Psychosis & Antipsychotic Medications

Transcription

1 Reality Non-reality VS. Psychosis & Antipsychotic Medications Disorganized thinking, hallucinations, delusions, bizarre behaviors

2 What is Psychosis? Psychosis is mental disorganization to such a degree that a person is not completely aware of reality. Someone with psychosis is out of touch with reality in one or more ways.

3 Loss of Touch with Reality May include Perceptual disturbances Disorganized thinking Behavior alterations

4 Perceptual Disturbances Perception is through the 5 senses: Seeing (visual) Hearing (auditory) Smelling (olfactory) Tasting (gustatory) Feeling (tactile)

5 Disturbed Visual Perceptions Visual hallucinations- seeing things that aren t there, or are very distorted. - could be anything (people, animals, objects, etc.) not really there. - could be an illusion (something really there but they see it as something else (see a phone cord as a snake.)

6 Disturbed Auditory Perceptions Auditory hallucinations- are the most common type of hallucination. These are voices or sounds that only the client can hear. - may be internal voices or sounds - may be external voices or sounds Voices that tell someone to do something (usually bad) are command hallucinations.

7 Command Hallucinations Tell the person to do something (usually something negative). Are frightening for the person experiencing them. Are dangerous- the person may do what the voice says so it will go away. Always assess a hallucinating client for command hallucinations!

8 Disturbed Perceptions cont. Disturbed tactile perceptions- person has feeling or sensation of touch or being touched though no stimuli is actually present. (Like bugs crawling on the skin.) Disturbed taste or smell perceptionsthese are less common. Examples: I keep tasting dirt. I can t stop smelling burning flesh.

9 Disorganized Thinking The patient has altered thought processes. This may be exhibited by: - False beliefs (delusions). - Confused thoughts. - Disorganized speech patterns and verbal content.

10 Delusions Delusions are false, constant ideas that can t be changed by reasoning. Usually involves a dominant theme (religion, power, money, fame, special talents, grandiosity, persecution, aliens, CIA, food being poisoned, etc.) Delusions affect behaviors.

11 Delusional Themes Persecution- paranoid, someone out to get them, they are being poisoned, followed Grandiosity- they are very important or powerful. Religiosity- they are a special messenger from God, they are God, they are Satan Somatic- they are in someone else s body, their arm is rotting off

12 More Delusions Delusions of Reference- Newspapers, magazines, television or radio etc., are sending special messages to the person. Thought broadcasting- believes their thoughts can be heard by others. Thought insertion or withdrawal- others can put thoughts inside patient s head, or remove the patient s thoughts.

13 Disorganized Thinking & Speech Psychotic thinking may be disorganized, person can t think logically, thought content is scrambled, can t fit thoughts together. We speak the way we think, so speech patterns will reflect disorganized thinking.

14 Disorganized Speech Patterns Loose associations- patient abruptly changes topic in a sentence, gets off track with the subject of the conversation, sentence ends with something that doesn t even match the original topic. Also known as derailment. Example: You re a student? I was a student and I changed the fibers of life into a plaid, weaved cloth.?!

15 Disorganized Speech Patterns Word salad- a jumbled mixture of words that don t go together. Shows significant thought impairment. Example: The hostile teapot of thought moved bricks now alright.

16 Disorganized Speech Patterns Neologisms- made-up words the patient uses in conversation. Example: The spinklemine has been spying again. Clang associations- rhyming in conversation. White knight, no appetite. Poverty of speech: minimal speech, slowed speech, inability to find words.

17 Behavior Alterations Psychotic patients may exhibit total absence of movement or awareness. wildly active and bizarre movements. very inappropriate sexual behavior. explosive and dangerous outbursts. many different types of unusual and unpredictable behaviors. Use caution when dealing with psychotic patients!

18 Psychotic Disorders Schizophrenia- the most common and severe psychotic disorder. We will discuss this more in depth. Psychosis NOS (Not Otherwise Specified)- means the person is psychotic but specific disorder not identified. Substance-Induced Psychosis- psychosis caused by alcohol or drugs, including prescribed medications.

19 Associated Causes of Psychosis Depression- severe depression may induce psychosis. Bipolar Disorder- patients in either the depressive or manic state may also have psychosis. Medical conditions- patients with epilepsy, brain tumors, dementia, stroke and other conditions may have psychosis due to the effects of the medical condition.

