Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 11Psychotic Disorders
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychosis Disorganization in mental processes Symptoms reflect behavior, emotional response, and thought processes of the person who has lost contact with reality Hallucinations, Delusions, Paranoia Perceptual disturbances, disorganized thinking, and behavior alterations Lacks judgment
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Perceptual Disturbances Hallucinations –Visual (seeing) –Auditory (hearing) –Olfactory (smelling) –Tactile (feeling) –Gustatory (tasting) Illusions –Sensory stimuli misinterpreted –Electrical cord is a snake
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorganized Thinking Delusions: false idea or belief that is inconsistent with reality and that cannot be changed by reasoning –Depressive –Somatic –Grandiose –Persecution –Thought broadcasting – thoughs heard by others –Thought insertion – others thoughts inserted in mind –Thought withdrawal – robbing thoughts
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorganized Thinking (cont.) Loose Association derailment –Content of topic is “off-track” Alogia (poverty of speech) –Decrease in the amount or speed of speach Word salad –Jumbled, unconnected and disorganized thoughts – Neologisms (new words) Clang associations –Rhythmic patterns
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Behavior Alterations Agitated Aggressive Silly, childlike Unpredictable Frenzied motor activity Unkempt appearance Sexually inappropriate
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Behavioral Alterations (cont.) Catatonic behaviors –Decreased reaction to surroundings –Lack of awareness or orientation –Rigid posture – resist efforts to be moved Waxy flexibility –Remains in one position until someone changes it –Arm, leg, or other body part can be moved by another person and will remain in that position until moved again
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Schizophrenia The person withdraws into delusional thoughts and misperceptions Beginning of illnessusually before psychotic episode Symptoms categorized as positive and negative –Box 11.3 Page 159
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Schizophrenia: Signs and Symptoms Prodromal phase (time before the first full-blown psychotic episode; beginning of the illness) –Increasing anxiety –Inability to concentrate –Distraction –Distortion of reality –Paranoia –Delusional thinking –Deteriorating relationships
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Positive Symptoms Acute symptoms evidenced early in disease –Alterations in thought processes –Delusional thinking –Perceptual disturbances –Bizarre behavior –Agitation –Catatonia –Misperceptions of personal identity
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Negative Symptoms Blunt or flat affect Anergia Avolition Inability to initiate hygiene, grooming Poor interactive ability Substance use Depression with suicidal end
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Schizophrenia Incidence and Etiology Onset typically between late adolescence and mid-30s Manifests differently in men and women –Women tend to experience less severe symptoms with fewer hospitalizations than men Prevalent in all populations (affects 1%) Genetic factor
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Schizophrenia Subtypes Paranoid –Prominent hallucinations and delusions Disorganized –Unintelligible speech, bizarre behavior, and a flat affect Catatonic –Severe decrease in motor activity and responsiveness to the environment Undifferentiated –Delusions, hallucinations, disorganized speech, strange behavior, blunted affect Residual –No longer has prominent psychotic symptoms
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Schizoaffective Disorder Form of schizophrenia, as the person usually has delusions, hallucinations, and disorganized behaviors At some time had demonstrated symptoms of major depression or mania
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Psychotic Disorders Combined approach improved outcomes Medications –Antipsychotic drugs –No cure, but manage symptoms Psychotherapy –Individual, group, family therapy
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied AssessmentPage 162 –Information about previous mental illness –Type of disturbance –Speech patterns, behavior patterns –Affect and emotional tone –Side effects of antipsychotic drug agents –Appearance, hygiene –Suicidal intent
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied Selected nursing diagnosesPage 164 –Diagnosis from data review –Treatment based on ability to control symptoms –Careful attention to physical, emotional, and social needs
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied Expected outcomesPage 164 –Depend on level of functioning, severity of symptoms
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied InterventionsPage 164 –Avoid expecting too much –Encourage clients to maximize ability to function –Assess clients for escalating behaviors
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied EvaluationPage 166 –Signs of improved functioning
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Individuals who believe that others are sending messages to them or that they can send messages are said to be having delusions of reference.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: A delusion of reference is a false belief that the behavior of others refers to oneself.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following refers to a jumble of unconnected and disorganized thoughts? A. Alogia B. Catatonic behaviors C. Poverty of speech D. Word salad
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. Word salad Rationale: Word salad refers to fragmented speech patterns that demonstrate disorganized thought processes.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is NOT a symptom of schizophrenia? A. Competitive behavior B. Blunted or flat affect C. Inability to concentrate D. Bizarre behavior
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Competitive behavior Rationale: The person with schizophrenia usually resists any type of competition with others, which leads to withdrawal from personal, work, and social relationships.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Application 11.1“Out of Touch” 11.2 “Easy Way Out” 11.3 “Distortions of the Mind” 11.4“Carmen’s Dilemma”