THOUGHT PROCESS DISORDERS Psychosis

- Mental state of experiencing reality

NEUROBIOLOGICAL RESPONSES
Cognition
- “It’s all about thinking”
- Act or process of knowing
- Involves awareness and judgment that
allows the brain to process information
(accuracy, storage, retrieval)
Cognitive Deficits
- Present in patients with clinical high risk
for psychosis before the onset of psychotic
illness
- Nakakapag-isip pero may kulang o mali
Neurobiological Disorders
- Inability to produce complex logical
thoughts or express coherent sentences
d/t neurotransmission malfunction
different from others
- This person is not manifesting to reality
perception (ego)
SCHIZOPHRENIA AND PSYCHOTIC DISORDERS
Complex neurobiological brain disorders
associated with the following:
1. Difficulty to understand
2. Frightened by experience
3. Have difficulty forming close relationships
4. Alienated from society
Schizophrenia
- Group of psychotic reactions causing
distorted and bizarre thoughts,
perceptions, emotions, movements,
communication, and behavior
- Eugene Blueler (Swiss Psychiatrist—1911)
- “schizein” (to split) and “phren” (mind)
- NOTE: It is not split of personality

Causes
Biological Theories
- Genetics: 1st to 2nd degree relative
- Neurobiology: decreased in brain tissue
and CSF, enlarged ventricles, cortical
atrophy, decreased glucose metabolism,
oxygen infection, trauma, or immune
neurodevelopment
- (+) signs = temporal love/limbic system
- (-) signs = frontal lobe
- Neurobiology: increased dopamine
(increased serotonin)

Predisposing Factors
- Psychological
- Sociocultural
- Environmental
Precipitating Stressors - Illusion
Health: - Ambivalence
- Poor nutrition, rest, sleep, exercise
- Fatigue 2. Disorganization of speech and behavior
- Infection - Speech (incoherence) – echopraxia, loose
- CNS drugs association, flight of ideas,
circumstantiality, tangentiality, pressured
Attitudes/Behaviors: speech
- “Poor me” (Low self-concept) - Bizarre behavior – catatonia, movement
- “Hopeless” (Lack of self-confidence) disorders, decreased social behavior
- “I’m a failure” (Loss of motivation)
- “Lack of control” (Demoralization) Negative Symptoms
- Poor social skills/support system - An absence or lack of normal function
- Violent/aggressive behavior (thinking behavior and perception);
- Poor medication management usually unresponsive to typical
- Poor symptom management antipsychotics (weak dopamine blocker)

