Mental Health Disorders and Their Treatment

Psychotic and Mood Disorders

• Definition: Disorders that affect thinking, behaviors, emotions, leading to a disconnect with reality.
• Onset: Typically between mid-teens to mid-twenties, but can occur later.
• Examples:
  • Schizophrenia: A severe mental disorder characterized by delusions, hallucinations, and disorganized thinking.
  • Delusional Disorder: Involves persistent false beliefs (delusions).
  • Schizoaffective Disorder: Symptoms of schizophrenia combined with mood disorder symptoms (depression or bipolar).

Symptoms of Psychotic Disorders

• Positive Symptoms: Manifestations of abnormal behavior.
  • Hallucinations: Seeing or hearing things that aren't present.
  • Delusions: Strongly held false beliefs.
  • Bizarre Behavior: Unusual actions that are not typical.
• Negative Symptoms: Absence of normal behavior.
  • Affect: Blunted or flat emotional expression (emotional response does not match the situation).
  • Alogia: Poverty of speech; difficulty in verbal output.
  • Anhedonia: Lack of pleasure or interest in activities normally enjoyed.
  • Avolition: Decrease in motivation to initiate and sustain activities.

Diagnosis Criteria

• Schizophrenia: A duration of at least six months of psychotic symptoms.
• Delusional Disorder: At least one month of delusions without the full-blown symptoms of schizophrenia.
• Schizoaffective Disorder: Symptoms meet both schizophrenia and mood disorder criteria.

Personality Disorders

• Definition: Persistent and inflexible patterns of behavior affecting identity and interpersonal relationships.
• Clusters:
  • Cluster A (Odd/Eccentric): Examples include paranoid, schizoid, schizotypal disorders.
  • Cluster B (Dramatic/Eccentric): Examples include antisocial, borderline, narcissistic disorders.
  • Cluster C (Anxiety/Fearful): Examples include avoidant, dependent, obsessive-compulsive disorders.

Treatment and Nursing Care

• Goals: Suppress symptoms, prevent episodes, ensure safety, and support clients through therapy and medication.
• Types of Therapy:
  • Cognitive Behavioral Therapy: Aims to change negative thought patterns.
  • Electroconvulsive Therapy (ECT): A treatment for severe depression and other illnesses.
  • Assertive Community Treatment: Provides intensive support in community settings.
• Common Medications:
  • Antidepressants: e.g., Paroxetine.
  • Mood Stabilizers: e.g., Lorazepam.
  • Antipsychotics: Divided into first-generation (e.g., Haloperidol) and second/third-generation (e.g., Olanzapine).

Side Effects of Antipsychotics

• Acute Dystonia: Severe muscle spasms, often involving the face and neck.
• Akathisia: Restlessness and inability to sit still.
• Tardive Dyskinesia: Involuntary movements, particularly of the face and tongue.
• Metabolic Syndrome: Cluster of conditions that may increase the risk of heart disease, stroke, and diabetes, often linked to weight gain and changes in glucose metabolism.

Somatic Disorders

• Definition: Psychological distress manifesting as physical symptoms without a medical explanation.
• Types:
  • Somatic Symptom Disorder: Excessive focus on physical symptoms.
  • Illness Anxiety Disorder: Misinterpretation of symptoms, such as fear of having a serious illness.
  • Factitious Disorder: Falsifying symptoms or self-harm to assume a sick role.

Nursing Considerations

• Therapeutic Communication: Avoid arguing and ask open-ended questions about hallucinations.
• Patient Education: Educate on treatment options, manage discharge needs, and reduce stigma in mental health care.
• Assessment Tools: Use the DSM-5 for diagnosing mental disorders, focusing on history and current symptoms.
• Treatment Planning: Assist clients with practical needs and integrate care to improve their quality of life.

Important Concepts for Exams

• Differentiate between positive and negative symptoms of schizophrenia.
• Be familiar with the characteristics of different personality disorder clusters.
• Understand common medications and their side effects in treating psychiatric conditions.
• Recognize the contribution of somatic disorders to patient anxiety and how to address them therapeutically.