THOUGHT DISORDERS

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THOUGHT DISORDERS

• SCHIZOPHRENIA

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HISTORY

• BLEULER 1950
• RENAMED DEMENTIA PRAECOX TO SCHIZOPHRENIA
• CONCEPT OF SPLITTING NOT SPLIT PERSONALITY BUT
  SPLIT FROM REALITY

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4 AS OF THE DIAGNOSIS

• AFFECTIVE DISTURBANCE
• DISORDERED ASSOCIATION
• AUTISTIC
• AMBIVALENCE

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STATISTICS

• 1 OF THE WORLD POPULATION
• 2.5 MILLION IN THE US
• 48 BILLION SPENT IN THE US YEARLY
• 25 OF PSYCH. BEDS
• 1/3 OF THE NATIONS HOMELESS
• 10-15 COMMIT SUICIDE BEFORE 30
• 8 OF PERSONS IN JAIL
• DISPROPORTIONATELY THE VICTIMS OF CRIME

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CHARACTERISTICS

• CANNOT TELL THE DIFFERENCE BETWEEN REAL AND
  UNREAL EXPERIENCES
• DIFFICULT TO THINK LOGICALLY
• DIFFICULT TO HAVE NORMAL EMOTIONAL RESPONSES TO
  OTHERS

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CHARACTERISTICS

• DIFFICULT TO BEHAVE NORMALLY IN SOCIAL SITUATIONS

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ONSET

• EARLY ADOLESCENCE 15 -25
• MEN AND WOMEN EQUALLY EARLIER IN MALES
• AVERAGE AGE 19
• ABRUPT OR INSIDIOUS

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PROGRESSION OF SYMPTOMS

• PREMORBID PERSONALITY
• FIRST SIGNS
• ILLNESS PREGRESSES

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PHASES

• PHASE I SCHIZOID PERSONALITY
• PHASE III SCHIZOPHRENIA
• PHASE IV RESIDUAL PHASE

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ETIOLOGY

• GENETIC FACTORS
• NEUROANATOMIC NEUROCHEMICAL
• FACTORS
• IMMUNOVIROLOGIC FACTORS

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SYMPTOMS

• POSITIVE SYMPTOMS
• NEGATIVE SYMPTOMS

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POSITIVE SYMPTOMS

• ALTERATIONS IN THINKING
• DELUSIONS
• IDEAS OF REFERENCE
• PERSECUTION
• GRANDEUR
• SOMATIC
• JEALOUSY

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DELUSIONS

• THOUGHT BROADCASTING
• THOUGHT INSERTION
• THOUGHT WITHDRAWAL
• DELUSIONS OF BEING CONTROLLED

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ASSOCIATIVE LOOSENESS

• NEOLOGISMS
• CONCRETE THINKING
• ECHOLALIA
• CLANG ASSOCIATION
• WORD SALAD

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ALTERATIONS IN PERCEPTION

• HALLUCINATIONS
• LOSS OF EGO BOUNDARIES
• ALTERATIONS IN BEHAVIOR

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NEGATIVE SYMPTOMS

• AFFECTIVE BLUNTING
• ANERGIA
• ANHEDONIA
• AVOLUTION
• POVERTY OF CONTENT OF SPEECH
• POVERTY OF SPEECH
• THOUGHT BLOCKING

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ASSOCIATED SYMPTOMS

• DEPRESSION AND SUICIDE
• WATER INTOXICATION
• SUBSTANCE ABUSE
• VIOLENT BEHAVIOR

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NURSING DIAGNOSES

• ALTERED THOUGHT PROCESSES
• SENSORY-PERCEPTUAL ALTERATION
• AUDITORY / VISUAL
• SOCIAL ISOLATION
• RISK FOR VIOLENCE SELF OR OTHERS
• SELF-CARE DEFICIT
• INEFFECTIVE FAMILY COPING DISABLING

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ANTIPSYCHOTICS / NEUROLEPTICS

• BLOCK POST SYNAPTIC DOPAMINE RECEPTORS
• SHOULD NOT USE WHEN CNS DEPRESSION IS EVIDENT
• MAY LOWER THE SEIZURE THRESHOLD
• AVOID EXTREMES IN TEMPERATURE

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CLASSES

• TYPICAL
• OLDER
• ACT AS DOPAMINE ANTAGONISTS
• TARGET THE POSITIVE SIGNS
• ATYPICAL
• NEWER
• DOPAMINE SEROTONIN ANTAGONISTS
• DIMINISH PSYCHOTIC SX AND ALSO LESSEN
  NEGATIVE SX.

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SIDE EFFECTS

• SEDATION
• PHOTOSENSITIVITY
• ANTICHOLINERGIC SYMPTOMS
• ORTHOSTATIC HYPOTENSION

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EXTRAPYRAMIDAL SIDE EFFECTS

• PSEUDOPARKINSONISM
• AKINESIA
• AKATHISIA
• DYSTONIA
• OCULOGYRIC CRISIS
• TARDIVE DYSINESIA
• NEUROLEPTIC MALIGNANT SYNDROME
• AGRANULOCYTOSIS / CLOZAPINE

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