ASDN 253 – LECTURE NOTES

THOUGHT DISORDERS

 

 

Review Mood Disorders

        Differentiate between Depression, Dysthymia, Grieving

        Nursing Process – Goal Setting, Interventions

                Mania – limit setting & safety, distraction, nutrition, sleep

                Depression – offering self, nutrition & sleep, self care,

self-esteem

                Suicide – safety, contract

                        Cues

 

Schizophrenia

        Etiology – theory

        Some genetic links

        Neuroanatomic

                Less brain tissue & cerebrospinal fluid

        Abnormalities in frontal (negative symptoms) and temporal lobes (positive symptoms)

                        Increased Dopamine & Serotonin

                        Immune response to virus?

 

        Cultural Aspects

                       

Positive Symptoms –

                Delusions – grandeur, persecution, guilt

                Hallucinations – any of 5 senses

                Illusions

                Disorganized thinking & speech

associative looseness, clang associations, neologisms

        Negative Symptoms – (video)

                5 A’s: Anhedonia, Alogia, Avolition, Affect, Apathy

 

        Types –

                Paranoid – “suspiciousness”

                        command hallucinations

can be aggressive & violent

                Disorganized –

                        unusual behavior, bizarre speech

                                word salad

                Catatonic – vacillate between rigidity (stupor) & agitation

can change states quickly, sometimes triggered by

loud noises or sudden movements

                        echolalia, echopraxia, waxy flexibility

 

Related Disorders

Schizophreniform Disorder – symptoms of schizophrenia for less than 6 months, may impair functioning

 

Schizoaffective Disorder – Psychosis plus mood disorder symptoms

 

Delusional Disorder – “believable” delusions

 

Brief Psychotic Disorder – psychosis lasting 1 day to 1 month

 

Shared Psychotic Disorder – two people “share” similar delusion

 

 

 

        Pharmacology

                Antipsychotics

                        1st Generation (Typical)

                                Thorazine, Haldol, Mellaril

                        2nd Generation (Atypical)

                                Clozaril, Respirdal, Zyprexa, Seroquel, Geodon

                        Side Effects –

Extrapyramidal – Dystonia (muscle spasms, torticollis), Pseudoparkinsonism (shuffling gait, flat fascies, “pill rolling”), Akasthesia (restless movements)

Tardive Dyskinesia – involuntary movements

        tongue protrusion, grimacing

Neuroleptic Malignant Syndrome (NMS) –

hyperpyrexia, hypertension, muscle rigidity, ^ CPK

can be fatal

Photosensitivity, Sedation, Weight Gain, Anticholinergic (dry mouth, blurred vision, constipation, urinary retention, orthostatic hypotension)

                Anticholinergics (to reduce side effects)

                        Cogentin, Benedryl

 

        Nursing Interventions

                Never reinforce delusions, hallucinations or illusions

                Do not whisper or laugh

                Do not put in competitive or embarrassing situations

                Build trust, keep promises

                Simple communication, emphasize positive behavior

 

Exercises in Neeb

               

Organic Brain Disorders

        Delirium – acute, reversible

 

Dementia – chronic, degenerative

        Alzheimers

 

        Nursing Interventions – safety, honesty, patience

                Stay calm

                Don't argue

                Clear & simple communication

                Allow time for patient to respond

                Use touch when appropriate

                Use restraints when appropriate

                Assist with ADL's as needed

                Provide adequate stimulation