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Schizophrenia and Other Psychoses

Overview of Psychosis

  • Psychosis: The inability to recognize reality, relate to others, or cope with life’s demands.
  • Most Common Type: Schizophrenia.
  • Other Psychotic Disorders include:
    • Brief psychotic disorder
    • Delusional disorder
    • Psychoses related to medical conditions or drug use.

Continuum of Neurobiological Responses

  • Neurobiological Functions: Exist along a continuum of behavioral responses.
    • Highly Adaptive: Effective responses to the environment.
    • Maladaptive: These behaviors can become destructive.
  • Individuals' Placement: Those who do not adapt well are placed at the middle of this spectrum.

Psychoses Throughout the Life Cycle

Psychoses in Childhood
  • Failure to Thrive Syndrome: Slowed physical growth due to inadequate integration of physical, emotional, and sensorimotor functioning.
    • Often related to neglect, adverse environmental conditions, and severe family stress.
  • Risk Factors for Childhood Schizophrenia include:
    • Genetic influences.
    • Complications during pregnancy or birth.
    • Biochemical imbalances.
    • Environmental factors.
Psychoses in Adolescence
  • Typical Behavior: Average teenagers maintain contact with reality, whereas adolescents with schizophrenia do not.
  • Behavioral Changes Noted:
    • Poor hygiene.
    • Strange and vague speech.
    • Social withdrawal.
    • Odd behaviors.
    • Bizarre thoughts and beliefs.
    • Unusual superstitions.
Psychoses in Adulthood
  • Onset of Symptoms: Typically occurs in men during their mid-twenties; women show symptoms in their late twenties.
  • Prognosis: More favorable when individuals had adaptive interpersonal relationships and acceptable school performance before symptom onset.
Psychoses in Older Adulthood
  • Diagnosis: Schizophrenia is rare in older adults.
  • Long-term Care: Those diagnosed may spend the remainder of their lives in long-term care facilities.
  • Investigation Required: Acute onset of psychotic behavior in any elderly client must be investigated.

Theories Related to Psychoses

Biological Theories
  • Genetic/Heredity Model: Suggests a genetic predisposition to schizophrenia.
  • Stress/Disease/Trauma Model: Focuses on the effects of stress on individuals, particularly during prenatal periods.
  • Neurochemical Models: Indicates neurotransmitters like serotonin, norepinephrine, and dopamine as possible causes of schizophrenia.
Other Theoretical Perspectives
  • Psychological Models: Posit that schizophrenia results from basic character flaws paired with poor family relationships.
  • Sociocultural Theories: Suggest that environmental effects can lead to the development of psychoses.

Psychotic Disorders

Schizophrenia
  • Subtypes:
    • Catatonic.
    • Disorganized.
    • Paranoid.
    • Residual.
    • Undifferentiated.
  • Signs, Symptoms, and Behaviors:
    • Characterized by loss of contact with reality, leading to gross impairment in functioning.
    • Affects various domains: perception, physical appearance, cognitive processes, language, speech, emotions, behavior, and social interactions.
  • Symptom Categories:
    • Positive Symptoms: Maladaptive thoughts or behaviors.
    • Negative Symptoms: Lack of adaptive mechanisms.
Phases of Schizophrenia
  • Course: Characterized by episodes of acute psychosis interspersed with periods of relative normality.
  • Diagnostic Criteria: Symptoms must persist for at least 1 year prior to diagnosis.
  • Stages of Development:
    • Prodromal Phase.
    • Prepsychotic Phase.
    • Acute Phase.
    • Remission.
Other Psychoses
  • Brief Psychotic Disorder: Lasts more than 1 day but less than 1 month.
  • Delusional Disorder: Defined by more than 1 month of nonbizarre (reality-based) fixed ideas.
  • Shared Psychotic Disorder: Influenced by another person with an established delusion.
  • Schizoaffective Disorder: Co-occurrence of depression or mania with schizophrenia symptoms.

Therapeutic Interventions

  • Goals of Inpatient, Short-Term Care:
    • Stabilization of the client.
    • Prevention of further decline in functioning.
    • Assistance in coping with their disorder.
  • Long-Term Goals: Focus on psychosocial and vocational rehabilitation.

Pharmacologic Therapy

  • Antipsychotic or Neuroleptic:
    • Functions to slow the central nervous system (CNS).
    • Post-administration effects:
    • Decrease in hallucinations and delusions.
    • Changes in thought processes.
    • Reduction in hyperactivity.

Nursing (Therapeutic) Process

  • Primary Nursing Diagnoses:
    • Disturbed thought processes.
    • Disturbed sensory perceptions.
    • Social isolation.
    • Impaired communications.
    • Ineffective management of therapeutic regimen.
  • Basic Goals of Care: Support clients in managing symptoms and achieving optimal functioning levels.

Special Considerations

  • Common Side Effects of Antipsychotic Medications: Reflect alterations in CNS and peripheral nervous system functions including:
    • Extrapyramidal side effects (EPSEs): e.g., akathisia, akinesia, bradykinesia, dyskinesia, dystonia.
    • Sedation.
    • Anticholinergic effects.
    • Neuroleptic malignant syndrome.

Nursing Responsibilities

  • Review medication actions, side effects, and incompatibilities for each prescribed medication.
  • Monitor client response to each medication.
  • Emphasize client and family education, highlighting its impact on the client’s functionality.