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Mental Health

Chapter 14: Psychotic Disorders

What do schizophrenia spectrum and other psychotic disorders affect? (pg. 118) Thinking, behavior, emotions & the ability to perceive reality
What causes schizophrenia? Combination of genetic, neurobiological, and non genetic (injury at birth, viral infection and nutritional) factors
Typical age onset of schizophrenia? -What about age 7 Late teens and early 20s. Can occur in young children and late adulthood --> dx not for younger than 7 bc it could be ADHD
Schizophrenia: define Psychotic thinking or behavior present for a least 6 months. Function areas: school/work/self-care/relationships are impaired
Schizotypal personality disorder: define Impairments of personality (self and interpersonal) functioning. --> Impairment is not as severe as w/ schizophrenia
Delusional disorder: define Delusional thinking for at least 1 month. Self or interpersonal functioning is not markedly impaired
Brief psychotic disorder: define Psychotic s/s lasting between 1 day to 1 month
Schizophreniform disorder: define S/S similar to schizophrenia but the duration is 1-6 months, and social/occupational dysfunction may/may not be present
Schizoaffective disorder: define Client's disorder meets both the criteria for schizophrenia and depressive or bipolar disorder
Substance-induced psychotic disorder: define Psychosis within 1 month of substance intoxication or withdrawal. May be caused by meds intended for therapeutic use.
Characteristics of psychotic disorders: 1. Positive symptoms define & examples Manifestations of things that are not normally present -Hallucinations, delusions, alterations in speech, bizarre behavior like walking backwards
2. Negative symptoms define The absence of things that are normally present (more difficult to treat)
Negative symptoms examples -Affect: define Usually blunted (narrow range of normal expression) or flat (facial expression never changes)
Negative symptoms examples -Alogia: define Poverty of thought or speech; client may sit w a visitor but mumbles or vaguely responds
Negative symptoms examples -Anergia: define Lack of energy
Negative symptoms examples -Anhedonia: define Lack of pleasure or joy; the client is indifferent to things that often make others happy
Negative symptoms examples -Avolition: define Lack of motivation in activities & hygiene
3. Cognitive symptoms: define & examples Problems with thinking make it very difficult for the client to live independently --> disordered thinking, inability to make decisions, poor problem-solving ability, difficulty concentrating to perform tasks
Cognitive symptoms examples continued -Memory deficits; expand Long-term memory & working memory (inability to follow directions to find an address)
4. Affective symptoms: define & examples Manifestations involving emotions --> Suicidal ideation & hopelessness
Examples of delusions! (Pg. 119) 1. ideas of reference misconstrues trivial events & attaches personal significance to them -ex. believing that others, who are discussing the next meal, are talking about him
Examples of delusions 2. Persecution Feels singled out for harm by others (ie. being hunted down by the FBI)
Examples of delusions 3. Grandeur Believes that she is all powerful & important, like god
Examples of delusions 4. Somatic delusions Believes that his body is changing in unusual ways, such as growing a 3rd arm
Examples of delusions 5. Jealousy May feel that her spouse is sexually involved with someone else
Examples of delusions 6. Being controlled Believes that a force outside his body is controlling him
Examples of delusions 7. Thought broadcasting Believes that her thoughts are heard by others
Examples of delusions 8. Thought insertion Believes that others thoughts are being inserted into his mind
Examples of delusions 9. Thought withdrawal Believes that thoughts have been removed from her mind by an outside agency
Examples of delusions 10. Religiosity Being obsessed with religious beliefs
What are delusions? Define Alterations in thought; false fixed beliefs that can't be corrected by reasoning and are usually bizarre
Alterations in speech (positive) examples 1. Flight of ideas Associative looseness, client may say sentence after sentence, but each sentence may relate to another topic, and the listener is unable to follow the client's thoughts
Alterations in speech (positive) examples 2. Neologisms Made-up words that have meaning only to the client
Alterations in speech (positive) examples 3. Echolalia The client repeats words spoken to him
Alterations in speech (positive) examples 4. Clang association Meaningless rhyming of words, often forceful, such as "oh fox, box and lox"
Alterations in speech (positive) examples 5. Word salad Words jumbled together w little meaning or significance to the listener; such as "hip hooray, the flip is cast and wide-sprinting forest"
What are hallucinations? Alterations in perceptions; sensory perceptions that do not have any apparent external stimulus.
