Psychology Chapter on Schizophrenia and Nursing

Somatoform Disorders and the Nursing Approach

• Somatic Symptom Disorders (SSD) are characterized by persistent worry and distress over physical symptoms.
• Distress may or may not be associated with a confirmed medical condition.
• Thoughts, feelings, and behaviors related to the symptoms are excessive.
• Hypochondriasis is similar to SSD, focusing on the fear or worry of illness rather than physical symptoms.
• SSD significantly burdens the healthcare system due to frequent doctor visits, unnecessary tests, and potential misdiagnoses.

Types of SSD

• Conversion Disorder (Conversion Reaction): Known as a loss or altered change in physical functioning. Manifestations include paralysis, blindness, or difficulty speaking.
• Factitious Disorder: Intentionally faking or exaggerating physical or psychological symptoms to assume the sick role, not for external rewards.

Concepts of Primary and Secondary Gain

• A patient might be deployed to a dangerous combat zone, developing paralysis in their legs to avoid deployment. This is primary gain, while the secondary gain might include extra care and support from family and medical personnel.

Illness Anxiety Disorder

• Intense fear of having or developing a serious illness, despite little or no evidence. This can be similar to hypochondriasis.

Characteristics of SSD

• One or more distressing physical symptoms (e.g., pain, fatigue).
• Excessive thoughts, feelings, or behaviors about the symptoms.
• Symptoms are persistent (lasting at least 6 months).

Factors Influencing SSD

• Biological factors (increased sensitivity to pain, genetics).
• Psychological factors (personality traits, cognitive distortions).
• Previous trauma.
• Co-existing mental health disorders.
• Social and cultural factors (cultural beliefs, family influence, support system, and gender differences).

Treatments for SSD

• Psychotherapy (often psychotreatment).
• Medication (antidepressants).
• Lifestyle changes.
• Support Groups.

Affection Disorders/Nursing Approach/Mood Disorders

• Depression is considered the "common cold" of psychiatric disorders due to its widespread occurrence.
• Bipolar disorder involves extreme shifts in mood, energy, and functional capacity, encompassing periods of profound depression and intense euphoria (mania).

Types of Affective Disorders (Mood Disorders)

• Major Depressive Disorder (MDD): Persistent feelings of sadness, hopelessness, and loss of interest in activities. Impairs social and occupational functioning for at least 2 weeks accompanied by no history of manic behavior.
• Bipolar I Disorder: Characterized by episodes of mania (elevated mood, energy, or irritability) and major depressive episodes. During a manic episode, hallucinations and delusions may occur.
• Bipolar II Disorder: Includes hypomanic episodes and major depressive episodes. This disorder never includes full-blown mania.
• Cyclothymia: Chronic, fluctuating mood swings between hypomania and mild depression.

Persistent Depressive Disorder (Dysthymia)

• Chronic low-level depression lasting at least 2 years in adults and 1 year in children/adolescents. It's characterized by feelings of sadness or hopelessness.

Challenges in Diagnosis and Assessment

• Subjectivity of symptoms
• Comorbidity (co-occurring disorders)
• Developmental variations
• Cultural factors

Suicide Risk Assessment and Management

• Direct assessment: Asking the patient directly about thoughts of self-harm.
• Assessing for plans and means.

Schizophrenia and Psychotic Disorders

• Characterized by disorganized thoughts, delusions, hallucinations, and problems with concentration and memory.
• Neologisms (making up new words), concrete thinking (literal interpretations), and disorganized thinking are hallmarks
• Positive Symptoms: reflect alterations or distortions in normal functioning, such as hallucinations, delusions, or disorganized speech.
• Negative Symptoms: reflect diminished or absent normal functioning, such as social withdrawal, flat affect, or apathy

Schizoaffective Disorder

• A combination of psychotic symptoms (delusions, hallucinations) and significant mood disturbance (depression, mania).
• Psychotic symptoms and mood disturbances co-exist for at least 2 weeks.

Brief Psychotic Disorder

• Occurs suddenly and lasts for less than a month. Characterized by psychotic symptoms that may follow a stressful event. Symptoms include hallucinations, delusions, and disorganized thoughts.

Substance-Medication-Induced Psychotic Disorder

• Psychotic symptoms directly attributable to substance use or medication side effects.

Causes/Risk Factors of Psychotic/Mood Disorders

• Genetic predisposition.
• Brain structure changes.
• Environmental factors.
• Chemical imbalances.
• Social isolation and trauma.

Eating Disorders

• Characterized by abnormal eating habits that significantly affect physical and mental health.

• Anorexia Nervosa: Extreme fear of gaining weight, distorted body image, and severe food restriction that leads to significantly low body weight.

• Bulimia Nervosa: Recurrent episodes of binge eating followed by purging behaviors like vomiting or compensatory behaviors such as excessive exercise, to prevent weight gain

• Binge Eating Disorder: Eating large amounts of food rapidly and compulsively, without compensatory behavior, resulting in a feeling of guilt and distress.

Other Specified Feeding or Eating Disorder (OSFED)

• A range of eating disorders that do not meet the full criteria for anorexia nervosa, bulimia nervosa, or binge-eating disorder.

Avoidant/Restrictive Food Intake Disorder (ARFID)

• A disorder in which there is a lack of interest in food. Avoiding or restricting food intake due to sensory characteristics, or fear of consequences.

Sexual Dysfunctions

• Characterized by problems with sexual desire, arousal, orgasm, or pain during sex.
• Sexual Arousal Disorders involve erectile or female sexual interest/ arousal disorders.
• Orgasmic Disorders include premature ejaculation and female orgasmic disorder (anorgasmia).
• Paraphilic Disorders involve sexual arousal from non-normative or unusual objects, situations, or individuals such as exhibitionism, fetishism, pedophilia, and voyeurism.
• Sexual Pain Disorders involve pain during sexual intercourse, including vaginismus and dyspareunia.
• Gender Dysphoria is characterized by discomfort with one's biological sex and an incongruence between expressed and biological sex, often leading to a desire to change sex.

Forensic Nursing

• Involves the application of nursing knowledge and skills within the legal and criminal justice systems and with individuals experiencing mental health and legal issues.
• Forensic Nurses can work in hospitals, prisons, law enforcement and legal settings.
• Includes assessing criminal suspects and victims, providing expert testimony, and handling legal issues.

Community/Family Mental Health

• Community-based interventions, like community mental health programs, partnerships, and outreach.
• Strategies for family support, including family-centered care strategies, support systems, and interventions.