Age of Onset of Schizophrenia
Schizophrenia occurs in early adulthood and is characterized as a mental health disorder with 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 and about three and a half million Americans (About Schizophrenia, 2018). Describe the Illness and its Pathophysiology Schizophrenia is a disease that impairs neurocognitive functioning (Snyder, 2013). People that are diagnosed with schizophrenia require long-term treatment, and symptoms can vary from mild to severe and differ in age groups. Patients can suffer from delusions which are false beliefs such as being tormented or hallucinations that impact all five senses (Snyder, 2013). Younger adults display social withdrawal, while older adult symptoms show a lack of motivation for school, work, or their environment (Snyder, 2013). Since schizophrenia can lead to suicidal ideations, establishing a therapeutic nurse-client relationship is essential (Snyder, 2013).
The true pathophysiology of schizophrenia is still unknown, and several theories exist. Those theories include anatomical, neurotransmitters, and immune system abnormalities (Frankenburg, July 2018). Imaging studies show that patients with schizophrenia have anatomical differences in their brains’ dopaminergic system, and they have changes in their hippocampus, decreased brain volume in the medial temporal areas, and the ventricles are slightly enlarged (Frankenburg, July 2018). This theory is supported because drugs that are used to treat this disorder share antidopaminergic properties. Patients are partially diagnosed with the presence of negative and positive symptoms (Schizophrenia: Overview and Treatment Options, September 2014). According to the article written by Dr. Frankenburg, patients that suffer from schizophrenia have altered immune function and inflammatory responses. Patients that were exposed to infection in utero or those that had postnatal stress may have an exaggerated inflammatory response which leads to an alteration in brain structure and function. Patients with schizophrenia have higher levels of cytokines, insulin resistance and metabolic disturbances (Frankenburg, July 2018).
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Nursing Customizing Care Schizophrenia is a life-changing mental health disorder that causes physiological and psychosocial effects. Some common nursing diagnoses are disturbed sensory perception (auditory), and a risk for social isolation. Disturbed sensory perception goals would be that the patient will talk about the hallucinations, reduce the occurrence of hallucinations, verbalize voices being part of the illness and find ways to interrupt the hallucinations. Nursing interventions can include observing the client for signs hallucinations and avoid touching the client since he/she may perceive a touch threatening, possibly eliciting an aggressive response. Conveying acceptance will encourage the patient to share the hallucinations with the nurse and prevent injuries especially from command hallucinations. The nurse can teach voice dismissal to dismiss auditory commands and distraction to bring the patient back to reality (Townsend & Morgan, 2015, p.355). Evaluation of desired outcomes would be that the patient has established a trust with the nurse, refrains from responding to delusional thoughts and verbalization, the patient discusses the content of hallucinations, and is able to interact with others appropriately. Another schizophrenia nursing diagnosis is social isolation. Desired outcomes for the patient would be that the patient will willingly attend therapy activities accompanied by a trusted staff member, and voluntarily spend time 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 the group activities. Evaluation of outcomes would be if the patient demonstrates the 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. Nonpharmacological approaches include individual, group, and cognitive-behavioral psychotherapy, and are used as an addition to medications (Townsend & Morgan, 2015, p.365). Locally, EastRidge Health Systems offer mental health services. Physiological Effect of Mental Illness 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, also antipsychotic medications such as Olanzapine and Clozapine can cause an increased weight gain and worsen pre-existing metabolic cardiovascular risk factors (Metabolic Monitoring of Antipsychotic Medications: What Psychiatrists Need to Know, 2017). If any 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).
Schizophrenia is a mood disorder characterized by a disturbed thought process and brain biochemistry dysfunction, genetics, physiological factors, and psychosocial stress. While schizophrenia has periods of exacerbation and remission, it is important to maintain a safe, realistic, and trusting environment, when caring for a schizophrenic client. Early interventions for psychosocial and physiological ailments are essential and can significantly improve patient outcomes.