Hallucination examples 1. Auditory Hearing voices or sounds -command; voice instructs to do something
Hallucination examples 2. Visual Seeing persons or things
Hallucination examples 3. Olfactory Smelling odors
Hallucination examples 4. Gustatory Experiencing tastes
Hallucination examples 5. Tactile Feeling bodily sensations
Different alterations in perception: 3 types Hallucinations, Personal boundary difficulties, Alterations in behaviors
Personal boundary difficulties are? Disenfranchisement with one's own body, identity, and perceptions.
Types of personal boundary difficulties are? Depersonalization and derealization
Depersonalization is? Nonspecific feeling that a person has lost her identity; self is different or unreal
Derealization is? Perception that the env't has changed
Alterations in behavior examples 1. Extreme agitation Including pacing & rocking
Alterations in behavior examples 2. Stereotyped behaviors Motor patterns that had meaning to client (sweeping the floor) but now are mechanical and lack purpose
Alterations in behavior examples 3. Automatic obedience Responding in a robotlike manner
Alterations in behavior examples 4. Wavy flexibility Excessive maintenance of position
Alterations in behavior examples 5. Stupor motionless for long periods of time, comalike
Alterations in behavior examples 6. Negativism Doing the opposite of what is requested
Alterations in behavior examples 7. Echopraxia Purposeful imitation of movements made by others
Standardized screening tools 1. GAF Global assessment of functioning scale -helps to determine ADLs and function independently -appropriate for all clients who have a mental health disorder
Standardized screening tools; other Scale for assessment of negative symptoms, brief psychiatric rating scale (BPRS), and abnormal involuntary movements scale (AIMS)
What is milieu care? nursing A structured, safe environment for the client in order to decrease anxiety and to distract the client from constant thinking about hallucinations
What is ACT? Assertive community tx: intensive case management and inter professional team approach to assist clients w community living needs
Appropriate communication w clients when addressing hallucinations? -ask directly -cannot argue or agree with anything the client is saying but can say "i do not hear anything but you seem frightened" -focus on feelings when addressing the hallucinations, don't argue -Focus on reality based (attempt)
Atypical antipsychotics: tx.. generally both positive and negative symptoms
Example of atypical antipsychotics Risperidone (risperdal), Olanzapine (zyprexa), Quetiapine (Seroquel), Ziprasidone (geodon), Aripiprazole (abilify), Clozapine (clozaril)
S/E for the atypical medications? Wt gain: advise client to follow a healthy, low-calorie diet, engage in regular exercise & monitor wt -s/s agitation, dizziness, sedation & sleep disruption may occur
Conventional antipsychotics.. used for Positive symptoms mainly
Conventional antipsychotic examples Haloperidol (Haldol), loxapine (loxitane), chlorpromazine (thorazine), fluphenazine (prolixin)
Conventional antipsychotic s/e: Anticholinergic effects; to avoid these--> chew sugarless gum, eat ^ fiber foods & drink 2-3L fluids/day
Conventional antipsychotic s/e: blood pressure Postural hypotension: sit or lie down. get up slowly
Antidepressants: Paroxetine (Paxil)
Paxil; used for how long? and may increase risk for what when first using? Temporarily. self-harm, Don't abruptly stop (withdrawal)
Anxiolytics/benzodiazipines; Lorazepam (Ativan), Clonazepam (Klonopin)
Anxiolytics/benzodiazipines s/e: Sedative effects, blood tests to monitor agranulocytosis, caution in elderly
Created by: mary.scott260!