Schizoaffective, Delusional and Other Psychotic Disorders

1
Schizoaffective, Delusional and Other Psychotic
Disorders

• Chapter 17

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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 mixed
  episode

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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

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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

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Nursing ManagementBiologic Domain -
Interventions

• Patient education
• Sleep patterns
• Nutrition
• Self-care activities
• Pharmacologic intervention
• Antipsychotic for psychosis
• Mood stabilizers or antidepressants

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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

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Nursing ManagementPsychological Domain -
Interventions

• Problem-solving skills
• Coping skill support
• Psychoeducation
• Decrease symptoms.
• Recognize early regression.
• Develop psychosocial skills.

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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

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Nursing ManagementSocial Domain - Interventions

• Provide social skills training.
• Focus education on conflict resolution.
• Help families deal with emotional overreaction.
• Encourage use of family systems.
• Identify resources.

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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

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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)

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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

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Other Psychotic Disorders

• Schizophreniform Like schizophrenia but less
  than six months
• Brief psychotic disorders
• Shared psychotic disorder
• Psychotic disorders due to substances