20 Schizophrenia Greek for split mind. This in reference to the fractured, or broken thought processes of the schizophrenic. It does NOT refer at all to a split personality, also known as multiple personality disorder (MPD) or the most appropriate term, Dissociative Identity Disorder (DID). Schizophrenia is a severe, disabling, chronic mental disorder. It affects 1% of people worldwide, regardless of race/ethnicity. It has strong genetic characteristics. The impact of this disease on personal, family and social lives is enormous. Schizophrenics account for the largest diagnostic group of inpatient mental health units (about 50%).

21 Common Signs of Schizophrenia Onset of sx is gradual, with person experiencing them for some time before 1 st full-blown psychotic episode. This period before the first psychotic episode is the prodromal phase. This phase signals the actual beginning of the illness. The person gradually deteriorates, showing sx such as delusions, paranoia and speech/thought pattern abnormalities.

22 Symptoms (patient symptoms will vary from patient to patient- one pt. won t have all the symptoms.) Positive sx- these are called positive because they show an EXCESS or distortion in normal functioning. Negative sx- these are called negative because they show a LESSENING or loss of normal functioning.

23 Positive (excess) Symptoms Delusions, Hallucinations, Illusions Water Intoxication Word Salad, Clang Associations, Neologisms Thought Broadcasting and Insertions Loose Associations Depersonalization Bizarre Behavior, Agitation Catatonia, Autism

24 Negative (lessening) Symptoms Blunt or Flat Affect Lack of Energy Anhedonia (failure to experience pleasure) Lack of motivation Self-care Deficiency Inability to speak or interact Substance Use Violence Depression and Suicidal Acts

25 Subtypes of Schizophrenia Paranoid Type (paranoid hallucinations and delusions) Disorganized Type (bizarre speech/behavior and flat affect) Catatonic Type (severe decrease in motor activity and responsiveness) Undifferentiated Type (a variety of sx not specific to any subtype) Residual Type (no longer has full-blown sx but still has unusual behavior) Symptoms, focused assessment and nursing diagnoses with interventions will depend on what type schizophrenia the client has and what type symptoms they exhibit.

26 Antipsychotic Medications Can drastically reduce or reverse symptoms of psychosis. Can enable many people to live outside mental institutions. Can have serious, even fatal side effects. Have a poor compliance rate.

27 Symptom Control Antipsychotic medications eliminate or reduce the common symptoms of psychosis when the patient is compliant with the medication regimen. Symptoms that may be controlled include: Delusions, hallucinations, illusions, etc. Depersonalization, bizarre behavior Anhedonia, avolition, etc.

28 Hope Thorazine was one of the earliest antipsychotics. It so drastically reduced psychosis symptoms that for the first time, many people with chronic mental illness had a chance to live successfully outside mental institutions.

29 Side Effects Antipsychotics have anticholinergic side effects, just as many other medications do (dry mouth, constipation, etc.) They may have more serious (and sometimes permanent) side effects like pseudoparkinsonism (shakes, tremors) and tardive dyskinesia (other uncontrolled body movements.

30 Fatal Side Effect Neuroleptic Malignant Syndrome: Onset 3-9 days after starting treatment Could potentially happen anytime during treatment Pt. has muscle rigidity, change in level of consciousness, hyperthermia (will spike fever) and can lead to organ failure and death of not treated as an emergency.

31 Compliance Rate Patients on antipsychotics have a poor compliance rate. This is due to: Side effects such as weight gain, tremors Limited access to health care Believing they are better now and don t need the medication

32 EPS & AIMS The side effects that involve abnormal muscle movement, tardive dykinesia, parkinson-like symptoms, neuroleptic malignant syndrome, etc. are known as Extrapyramidal Symptoms (EPS) A scale is used to assess the EPS symptom of abnormal movement; the score may indicate intervention is needed, such as medication change. Abnormal Involuntary Movement Scale (AIMS).

33 Common Antipsychotics Thorazine Prolixin Mellaril Risperdal Haldol Clozaril Zyprexa Haldol and Prolixin can be given IM in an extended-release form, so the patient must only take a periodic injection rather than daily pills. Clozaril is often used as a last resort as it requires weekly blood samples be taken. This is hard for people with chronic mental illness to comply with, usually due to lack of transportation.

34 Psychosocial Issues For the patient: will treatment be effective enough to allow them some normalcy in relationships, family life, education, employment, do they have a support system (many chronically mentally ill have no support system and are homeless) For the family: can the patient care for themselves or will the family need to provide constant care the rest of the patient s life? For society: how do we best care for the chronically mentally ill?

35 Reference Womble, D. M. (2005). Introductory mental health nursing. Philadelphia: Lippincott Williams & Wilkins.