Thought Disorders Flashcards
Schizophrenia
A group of psychotic disorders that affect the perception of thought, the way language is spoken as well as how it is perceived, emotions, social behavior, and the ability to perceive reality
How does schizophrenia progress?
It is a chronic illness that worsens with time and with an eventual halt in the progression of the symptoms
** Only for elderly patients with schizophrenia has it been suggested that improvement might occur
Is there a standard treatment for schizophrenia?
No, treatment is so customized and unique that it can vary from one person to the next, as well as one episode of an individual to the next
Early Age Onset of Schizophrenia is usually associated with what?
18-25 years old
- More often male
- Poorer premorbid adjustment
- More structural brain abnormalities
- More prominent negative symptoms
* * The younger the patient is at the onset of schizophrenia, the more discouraging the prognosis
Later Age Onset of Schizophrenia is usually associated with what?
25-35 years old
- More female cases
- Less structural brain abnormalities
- Better outcomes
Which has a more favorable prognosis, an abrupt onset or a slow onset?
An abrupt onset
Characteristics of Schizophrenia
- Dependency
- Depressive symptoms
- Anxiety disorders
- Psychosis-Induced Polydipsia
Characteristics of Schizophrenia: Dependency
Very common characteristic, 75-85% schizophrenic client’s smoke. They tend to smoke 2-3 times more than the average smoker
Characteristics of Schizophrenia: Depressive Symptoms
Suicide is the leading cause of premature death and 20 times higher with schizophrenics than those of the general population
Characteristics of Schizophrenia: Anxiety Disorders
Significantly higher in those with schizophrenia than those in the general population
Characteristics of Schizophrenia: Psychosis Induced Polydipsia
Compulsive drinking of water (up to 4-10 L/day) seen in those with schizophrenia and severe mental illness. May result in severe hyponatremia, cerebral edema, and death
Diagnostic Criteria for Schizophrenia
The criteria for the diagnosis of schizophrenia includes a mixture of core (positive and/or negative) symptoms for a significant portion of a one month period but with continuous signs of disturbance persisting for at least 6 months
Types of Schizophrenia
- Disorganized
- Catatonic
- Paranoid
- Undifferentiated
- Residual
* * Recent research indicates that subtyping schizophrenia is not useful for predicting course of disease and subtypes may no longer be recognized by DSM
Disorganized Schizophrenia Onset
Before the age of 25, usually early to mid-teens
Characteristics of Disorganized Schizophrenia
- Chronic
- Behavior is aggressive and primitive
- Poor reality orientation
- Flat or incongruent affect
- POOR prognosis, usually institutionalized
- Hebephrenic
- Word salad, thought blocking, clang association
How would get a Disorganized Schizophrenic to communicate with you?
Parallel play
Catatonic Schizophrenia
Its essential feature is extreme abnormal motor behavior. They exhibit either extreme motor agitation or extreme psychomotor retardation
- Echolalia
- Echopraxia
Two Types of Catatonic Schizophrenia
- Catatonic stupor
2. Catatonic excitement
Catatonic Stupor
Characterized by extreme psychomotor retardation such as a pronounced decrease in spontaneous movements and activity
- May have mutism
- May have negativism (an apparent senseless resistance to all instructions or attempts to be moved)
- May have waxy flexibility
Catatonic Excitement
- Extreme psychomotor retardation
- Frenzied and purposeless movements accompanied by incoherent verbalizations and shouting
Why does a patient in catatonic excitement require urgent medical attention?
