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CHAPTER 15 ■ Schizophrenia Spectrum and Other Psychotic Disorders
Catatonic Disorder Due to Another Medical Condition
majority of the time. The prognosis for schizoaffec- tive disorder is generally better than that for other schizophrenic disorders but worse than that for mood disorders alone. Catatonic features also may be associated with this disorder.
This diagnosis is made when catatonic features are evidenced from medical history, physical examina- tion, or laboratory findings to be directly attribut- able to the physiological consequences of another medical condition (APA, 2022). Types of medical conditions that have been associated with catatonic disorder include metabolic disorders (e.g., hepatic encephalopathy, diabetic ketoacidosis, hypo- and hyperthyroidism, hypo- and hyperadrenalism, and vitamin B 12 deficiency) and neurological conditions (e.g., epilepsy, tumors, cerebrovascular disease, head trauma, and encephalitis) (APA, 2022; Mathews et al., 2013). Schizophreniform Disorder The essential symptoms of schizophreniform dis- order are identical to those of schizophrenia (Cri- terion A), but the duration, including prodromal, active, and residual phases, is at least 1 month but less than 6 months (APA, 2022). If the diagnosis is made while the individual is still symptomatic but has been so for less than 6 months, it is qualified as “pro- visional.” The diagnosis is changed to schizophre- nia if the clinical picture persists beyond 6 months. Schizophreniform disorder is thought to have a good prognosis if two of the following features are present: the individual’s affect is not blunted or flat, there is a rapid onset of psychotic symptoms from the time the unusual behavior is noticed, there is confusion or perplexity, or the premorbid social and occupational functioning was satisfactory (APA, 2022). Catatonic features also may be associated with this disorder. Schizoaffective Disorder This disorder is manifested by signs and symptoms of schizophrenia, along with a strong element of symptomatology associated with the mood disor- ders (depression or mania). The client may appear depressed with psychomotor retardation and suicidal ideation, or symptoms may include euphoria, gran- diosity, and hyperactivity (see the “Real People, Real Stories” interview with Josh, who describes his diag- nosis and experience with schizoaffective disorder in Chapter 16, “Depressive Disorders”). A defining factor in the diagnosis of schizoaffective disorder is the presence of hallucinations and/or delusions that occur for at least 2 weeks in the absence of a major mood episode (APA, 2022). However, prominent mood disorder symptoms must be evident for the
Application of the Nursing Process Background Assessment Data
The diagnostic criteria for schizophrenia were pre- sented Box 15–1. As previously stated, symptoms may present in phases with schizophrenia representing the active phase of the disorder. Symptoms associated with the active phase are discussed in this section. In the first step of the nursing process, the nurse gathers a database from which nursing diagnoses are derived and a plan of care is formulated. This first step of the nursing process is extremely important because problem identification, objectives of care, and outcome criteria cannot be accurately deter- mined without an accurate assessment. Assessment of the patient with schizophrenia may be a complex process based on information gath- ered from a number of sources. Patients in an acute episode of their illness may not be able to make sig- nificant contributions to their history. Data may be obtained from family members if possible, from old medical records if available, or from other individu- als who are able to report on the progression of the patient’s symptoms. The nurse must be familiar with symptoms com- mon to the disorder to be able to obtain an ade- quate assessment of the patient with schizophrenia. This includes positive and negative symptoms. Most but not all clients exhibit a mixture of both types of symptoms. The seven domains of cognitive dysfunction that are common in schizophrenia are working memory, attention, speed of processing thoughts, and ver- bal learning, with substantial deficit in reasoning, abstract thinking, and problem-solving. Tripathi and associates (2018) estimate the 98% of patients with schizophrenia have these cognitive deficits, which can aggravate other symptoms and dramatically interfere with quality of life. To date, pharmacolog- ical treatments have generally been ineffective in treating these symptoms. It is important to note that not all patients with schizophrenia experience all of these symptoms. Bora (2015) notes that in individuals who develop cognitive deficits, the age of onset is variable, and
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