1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

2. Chapter 11Psychotic Disorders

3. 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

4. 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

5. 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

6. 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 –http://www.youtube.com/watch?v=AoY3v6gQWv0http://www.youtube.com/watch?v=AoY3v6gQWv0 Neologisms (new words) Clang associations –Rhythmic patterns

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Behavior Alterations Agitated Aggressive Silly, childlike Unpredictable Frenzied motor activity Unkempt appearance Sexually inappropriate

8. 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

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Schizophrenia The person withdraws into delusional thoughts and misperceptions Beginning of illnessusually before psychotic episode Symptoms categorized as positive and negative –Box 11.3 Page 159

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied Expected outcomesPage 164 –Depend on level of functioning, severity of symptoms

20. 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

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied EvaluationPage 166 –Signs of improved functioning

22. 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.

23. 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.

24. 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

25. 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.

26. 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

27. 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.

28. 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”