Psychotic behavior

Psychotic behavior reflects an inability or unwillingness to recognize and acknowledge reality and to relate with others. It may begin suddenly or insidiously, progressing from vague complaints of fatigue, insomnia, or headaches to withdrawal, social isolation, and preoccupation with certain issues, resulting in gross impairment in functioning.

Various behaviors together or separately can constitute psychotic behavior. These include delusions, illusions, hallucinations, bizarre language, and perseveration. Delusions are persistent beliefs that have no basis in reality or in the patient's knowledge or experience such as delusions of grandeur. Illusions are misinterpretations of external sensory stimuli such as a mirage in the desert. In contrast, hallucinations are sensory perceptions that don't result from external stimuli. Bizarre language reflects a communication disruption. It can range from echolalia (purposeless repetition of a word or phrase) and clang association (repetition of words or phrases that sound similar) to neologisms (creation and use of words whose meaning only the patient knows). Perseveration, a persistent verbal or motor response, may indicate organic brain disease. Motor changes include inactivity, excessive activity, and repetitive movements.

History and physical examination

Because the patient's behavior can make it difficult—or potentially dangerous—to obtain pertinent information, conduct the interview in a calm, safe, and well-lit room. Provide enough personal space to avoid threatening or agitating the patient. Ask him to describe his problem and circumstances that may have precipitated it. Obtain a drug history, noting especially the use of an antipsychotic, and explore his use of alcohol and other drugs, such as cocaine, indicating duration of use and amount and when it was last taken. Ask about recent illnesses or accidents.

As the patient talks, watch for cognitive, linguistic, or perceptual abnormalities such as delusions. Do thoughts and actions seem to match? Look for unusual gestures, posture, gait, tone of voice, and mannerisms. Does the patient appear to be responding to stimuli? For example, is he looking around the room?

Interview the patient's family. Which family members does he seem closest to? How does the family describe the patient's relationships, communication patterns, and role? Has a family member ever been hospitalized for psychiatric or emotional illness? Ask about the patient's compliance with his drug regimen.

Finally, evaluate the patient's environment, educational and employment history, and socioeconomic status. Are community services available? How does the patient spend his leisure time? Does he have friends? Has he ever had a close emotional relationship?

Medical causes

Organic disorders.Various organic disorders, such as alcohol withdrawal syndrome, cocaine or amphetamine intoxication, cerebral hypoxia, and nutritional disorders, can produce psychotic behavior. Endocrine disorders, such as adrenal dysfunction, and severe infections, such as encephalitis, can also cause psychotic behavior. Neurologic causes include Alzheimer's disease and other dementias.

Psychiatric disorders.Psychotic behavior usually occurs with bipolar disorder, personality disorder, schizophrenia, and some pervasive developmental disorders.

Other causes

Drugs.Certain drugs can cause psychotic behavior. (See Psychotic behavior: An adverse drug effect, pages 492 and 493.)However, almost any drug can provoke psychotic behavior as a rare, severe adverse or idiosyncratic reaction.

Surgery.Postoperative delirium and depression may produce psychotic behavior.

Nursing considerations

▪ Frequently evaluate the patient's orientation to reality.

▪ Help him develop a conception of reality by calling him by his preferred name, telling him your name, describing where he is, and using clocks and calendars. (See Controlling psychotic behavior, page 493.)

▪ Encourage the patient to become involved in structured activities; however, if he's nonverbal or incoherent, be sure to spend time with him.

▪ Refer the patient for psychiatric evaluation.

▪ Administer an antipsychotic or other drugs, as needed, and prepare him for transfer to a mental health center, if necessary.

▪ Monitor the patient's eating and elimination habits.

▪ Ensure patient and health care worker safety.

Patient teaching

▪ Explain the importance of structured activities.

▪ Discuss the patient's medications and how to take them correctly.

Pictures

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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