Week 2: Individuals with Thought Disorders

Question 1

Schizophrenia

Answer 1

• chronic, severe, and disabling brain disorder that has affected people throughout history. Not spilt personality.. Rather deteriorating personality
• hear voices, hallucinations, delusions
• believe other people are reading their minds, controlling their thoughts, or plotting to harm them
• all of this can make them withdrawn and extremely agitated
• presents with stressors trigger between ages 16-30
• men tend to experience symptoms earlier than women

Question 2

Why do men tend to have a more severe course than women?

Answer 2

Women tend to have more positive symptoms of schizophrenia (versus negative symptoms). It is thought that Estrogen serves as a moderator of dopamine and thus may play a somewhat protective role for women.

Question 3

A combination of factors can predict schizophrenia in up to 80 percent of youth who are at high risk of developing the illness?

Answer 3

These factors include isolating oneself and withdrawing from others, an increase in unusual thoughts and suspicions, and a family history of psychosis.6 In young people who develop the disease, this stage of the disorder is called the “prodromal” period.

Question 4

Number 1 cause of death for people with schizophrenia

Answer 4

HEART DISEASE

Question 5

Schizophrenia, delusional disorders, paranoid disorders, depression with psychosis, bipolar disorder

Answer 5

Thought disorders or can have components of thought disorders

Question 6

“parents are the ones born at another time from the kids. More food feeds a person but needs to be hungry” example of?

Answer 6

disorganized speech

Question 7

no logical relationship between thoughts and speech, so speech is illogical and does not flow appropriately- “balloons are dancing across this table to deliver the food that people in Europe are eating tonight.”?

Answer 7

loose association

Question 8

fixed false idea that has no basis in truth

Answer 8

delusion

Question 9

a stimulus that causes you to see something that isn’t there. “this black thing is a house”

Answer 9

illusion

Question 10

the feeling that others don’t have your best interest at heart

Answer 10

paranoia

Question 11

Positive Symptoms of schizophrenia

Answer 11

• Hallucinations
• Delusions
• Illusions
• Paranoia
• Sleep Disorders
• Disorganized Speech
• Looseness of Association
• Bizarre Behavior

Question 12

Negative Symptoms of schizophrenia

Answer 12

• Poverty of Speech
• Affective Blunting
• Anhedonia
• Social Withdrawal
• Apathy
• Avolition
• Poor Grooming
• Attentional Impairment
• Asocial behavior

Question 13

not much talking at all

Answer 13

poverty of speech

Question 14

not much expression there at all, limited eye contact

Answer 14

affective blunting

Question 15

not finding pleasure

Answer 15

Anhedonia

Question 16

neglect of activities like bathing or taking care of their bodies. Lack of drive or motivation

Answer 16

Avolition

Question 17

negative symptoms of schizophrenia respond best to what kinds of medications?

Answer 17

newer antipsychotics

Question 18

Magical thinking

Answer 18

believe that thinking about it is the same as doing it. Not realistic about cause and effect.

Question 19

• thoughts and speech stray from the original thinking so that the question is never answered- even tho the person thinks a complete response has been presented. “Where is the car parked? The car, is a white one, white is the color of daisies in Mary’s garden that I have spent so much time wandering around because there is a pond there and it is so relaxing.”

Answer 19

Tangential thinking

Question 20

Preoccupation with self with little concern for external reality

Answer 20

autistic thinking

Question 21

stringing together unrelated topics

Answer 21

loose associations

Question 22

made up words, often blended- “foodsaver= frig”, “weatherprotector= coat”

Answer 22

neologisms

Question 23

involuntary repetition of others’s words

Answer 23

echolalia

Question 24

In simpler terms, these are groupings of words based on their sounds, generally rhyming or partially rhyming, without necessarily having any logical reason to be put together – pathetic, apologetic, paramedic

Answer 24

clang associations

Question 25

describes a very jumbled manner of speaking in which words are put together even though they don't form meaningful sentences. For example, a sentence such as "market dog blue asphalt" -- these words all have meaning but not when put together in this fashion.

Answer 25

word salad

Question 26

Dialog that does not sound like natural speech. Forced, unnatural

Answer 26

stilted language

Question 27

a belief by some mentally ill patients that thoughts of other people can be inserted into their own minds

Answer 27

Thought insertion-

Question 28

symptom of psychosis in which the patient believes that his or her thoughts are "broadcast" beyond the head so that other people can hear them.

Answer 28

thought broadcasting

Question 29

A symptom complex in which, through the mechanism of projection, an individual incorrectly believes himself or herself to be the direct object of casual remarks or incidents or of external events

Answer 29

ideas of reference

Question 30

biggest perceptual change in schizophrenia

Answer 30

sense of self

Question 31

form a necessary basis for distinguishing real from not real

Answer 31

ego boundaries

Question 32

* Distorted perception of identity * Distorted perception of body image * Distorted image of life * Altered sense of self perception * Detachment from self reality * What can be more frightening than feeling as though you are detached from yourself? This is the central feature of depersonalization. It is a feeling of being outside of yourself without any sense of control. Some sufferers often describe the sensation as observing themselves from outside of the body.

