Unit 7: Schizophrenia Spectrum and Other Psychotic Disorders
Unit 7: Schizophrenia Spectrum and Other Psychotic Disorders
Unit 7: Schizophrenia Spectrum and Other Psychotic Disorders
Disorders
▪ The intensity of psychosis tends to diminish with age. Many clients with longterm impairment regain
some degree of social and occupational functioning.
▪ Over time, the disease becomes less disruptive to the person’s life and easier to manage but rarely can
the client overcome the effects of many years of dysfunction. In later life, these clients may live
independently or in a structured family-type setting and may succeed at jobs with stable expectations
and a supportive work environment. However, many clients with schizophrenia have difficulty
functioning in the community, and few lead fully independent lives.
▪ Schizoaffective disorder was described earlier. Other disorders are related
to but distinguished from schizophrenia in terms of presenting symptoms
and the duration or magnitude of impairment. Mojtabai et al. (2017)
identify:
1. Schizophreniform disorder: The client exhibits an acute, reactive psychosis for
less than the 6 months necessary to meet the diagnostic criteria for schizophrenia.
If symptoms persist over 6 months, the diagnosis is changed to schizophrenia.
Social or occupational functioning may or may not be impaired.
2. Catatonia: is characterized by marked psychomotor disturbance, either
excessive motor activity or virtual immobility and motionlessness.
• Motor immobility may include catalepsy (waxy flexibility) or stupor. Excessive
motor activity is apparently purposeless and not influenced by external stimuli.
• Other behaviors include extreme negativism, mutism, peculiar movements,
echolalia, or echopraxia.
• Catatonia can occur with schizophrenia, mood disorders, or other psychotic
disorders.
3. Delusional disorder: The client has one or more non bizarre delusions— that is,
the focus of the delusion is believable. The delusion may be persecutory,
erotomanic, grandiose, jealous, or somatic in content. Psychosocial functioning is
not markedly impaired, and behavior is not obviously odd or bizarre.
4. Brief psychotic disorder: The client experiences the sudden onset of at least
one psychotic symptom, such as delusions, hallucinations, or disorganized speech
or behavior, which lasts from 1 day to 1 month. The episode may or may not have
an identifiable stressor or may follow childbirth.
5. Shared psychotic disorder (folie à deux): Two people share a similar delusion.
The person with this diagnosis develops this delusion in the context of a close
relationship with someone who has psychotic delusions, most commonly siblings,
parent and child, or husband and wife. The more submissive or suggestible person
may rapidly improve if separated from the dominant person.
6. Schizotypal personality disorder: This involves odd, eccentric behaviors,
including transient psychotic symptoms. Approximately 20% of persons with this
personality disorder will eventually be diagnosed with schizophrenia.
➢Genetic Factors
▪ Identical twins have a 50% risk of schizophrenia; that is, if one twin
has schizophrenia, the other has a 50% chance of developing it as
well.
▪ Fraternal twins have only a 15% risk.
▪ Other important studies have shown that children with one biologic
parent with schizophrenia have a 15% risk
▪ the risk rises to 35% if both biologic parents have schizophrenia.
➢ Neuroanatomic and Neurochemical Factors
▪ Findings have demonstrated that people with schizophrenia have relatively less brain tissue and
cerebrospinal fluid than those who do not have schizophrenia; this could represent a failure in the
development or a subsequent loss of tissue.
▪ Computed tomography scans have shown enlarged ventricles in the brain and cortical atrophy.
▪ Positron emission tomography studies suggest that glucose metabolism and oxygen are diminished in
the frontal cortical structures of the brain. The research consistently shows decreased brain volume and
abnormal brain function in the frontal and temporal areas of persons with schizophrenia.
▪ Intrauterine influences, such as poor nutrition, tobacco, alcohol, and other drugs, and stress are also
being studied as possible causes of the brain pathology found in people with schizophrenia.
▪ Currently, the most prominent neurochemical theories involve dopamine and serotonin. One prominent
theory suggests excess dopamine as a cause.
▪ Some believe that excess serotonin itself contributes to the development of schizophrenia.
▪ Newer atypical antipsychotics, such as clozapine (Clozaril), are both dopamine and serotonin
antagonists.
