Schizophrenia Spectrum Disorder Overview

Schizophrenia Spectrum Disorder

• Schizophrenia Spectrum Disorders and Psychosis
  • Range of disorders with psychotic symptoms
  • Schizophrenia: includes symptoms such as depression
  • Schizoaffective disorder: more symptoms associated with depression
  • Schizophreniform disorder: brief psychotic disorder
  • Delusional disorder
  • Shared psychotic disorder
  • Substance-induced psychotic disorder
  • Late-onset schizophrenia
• No cure, but treatment focuses on symptom management and maintaining/improving daily functioning
• Nursing Responsibilities
  • Liaison for clients and other interprofessional teams and community organizations
  • Initiate referrals to primary care or specialized mental health services
  • Recognize psychosis as a hallmark symptom of a psychotic-related disorder, which is a disconnect from reality due to disturbances in a client's thoughts and perceptions. Includes hallucinations and delusions.
  • Understand emotional changes, withdrawal, and lack of self-care as possible symptoms.
  • Eliminate other potential medical causes of symptoms
• Diagnosis
  • Gradual onset
  • Family history
• Treatment (Tx)
  • Antipsychotic medications (side effects can be problematic)
  • Psychotherapy (cognitive behavioral therapy)
  • Support and education for the client and family
  • DSM-5-TR Criteria for Schizophrenia diagnosis, typically diagnosed between 16 and 30 years old.
  • More common in males
  • Stigma impacts access to care.
  • Clients benefit from treatment and support
  • 14 times more likely to be victims of crime/violence than the general population
  • Often co-occurs with other mental health disorders (50%)
• Risk Factors and Etiology
  • Genetics

Clinical Manifestations

• Positive symptoms (added symptoms) include hallucinations and delusions & disorganized speech

• Negative symptoms (symptoms that are diminished or lost) include Alogia (reduced speech), Anergia (lack of energy), Anhedonia (inability to experience pleasure).

• Cognitive symptoms: poor concentration, slowed thinking, and poor memory

Nurse's Role

• Create & maintain a safe therapeutic relationship
• Ensure a safe therapeutic environment
• Advocate and support early detection of psychosis
• Ensure thorough assessment (including mental status examination)
• Provide interventions to stabilize the client
• Support the client in recovery, self management, & engagement

Phases of a Therapeutic Relationship

• Orientation: client may not recognize the need for assistance and block alliance
• Identification: may have difficulty self reporting symptoms, may believe nothing is wrong with them, challenges with communication & daily functioning
• Explore and prioritize safety, interventions, medications and cognitive therapies

Interventions (recognize triggers, progression toward recovery, resolution, treatment)

• Assess if clients are taking prescribed meds and if they're being truthful
• Recognize medical and psychological symptoms including extrapyramidal symptoms(EPS), acute dystonia, akathisia, pseudoparkinsonism, and tardive dyskinesia,
• Establish a therapeutic milieu (environment that promotes healing).
• Social problems (jail/prison, stigma, isolation, loneliness, victimization, economic challenges, unemployment, homelessness, caregiver burden).
• Nonadherence to treatment, Tx inadequacies, Anosognosia (client believes nothing is wrong with them).

This quiz covers the various types of schizophrenia spectrum disorders and their symptoms, including psychosis and depression. It highlights the nursing responsibilities in managing these conditions and understanding the impact on clients' daily functioning. Gain insights into the treatment focus and interprofessional collaboration.