THOUGHT DISORDER Biological Theories

• Serious and often persistent mental illness • Genetics (monogenic, polygenic,

characterized by disturbance in
REALITY ORIENTATION, THINKING AND
SOCIAL INVOLVEMENT a cognitive
disturbance that affects communication,
language, or thought content, including poverty
of ideas, neologisms, paralogia, word salad, and
delusions.
• Also called thought disturbance (APA, 2018)
• "Schizo" means split, "phenia" means mind
(but not to be confused with multiple personality
or dissociative identity disorder
chromosomal)
• Neurochemical and neuroanatomic changes
• Enlargement of the lateral cerebral ventricles
affecting the cortical and subcortical regions of
the brain)
• Under developed frontal lobe (birth injuries or
during perinatal period, viral exposure in utero)
• Neurochemical imbalance (esp Inc. Dopamine
and Dec. Norepinephrine)
• Irregular patterns of certain brain cells (Left
hemisphere overactivation)

SCHIZOPHRENIA Psychosocial Theory

• "Schizo" means split, "phenia" means mind • Stress-Vulnerability Model
(but not to be confused with multiple personality • Family Systems Theory
or dissociative identity disorder) • Environmental (early exposure to infection
• Abnormal or scattered/fragmented pattern of during prenatal period, autoimmune disease,
thinking psychological stress
• Most prevalent among thought disorders;
affects 1% of people worldwide
• Not a single disease but a Syndrome (multiple
symptoms, different patients different
symptoms)
• Symptoms lasting for at least 6 months
• Affect relationships (can lead to
stigmatization) and treatable
• Risk factors: Men, Mid 20s (productive years),
Industrialized cities, Low socioeconomic groups
• Disorganized speech and thought
POSITIVE SYMPTOMS (at least 2 of the ff) • Circumstantiality
• Hallucinations • Loose associations/ flight of ideas
• Tactile, • Neologism
• Auditory • Clang Associations
• Delusions • Word Salad
• Delusions of Reference • Concrete thinking
• Delusions of Control • Tangetiality
• Delusions of Grandeur • Pressured Speech
• Persecutory(paranoid) delusions • Disorganized and Bizarre behavior
• Accompanied by thought broadcasting, thought (Clothing, appearance. Social, sexual,
insertion and thought withdrawal aggressive, agitated, repetitive
EXAMPLES • Negative State/ Decreased emotions
LOOSE ASSOCIATIONS • Flat Affect
• "I like to dance, all people have hands." • Alogia - poverty of speech
• "I like to play games because the river is • Avolition
flowing down a mountain." • Anhedonia
• "The weather is sunny, the monkey has a long • Attentional impairment
tail"
CLANGING
• "I wrote the goat overload boat my float tote."
• "He rained the train brain grain strain the
crane."
• "On my way to the store bore some more
chore."
NEOLOGISM
• "I got so angry I picked up a dish and threw it
at the geshinker"
• "So I sort of bawked the whole thing up" COGNITIVE SYMPTOMS
WORD SALAD • Attention
• "Trees summer... green... I gardening... water • Distractibility
hard sun summer set... best time." • Poor concentration
• "Cars driving... road... walking... ground level • Difficulty in selective attention
wind past... cold." Memory
• "Lunch afternoon... table.. eating... newspaper • Impaired ability to retrieve stored memory
sounds people..." • Impaired short- and long-term memory
CONCRETE THINKING Decision making and judgement
• "What brought you to the hospital today?" • Indecisiveness
"A car" • Difficulty in initiating tasks
TANGENTIALITY • Impaired judgement
• When a therapist poses the question, "How was • Illogical thinking
your week?" a person may respond with, "When • Lack of insight
I was five, my cat was killed." When the • Lack of planning and problem-solving skills
therapist asks about the cat the person may then • Impaired abstract thinking
begin to discuss something completely different
such as religious beliefs or previous illnesses. OTHER SYMPTOMS
• Lack of insight
• Water Intoxication

PHASES
• PRODORMAL PHASE
• Withdrawn
• ACTIVE PHASE
• Severe symptoms
• RESIDUAL PHASE
NEGATIVE SYMPTOMS • Cognitive symptoms
 PHARMACOLOGIC INTERVENTIONS
ANTIPSYCHOTIC MEDICATIONS.
• Antipsychotic medications - decrease D2
receptors of dopamine
• Antipsychotic medications do not cure
schizophrenia but decreases associated
long-term comorbidities

SUBTYPES
• Paranoid Type
• Disorganized Type
• Catatonic Type
• Undifferentiated Type
• Residual Type

GOALS OF TREATMENT
• Safety in all settings
• Stabilization on antipsychotic medications
• Client and family education about
schizophrenia and its treatment
Physical care of client
• Psychosocial support of client and family
PSYCHOSOCIAL INTERVENTIONS
• MILLEU MANAGEMENT.
• INDIVIDUAL AND GROUP THERAPY
• COGNITIVE BEHAVIORAL THERAPY
• SOCIAL SKILLS TRAINING
• VOCATIONAL REHABILITATION
COMMON NURSING DIAGNOSIS
• Disturbed thought processes
• Disturbed sensory perception
• Risk for Other-Directed or Self-Directed
Violence
• Social isolation
• Noncompliance with medication regimen
Interrupted family processes • Stress reduction techniques
• Risks for ineffective family management of • Maintain physical health (diet, exercise and
therapeutic regimen sleep)
• Support groups
NURSING MANAGEMENT
• Intervening in disturbed thought processes and
sensory perceptions
• Managing violent behaviors
• Lessening social isolation (developing trust,
initiating interaction, modeling affect
• Promoting adherence to medication regimens
• Promoting improved individual coping skills
• Strengthening family processes
• Providing client and family education
• Teaching symptom management

OTHER THOUGHT DISORDERS

• SCHIZOPHRENIFORM DISORDER -
Same with schizophrenia but shorter duration< 6
months
• SCHIZOAFFECTIVE DISORDER - occurs
following an illness. With mood of sessions or in
lucinapons without eded drylond by 2
• DELUSIONAL DISORDER - 1 month of
non-bizarre delusions (functioning not
impaired); can be jealous, persecutory, somatic,
grandiose or erotomanic.
• BRIEF PSYCHOTIC DISORDER - I day to
I month positive signs of schizophrenia (no
negative signs); common in post-partum
• SHARED PSYCHOTIC DISORDER
(FOLIE A DEUX) - two people share the same
delusions (e.g. twins, mother and child)
• PSYCHOTIC DISORDER NOT
OTHERWISE SPECIFIED

PREVENTION
• Follow medication regimen
• Participate regularly in treatment
• Know the early signs of relapse and notify the
physician immediately
• Discuss any troubling side effects of
medications
• Avoid drugs and alcohol