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CHAPTER 15 ■ Schizophrenia Spectrum and Other Psychotic Disorders
Introduction The term schizophrenia was coined in 1908 by the Swiss psychiatrist Eugen Bleuler. The word was derived from the Greek “skhizo” (split) and “phren” (mind). Over the years, much debate has surrounded the concept of schizophrenia. Various definitions of the disorder have evolved, and numerous treatment strategies have been proposed, but none has proven to be uniformly effective or sufficient. Evidence suggests that schizophrenia is probably not a homogeneous disease entity. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision; (DSM-5-TR; American Psychiatric Associa- tion [APA], 2022) supports this concept by describing schizophrenia as one of the schizophrenia spectrum disorders. Although current consensus points to schizophrenia as a neurodevelopmental disorder (Álvarez et al., 2015), schizophrenia spectrum disor- ders may have several etiological influences includ- ing genetic predisposition, biochemical dysfunction, physiological factors, and psychosocial stress. Tripa- thi and colleagues (2018) believe that the neurode- velopmental hypothesis falls short in explaining the magnitude of brain changes that occur in schizo- phrenia. They suggest that these changes can better be explained as “the cumulative effect of neurode- velopmental abnormality, change in neuroplasticity, and alteration in neuronal maturation” (p. 8). Although research is ongoing, there may never be a single treatment that cures the disorder. Effec- tive treatment requires a comprehensive, multidis- ciplinary effort, including pharmacotherapy and various forms of psychosocial care, such as housing, living skills, social skills training (training in verbal and nonverbal skills needed for effective interper- sonal relationships), rehabilitation and recovery, and family therapy. Emerging evidence indicates that early intervention and a comprehensive, patient-cen- tered approach offer hope for a recovery process and improved quality of life for this population. Of all the mental illnesses that cause suffering in society, schizophrenia is likely responsible for longer hospitalizations, greater chaos in family life, more exorbitant costs to individuals and governments, and more fear than any other. Studies have shown that people with a serious mental illness (SMI) like schizophrenia have, on average, a 25-year shorter life span than the general population (Chesney et al., 2014; Druss et al., 2011; Roberts et al., 2017). SMI is defined as a mental, behavioral, or emotional dis- order resulting in serious functional impairment,
which substantially interferes with or limits one or more major life activities. Because schizophrenia is such an enormous threat to life and happiness and because its causes are an unsolved puzzle, it has probably been studied more than any other mental disorder. Risk for suicide is a significant concern among patients with schizophrenia. About 20% to 40% of people with schizophrenia attempt suicide, and current evidence suggests that about 5% die by sui- cide (Lewis et al., 2017). This chapter explores var- ious theories of predisposing factors that have been implicated in the development of schizophrenia. Symptomatology associated with different diagnos- tic categories of the disorder is discussed. Nursing care is presented in the context of the six steps of the nursing process. Various dimensions of medical treatment are explored. Nature of the Disorder Psychosis is a severe mental condition in which there is disorganization of the personality, deterioration in social functioning, and loss of contact with or distortion of reality. There may be evidence of hallucinations (false sensory perceptions not associated with real external stimuli) and delusions (fixed, false beliefs). Psychosis can occur with or without the presence of organic impairment. Schizophrenia is a disabling mental disorder. In untreated clients or those not responsive to treat- ment, the disturbances in thought processes, percep- tion, affect, and behavior invariably result in a severe deterioration of social and occupational functioning. The lifetime prevalence of schizophrenia is about 0.7% in the general population. Symptoms generally appear in late adolescence or early adulthood, although they may occur in middle or late adult life. Early-on- set schizophrenia refers to symptoms that begin in childhood and adolescence before age 18 years. This condition, although rare, is recognized as a progres- sive neurodevelopmental disorder with a chronic and severely symptomatic course. Some studies have indi- cated that schizophrenia occurs more often and earlier in men than in women (B. Miller, 2020). Phases of Schizophrenia CORE CONCEPT Psychosis The pattern of development of schizophrenia may be viewed in four phases: premorbid, prodromal,
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