They require physical and medical control due to destructive and violent behavior to others. Excitement may cause them to injure themselves or collapse from exhaustion
Paranoid Schizophrenia Onset
Mid to late 20s-30s
Characteristics of Paranoid Schizophrenia
- Delusion of persecution or grandeur
- Hallucinations (usually auditory - most common)
- Usually centered on a single theme (hurt themselves, degrade themselves)
- Often have good social/occupational function with help
- Unable to trust
- They are guarded, apprehensive, and reserved
- Projection is the most common defense mechanism used
* * TRUST is very important with these patients
Undifferentiated Schizophrenia Onset
Begins early and has insidious onset (early to middle teens)
Characteristics of Undifferentiated Schizophrenia
- Psychosis with a mixture of positive and negative behaviors
- Active signs of disorder, but does not meet the criteria for a specific sub-schizophrenia
- Premorbid state is less predictable, and disability remains fairly stable, although persistent over time
Residual Schizophrenia
- Active phase symptoms (delusions, hallucinations, or disorganized speech) no longer exist, but at least 2 residual symptoms are present
- Residual symptoms include lack of initiative, social withdrawal, inability to work or study, vague or lack of content in speech, and magical thinking or odd beliefs
Phases of Schizophrenia
- Prodromal Phase
- Acute Phase
- Maintenance Phase
- Recovery Phase (Stabilization)
Prodromal Phase
- May appear in a month or a year before the first psychotic break
- Occurs in up to 80-90% of people before the acute phase
- Has early and late symptoms
Early Symptoms of Prodromal Phase
- More withdrawn, and have odd behavior (neglect personal hygiene/grooming)
- There is a lack of initiative, interests, or energy
- Blunted or inappropriate affect
- Speech may be characterized by unclear symbolism
Late Symptoms of Prodromal Phase
- Words and phrases may become indecipherable
Three Kinds of Symptoms in the Acute Phase
- Positive symptoms
- Negative symptoms
- Cognitive symptoms
Positive Symptoms of the Acute Phase
- Hallucinations
- Delusions
- Disorganized behavior
- Bizarre behavior
Negative Symptoms of the Acute Phase
- Blunted affect
- Alogia
- Avolation
- Anhedonia
Alogia
“Poverty of thought”
- Alogia is the inability to speak because of mental defect, mental confusion, or aphasia. It is a speech disturbance that can be seen in people with dementia. However, it is often associated with the negative symptoms of schizophrenia.
Avolation
Loss of motivation
Anhedonia
Inability to experience pleasure
Cognitive Symptoms of the Acute Phase
- Inattention
- Impaired memory
- Illogical thinking
- Impaired judgement
Maintenance Phase of Schizophrenia
Acute symptoms decrease in severity - particularly positive symptoms
Recovery Phase (Stabilization) of Schizophrenia
- Symptoms go into remission
2. Milder persistent symptoms may be present (withdrawn, lack of interest, lack of energy)
Delusion
Personal beliefs not consistent with a person’s intelligence or cultural background
Hallucination
False sensory perception not associated with real external stimuli. May involve any of the 5 senses
Illusion
Misperception of a real external stimuli
Neologisms
New words that a person develops that are meaningless to others, but have a symbolic meaning to the psychotic person
Concrete Thinking
Literal interpretations of the environment
Clang Association
Choice of words governed by sounds
Word Salad
Group of words that are put together randomly, without logical connection
Depersonalization
Alteration in the perception or experience of the self so that the feeling of one’s own reality is temporarily lost
Circumstantiality
The delay of a person to reach the point of communication, owing to unnecessary and tedious details when speaking
Echolalia
Parrot-like repetition by an individual with loose ego boundaries of the words spoken by another
Echopraxia
Mimicking a movement or gesture made by others
Magical Thinking
A belief that one’s thoughts have control over a specific situation, object, or people
Religiosity
Excessive demonstration of or obsession with religious ideas and behavior
Paranoia
Extreme suspiciousness of others and of their actions of perceived intentions
Associative Looseness
Thinking characterized by speech in which ideas shift from one unrelated topic to the next
Waxy Flexibility
When placed in an awkward position by someone else, the position is held for an uncomfortable length of time
“A man believing that wiring and gas lines make him ill and chooses not to go into buildings unless all the windows are open”
Paranoia
“9 am meds, 9 am meds, 9 am meds”
Echolalia
“Oh, I love to watch So You Think Can Dance, but the car does not eat bananas”
Associative Looseness
“Doing an Indian Rain Dance will cause precipitation to fall from the sky”
Magical Thinking
“I am the President of the United States”
Delusion
“GET UP!!! … Don’t sit there! … Can’t you see that Molly is sitting there!”
