Thought Disorders – Psychiatry | Lecturio


[Music] now let’s talk a little bit more about the thought disorders there are different types of thought disorders we think about disordered thought content this looks like disruption in a patient’s beliefs ideas and interpretations of their surroundings disordered thought process is a manner in which the patient links ideas and words together let’s consider a couple of the common types of thought disorder what do you think it means when we say a patient has a loggia or poverty of content well this is where very little information is conveyed by speech how about thought blocking in clinical practice this is when a patient suddenly loses their train of thought it’s exhibited by an interruption in their speech and then they have trouble picking right back up again loosening of associations describes a speech content notable for ideas presented in sequence that are not closely related so it’s where somebody jumps all over the place tangential thought process is another type of disorganized thought so this is where answers to interview questions diverge increasingly from topic to topic being asked about some call this circumstance reality if the content is eventually returned to the original topic when somebody’s tangential they basically go off course and can never return to the point clanging or clang associations is another type of thought disorder so this is where words are used in a sentence that are linked together by rhyming or due to phonetics here’s an example of what a patient might say I fell down the well Sal bell so things rhyme but they don’t really make any sense used together a word salad is another important type of thought disorder and this is where real words are linked to there but incoherently so it’s nonsensical an example would be a patient saying treeway of nothing house it makes no sense a perseveration is repeating words or ideas persistently often even after the interview topic has changed so it’s where somebody really can’t let go of a point and they just keep bringing it up over and over again I want to give you this case 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 years due to an inability to get to class because he has low motivation so his parents come out to college to visit him and he find his dorm room a complete mess their son mr. B is malodorous and he has not been taking care of his hygiene he talks nonsense when his parents ask him what’s wrong the only thing they can decipher is their son saying my professor wants to kill me so you meet mr. B in the emergency room and you start evaluating him if this is all you know at this point what’s your differential diagnosis of course it’s broad so you’re going to consider all of these things alright so you’re going to consider general medical conditions now I can’t overemphasize this point enough when ever considering a psychiatric disorder you must always consider medical conditions first they’re easy to treat and more likely to be reversible also think about whether or not this disorder and whether or not the symptoms are actually substance related something else that can be quickly treated and possibly reversed beyond that you’re gonna think of some psychiatric disorders like a brief psychotic disorder schizophrenia form disorder schizoaffective schizophrenia schizotypal personality disorder a mood disorder with psychotic features and you may think of a schizoid personality disorder so when you consider that case of mr. B you’ve got a broad differential diagnosis now and at the top of your list of course is a general medical problem so when it comes to psychosis what types of general medical problems are important to rule out in treating your patient it’s a long list so let’s go through it delirium you’re gonna think of this of course delirium is a frequent cause of psychotic symptoms okay and this could be due to fluid or electrolyte abnormalities also substance intoxication our withdrawal hypoglycemia hypercapnia hypoxia or infections or from other medications these are all possible causes of a delirious patient that could look psychotic you’re also gonna think of endocrine problems things like thyroid disease parathyroid or adrenal disease and then the liver can be disrupted and also present as psychotic symptoms so think about hepatic encephalopathy and uremic encephalopathy other medical causes you’re gonna want to rule out are infectious diseases things like syphilis herpes Lyme disease prion disorder and HIV or AIDS inflammatory disorders like lupus anti-nmda receptor encephalitis leukodystrophies multiple sclerosis and you’re gonna think of metabolic disorders like porphyria or Wilson’s disease other things to rule out are neurodegenerative diseases things like Lewy body dementia Huntington’s disease Parkinson’s and Alzheimer’s neuro other neurological conditions and Q includes space-occupying lesion z’ like a tumor seizure disorder or stroke and any kind of a head injury or trauma to the brain finally you want to rule out that there’s a vitamin deficiency especially b12 now because there’s a long list we have here a summary an acronym that you may find useful in thinking about what categories and groups of medical conditions present as a psychotic disorder at the end of this lecture now I hope that you appreciate how important it is to formulate a differential diagnosis for the psychotic patient especially including general medical conditions and a substance abuse problem and to rule out anything that could be easily treatable and reversible before formulating a psychiatric diagnosis [Music] you

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