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Psychotic Disorder
Primarily a disorder of thought and cognition with a gross impairment in reality orientation; There is an absense of reality orientation
Psychosis
is not a disease, but a symptom. Means "no reality orientation"
Delusions
a fixed false perception not subject to reason and is inconsistent with reality.
Hallucinations
sensory perception in the absence of a stimulus. Auditory most common
Illusion
Stimulus is present but misinterpreted
Disorganized/Bizarre behaviors
unusual behaviors (isolated, intrusive, no hygiene, ADLs taken for granted)
Physical symptoms
somatic complaints such as feelings of body exploding, heart coming out of chest, etc.
Brief psychotic disorder
SUDDEN onset of psychotic disorders b/w HOURS to ONE MONTH duration due to psychosocial stressor; no longer than 1 mo; pt may return to pre-morbid state.
Delusional Disorder
presence of presistent non-bizarre delusions that follow a theme not r/t mental disorder. Delusions cannot be corrected & are persistent. ( I will be an astronaut)
Schizoaffective disorder
the presence of symptoms of schizophrenia and having an affective disorder + symptoms or mainia/depression
Schizophreniform Disorder
same as breif psychotic disorder except duration b/w 1 month to 6 months. Beyond 6 mo is Schizophrenia
Schizophrenia (Disorder)
a chronic and most common, most disabling psychotic disorder characterized by severe & often times irreversible personality deterioration of affect, intellect, social & occupational fxn
Psychotic NOS
psychotic features are present but do not meet the DSM criteria for specific type of psychotic disorder
Shared Psych Disorder "Folie a deux"
2 individuals closely associated share the same delusion. Dominant person has the psychotic disorder.
Substance induced psychosis
caused by alcohol, cocaine, LSD, PCP, etc
Psychotic Disorder r/t medical problems
brain tumor, increaced ICP, Stroke, thyriod, etc
Schizophrenia
a disconnect b/w the thinking and emotional part of mind. Schizo - split phrenia - mind Types: Catatonic, Disorganized, Paranoid, Undifferentiated, Residual (simple or ambulatory), and Process
Catatonic
characterized by severe abnormality in motor fxn
Catatonic Stupor
extreme psychomotor retardation manifested by bizarre posturing; vegetative states
Catatonic Excitement
Extreme psychomotor agitation manifested by excessive talking; very loud; "walkies and talkies"
Disorganized Schizophrenia
has the worst prognosis; behavior is markedly primitive, regressive; gross develioment is retarded; behaving childishly
Paranoid Schizophrenia
extremely suspicious, hostile, argumentative, violent tendencies, agressive, DTO (danger to others), DTS (self) Nursing DX: Danger to Others
Undifferentiated Schizophrenia
clearly with psychotic begaviors (delusions, hallucinations) but difficult to classify
Residual, simple or ambulatory schizophrenia
in a state of remission (delusions and hallucinations are gone) but bizarre behaviors are present such as no hygiene, lack of ADLs
Process Schizophrenia
developing insidiously or treacherously
Diagnosis
Long term observation Complete Hx Physical exam Mental status Exam Lab tests (thyroid, liver, CBC c diff, HcG, Urine, Blood
Assessment Data Clinical Manifestations NEGATIVE
4 A's Affect, Associative looseness, Ambivalence, Autism
Affect (Blunted, Flat)
no emotions or no expressions, is incongruent with mood and feeling and may be related to personality deterioration
Associative looseness
unable to associate, relate or connect situations together due to disorganized thoughts
Ambivalence
simultaneous presence of opposing desires, feelings and emotions towards a person or event
Autism
extremely focused on INTERNAL mental life excluding the external environment
Apathy
lack of interest
Anhedonia
Unable to experience pleasure
Avolition
lack of motivation
Alogia
thought blocking; stop talking because they forget what they are talking about
Anergia
absence of energy
Assessment POSITIVE manifestations
are more responsive to antipsychotics than the negative symptoms
Positive Behavioral Disturbances
Akathisia, Echopraxia, Sterio behavior, combativeness, Waxy flexibility, severe agitation
Akathisia
Motor recklessness, most common extrapyramidal side effects (EPSE)
Echopraxia
mimicking other people's actions
Stereo Behavior
rocking, pacing for comfort measures
Combativeness
seen especially in paranoid schizophrenics
Waxy flexibility
abnormal posturing
Positive Disturbance in thought and perception
Delusions, Hallucinations, Thought insertion, Concrete thinking, flight or ideas, tangentiality, illogical/incoherence
Delusions
Fixed false perception including: ideas of reference, persecution, delusions of grandeur, somatic, nihilism
Ideas of reference
events and actions related to the pt
persecution
feelings of being threatened
delusions of grandeur
exaggerated sense of self worth
somatic
false belief about body fxn
nihilism
belief of destruction and death
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