Hallucination
“Imagine the worst systematic, sympathetic, quite pathetic, apologetic, paramedic as your heart is prosthetic”
Clang Association
“I am involved with the CIA”
Delusion
A woman runs out of her room upset and states, “I hear my baby crying!!” when actually it is two cats howling outside her window
Illusion
“As soon as I get out of school, the first thing that I am going to do is buy me a sproggle”
Neologisms
“Market blue dog asphalt jeans”
Word Salad
A client in group therapy overheard a visitor say “What a storm! It’s raining cats and dogs out there” The patient asked the group leader to go outside to pick out a pet for group therapy”
Concrete Thinking
Define positive symptoms
These are often called florid symptoms because they are so dramatic in nature. These are associated with an acute onset, normal CT findings, and normal neuropsychological test findings.
Examples of positive symptoms
- Hallucinations
- Delusions
- Disorganized speech
- Bizarre behavior, such as walking backwards constantly
Do positive symptoms respond well to treatment?
Yes (hospitalization, medication, reduced stimuli, and interactive therapy)
Define negative symptoms
These tend to reflect a decrease or loss of normal functioning. Negative symptoms are associated with an insidious onset.
- These symptoms are more debilitating in the long run
- Much harder to recognize than positive symptoms
Examples of Negative Symptoms
- Unchanged facial expression
- Poor eye contact
- Reduced body language
- Anergia
- Avolution
Schizophrenia and Older Typical Antipsychotics
There is a poor response to the older typical antipsychotics, and may worsen when these drugs are used to treat the positive symptoms, making medication compliance an issue for client and family. Newer atypical antipsychotics drugs have promised better results for negative symptoms
Pharmacologic Interventions for Schizophrenics
- Lorazepam
- Haloperidol
- Quetiapine
Activity and Exercise Interventions for Schizophrenic Patients
The encouragement of activity and exercise is essential, not only to maintain a healthy lifestyle but also to counteract the side effects of psychiatric medications that cause weight gain.
** Exercise increases Serotonin
Communication Guidelines for Schizophrenics
- Lower the patient’s anxiety
- Decrease defensive patterns
- Encouraging participation in therapeutic and social events
- Raising feelings of self-worth
- Increasing medication compliance
Schizophreniform Disorder
Exact essential features of those with schizophrenia except:
- Duration of illness is al least one month but less than 6 months
- Impaired social or occupational functioning may not be noticeable
Brief Psychotic Disorder
Characterized by a sudden onset of psychotic symptoms (delusions, hallucinations, disorganized speech) or grossly disorganized or catatonic behavior
- Episode lasts at least one day, but less than one month, returning to the patient’s premorbid level of functioning
- Seems to suddenly follow after an extremely stressful life event
Schizoaffective Disorder
“Schizophrenia with a mood disorder”
- Must not be the result of any substance use or abuse or to a general medical condition
Delusional Disorder
Involves non-bizarre delusions (situations that occur in real life, such as being followed, infected, loved at a distance, deceived by a spouse, or having a disease) of at least one month’s duration. The person’s ability to function is not markedly impaired, nor is the person’s behavior obviously odd or bizarre
Types of Delusional Disorders
- Erotomatic
- Grandiose
- Jealous
- Persecutory
- Somatic
Erotomatic Type
Believes that someone, usually of a higher status is in love with him or her.
Grandiose Type
Has irrational ideas about their own worth, talent, or power
Jealous Type
Centers on the idea that the person’s sexual partner is unfaithful. It is irrational and without cause
Persecutory Type
Most common - individuals believe that they are being maliciously treated in some way
Somatic Type
Believe that they have some form of physical defect, disorder, or disease
