thought disorders & adults
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Thought Disorders & Adults . Jaymie McAllister and Jessica Nemerovsky October 31, 2012 EBP Presentation . Schizophrenia . A thought disorder that affects cognitive, emotional and behavioral functioning Linked to genetic vulnerability and environmental factors . Incidence & Prevalence. - PowerPoint PPT PresentationTRANSCRIPT
Thought Disorders &
Adults Jaymie McAllister and Jessica Nemerovsky
October 31, 2012EBP Presentation
Schizophrenia A thought disorder that affects cognitive,
emotional and behavioral functioning Linked to genetic vulnerability and
environmental factors
Incidence & Prevalence
1.2% of the U.S. population over the age of 18 10% of these people have a first-degree
relative with the disease (mother, father, siblings)
Average onset: 15-35 years old Diagnosed most frequently in men in their
early 20’s and women in their late 20’s Affects 24 million people worldwide
>50% are not receiving appropriate care
Symptoms Must be present for at least 6 months before
diagnosis can be made Positive symptoms:
Excess or distortion of normal functioning i.e. Hallucinations, distortions, disorganized speech
Negative Symptoms Represents a deficit in functioning
i.e. Flat affect, apathy, avolition, anhedonia, alogia
Self Care deficit
Self-care deficit
Positive Symptoms Hallucinations: perceptual disturbances,
subjective experiences that are not caused by external stimuli Can be visual, auditory, olfactory, gustatory or
tactile Most common: hearing voices (auditory)
Can be hostile or friendly
Delusions: Mistaken or false beliefs about self or the environment that are firmly believed i.e. patient believes the FBI is following them
Positive Symptoms Disorganized speech/behavior
Outward sign of disorganized thoughts Flight of ideas/Loose associations (less severe) Word Saladspeech cannot be logically
understood (more severe) Clanging (rhyming) Echolalia
Behavior can be agitated, nonpurposeful or random Disorganized Catatonic: waxy flexibility
Negative Symptoms Flat Affect: absence of affective expression Alogia: brief, empty verbal responses
Poverty of speech
Apathy: Feelings of indifference towards people and the environment
Anhedonia: Lack of pleasure Avolition: Lack of motivation
Self Care Deficit Patient may appear dirty and unkempt
Indifference about personal care May be wearing dirty clothes or clothes
inappropriate for the season Neglect to bathe or brush hair/teeth
Paranoid Schizophrenia
Prominent delusions and hallucinations Persecutory and grandiosity
Delusions of government conspiracy common False abilities (flight) Beliefs of power (God, Jesus, King)
Auditory Hallucinations Commonly hostile Linked to delusions Can make commands
Other characteristics: social isolation, suspicious/guarded behavior
NCLEX Which of the following client statements
demonstrates the major symptoms of schizophrenia?
1. “I’ve had too much to drink last night, started feeling all-powerful, and stupidly drove my truck into a tree.”
2. “A stitch in time saves nine’ means that prevention is easier than fixing a real problem.”
3. “I’ve been depressed ever since our house was destroyed by fire.”
4. “You can read my mind. This light of mine will shine, fine; blinding world will end at nine.”
NCLEX “You can read my mind. This
light of mine will shine, fine; blinding world will end at nine.”
NCLEX A family member asks you, “As both of my siblings have
schizophrenia, why are my brother’s symptoms so different from my sister’s? He withdraws when there’s a change in his environment or routine. She starts cursing and yelling about the Mafia and the CIA when I do something that’s less than perfect.” Based on your knowledge, your response should address:
1. The effect on gender on clinical presentation in schizophrenia.
2. The many differences in the presentation of schizophrenia.
3. The significance of paranoid content in the differential diagnosis of paranoid schizophrenia.
4. The typical progression of symptoms with an individual over time.
NCLEX The many differences in the
presentation of schizophrenia.
NCLEX You have presented your client with written aftercare
medication directions: “Take one capsule three times per day.” Your client informs you that she has reviewed the material. Which response specifically addresses your concerns about adherence?
1. “This medications work best if you take one capsule three times per day.”
2. “What might get in the way of taking your medications?”
3. “Do you understand everything?”
4. “If you forget one dose, you can double the next one.”
NCLEX “What might get in the way of
taking your medications?”
