Chapter 22  Schizophrenia and Schizophrenic-like Disorders

1. Chapter 22Schizophrenia and Schizophrenic-like Disorders

2. The burden of psychiatric conditions has been heavily underestimated. Disability caused by active psychosis in schizophrenia produces disability equal to quadriplegia. National Institute of Mental Health, 2001

3. Learning Objectives • Compare at least three current theories contributing to the understanding of the development of schizophrenia • Articulate the classification of the five phases of schizophrenia • Differentiate the positive, negative, and disorganized symptoms of schizophrenia • Distinguish the five subtypes of schizophrenia • Understand why cultural differences should be considered when assessing clinical symptoms in clients with suspected psychotic disorders • Analyze why an antidepressant drug and an atypical antipsychotic agent may be necessary to stabilize the clinical symptoms of schizophrenia

4. Learning Objectives (cont.) • Articulate the criteria that indicate the presence of metabolic syndrome • Recognize the importance of assessing for the presence of psychogenic polydipsia • Explain the terms awareness syndrome or awakening phenomena • Discuss why a client with the diagnosis of schizophrenia may develop treatment-resistant symptoms • Compare and contrast the rationale for the use of the following interactive therapies generally effective when providing care for clients with schizophrenia: group therapy, cognitive–behavioral therapy, and personal therapy

5. Learning Objectives (cont.) • Discuss the purpose of including the client and family in multidisciplinary treatment team meetings • Comprehend the importance of continuum of care for clients with schizophrenia • Construct therapeutic nursing interventions when planning care for a client with the diagnosis of schizophrenia, paranoid type

6. Schizophrenia • Schizophrenia is considered the most common and disabling of the psychotic disorders. Although it is a psychiatric disorder, it stems from a physiological malfunctioning of the brain. • This disorder affects all races and is more prevalent in men than in women.

7. Onset of Schizophrenia • The onset of schizophrenia may occur late in adolescence or early in adulthood, usually before the age of 30. Although the disorder has been diagnosed in children, approximately 75% of persons diagnosed as having schizophrenia develop the clinical symptoms between the ages of 16 and 25.

8. Genetic predisposition theory Biochemical and neurostructural theory Organic or psychophysiologic theory Environmental or cultural theory Developmental theory Psychological or experiential theory Vitamin deficiency theory Etiology of Schizophrenia

9. Dopamine Receptors (The Dopamine Hypothesis)

10. Clinical Symptoms and Diagnostic Characteristics • Positive symptoms • Overt psychotic or distorted behavior • Hallucinations • Delusions • Suspiciousness • Negative symptoms • Diminution or loss of normal functions • Flat or blunted affect • Poor motivation • Inability to enjoy activities • Disorganized symptoms • Confused thinking • Incoherent or disorganized speech • Disorganized behavior

11. Clinical Symptoms and Diagnostic Characteristics (cont.) • Paranoid type • Catatonic type • Disorganized type • Undifferentiated type • Residual type

12. Schizophrenic-Like Disorders • Schizoaffective disorder • Schizophreniform disorder • Brief psychotic disorder • Psychotic disorder due to a general medical condition

13. The Nursing Process • Assessment • Nursing diagnoses • Outcome identification • Planning interventions • Implementation • Evaluation

14. Assessment • Presence or absence of clinical symptoms • History and physical examination • Transcultural considerations

15. Nursing Diagnoses • Disturbed thought processes • Disturbed sensory perception • Self-care deficit • Impaired verbal communication • Noncompliance • Disturbed sleep pattern • Social isolation • Ineffective coping

16. Outcome Identification Outcomes are influenced by several factors: • The client’s present coping strategies and level of cognitive function • The presence or absence of support systems • The presence or absence of adequate income • The clinical setting in which each treatment occurs

17. Planning Interventions Interventions planned may include the following: • Medical interventions • Diagnostic studies • Medication • Cognitive therapy • Behavioral techniques • Other supportive therapies • Electroconvulsive therapy

18. Implementation • Assistance in meeting basic needs • Medication management • Interactive therapies • Psychosocial therapies • Client and family education

19. Evaluation • Compare the client’s current mental status with stated desirable outcomes identified. • If the outcomes have not been met, consider the reasons why.

20. Affective disturbance Ambivalence Autistic thinking Awakening phenomena Awareness syndrome Dementia praecox Disorganized symptoms Dopamine hypothesis Double-bind situation Echolalia Echopraxia Looseness of association Negative symptoms Pica Positive symptoms Psychogenic polydipsia Schizophrenia Key Terms

21. ? Reflection • Reread the chapter-opening quote. • In what manner does active psychosis in schizophrenia produce disability equal to quadriplegia? Cite two or three examples to substantiate your explanation. • How would these examples of disability affect the family of a client with schizophrenia? Identify what support systems the family and the client could use.