1. Schizoaffective, Delusional and Other Psychotic Disorders Chapter 17

2. 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

3. 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

5. 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

7. Nursing Management: Biologic Domain - Interventions Patient education –Sleep patterns –Nutrition –Self-care activities Pharmacologic intervention –Antipsychotic for psychosis –Mood stabilizers or antidepressants

8. 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

10. Nursing Management: Psychological Domain - Interventions Problem-solving skills Coping skill support Psychoeducation –Decrease symptoms. –Recognize early regression. –Develop psychosocial skills.

11. 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

12. Nursing Management: Social Domain - Interventions Provide social skills training. Focus education on conflict resolution. Help families deal with emotional overreaction. Encourage use of family systems. Identify resources.

13. 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

14. 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)

15. 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

16. Other Psychotic Disorders Schizophreniform: Like schizophrenia but less than six months Brief psychotic disorders Shared psychotic disorder Psychotic disorders due to substances