Psychotic disorders

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  1. Which disorder is the biggie for the homeless population?
    • Schizophrenia
    • Chronic mentally ill are 35% to 50% of homeless population
  2. What is schizophrenia?
    • Impairment in reality testing
    • Loss of ego boundaries
    • Has a biological basis
    • Is related to genetics
    • Problem with the way they think & perceive
    • Takes over the person’s life
  3. What is the neurochemical theory on schizophrenia?
    • Overproduction of dopamine
    • Decreased blood flow to frontal cortex
    • Cat scans, MRI and PET scans- show brain changes
  4. What is the Genetic theory of schizophrenia?
    • People have the schizophrenic gene so strong genetic component. 
    • Activated by early childhood life or traumatic experience (activating event), exposure to toxic substances
  5. What is the typical course of the disease?
    • Experience symptoms 1 month to 1 year before first break:
    • May be withdrawn, lonely, and depressed as adolescents
    • Patient reports:
    • Mind wandering
    • Difficulty concentrating
    • Unwanted intrusive thoughts
    • Misinterprets things
    • Mistakes others as having a harmful intent

    • As disease develops:
    • Feels rejected
    • Lonely, hopeless
    • Withdraws emotionally & physically, isolates
    • Unable to trust others
    • Withdraws from reality 
    • Begins delusions & hallucinations
    • Has odd mannerisms
    • Some think their thoughts are controlled by others or broadcasted
    • Voices seem to come from outside the person
    • Preoccupied with religion, mysticism or metaphysical
  6. What is the DSM-IV definition of schizophrenia?
    • Two or more of:
    • Delusions: fixed false belief that is inconsistent with social norms. 
    • Hallucinations: misrepresentation of 5 senses. Auditory is the most common followed by visual. 
    • Disorganized speech
    • Derailment: run off on tangents while speaking. 
    • Incoherence
    • Disorganized or catatonic behavior
    • Negative symptoms
    • Flat affect

    • Social/occupational  or ADL’s dysfunction
    • Signs persist for 6 months with at least 1 month of symptoms
    • R/O medical condition or other psychiatric disorder
  7. What is paranoid type of schizophrenia?
    • Delusions- persecutory & grandiose & may be organized around a theme
    • Associated features:  anxiety, anger, aloofness, & argumentativeness
    • Has a superior, patronizing manner, stilted or formal quality
    • Highly suspicious
  8. What is the catatonic type schizophrenia?
    • Motor immobility or stupor, waxy flexibility
    • Excessive motor activity, purposeless
    • Negativism- moveless resistance, mute
    • Peculiarities of voluntary movement
    • --Posturing ( assuming inappropriate bizarre postures],  prominent mannerisms & grimacing
    • Echolalia: Will "echo" things said.
    • Echopraxia: Will mimic gestures. 
  9. What is undifferentiated type?
    When you can't figure out which kind it is. 
  10. How can you tell the difference between schizophrenia and a brief psychotic reaction?
    • Not schizophrenia if one or more of: 
    • Hallucinations
    • Delusions
    • Disorganized speech
    • Disorganized behavior
    • Duration:  1 day to 1 month
    • With or without marked stressor present
  11. What is schizoaffective disorder
    • Either a manic or depressive episode +
    • Symptoms of hallucinations and delusions
    • And:
    • Speech has obscure symbolism
    • Speech often understood as their relating to a private world
    • May have doubts about sexuality & may become hypersexual
    • Has fears of intimacy
    • Regression occurs:
    • Preoccupied with self
    • Isolation
  12. What are some not-so-obvious assessment signs? 
    • Neologisms: making up new words 
    • Word salad
    • Concrete thinking 
    • --Literal meanings
    • --Specific details
    • Emotionally labile
    • Clang associations: rhyme conversation.  
    • Depersonalization: a feeling of unreality from self, difficulty distinguishing self from others. 
  13. What are some nursing interventions for schizophrenia?
    • Protect the patient & others from harm
    • Structure environment
    • Administer Medications & monitor side effects
    • Administer medications as needed for side effects and behavioral management
    • Present reality (esp with hallucinations)
    • Monitor and deal with pts anxiety (increase in delusions & hallucinations
    • Prompt with self-care activities as needed
    • Focus on here & now
    • Deal with patients who refuse medication
    • Establish a relationship through consistency and predictability 
    • Deal with aggression
    • May need PRN medication
    • Deal with pts who are escalating or getting out of control: De-escalate, distract, quiet room, contain as last resort
  14. What is the focus or theme of nursing interventions for schizophrenics?
    • Focus on underlying unmet need or feeling. Will need to pick up on theme of delusion or hallucination. 
    • Do not focus on content of delusion
    • Gain the content of the delusion without reinforcing it, ie “Are they good voices or bad voices?” 
  15. Nursing interventions of paranoid schizophrenia?
    • Ask indirect questions, i.e., "I'm wondering if..." "I suppose you..." 
    • Be honest & consistent
    • Let patient set interpersonal distance
    • Evaluate delusional themes & feeling content
    • Use non-defensive stance
    • Use simple, clear words
    • Do not argue with content of delusions
    • Clarify & restate role
    • No touching, except for vital signs. Be sure to get BP for pts on antipsychotics (orthstatic hypotension.) 
    • Maintain  boundaries
    • Not close, limit time &
    • No touching
Card Set:
Psychotic disorders
2013-01-29 04:05:22

Mental Health
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