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“Let s talk a little bit more nabout. The thought disorders. There are different types types nof thought disorders. We think about disordered nthought content.
This looks like disruption nin patient s beliefs ideas and interpretations nof their surroundings disordered. Thought process is a manner in which the patient nlinks ideas and words together. Let s consider a couple of the ncommon types of thought disorder. What do you think it means when we say a npatient has alogia or poverty of content.
Well. This is where very little ninformation is conveyed by speech. How about thought blocking in clinical practice. This is when a patient suddenly nloses their train of thought.
It s exhibited by an ninterruption in their speech. And then they have trouble npicking right back up again loosening of associations describes na speech content. Notable for ideas presented in sequence that nare not closely related. So it s where somebody njumps all over the place tangential.
Though process is another ntype of disorganized. Thought. So..
This is. Where answers. Nto interview. Questions diverge.
Increasingly from topic nto topic being asked about some call. This circumstantiality. If the is neventually returned to the original topic when somebody s tangential nthey basically go off course and can never return nto. The point clanging or clang association.
Is nanother type of thought disorder. So this is where words nare used in a sentence that are linked together by nrhyming or due to phonetics. Here s an example of what na patient might say i fell down the well sell bell. So things rhyme.
But they don t nreally make any sense used together a word salad is another important ntype of thought disorder. And this is where real words are nlinked together. But incoherently so it s nonsensical. An example would be a patient saying n.
Tree way of nothing house. It makes no sense. A perseveration is repeating nwords or ideas..
Persistently. Often even after the ninterview topic has changed. So it s where somebody really ncan t let go of a point. And they just keep bringing nit up over and over again.
I want to give you this ncase study to consider mr. B is a 22 year old man. He s been having trouble in college rather than graduating on time. He has had to repeat a few nyears due to an inability to get to class because nhe has low motivation.
So his parents come out nto college to visit him. And they find his dorm nroom. A complete mess their son mr b. Is malodorous.
And he has not been taking ncare of is hygiene. He talks nonsense when his nparents ask him what s wrong the only thing they can ndecipher is their son. Saying. My professor wants to kill me so you meet mr b.
In the emergence. Nroom and you start evaluating him. If..
This is all you know at this point. Nwhat s your differential diagnosis of course. It s broad. So you re going nto.
Consider all of these things all right so you re going to nconsider general medical conditions now. I can t overemphasize nthis point enough whenever considering a npsychiatric disorder. You must always consider nmedical conditions first they re easy to treat and nmore likely to be reversible also think about whether nor not this disorder and whether or not these symptoms nare actually substance related. Something else that can be quickly ntreated and possibly reversed.
Beyond that you re going to think nof some psychiatric disorders like a brief psychotic disorder nschizophreniform disorder schizoaffective schizophrenia schizotypal personality disorder a mood disorder with npsychotic features and you may think of schizoid npersonality disorder. So when you consider that case of mr b. You ve got a broad ndifferential diagnosis. Now and on the top of your list of ncourse is a general medical problem so when it comes to psychosis what types of general medical nproblems are important to rule out in treating your patients.
It s a long list. So nlet s go through it delirium you re going to think of this of course delirium is a frequent ncause of psychotic symptoms okay and this could be duet to fluid nor electrolyte abnormalities also substance nintoxication or withdrawal hypoglycemia hypercapnea. Hypoxia or ninfections or from other medications. These are all possible causes of a delirious npatient that could look psychotic.
We re also going to think nof endocrine problems things like thyroid disease nparathyroid or adrenal disease. And then the liver can be disrupted and nalso present as psychotic symptoms. So think about hepatic encephalopathy nand uremic encephalopathy..
Other medical causes you re going to nwant to rule out our infectious diseases things like syphilis herpes lyme ndisease prion disorder and hiv or aids inflammatory disorders. Like lupus anti nmda receptor encephalitis leukocytosis or leukodystrophies nmultiple sclerosis and you re going to think nof. Metabolic disorders. Like porphyria or nwilson s disease.
Other things to rule out are nneurodegenerative diseases. Things like lewy body dementia. Huntington s ndisease. Parkinson s and alzheimer s there are other neurological conditions ninclude space.
Occupying lesions like a tumor seizure disorder or stroke. And any kind of a head injury nor trauma to the brain. Finally you want to rule out. If there s na vitamin deficiency.
Especially b12. Now because there s a long nlist. We have here a summary. An acronym that you may find nuseful in thinking about what categories and groups of medical nconditions can present as a psychotic disorder at the end of this lecture nnow i hope that you appreciate how important it is to formulate na differential diagnosis for the psychotic patient especially nincluding general medical conditions and the substance abuse problem.
And to rule out anything that ncould be easily treatable. ” ..
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