Environment: 1. Problems in Emotion

- Hostile/critical environment - Flat/Blunt Affect
- Changes in life events and daily patterns - Anhedonia (lack of pleasure)
- Interpersonal difficulties - Asociality (social withdrawal)
- Lack of social support - Apathy (indifference towards people)
- Stigmatization
- Poverty 2. Impaired Decision Making
- Inability to get/keep a job - Alogia (restricted speech/content)
- Avolition (absence of will, dive)
ONSET - Inattention
Peak: 15-25 (men); 25-35 (women)
May be abrupt or insidious TYPES OF SCHIZOPHRENIA
Paranoid Schizophrenia
Initial: Social withdrawal, unusual behavior, loss of - One or more delusions or many auditory
interest in school/work, neglected hygiene hallucinations
active positive symptoms o Suspicious, argumentative,
hostile, and aggressive
Signs/Symptoms o Not socially impaired
DSM V CRITERIA o Good prognosis
2 or more is present during 1-month period:
- Delusions Disorganized Schizophrenia
- Hallucinations - Disorganized speech and behavior
- Disorganized speech - Flat or inappropriate affect
- Grossly disorganized or catatonic behavior - Associative disturbance
- Negative symptoms o Odd mannerisms, extreme social
Positive Symptoms withdrawal, and neglect with
- An exaggeration of distortion of normal hygiene
functions
Catatonic Schizophrenia
1. Disorder of Thinking - Psychomotor disturbances (difficulty,
- Delusions resistance, excessive, abnormal)
- Hallucinations (sense: auditory, visual, - Echolalia, echopraxia
tactile)
Types:
a. Catatonic Stupor
- Abnormal maintenance of posture
b. Catatonic Excitement
- Excessive psychomotor disturbances
Undifferentiated Schizophrenia
2 or more of the following:
Delusions, hallucinations, disorganized speech or
behavior, and negative symptoms
- Does not meet criteria for other types
Residual Schizophrenia
- Negative symptoms
- Withdrawal, disinterest, not speaking,
impaired role functioning
- History of past acute episodes
OTHER PSYCHOTIC DISORDERS
Brief Psychotic Disorder (Brief Psychosis)
At least one of the following:
- Delusions
- Hallucinations
- Disorganized speech/behavior
- Lasts for one day to one month
Schizophreniform Disorder
- Reactive psychosis for less than 6 months
- Social or occupational functioning may or
may not be impaired
Delusional Disorder
- One or more nonbizarre delusions
(persecutory, erotomanic, grandiose,
jealous or somatic)
- Psychosocial functioning not markedly
impaired. Behavior is not obviously odd or
bizarre
Shared Psychosis
- “Folie a deux”
- Two people share a same delusion
- Developed in a context of a close
relationship
Schizoaffective
- “Psychosis + Mood Disorder”
- May occur simultaneously or alternate
Psychotic Disorder due to:
- General medical condition
- Substance induced
Management
- Promote safety of client and others
- Establish trusting therapeutic relationship
- Therapeutic communication (feelings,
disorganized thoughts and feelings)
For withdrawn and isolated:
- Planned, short, frequent and
undemanding times
- Consistency and honesty
- Social skill training and gradual interaction
in non-threatening situations
- Measures to enhance self-esteem
For regressive and unusual behaviors:
- Non-judgmental as a matter of fact
approach
- Treat client as an adult
- Monitor eating pattern (intervene as
necessary)
- Assist client with hygiene and grooming
- Routine schedule
- (+) ambivalence = simple choices
- Supportive. Do not make them feel
punished
For unclear communication patterns:
- Clear and unambiguous manner (verbal or
non)
For suspicious or hostile: o Thought stopping: I won’t think
- Professional relationship (no about it
overfriendliness)
- Be cautious with the use of touch PSYCHOSOCIAL TREATMENT
- Allow client as much control within the - Individual and group therapy
limits - Cognitive behavioral therapy
- Trust! Avoid reinforcing suspicion - Cognitive enhancement therapy
- Explain treatments before initiating them - Milieu therapy
- Identify and respond to emotional needs - Family therapy
- Avoid misinterpretation
- (+) anxiety or acting out = intervene! Pharmacologic: “neuroleptics”
- Typical Anti-psychotics: treat (+) and (-)
For agitation (potential for violence): symptoms
- Observe for early signs and prompt o WOF: EPS: Parkinsonism,
intervention akathisia, akinesia, dystonia,
- Safe, quiet and non-stimulating tardive dyskinesia
environment - Atypical anti-psychotics: (-) symptoms
- Avoid retaliating
- Encourage to talk vs act out
- Set limits for unacceptable behavior
- Ensure adequate number of staff
- (+) agitation = isolate client from general
milieu

For delusions and hallucinations:

- Do not openly confront or argue
- Do not focus on thoughts, interrupt and
interact
- Establish, maintain, and reorient to reality
- Point out that you do not share with
perception but validate that you believe
it’s real for him (ex: I know you are hearing
voices but I do not hear the voices that you
hear)
- Respond to feelings during occurrence (ex:
you seem frightened)
- Move client to a non-stimulating
environment
- Wait symptoms to stop teaching
sessions will explain that those are
symptoms of disorder
- Point out that stimulation and anxiety
caused it
- Help to focus on reality and take
medications
- Learn to ignore belief and act
appropriately
- Cognitive strategies:
o Self-talk: The voices are not real