➢Immunovirologic Factors
▪ Popular theories have emerged, stating that exposure to a virus or the
body’s immune response to a virus could alter the brain physiology of
people with schizophrenia.
▪ It is believed that cytokines may have a role in the development of
major psychiatric disorders such as schizophrenia
▪ Recently, researchers have been focusing on infections in pregnant
women as a possible origin for schizophrenia.
Psychiatric Treatment Of Schizophrenia
A comprehensive, multidisciplinary treatment plan including:
• Pharmacotherapy
• Social support
• Social/life skill straining
• Self-help groups
• Family therapy can be helpful to maintain the patient effectively.
• Gaining life skills to deal with every day challenges, occupational training, and
family education have been help ful.
• Intensive individual psychotherapy is generally not as effective, but reality based
therapy to promote trust can be incorporated in to the plan.
• Ongoing support can promote compliance with antipsychotic medications.
Management of antipsychotic medications is generally the primary treatment.
▪ Atypical antipsychotic drugs treat both the positive and
negative symptoms and generally have fewer side effects.
▪ Most of these agents are available only in oral form.
▪ A few are available as along- acting injection that is given
every few weeks. These include haloperidol ,fluphenazine
,and risperidone.
▪ Some medications come in liquid forms or quick dissolving
tablets, which can also be use full if the patient is not
cooperative with taking oral medication.
•The atypical are generally less associated with extrapyramidal
symptoms than the typical agents ,but there is a wide range of other side
effects, so close monitoring of the prescribed drug is essential.
•Some atypical are disposed to anticholinergic effects.
•Serious side effects in specific atypical can include: reduced seizure
threshold, blood dyscrasias, and cardiac arrhythmias.
•One of the most serious is agranulocytosis, which is a rare blood
complication of clozapine requiring close monitoring of the white
blood cell count.
• Extrapyramidal symptoms can be devastating to quality of life. Close
monitoring to treat these and prevent long-term consequences must be part of
the treatment plan.
Extrapyramidal Side Effects can be include:
1. Dystonia: muscle rigidity, torticollis (neck turned in awkward angle).
2. Pseudo parkinsonism or dyskinesia: stiffness, tremors, shuffling gait.
3. Akathisia: restlessness, inability to sit still.
4. Tardive dyskinesia: late on set movement disorder that includes lip
smacking, grimacing, tongue protrusion.
5. Extrapyramidal symptoms are generally managed with anticholinergic
drugs such as benztropine, biperiden, trihexyphenidyl, dopaminergic agonists
such as amantadine, or antihistamines such as diphenhydramine.
The nursing care for patients with schizophrenia not requires
compassion.
❖ Common nursing diagnoses for the schizophrenic patient include:
•Self-care deficit.
•Sensory perception disturbed.
•Social isolation.
•Thought processes disturbed.
•Risk for violence.
➢ For Clients with Schizophrenia
❑ Promoting safety of client and others and right to privacy
and dignity.
❑ Establishing therapeutic relationship by establishing trust.
❑ Using therapeutic communication (clarifying feelings and
statements when speech and thoughts are disorganized or
confused).
❑ Interventions for delusions:
1. Do not openly confront the delusion or argue
with the client.
2. Establish and maintain reality for the client.
3. Use distracting techniques.
4. Teach the client positive self-talk, positive
thinking, and to ignore delusional beliefs.
❑ Interventions for hallucinations:
1. Help present and maintain reality by frequent contact and
communication with client.
2. Elicit description of hallucination to protect the client and
others.
3. The nurse’s understanding of the hallucination helps him or
her know how to calm or reassure the client.
4. Engage client in reality-based activities, such as card
playing, occupational therapy, or listening to music.
❑ Coping with socially inappropriate behaviors:
1. Redirect the client away from problem situations.
2. Deal with inappropriate behaviors in a nonjudgmental and matter of fact
manner; give factual statements; and do not scold the client.
3. Reassure others that the client’s inappropriate behaviors or comments are
not his or her fault (without violating client confidentiality).
4. Try to reintegrate the client into the treatment milieu as soon as possible.
5. Do not make the client feel punished or shunned for inappropriate
behaviors.
6. Teach social skills through education, role modeling, and practice.
7. Client and family teaching.
8. Establishing community support systems and care.