Schizoaffective disorder
Schizoaffective disorder: Excerpt from Handbook of Diseases
Patients who show concurrent symptoms of both mood disorders (bipolar or depressive types) and psychotic disorder are given the diagnosis of schizo-affective disorder. Onset is usually during young adulthood. The chronic symptoms are typically fewer and less severe than among those patients with schizophrenia.
Causes
Schizoaffective disorder may result from a combination of physiologic and psychological causes. The specific cause is unknown.
Signs and symptoms
The patient must show clear symptoms of schizophrenia. During both the active and residual phases of the illness, symptoms of mood disturbance must also occur. These symptoms may not be caused by substance abuse or by a medical condition. Patients may experience difficulty functioning in the workplace. They have a restricted range of social contacts and may also have difficulty performing self-care.
Diagnosis
According to the classification found in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition – Text Revision, a schizoaffective disorder is diagnosed if the patient’s symptoms meet the following criteria:
❑ The patient experiences a period of uninterrupted illness in which there’s a major depressive episode (with depressed mood), a manic episode, or a mixed episode, concurrent with symptoms of schizophrenia.
❑ During the same period of illness, the patient experiences delusions or hallucinations for at least 2 weeks, without prominent mood symptoms.
❑ The patient experiences symptoms of the mood episode, and they’re pres-ent for a substantial portion of the total duration of the active and residual periods of the illness.
❑ The illness of the patient isn’t due to direct physiologic effects of a substance (drug abuse, medication) or a general medical condition.
Schizoaffective disorder can be classified as a specific type:
❑ With the bipolar type, the disturbance includes a manic or a mixed episode, or a manic or a mixed episode plus a major depressive episode.
❑ With the depressive type, the disturbance includes only major depressive episodes.
Treatment
As is indicated by the symptoms, treatment must focus on both psychotic and mood disorders. An antipsychotic is used to control the symptoms of schizophrenia. An antidepressant and an antimanic drug are used for the mood disorder. Psychotherapy can be useful to help the patient understand the nature of the illness and the need for ongoing treatment. Support groups increase socialization and provide safe opportunities to build interpersonal skills. The family should be encouraged to attend a support group to understand the illness better and to learn ways they can be supportive of the patient.
CLINICAL TIP: Strategies that work with patients who have a mood disorder may not be appropriate for someone who also has a thought disorder. Gauge the extent of the thought disorder before you develop a plan of treatment.
Special considerations
❑ As symptoms subside, encourage the patient to assume responsibility for personal care.
❑ Provide emotional support, maintain a calm environment, and set realistic goals for the behavior.
❑ Collaborate with other staff members to provide consistent responses to the patient’s manipulative or acting-out behaviors.
❑ Watch for early signs of frustration, and intervene appropriately to prevent acting out.
❑ If the patient is hitting and behavior is unacceptable, calmly tell him so. Tell him that the staff will move him to a quiet area and will help him control his behavior.
❑ If the patient is taking lithium, tell him and his family to notify the physician immediately if he experiences signs or symptoms of a toxic reaction (diarrhea, abdominal cramps, vomiting, unsteadiness, drowsiness, muscle weakness, polyuria, or tremors).
❑ If the patient is having trouble expressing his feelings, encourage him to talk about them or write them down.
❑ Record behavior and conversations.
❑ Institute suicide precautions as indicated by facility policy.
❑ Attend to the patient’s physical needs (hygiene, meals, physical activity, sleep) if he’s too depressed to take care of himself.
❑ Speak slowly and allow ample time for the patient to respond; his thinking and reactions may be sluggish.
❑ Affirm the patient by listening attentively and respectfully, preventing interruptions, and avoiding judgmental responses.
❑ Provide a structured routine, including noncompetitive activities, to build the patient’s self-confidence and encourage interaction with others.
❑ Urge the patient to join group activities and to socialize.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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