Schizophrenia: Insights from Psychological Research

Schizophrenia, a multifaceted mental health disorder, is marked by psychotic features, disrupted interpersonal relationships, and cognitive disturbances that profoundly impact an individual's mood, thoughts, and behaviors. This condition affects approximately 1.1% of the global population, translating to about three and a half million Americans (About Schizophrenia, 2018). Schizophrenia not only impairs neurocognitive functioning but also necessitates long-term treatment due to the variable severity of its symptoms across different age groups (Snyder, 2013).

Symptoms and Social Implications

Individuals diagnosed with schizophrenia often endure delusions—false beliefs such as feelings of persecution—and hallucinations that can engage all five senses (Snyder, 2013).

These symptoms manifest differently across age groups, where younger adults may exhibit social withdrawal, and older adults might show diminished motivation for activities related to school, work, and their environment (Snyder, 2013). Establishing a therapeutic relationship between the nurse and client is crucial, as schizophrenia can lead to suicidal ideation, necessitating vigilant care and support (Snyder, 2013).

Theories and Pathophysiology

The exact pathophysiology of schizophrenia remains elusive, yet several theories suggest abnormalities in brain anatomy, neurotransmitter functions, and immune responses (Frankenburg, July 2018). Imaging studies have revealed that patients with schizophrenia often exhibit anatomical differences in their dopaminergic systems, alterations in the hippocampus, decreased brain volume in medial temporal areas, and mildly enlarged ventricles (Frankenburg, July 2018). This anatomical theory is supported by the effectiveness of antidopaminergic properties in medications used to treat the disorder. Furthermore, research indicates altered immune function and inflammatory responses in those with schizophrenia, suggesting that prenatal infections or postnatal stress might trigger an exaggerated inflammatory response, leading to changes in brain structure and function (Frankenburg, July 2018). Notably, these patients tend to have elevated cytokine levels, insulin resistance, and metabolic disturbances.

Nursing Diagnoses and Interventions

Schizophrenia profoundly impacts both physiological and psychosocial dimensions of life. Common nursing diagnoses include disturbed sensory perception, particularly auditory hallucinations, and a significant risk for social isolation. For disturbed sensory perception, goals include encouraging patients to discuss their hallucinations, reducing their frequency, and helping patients develop strategies to interrupt these experiences. Nursing interventions might involve closely observing patients for signs of hallucinations and interacting with them cautiously, as they may perceive touch as threatening. Acceptance from the nurse can encourage patients to open up about their hallucinations and help prevent injuries, particularly those resulting from command hallucinations. Techniques such as voice dismissal and distraction can aid in bringing the patient back to reality (Townsend & Morgan, 2015, p.355).

Another critical nursing diagnosis is social isolation. Desired outcomes for patients include a willingness to participate in therapeutic activities with a trusted staff member and spending time voluntarily with peers and staff in group activities. Nursing interventions can involve providing positive reinforcement and adopting an accepting attitude through brief, frequent contacts to enhance feelings of self-worth and build trust (Townsend & Morgan, 2015, p.357). Nurses can also demonstrate positive regard and provide emotional security by accompanying clients to group activities. Evaluating outcomes involves assessing whether the patient demonstrates a willingness and desire to socialize with others, attends group activities voluntarily, and initiates one-to-one interactions (Townsend & Morgan, 2015, p.363).

Treatment Approaches and Cardiovascular Considerations

Pharmacotherapy remains the cornerstone of schizophrenia treatment, utilizing both conventional and novel antipsychotics. Complementary non-pharmacological approaches include individual, group, and cognitive-behavioral psychotherapy (Townsend & Morgan, 2015, p.365). Locally, facilities like EastRidge Health Systems provide mental health services tailored to individuals with schizophrenia.

However, it is crucial to recognize that individuals with schizophrenia are reported to be three times more likely to experience sudden cardiac death compared to the general population. This elevated risk is attributed to the obstruction of blood flow to the coronary arteries by atherosclerosis, which narrows the arteries and impedes oxygen-rich blood flow to the heart. While risk factors such as obesity, smoking, diabetes, hypertension, and dyslipidemia contribute to cardiovascular disease, certain antipsychotic medications, including Olanzapine and Clozapine, can exacerbate weight gain and worsen pre-existing metabolic cardiovascular risk factors (Metabolic Monitoring of Antipsychotic Medications: What Psychiatrists Need to Know, 2017). Therefore, for patients diagnosed with schizophrenia and undergoing antipsychotic treatment, meticulous assessment of cardiovascular risk factors and metabolic monitoring are essential to prevent the progression of coronary artery disease. Effective strategies include exercise, a balanced diet, maintaining optimal weight, patient education, and continuous monitoring of hypertension, hyperlipidemia, and glucose levels to prevent cardiovascular diseases in patients with schizophrenia (Metabolic Monitoring of Antipsychotic Medications: What Psychiatrists Need to Know, 2017).

Conclusion

In conclusion, schizophrenia is a complex mood disorder characterized by disturbed thought processes and dysfunction in brain biochemistry. Genetic predispositions, physiological factors, and psychosocial stressors also contribute to its manifestation. Although schizophrenia involves periods of exacerbation and remission, maintaining a safe, realistic, and trusting environment is paramount when caring for individuals with this disorder. Early interventions targeting both psychosocial and physiological issues are critical and can significantly improve patient outcomes, underscoring the importance of comprehensive care that integrates both pharmacological and non-pharmacological treatment strategies.

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