people suffer from schizophrenia

 

            Symptoms begin in most between ages of 17-25

 

            95% of the people have it for a lifetime.

 

    1. Types of Thought Disorders

General:

    1. Schizophrenia- at least two of the following present for significant period of time in a 1-month period:

Delusions, hallucinbations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms.

 

After onset of symptoms one or more areas of functioning is effected by being lower than previous level of functioning. Signs last 6 months.

 

  1. Positive and negative symptoms

Positive symptoms are additional symptoms such as: delusions (paranoid, somatic, grandiose, religious, nihilistic, persecutory themes, thought broadcasting, insertion, control)

 

Hallucinations (auditory, tactile, visual, gustatory, olfactory)

 

Thought disorder ( word salad/incoherence, illogical, loose association, tangential, pressured speech, distractable speech, poverty of speech)

 

Negative symptoms are symptoms of a loss of ability such as: lessening or a loss of function, affective flattening with a limited range of emotions, restricted thought and speech, lack of initiative ( due to symptoms of disease), anhedonia (inability to experience pleasure), attention impairment.

 

Neurobiology with dopamine/ serotonin dysfunction

 

Soft signs-neurologic deficits that are consistent with a brain injury to the front or parietal lobes. Problems in this area mean difficulty with fine motor movement, making the person appear clumsy.

 

 

    1. Delusional Disorders

Schizoaffective-schizophrenia and bipolar or major depressive

 

Schizophreniform- Meets criteria of schizophrenia with episode lasting 1 month but less than 6 months.

 

Paranoia-

 

3. Other Psychotic Disorders

            Delusional Disorder- Has never met the criteria for schizophrenia but has nonbizzare delusions such as being followed, poisoned, having a disease.

 

Shared psychotic disorder (folie /a deux)- the delusions of two people in a close relationship are similar in content

 

Catatonic-motor immobility AEB catalepsy( a trance-like state)

Excessive motor activity, extreme negatism or mutism, posturing, echolalia ( mimicking or imitating the speech of another person) or echopraxia (mimicking or imitating the movements of another person

 

Psychotic Symptoms

 

    1. Cognitive-the process of knowing

 

Memory-difficulty retrieving with impaired short-term/long term memory

 

Attention-poor concentration with easy distractibility

 

 Form and organization of speech-loose associations, incoherence, neologisms, pressured speech

Thought content-delusions, paranoid, grandiose,ets, see positive signs

 

Decision making-failure to abstract, stays concrete in thinking; indecisive, lack of insight, impaired judgement, lack of planning and problem-solving skills,difficulty initiating tasks.

 

    1. Perception-

 

    1. Emotion

 

    1. Behavior

 

    1. Socialization-stigma

 

Nursing Care

 

Assessment:

 

Importance of triggers/stressors

 

Expected outcome: The patient will live, learn, and work at the maximum possible level.

Nursing intervention to prevent a relapse: Identify symptoms of relapse

Patient can seek, utilize feedback

Importance of patient education on recognizing signs and symptoms of relapse.

 

Important for the nurse to know: patients have difficulty in multiple stage instructions, keep it simple.

 

They have difficulty managing oney due to concrete thinking.

 

Literal interpretations make for problematic behavior.

Magical thinking: metaphors interpreted literally.

 

Crutial time to intervene in first two stages of relapse-

 

Stage one

Overextension: overwhelmed

Anxiety

Decreasing performance

 

Stage two: restricted consciousnes

Depression added to stage one symptoms

Appears bored, apathetic, obsessive

 

Stage three:

Disinhibition with Psychotic features

Hallucinations, delusions

 

Stage four:

Psychotic disorganization, patient loses control

 

Stage five:

Psychotic resolution: patient hospitalized, medicated and symptoms quieted. Patient appears dazed, robot-like.

 

Planning and goal setting:

Short term

 

Long term

 

Intervention:

 

Reality orientation, patience, clarity, validation of feelings, developing a therapeutic relationship, clarification of symptoms, triggers, stressors, educational needs, abilities, medication teaching, family and support clarified.

 

Medications:

 

Antipsychotics ( major tranquilizers)

Haldol

 

Navane

 

Prolixin

 

Mellaril

 

Thorazine

 

Stelazine

 

Clozaril

 

Risperdal

 

Zyprexa

 

Seroquel

 

Antidepressants:

Tricyclics-

Elavil

 

Trazadone

 

MAO inhibitors-

Nardil

 

Parnate

 

Seratonin Reuptake Inhibitors ( SSRI’s)

Paxil

 

Prozac

 

Zolof

 

Serzone

 

Mood stabilizers (for mania) Blood levels important due to toxicity:

Lithium

 

Depakote

 

Neurontin

 

Topamax

 

Antianxiety ( minor tranquilizers):

Ativan

 

Klonopin

 

Valium

 

Xanax

Treatment of side effects of meds:

anti-parkinsonians and others:

Cogentin

 

Benadryl

 

Amantadine/Symmetrel

 

Artane

 

Inderal

 

Sedatives/ sleepers

Restoril

 

Serax

 

Benadryl

 

Trazadone