PSYCHOTIC DISORDERS

Prepared by: Mala

Definition:

Psychosis is a loss of contact with reality, typically including delusion and hallucination and daily activities are grossly disturbed.
Psychosis is a severe type of mental illness in which personality of the person is affected and is characterized by altered in thought process,emotion,loss of insight, impairment in attention,concentration,memory and orientation.

Symptoms:
Loss of reality Hallucination Delusion illusion Loss of insight Disorganized thought or speech behavior Inappropriate mood

TYPES OF PSYCHOSIS: 2 types of psychosis:

1.FUNCTIOONAL PSYCHOSIS: Schizophrenia Mood disorder 2.ORGANIC PSYCHOSIS: Delirium Dementia

Schizophrenia:

Schizophrenia was coined in 1908 by Swiss psychiatrist Eugene Bleur.Derived from greek word Skhizo(spilt) and phren(mind). Def: schizophrenia is a psychotic condition characterized by disturbance in thinking,emotion,volitions,and faculties in the presence of clear consciousness,which usually leads to social withdrawal. It is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness.

Epidemiology:

About 15% of new admission in mental hospital are schizophrenic patients.schizophrenia occupies 50% of all mental hospital beds.3-4/100 in every community suffer from schizophrenia.peak age of onset is 15-25 for men and 25-35 for women.

Etiology of schizophrenia:
Genetic

factors Biochemical factors Psychological factors Social factors

Signs and symptoms of schizophrenia:

Ambivalence Autism Affect disturbance Association disturbances

Schneiders first rank symptoms of schizophrenia:

Audible thoughts Voice heard arguing Voices commenting on ones action Thought withdrawal Thought diffusion and broadcasting Delusional perception Somatic passivity Made volitions or acts Made impulses Made feelings or affects

Negative symptoms of schizophrenia:

Affective flattening or blunting Avolition-apathy Attention impairment Anhedonia Asociality alogia

Common signs and symptoms:

Thought and speech disorder: autistic thinking,loosening of association,thought blocking neologism,poverty of speech,poverty of ideation,echolalia. perservation,verbigeration,delusion of various kinds

Disorder of thought Disorder of affect: includes apathy,emotional blunting,emotional shallowness,anhedonia and inappropriate emotional response. Disorder of motor behaviour Other features: Decreased functioning in work,social relation and self care,loss of ego boundaries,loss of insight,poor judgement,sucidial tendency,disturbance of consciousness,orientation,attention,memory and intelligence.

Types :

Paranoid schizophrenia Hebephrenic schizophrenia:marked thought disorder,incoherence,lossening of association,extreme social impairment,delusion,hallucination

Catatonic schizophrenia
Undifferentiated schizophrenia

Simple schizophrenia

Residual schizophrenia:
-emotional blunting,eccentric behaviour,illogical

thinking,social withdrawal,lossening of association.chronic form of schizophrenia.

Post schizophrenic depression:

- Depressive features can occur due to side effect of antipsychotics, regaining insight after recovery.

Management:
Pharmacology: chlorpromazine:300-1500mg/day PO,50-100 mg/day I/M Fluphenazines deaconate: 25-50 mg I/M every 1-3 weeks Haloperidol:5-100mg/day PO,1-5mg/day I/M Trifluperazine:15-60mg/day PO,1-5mg/day I/M. Clozapine:25-450 mg/day PO Resperidone:2-10 mg/day PO

Electroconvulsive therapy

Psychological therapies
Psychosocial rehabilitation

Nursing management:

Psychological care
Physical needs Emotional needs

Therapeutic needs Stimulation and recreation needs

Nursing intervention for Schizophrenic patients:

Decrease the environmental stimuli. Modify the environment to minimize the objects. Use furniture so heavy that it cannot be lifted by client. Remove all the dangerous objects from the client environment. When using restraint evaluation of the patient s status must be done.

Arrange non threatening activities that involve these patients in doing something. Help patients to participate in decision making as appropriate. Establishing therapeutic relationship by establishing trust. Reinforce appropriate grooming and hygiene. Make sure that 1 relative is always with the patient. Dont argue,criticize with psychotic thinking

Dont judge the clients behaviour. Assess the fluid and electrolyte status and nutrition. Engage client in reality based activity Observe the clients for signs of hallucination Keep a comfortable distance away from the patient. Be prepared to move. Give needed information to patient and the family and clear doubts if any. Administer tranquilizing medications as ordered.

