Age of Onset of Schizophrenia

Schizophrenia, which occurs in late adulthood, is characterized as a mental health disorder marked by psychotic features, disrupted relationships, and thought processes that disturb a person's mood, thoughts, and behavior. It affects approximately 1.1% of the world's population, or about three and a half million Americans (About Schizophrenia, 2018). Schizophrenia, a disease that impairs neurocognitive functioning (Snyder, 2013), requires long-term treatment given the varying severity of symptoms across different age groups. Affected individuals may suffer from delusions, false beliefs such as being persecuted, and hallucinations that impact all five senses (Snyder, 2013).

Social withdrawal is noted in younger adults, while older adults show a lack of motivation for school, work, and their environment (Snyder, 2013). Establishing a therapeutic nurse-client relationship is essential, as schizophrenia can lead to suicidal ideation (Snyder, 2013).

The true pathophysiology of schizophrenia is still uncertain; however, several theories propose anatomical, neurotransmitter, and immune system abnormalities (Frankenburg, July 2018). Imaging studies show that patients with schizophrenia have anatomical differences in their dopaminergic system, changes in their hippocampus, decreased brain volume in the medial temporal areas, and mildly enlarged ventricles (Frankenburg, July 2018). This theory gains support from drugs used to treat the disorder, which share antidopaminergic properties. Diagnosis partially relies on the presence of negative and positive symptoms (Schizophrenia: Overview and Treatment Options, September 2014). According to an article by Dr. Frankenburg, altered immune function and inflammatory responses are present in patients with schizophrenia. Those exposed to infection in utero or who experienced postnatal stress may exhibit an exaggerated inflammatory response, leading to changes in brain structure and function. These patients have higher levels of cytokines and insulin resistance, along with metabolic disturbances (Frankenburg, July 2018).

Schizophrenia, a life-altering mental health disorder, leads to physiological and psychosocial impacts. Common nursing diagnoses include disturbed sensory perception (auditory) and risk for social isolation. Goals for disturbed sensory perception include encouraging patients to talk about their hallucinations, reducing their frequency, and helping patients find ways to interrupt these hallucinations. The nursing interventions can involve observing patients for signs of hallucinations and treading lightly, as individuals may perceive touch as threatening. Acceptance from the nurse can encourage patients to share their hallucinations and prevent injuries, especially those stemming from command hallucinations. Techniques such as voice dismissal to discard auditory commands and distraction to return the patient to reality can also be taught (Townsend & Morgan, 2015, p.355). Evaluations of desired outcomes may reveal an established trust between the nurse and patient, refraining from responding to delusional thoughts and verbalizations, discussing the content of hallucinations, and the ability to interact appropriately with others. Another nursing diagnosis for schizophrenia is social isolation. Desired patient outcomes include willingness to attend therapy activities with a trusted staff member and spending time voluntarily with other clients and staff members in group activities.

Nursing interventions can include giving positive reinforcement and conveying an accepting attitude by making brief, frequent contacts to increase feelings of self-worth and facilitate trust (Townsend & Morgan, 2015, p.357). The nurse can also show positive regard and provide emotional security by accompanying the client to group activities. The evaluation of outcomes would be if the patient demonstrates a willingness and desire to socialize with others without isolation, attends group activities voluntarily, and approaches others for one-to-one interactions (Townsend & Morgan, 2015, p.363). Pharmacotherapy is the main component of schizophrenia treatment. Conventional and novel antipsychotics are used. Non-pharmacological approaches include individual, group, and cognitive-behavioral psychotherapy and are used in addition to medications (Townsend & Morgan, 2015, p.365). Locally, EastRidge Health Systems offers mental health services. Studies show that people with schizophrenia have been reported to be three times as likely to experience sudden cardiac death compared to the rest of the population. The blood flow to the coronary arteries becomes obstructed by atherosclerosis, causing the narrowing of the coronary arteries and impeding oxygen-rich blood flow to the heart.

While the risk factors of obesity, smoking, diabetes, hypertension, and dyslipidemia contribute to cardiovascular disease, antipsychotic medications such as Olanzapine and Clozapine can also cause increased weight gain and worsen pre-existing metabolic cardiovascular risk factors (Metabolic Monitoring of Antipsychotic Medications: What Psychiatrists Need to Know, 2017). If a patient has a diagnosis of schizophrenia and is being treated with antipsychotics, the attentive assessment of cardiovascular risk factors and metabolic monitoring are essential to prevent progression to coronary artery disease (Metabolic Monitoring of Antipsychotic Medications: What Psychiatrists Need to Know, 2017). Exercise, diet, optimal weight, patient education, and improving and monitoring hypertension, hyperlipidemia, and glucose levels help in the prevention of cardiovascular diseases in schizophrenic patients (Metabolic Monitoring of Antipsychotic Medications: What Psychiatrists Need to Know, 2017).

Conclusion

Schizophrenia is a mood disorder characterized by disturbed thought processes and brain biochemistry dysfunction. Genetics, physiological factors, and psychosocial stress also play a role. While schizophrenia has periods of exacerbation and remission, it is important to maintain a safe, realistic, and trusting environment when caring for a client with schizophrenia. Early interventions for psychosocial and physiological issues are essential and can significantly improve patient outcomes.

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