1125 Unit 3 Client needs related to selected thought and cognitive alterations

SCHIZOPHRENIA SPECTRUM DISORDERS

  • Range of disorders with psychotic symptoms

  • No cure available

Characteristics

  • Disconnect from reality leading to:

    • Hallucinations- involve feeling seeing or hearing things that others do not experience.

      • Vivid, clear experiences of altered perception without external stimuli

    • Delusions

      • False beliefs such as persecution or grandeur

    • Emotional changes

    • Withdrawal from social interactions

    • Lack of self-care

Impact on Life

  • Individuals can lead productive lives with treatment and support.

  • Stigma affects access to healthcare leading to:

    • Underdiagnoses

    • Undertreatment

  • High prevalence of co-occurring mental health disorders (50%)

  • Typical age of diagnosis: 16-30 years

  • Increased risk of becoming victims of crime or violence (14X)

  • Elevated risk for premature mortality

  • 5% die by suicide. average life expectancy 28.5 years

TYPES OF DISORDERS

  • Schizophrenia - A chronic and severe mental disorder that affects how a person thinks, feels, and behaves, often leading to a detachment from reality.

  • Schizotypal Personality Disorder: Impairments in personality functioning, less severe than schizophrenia.

  • Delusional Disorder: Delusional thinking for at least 1 month; self or interpersonal functioning not markedly impaired.

  • Brief Psychotic Disorder: Psychotic manifestations lasting from 1 day to 1 month.

  • Schizophreniform Disorder: Similar symptoms to schizophrenia lasting from 1 to 6 months; social/occupational dysfunction may not be apparent.

  • Schizoaffective Disorder: Criteria for both schizophrenia and a mood disorder.

  • Substance-Induced Psychosis: Psychosis due to substance use or withdrawal.

DIAGNOSIS CRITERIA

  • Psychotic thinking or behavior present for at least 6 months.

  • Significant impairment in school/work, self-care, or interpersonal relationships.

ETIOLOGY

  • Genetics:

    • Multiple genes contribute to vulnerability

  • Physiological:

    • Neurodevelopment, hypoxia, infections

  • Biochemical:

    • Chronic cortisol exposure

  • Environmental:

    • Cannabis use

SYMPTOMS

  • Positive Symptoms:

    • Hallucinations

    • Delusions

    • Disorganized speech

    • Bizarre behavior

  • Negative Symptoms:

    • Affect blunting

    • Alogia (lack of speech)

    • Anergia (lack of energy)

    • Anhedonia (lack of pleasure)

  • Cognitive Symptoms:

    • Poor concentration

    • Slow thinking

    • Poor memory

THERAPEUTIC RELATIONSHIP PHASES

  1. Orientation

  2. Identification

  3. Exploitation

  4. Resolution

CHALLENGES IN THERAPY

  • Clients may not recognize need for help.

  • Family/friends unable to assist due to client history.

  • Manifestations of psychosis affecting communication.

INTERVENTIONS FOR SUPPORT

  • Creating a safe therapeutic relationship.

  • Advocating for early detection.

  • Complete mental status exams.

  • Focusing on stabilizing interventions & recovery.

TREATMENT APPROACHES

  • Recovery-oriented care including:

    • Medications

    • Cognitive behavioral therapy

    • Family education and support

    • Assertive community treatment

CLIENT TEACHING PRIORITIES

  • Discharge instructions on medications, diet, and exercise.

  • Signs of relapse & referrals for continued support.

MEDICATIONS

  • Antipsychotics:

    • 1st Generation: Treat positive symptoms, e.g., Haloperidol.

    • 2nd Generation: Treat both positive and negative symptoms, e.g., Risperidone, Olanzapine.

    • 3rd Generation: Improve cognitive function, e.g., Aripiprazole.

  • Adjunct Medications:

    • Antidepressants for depression linked to psychotic disorders, e.g., Paroxetine.

    • Mood Stabilizers for anxiety, e.g., Lamotrigine.

ADVERSE EFFECTS OF ANTIPSYCHOTICS

  • Akathisia, tardive dyskinesia, Parkinsonism.

  • Dystonia, impulse control disorders, sedation.

  • Orthostatic hypotension, metabolic effects, agranulocytosis.

SOCIAL AND ECONOMIC CHALLENGES

  • Social Problems:

    • Stigma and isolation

    • Increased victimization

  • Economic Challenges:

    • Unemployment and homelessness

    • Caregiver burden

NEUROCOGNITIVE DISORDERS

  • Delirium: Short-term cognitive disturbance and attention issue.

  • Dementia: Chronic cognitive decline with several variants.

  • Assessment Criteria:

    • Focus on distinguishing between delirium and dementia based on onset, cognition, and emotional state.

NURSE'S ROLE

  • Provide equitable and sensitive care based on knowledge and empathy.

  • Safety monitoring and advocacy to ensure least restrictive environment.

  • Education and support for families.

ASSESSMENT AND EVALUATION

  • Regular assessment of cognition and caregiver strain.

  • Monitor medication effectiveness and adherence.