Assessing And Treating Clients With Psychosis And Schizophrenia
Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Psychosis and schizophrenia
Psychosis is a difficult term to define and is frequently misused, not only in the media but unfortunately among mental health professionals as well. Stigma and fear surround the concept of psychosis, and sometimes the pejorative term “crazy” is used for psychosis. This chapter is not intended to list the diagnostic criteria for all the different mental disorders in which psychosis is either a defining feature or an associated feature. The reader is referred to standard reference sources such as the DSM ( ) of the American Psychiatric Association and theDiagnostic and Statistical Manual ICD ( ) for that information. Although schizophrenia isInternational Classification of Diseases emphasized here, we will approach psychosis as a syndrome associated with a variety of illnesses that are all targets for antipsychotic drug treatment.
Symptom dimensions in schizophrenia
Clinical description of psychosis
Psychosis is a syndrome – that is, a mixture of symptoms – that can be associated with many different psychiatric disorders, but is not a specific disorder itself in diagnostic schemes such as the DSM or ICD. At a minimum, psychosis means delusions and hallucinations. It generally also includes symptoms such as disorganized speech, disorganized behavior, and gross distortions of reality.
Therefore, psychosis can be considered to be a set of symptoms in which a person’s mental capacity, affective response, and capacity to recognize reality, communicate, and relate to others is impaired. Psychotic disorders have psychotic symptoms as their defining features; there are other disorders in which psychotic symptoms may be present, but are not necessary for the diagnosis.
Those as a feature of the diagnosisdisorders that require the presence of psychosis defining include schizophrenia, substance-induced (i.e., drug-induced) psychotic disorders, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, and psychotic disorder due to a general medical condition ( ). Table 4-1 Disorders that may or may not have
as features include mania and depression as well as severalpsychotic symptoms associated cognitive disorders such as Alzheimer’s dementia ( ).Table 4-2
Psychosis itself can be paranoid, disorganized/excited, or depressive. Perceptual distortions and motor disturbances can be associated with any type of psychosis. includePerceptual distortions being distressed by hallucinatory voices; hearing voices that accuse, blame, or threaten punishment; seeing visions;
Table 4-1 Disorders in which psychosis is a defining feature
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reporting hallucinations of touch, taste or odor; or reporting that familiar things and people seem changed. are peculiar, rigid postures; overt signs of tension; inappropriate grinsMotor disturbances or giggles; peculiar repetitive gestures; talking, muttering, or mumbling to oneself; or glancing around as if hearing voices.
In , the patient has paranoid projections, hostile belligerence and grandioseparanoid psychosis expansiveness. includes preoccupation with delusional beliefs; believing thatParanoid projection people are talking about oneself; believing one is being persecuted or being conspired against; and believing people or external forces control one’s actions. is verbal expression ofHostile belligerence feelings of hostility; expressing an attitude of disdain; manifesting a hostile, sullen attitude; manifesting irritability and grouchiness; tending to blame others for problems; expressing feelings of resentment; complaining and finding fault; as well as expressing suspicion of people. Grandiose
is exhibiting an attitude of superiority; hearing voices that praise and extol; believingexpansiveness one has unusual powers or is a well-known personality, or that one has a divine mission.
In a there is conceptual disorganization, disorientation, anddisorganized/excited psychosis excitement. can be characterized by giving answers that are irrelevant orConceptual disorganization incoherent, drifting off the subject, using neologisms, or repeating certain words or phrases.
is not knowing where one is, the season of the year, the calendar year, or one’s ownDisorientation age. is expressing feelings without restraint; manifesting speech that is hurried; exhibitingExcitement an elevated mood; an attitude of superiority;
Table 4-2 Disorders in which psychosis is an associated feature
dramatizing oneself or one’s symptoms; manifesting loud and boisterous speech; exhibiting overactivity or restlessness; and exhibiting excess of speech.
Depressive psychosis is characterized by psychomotor retardation, apathy, and anxious self-punishment and blame. and are manifested by slowed speech;Psychomotor retardation apathy indifference to one’s future; fixed facial expression; slowed movements; deficiencies in recent memory; blocking in speech; apathy toward oneself or one’s problems; slovenly appearance; low or whispered speech; and failure to answer questions. is theAnxious self-punishment and blame tendency to blame or condemn oneself; anxiety about specific matters; apprehensiveness regarding vague future events; an attitude of self-deprecation, manifesting as a depressed mood; expressing feelings of guilt and remorse; preoccupation with suicidal thoughts, unwanted ideas, and specific fears; and feeling unworthy or sinful.
This discussion of clusters of psychotic symptoms does not constitute diagnostic criteria for any psychotic disorder. It is given merely as a description of several types of symptoms in psychosis to give the reader an overview of the nature of behavioral disturbances associated with the various psychotic illnesses.
Schizophrenia is more than a psychosis
Although schizophrenia is the commonest and best-known psychotic illness, it is not synonymous with psychosis, but is just one of many causes of psychosis. Schizophrenia affects 1% of the population, and in the US there are over 300 000 acute schizophrenic episodes annually. Between 25% and 50% of schizophrenia patients attempt suicide, and 10% eventually succeed, contributing to a mortality rate eight times greater than that of the general population. Life expectancy of a patient with schizophrenia may be 20-30 years shorter than the general population, not only due to suicide, but in particular due to premature cardiovascular disease. Accelerated mortality from premature cardiovascular disease in patients with schizophrenia is caused not only by genetic and lifestyle
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factors, such as smoking, unhealthy diet, and lack of exercise leading to obesity and diabetes, but also – sorrily – from treatment with some antipsychotic drugs which themselves cause an increased incidence of obesity and diabetes, and thus increase cardiac risk. In the US, over 20% of all social security benefits are used for the care of patients with schizophrenia. The direct and indirect costs of schizophrenia in the US alone are estimated to be in the tens of billions of dollars every year.
Schizophrenia by definition is a disturbance that must last for six months or longer, including at least one month of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms. are listed in and shown in Positive symptoms Table 4-3 Figure
. These symptoms4-1
Table 4-3 Positive symptoms of psychosis and schizophrenia
of schizophrenia are often emphasized, since they can be dramatic, can erupt suddenly when a patient decompensates into a psychotic episode (often called a psychotic “break,” as in break from reality), and are the symptoms most effectively treated by antipsychotic medications. areDelusions one type of positive symptom, and these usually involve a misinterpretation of perceptions or experiences. The most common content of a delusion in schizophrenia is persecutory, but it may include a variety of other themes including referential (i.e., erroneously thinking that something refers to oneself), somatic,…