Answer 32

depersonalization

Question 33

* Where depersonalization focuses on one’s sense of self, derealization focuses on one’s sense of his or her surroundings. Sufferers often describe the sensation of derealization as being in a dream-like state where the environment seems unreal, foggy or hazy. * Other sensations of derealization may include: * feeling cut off from one’s surroundings * feeling like being trapped in a glass bubble * feeling like surrounding objects are unreal or cartoon-like *

Answer 33

derealization

Question 34

automatism

Answer 34

robot-like

Question 35

The involuntary imitation of the movements of another person

Answer 35

echopraxia

Question 36

name at least 5 nursing diagnosis for schizophrenic patient

Answer 36

* Altered Thought Processes * Risk for other directed Violence * Social Isolation * Altered Health Maintenance * Impaired Social Interaction * Ineffective Family Coping * Self Care Deficit * Sleep Disturbance

Question 37

auditory hallucinations effective interventions

Answer 37

* 25 – 30% do not respond to medications * _Behavioral strategies_ can be effective adjunct to meds. * _Study of short and long-term effects of a 10 week group education intervention:_ - Decreased frequency, decreased clarity - Increased self-control - Lessened distractibility - Patients would recommend classes to others.

Question 38

Strategies for Managing Auditory Hallucinations

Answer 38

* Self monitoring * Talking with someone about anything * Listening to music * Watching television * Saying “STOP” or “channel changing” * Using an earplug * Using relaxation exercises * Keeping busy doing something * Taking prescribed medications * Avoiding drugs or alcohol

Question 39

managing the pt. with disorganized thinking

Answer 39

* Limit need for decisions * Give simple, concrete directions * Use verbal cueing * Monitor and assist with self-care * Redirect as needed

Question 40

* Treat both Positive and Negative Symptoms * Fewer problems with EPS (but can still occur) * _Metabolic Syndrome:_ - ↑appetite; ↑blood sugar; ↑lipids - Higher costs

Answer 40

* Atypical (nontraditional, second, third, generation) Antipsychotics - most typically used

Question 41

* As good for Positive Symptoms * Cheaper * More side effect

Answer 41

Typical (traditional) Antipsychotics

Question 42

tordi colis

Answer 42

dystonia where the head goes off to the side. It's painful and it's an emergency. Treated with IM of cogentin and some ativan

Question 43

typical antipsychoticsha

Answer 43

haldol, trilifon (profenizine), prolixin (flufenizine), navane

Question 44

Side Effects/Adverse Events of antipsychotics

Answer 44

* Dry mouth, blurred vision, constipation, urinary retention * Sedation * Orthostatic hypotension, dizziness, gait disturbance * EPS * NMS: lifethreatening side effect (can even happen with the atypicals) - Fever - Stiffness, rigidity - Change in mental status - Possible death

Question 45

occulogyric crisis

Answer 45

type of distonia where the eyes roll back into the head

Question 46

* Benzotropine (Cogentin) 1mg * Trihexyphenidyl (Artane) 2mg * Diphenhydramine (Benadryl) 50 mg * _effects_: - Dry Mouth/Constipation/Decreased sweating - Nasal congestion - Urinary hesitation/retention - Blurred vision/photophobia - Fever

Answer 46

anticholinergic medications (ordered for EPS)

Question 47

feel like their skin is crawling, like they are going to jumpt out of their skin

Answer 47

akathesia

Question 48

AIMS exam

Answer 48

given prior to receiving atipsychotics and then every six months. Scales all of the involntary movements so you might catch it early and switch antibiotics. It also documents the progression of tarditive dyskenesia

Question 49

when pt. receives antipsychotic, assess for

Answer 49

cogwheel rigidity. Exercise their arm back and forth, tell them to relax. If it's possitive it will ratchet instead of move smoothly. Can also check it in wrist and leg.

Question 50

what would you tell your pt. the antipsychotic medication is for?

Answer 50

"this is the medicine that is going to help you get your thoughts together in an organized way...or be less frightened...etc"

Question 51

Phases of Schizophrenic Disorder

Answer 51

* _Acute Relapsing_: (in hospital) reduce stimulation * _Stabilizing_: Titration of medications * _Stable_: symptoms controlled * _Recovery_: psychosocial goals * _Refractory_: cope with level of symptoms. Persistent psychotic symptoms

Question 52

community resources for the mentally ill

Answer 52

* _Nami_: national alliance of mental illness * _MHA_: mental health america