Schizoaffective, Delusional and Other Psychotic Disorders

1. Schizoaffective, Delusional and Other Psychotic Disorders Chapter 17

2. Schizoaffective Disorder • First recognized by Kasanin – 1933 • Varying degrees of both schizophrenia and mood disorders • 1987: First recognized in DSM-III-R • Uninterrupted period of illness during which there is a major depressive, manic or mixedepisode

3. Review of Terms • Psychosis • Positive symptoms • Hallucinations, delusions, disorganized thoughts • Schizoaffective disorder • Intense periods of symptoms and then remission • Symptoms of schizophrenia and mood disorder

4. Schizoaffective Disorder • Difficulty in conceptualization • Risk for suicide (attempts in 23 to 42%) • Less common than schizophrenia • Rare in children • More common in women, but developed later

5. Biologic Theories of Causation • Neuropathologic changes • Genetic predisposition • Overactivity of dopamine pathways • Season of birth (excess first quarter of year) • More OB complications in winter and late spring

6. Nursing Management: Biologic Domain • Assessment • Careful history • Thorough review of systems and medication use • Nursing Diagnosis • Disturbed thought process • Disturbed sleep patterns • Disturbed sensory perception

7. Nursing Management:Biologic Domain - Interventions • Patient education • Sleep patterns • Nutrition • Self-care activities • Pharmacologic intervention • Antipsychotic for psychosis • Mood stabilizers or antidepressants

8. Medication Issues • Compliance or adherence – monitoring important • Side effects – similar to schizophrenia • Drug interactions • Valporic acid • Lithium and antipsychotic medication should be given cautiously. • Patient teaching • Orthostatic hypotension • Body temperature (NMS) • No OTC without checking

9. Nursing Management: Psychological Domain • Assessment • Determine insight into illness. • Evaluate stresses and anxiety. • Mental status • Reality contact • Nursing diagnosis • Hopelessness • Powerlessness • Ineffective coping • Low self-esteem

10. Nursing Management:Psychological Domain - Interventions • Problem-solving skills • Coping skill support • Psychoeducation • Decrease symptoms. • Recognize early regression. • Develop psychosocial skills.

11. Nursing Management: Social Domain • Assessment • Premorbid adjustment (level of functioning related) • Social skills deficit • Interpersonal conflicts • Childhood experiences (rejection) related to mood (anger) • Nursing diagnosis • Compromised family coping • Impaired home maintenance • Social isolation

12. Nursing Management:Social Domain - Interventions • Provide social skills training. • Focus education on conflict resolution. • Help families deal with emotional overreaction. • Encourage use of family systems. • Identify resources.

13. Continuum of Care • Inpatient • During psychotic or suicidal episodes • Calm, reassuring approaches • Reduce environmental stimulation • Emergency care • May become aggressive, agitation • Treated with benzodiazepines (usually) • Family intervention • Support family, especially during home visit • Community treatment • Ongoing, continuous • Stepdown care useful

14. Delusional Disorder • Stable, well systemized and logical, nonbizarre delusions that occur in the absence of other psychiatric disorders • Delusions: fixed false beliefs • Non-bizarre delusions: plausible, but still fixed false beliefs • Types • Erotomania • Grandiose • Jealous • Somatic • Unspecified (persecutory)

15. Nursing Management • Assessment: Usually normal except for delusion and functioning related to delusion • Interventions: Medications as ordered, supportive relationship, support social relationships • Outcomes: • Decreased somatic complaints (if somatic delusions) • Increased reality orientation • Increased social function

16. Other Psychotic Disorders • Schizophreniform: Like schizophrenia but less than six months • Brief psychotic disorders • Shared psychotic disorder • Psychotic disorders due to substances