Observe for side effects of drugs,record and report side effects of medicines. Explain about side effects to the patients and clear instructions regarding intake of medicines. Advice the family members to involve the patient in all domestic activities. Provide assistance with the self care needs. Orient the client to the reality.

Mood or Affective disorders:

Anergia Exhaustion Agitation Noise intolerance Slowed thinking process

Definition:

The mood or affective disorders are mental disorders characterized by the periods of depression, sometimes alternating with the periods of elevated mood. The mood or affective disorders are mental disorders that primarily affect mood and interfere with the activities of daily living..usually including major depressive disorder and bipolar disorder. The mood disorders are chacterized by a disturbance of mood ,accompanied by a full or partial manic or depressive syndromes, which is not due to any other physical or mental disorder.

Incidence:

Mood disorders affect about 10% of the population.

Classification:
Manic episode Depressive episode Bipolar mood Persistent mood disorder

Etiology:
1.Biological theories: Genetic hypothesis: -children with one parent with mood
disorder:27% -lifetime risk for the first degree relative of patient with bipolar disorder:25% and -of normal control is 7% -children with both parents with mood disorder has risk of:74% - monozygotic twins with mood disorder:65% -dizygotic twins with mood disorder:15%

2.Biochemical theories:
Serotonine has many roles in the behaviour:mood,activity,aggressiveness and irritability,cognition,pain and neuroendocrine processes

3.Neuroendocrine influences
-Hypothalamic pituitary adrenocortical axis ( Dexamethasone suppression test abnormal only in 50% of depressed people) -Hypothalamic pituitary thyroid axis( reduced thyroid stimulating hormone)

4.Biologic cycles 5.Psychological cycles:

Freuds psychoanalytic theory,behavioural theory, cognitive theory, sociological theory.

MANIA

Definition:

Mania is an unfound elation ,recognized by extreme talkativeness, grandiose plans and new ideas, new bursts of creativity, pressured ,constant speech with jokes, plays on words,rhyming,distractibility,flight of ideas, speech difficult to interpret. Mania refers to a syndrome in which the central features are over activity, mood change and self important ideas. Three degrees of severity are specified here: - sharing the common underlying characteristic of elevated mood -An increase in quantity of speech -Increase in physical and mental activity.

EPIDEMIOLOGY:
Age: highest prevalence rate between 34 and 45 years. Sex: bipolar disorder equally common among men

and women.

Marital status: more common among the

divorced

Classification of Mania:
Hypomania Mania without psychotic symptoms Mania with psychotic symptoms Manic episode unspecified.

Diagnostic criteria for mania without psychotic symptoms

1.Mood change must be prominent and sustained for atleast 1 week. 2.severe interference with personal functioning of daily living: -increased activity -increased talkativeness -Flight of idea -loss of normal social inhibitions -decrease need for sleep -grandiosity -distractibility 3.no hallucination or delusion

4.Not attributed to psychoactive substances use or organic mental disorder 5.Impairment in work

Clinical features:
1. Elevated, expansive or irritable mood: - Euphoria -Elation -Exaltation -Ecstasy 2.Psychomotor activity 3.Speech and thoughts:
Flight of ideas, pressure of speech, delusion of persecution,distractibility,grandiosity,inflated self esteem.

4. other features: - Decreased need for sleep

- Decrease food intake -Attention easily distracted by unimportant objects or events -more goals and goal oriented activities -poor judgement -Absent judgement -Agitation -involvement in high risk activities -mood disturbance

Feeling lack of energy Laughing inappropriately Increase in activities Disorientation Insomnia Weight loss Paranoia Violent behaviour,impulsive behavior Increased sexuality Heightened perceptions Increase in religious thinking Decrease in attention Dress is often inappropriate with bright colors

MANAGEMENT OF MANIA:

1.Hospitalization 2.Pharmacotherapy: -Lithium:300-2100 mg/day -Carbamazepine:600-1800 mg/day -sodium valporate:600-2600 mg/day -other drugs ,clonazepam,calcium channel blockers -Electroconvulsive therapy -Psychosocial treatment: family and marital therapy.

Nursing management:

-Diet -Drugs -maintain safety

-emotional needs
-maintaining therapeutic environment.

Nursing interventions:

Keep environmental stimuli minimum Remove hazardous objects Engage in activities Administer mediaction as prescribed Observe every 15 minutes Encourage verbal expression Provide high calorie diet Maintain intake and output Weight the patient Dont argue Give positive reinforcement Explain about side effects and instructions about the medicines. Refer durga subedis Mental health and psychiatric nursing.