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Flashcards in Week 2: Individuals with Thought Disorders Deck (53):
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Schizophrenia

  • 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-all of this can make them withdrawn and extremely agitated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

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

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.

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

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.

 

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Number 1 cause of death for people with schizophrenia

HEART DISEASE

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

Thought disorders or can have components of thought disorders

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

 

disorganized speech

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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."?

loose association

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fixed false idea that has no basis in truth

delusion

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a stimulus that causes you to see something that isn't there.  "this black thing is a house"

illusion

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

paranoia

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Positive Symptoms of schizophrenia

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

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Negative Symptoms of schizophrenia

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

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not much talking at all

poverty of speech

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not much expression there at all, limited eye contact

affective blunting

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not finding pleasure

Anhedonia

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

Avolition

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

newer antipsychotics

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Magical thinking

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

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  • 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."

Tangential thinking

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Preoccupation with self with little concern for external reality

autistic thinking

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stringing together unrelated topics

loose associations

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

neologisms

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involuntary repetition of others’s words

echolalia

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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

clang associations

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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.

word salad

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

stilted language

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

Thought insertion- 

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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. 

thought broadcasting

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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

ideas of reference

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biggest perceptual change in schizophrenia

sense of self

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form a necessary basis for distinguishing real from not real

ego boundaries

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  • 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.

depersonalization

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  • 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
  •  

derealization

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automatism

robot-like

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The involuntary imitation of the movements of another person

echopraxia

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name at least 5 nursing diagnosis for schizophrenic patient

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

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auditory hallucinations effective interventions

  • 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.

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Strategies for Managing Auditory Hallucinations

  • 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

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managing the pt. with disorganized thinking

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

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  • Treat both Positive and Negative Symptoms
  • Fewer problems with EPS (but can still occur)
  • Metabolic Syndrome:

                 -↑appetite; ↑blood sugar; ↑lipids

                 -Higher costs

  • Atypical (nontraditional, second, third, generation) Antipsychotics

-most typically used

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

Typical (traditional) Antipsychotics

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tordi colis

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

 

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typical antipsychoticsha

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

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Side Effects/Adverse Events of antipsychotics

  • 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

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occulogyric crisis

type of distonia where the eyes roll back into the head

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  • 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

anticholinergic medications (ordered for EPS)

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

akathesia

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AIMS exam

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

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when pt. receives antipsychotic, assess for 

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.

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

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

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Phases of Schizophrenic Disorder

  • 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

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community resources for the mentally ill

  • Nami: national alliance of mental illness
  • MHA: mental health america

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