Schizoaffective delusional and other psychotic disorders
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Schizoaffective, Delusional and Other Psychotic Disorders. Chapter 17. Schizoaffective Disorder. First recognized by Kasanin – 1933 Varying degrees of both schizophrenia and mood disorders 1987: First recognized in DSM-III-R

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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 mixedepisode


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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


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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


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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 Management:Biologic 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


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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 Management:Psychological 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 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.


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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


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