(Sturman, 2005)
EBP Article “Many of the available instruments measure all of
the abilities relevant to competency, including the MacCAT-T, MacCAT-CR, CAT, SICIATRI, CCTI, and CIS. Of these instruments, the MacCAT-T and MacCAT-CR have been tested in more diagnostic categories than any others, and can be said to be the GOLD STANDARDS.”
“Nevertheless, some measures may be preferred over the MacCAT instruments for particular populations. For instance, the CCTI has been tested extensively in patients with dementia, especially Alzheimer's disease. Likewise, the CAT may be a useful instrument for primary care patients.”
(Grisso, Appelbaum & Hill-Fotouhi, 1997)
MacCAT-T “Gold Standard” assessment tool for patients
with schizophrenia. “The instruments assesses patients’
competence to make treatment decisions by examining their capacities in four areas - understanding information relevant to their condition and the recommended treatment, reasoning about the potential risks and benefits of their choices, appreciating the nature of their situation and the consequences of their choices, and expressing a choice.”
MacCAT-T “The MacCAT-T offers a flexible yet structured method with
which caregivers can assess, rate, and report patient’s abilities relevant for evaluating competence to consent to treatment.”
The MacCAT-T is basically an assessment tool comprised of smaller assessment tools that is very complex and takes a great deal of time. Within the MacCAT-T patients are given the DISSI (Diagnostic Interview Schedule Screening Instrument).
“Understanding is assessed by exploring the patient’s ability to paraphrase what has been disclosed concerning the disorder, the recommended treatment, and the treatment’s benefits and risks. The interview typically requires 15-20 minutes.”
(Grisso, Appelbaum & Hill-Fotouhi, 1997)
BPRS In addition to the DISSI, patients completed
the 19-term Brief Psychiatric Rating Scale (BPRS) which was used to assess severity of psychiatric symptoms. BPRS scores above 40 commonly are associated with the need for in-patient treatment.
“BPRS total scores were not significantly related to MacCAT-T performance, although greater symptom severity tended to correlate with lower MacCAT-T ratings.
(Grisso, Appelbaum & Hill-Fotouhi, 1997)
(Grisso, Appelbaum & Hill-Fotouhi, 1997)
BPRS The Brief Psychiatric Rating Scale (BPRS) is a widely used
instrument for assessing the positive, negative, and affective symptoms of individuals who have psychotic disorders, especially schizophrenia. It has proven particularly valuable for documenting the efficacy of treatment in patients who have moderate to severe disease.
It should be administered by a clinician who is knowledgeable concerning psychotic disorders and able to interpret the constructs used in the assessment. Also considered is the individual's behavior over the previous 2-3 days and this can be reported by the patient's family.
The BPRS consists of 18 symptom constructs and takes 20-30 minutes for the interview and scoring. The rater should enter a number ranging from 1 (not present) to 7 (extremely severe). 0 is entered if the item is not assessed.
BPRS Rating http://www.youtube.com/watch?v=kvdw4b7t
C-8
Reference Page Grisso, T., Appelbaum, P. S., & Hill-Fotouhi, C. (1997). The
maccat-t:a clinical tool to assess patients' capacities to make treatment decisions. Psychiatric services, 48(11), 1415-1419. Retrieved from http://psychrights.org/Research/Digest/Decisionmaking/themaccat-t.pdf
Hafner, H. (1997, March 02). Pubmed.gov. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9067063
Kneisl, C. R., & Trigoboff, E. (2013). Contemporary psychiatric-mental health nursing. (3rd ed.). Upper Saddle River, NJ: Pearson Education, Inc.
Mayo Clinic Staff. (2010, December 16). Mayo clinic. Retrieved from http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862/DSECTION=symptoms
Reference Page Nclex review questions. (1985-2012). Retrieved from
http://wps.prenhall.com/chet_kneisl_contemporary_2/95/24454/6260344.cw/content/index.html
Sturman, E. D. (2005). The capacity to consent to treatment and research: A review of standardized assessment tools. Clinical Psychology Review, 25(7), 954-974. Retrieved from http://www.sciencedirect.com.ezproxy.lib.usf.edu/science/article/pii/S0272735805000498
World Health Organization. (2011, May 6). Mental health: Schizophrenia. Retrieved from http://www.who.int/mental_health/management/schizophrenia/en/