Schizophrenia Spectrum - NURS 1028 Chapter 21

Schizophrenia Spectrum - NURS 1028 Chapter 21

• Schizophrenia is a major psychotic disorder affecting thinking, language, emotions, social behavior, and reality perception.
• Individual symptoms and experiences vary significantly between individuals and even within the same person across episodes.
• It frequently emerges during adolescence or early adulthood; symptoms can be confused with teenage anxiety or mood swings.
• Treatable when detected early, but a chronic and potentially disabling mental illness.

Risk Factors

• Rare genetic changes may contribute to the onset.
• Perinatal stressors, such as starvation, poor nutrition, infections, and obstetrical complications, can impact neurodevelopment and increase risk factors.
• Genetic and family predisposition is a considerable risk factor.
• Infants exposed to maternal stressors during pregnancy may experience low birth weight & developmental challenges.
• Poor neuroanatomy and brain changes linked with adverse circumstances can increase the risk.
• Childhood CNS infections are potential risk factors.
• Individuals born in urban settings have a higher risk than rural counterparts.

Risk Factors: Age of Onset, Gender, Ethnic and Cultural Differences, Familial Differences

• Late adolescence to early adulthood (before age 25).
• Evidence of disruption in developmental milestones (e.g., education, employment, relationships)
• Men are often diagnosed earlier (mid-20s) than women (late 20s).
• Lower incidence in Asian populations compared to non-Asian countries.
• First-degree relatives of someone with schizophrenia have a 10x greater risk compared to the general population; this risk is higher for identical twins compared to fraternal ones.

Risk Factors: Comorbidities, Substance Abuse

• Co-occurring somatic and psychological disorders frequently accompany schizophrenia (e.g., depression, diabetes, substance use disorders).
• Depression commonly experienced within various stages (acute, stabilization, recovery, relapse).
• Type 2 diabetes is a documented comorbidity; linked to weight gain from antipsychotic medications commonly used in treatment.
• Cannabis use has been associated with an increased risk of psychosis onset; research on the exact nature of the impact of cannabis on mental health is ongoing.

DSM-5 Diagnostic Criteria: Schizophrenia

• Requires two or more presenting symptoms observed for a significant amount of time over a one-month period (or less if successfully treated). At least one symptom must be: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (diminished emotional expression or avolition).
• There must be a significant decrease in functioning in one or more areas (e.g., work, relationships, self-care) compared to prior performance, or what's expected of someone of that age during adolescence or childhood).
• The symptoms must persist continuously for at least six months, including at least one month of active-phase symptoms.

Positive Symptoms

• Reflect an excess or distortion of normal functions.
• Delusions: fixed false beliefs related to misinterpreting daily experiences. Examples: hearing voices, believing others are plotting against you or thoughts are being read).
• Hallucinations: sensory experiences (see, hear, smell, etc) without external stimulation. Example: hearing voices, seeing things that aren't present.

Negative Symptoms

• Reflect a reduction/loss in normal functions.
• Affective Flattening: reduced expression of feelings/emotions.
• Avolition: decreased motivation (lack of interest/drive)
• Asocial: social withdrawal & reduced ability to maintain & form relationships.
• Apathy: reduced enthusiasm, lack of emotional response or interest.
• Alogia: reduced fluency/productivity in speaking.
• Anergia: lethargy, lack of energy.
• Anhedonia: inability to experience pleasure from activities.

Neurocognitive Impairment

• Short-term (working memory) and long-term memory issues.
• Challenges with sustained attention, verbal fluency.
• Executive functioning problems.
• Impairments can hinder educational and vocational opportunities, among other spheres of life.
• Illusion of objects is categorized separately from hallucinations (when an object exists but perceived differently and/or misidentified).

Family Response

• Initial response is often one of mixed emotions, typically including elements of shock, disbelief, fear, concern, care, hope
• Families may seek reasons for psychotic episodes, attributing problems such as substance use or extraordinary stress to the episode.
• Parents may blame themselves.
• Families may struggle with finding appropriate ways to support those affected and understanding what to expect.

Treatment

• Interdisciplinary approach is essential.
• Involving multiple professionals such as nurses, psychiatrists, psychologists, social workers, occupational therapists, and peer support workers ensures holistic approach and care.

Planning Client Outcomes

• Focuses on the acute phase and includes safety, establishing a connection with reality, interaction with others, expressing feelings in a safe manner, and involvement in therapeutic interventions.
• Long-term outcomes target participation in prescribed treatment plans (including medications), maintaining adequate routines for sleep and nutrition, achieving self-care independence, and effectively communicating with others in the community to support their needs.

Nursing Intervention (Biological Domain)

• Managing fluid balance by conducting daily weights and monitoring urine specific gravity/serum sodium levels.
• Evaluating the efficacy of antipsychotic medications over time; assessing for and taking care of any side effects related to those medications.
• Encouraging self-care activities such as scheduled grooming, dressing, bathing & other daily routine habits.
• Educating clients on the importance of medication adherence to prevent relapse.
• Monitoring & managing weight gain/loss that can occur due to antipsychotic treatments.
• Suggesting activities that help maintain a healthy lifestyle (e.g., diet, exercise) to help manage risk factors.

Nursing Intervention (Psychological Domain)

• Maintaining a consistent, calm, and caring demeanor when interacting with clients and ensuring safety and stability
• Validating the client's experiences, validating their distress and discomfort.
• Employing creative therapeutic strategies that accommodate client preferences
• Engaging clients and families in educational interventions that emphasize managing the illness
• Employing strategies to help increase trust and decrease anxiety; helping them take ownership of their care, needs and concerns.

Nursing Intervention (Social Domain)

• Creating a safe, predictable, secure environment to promote safety & prevent client harm; providing access to support systems, such as family members, support groups
• Implementing interventions to prevent relapse with tools like high risk monitoring, routines, and behavioural interventions.
• Promoting continuity of care (contact with support systems) with care coordination planning to prevent “loss” of support or access to services following discharge.