SCHIZOAFFECTIVE DISORDERDSM-IV295.

70 Schizoaffective disorder This disorder emph asizes the temporal relationship of schizophrenic and moodsymptoms and is used f or conditions that meet the criteria for both schizophreniaand a mood disorder w ith psychotic symptoms lasting a minimum of 1 month. Theclinical features must o ccur within a single uninterrupted period of illness (for some,this may be years or even decades) that is judged to last until the individual iscompletely recov ered for a significant period of time, free of any significantsymptoms of the di sorder. In comparison with schizophrenia, schizoaffectivedisorder occurs more co mmonly in women than in men.ETIOLOGICAL THEORIESPsychodynamicsRefer to CPs: Schi zophrenia, Major Depression, and Bipolar Disorder.BiologicalRefer to CPs: Schizo phrenia, Major Depression, and Bipolar Disorder.Recent studies suggest that schi zoaffective disorder is a distinct syndromeresulting from a high genetic liabili ty to both mood disorders and schizophrenia.Family DynamicsRefer to CPs: Schizop hrenia, Major Depression, and Bipolar Disorder.CLIENT ASSESSMENT DATA BASENeuros ensoryDepressed mood (at least 2 wks); manic or mixed mood (at least 1 wk)Pronou nced manic and depressive features intermingled with schizophrenic featuresDelus ions and hallucinations for at least 2 wks (in absence of prominent moodsymptoms )Difficulty following a moving object with the eyesTeaching/LearningMay report p revious episode(s) and remission free of significant symptoms; usuallybegins in early adulthood (generally earlier than mood disorders)Absence of substance use or general medical conditions that could account forsymptomsDIAGNOSTIC STUDIESRe fer to CPs: Schizophrenia, Major Depression, and Bipolar Disorder.NURSING PRIORI TIES1.Provide protective environment; prevent injury. 2.Assist with self-care.3.Promote interaction with others.4.Identify resources a vailable for assistance.5.Support family involvement in therapy.DISCHARGE GOALS1 .Signs of physical agitation are abating and no physical injury occurs.2.Improve d sense of self-esteem, lessened depression, and elevated mood arenoted.3.Approa ches and socializes appropriately with others, individually and in groupactiviti es.4.Adequate nutritional intake is achieved / maintained.5.Client / family disp lays effective coping skills and appropriate use of resources.6.Plan in place to meet needs after discharge.(Refer to CPs: Schizophrenia, Major Depression, and Bipolar Disorder for other NDsthat apply, in addition to the following.)NURSING DIAGNOSISVIOLENCE, risk for, directed at self/othersRisk Factors May Include:Dep ressed mood; feelings of worthlessness;hopelessnessUnsatisfactory parent/child r elationship; feelingsof abandonment by significant other(s)Anger turned inward/d irected at the environmentPunitive superego and irrational feelings of guiltNume rous failures (learned helplessness)Misinterpretation of realityExtreme hyperact ivity[Possible Indicators:]History of previous suicide attempts; makingdirect/in direct statements indicating a desire tokill self/having a planHallucinations; d elusional thinkingSelf-destructive behavior (hitting body partsagainst wall/furn iture); destruction of inanimateobjects Temper tantrums/aggressive behavior; inc reasedagitation and lack of control over purposelessmovementsVulnerable self-est eemDesired Outcomes/Evaluation Criteria Express improved sense of well-being/self-Cl ient Will:concept.Manage behavior and deal with angerappropriately.Demonstrate s elf-control without harm to self orothers. ACTIONS/INTERVENTIONSRATIONALEIndependentNote direct statements of a desire to k ill self; alsoDirect and indirect indicators of suicidal intentnote indirect act ions indicating suicidal wish,need to be attended to and addressed as being(e.g. , putting affairs in order, writing a will, givingpotentially acted on.away priz ed possessions; presence of hallucinationsand delusional thinking; history of pr evious suicidalbehavior / acts; statements of hopelessness regardinglife situati on).Ask client directly if suicide has been considered / The risk of suicide is greatly increased if theclientplanned and if the means are available to carry o uthas developed a plan, and particularly if meansthe plan.exist to execute the p lan.Provide a safe environment for client by removingProvides protection while t reatment isbeingpotentially harmful objects from access (e.g., sharpundertaken t o deal with existing situation.Client sobjects; straps, belts, ties; glass items; sm okingrationality is impaired, she or he may harm self materials).inadvertently.A ssign to quiet unit, if possible.Unit milieu may be too distracting, increasinga

gitation and potential for loss of control.Reduce environmental stimuli (e.g., p rivate room,In hyperactive state, client is extremelysoft lighting, low noise le vel, and simple roomdistractible, and responses to even the slightestdecor).stim uli are exaggerated.Stay with the client / request client remain in staffProvide s support and feelings of security asview. Provide supervision as necessary.agit ation grows and hyperactivity increases.Formulate a short-term verbal contract w ith theAn attitude of acceptance of the client as aclient stating that he or she will not harm selfworthwhile individual is conveyed. Discussion of during speci fied period of time. Renegotiate contractsuicidal feelings with a trusted indivi dualas necessary.provides a degree of relief to the client. Acontractgets the su bject out in the open and places someof the responsibility for own safety on the client.Ask client to agree to seek out staff member / friendThe suicidal client is often veryambivalent aboutif thoughts of suicide emerge.own feelings. Discus sion of these feelings with atrusted individual may provide assistance beforethe client experiences a crisis situation.Encourage verbalization of honest feeling s. ExploreBecause of elevated anxiety, client mayneedand discuss symbols of hope client can identify inassistance to recognize presence of hope in lifeown life.situations.Promote expression of angry feelings withinDepression and suicidal behaviors may beviewedappropriate limits. Provide safe method(s) o fas anger turned inward on the self, or anger mayhostility release. Help client identify true source ofbe expressed as hostile acting-out towardothers. If anger , and work on adaptive coping skills forthis anger can be verbalized and / or re leased in acontinued use.nonthreatening environment, the client may beable to re solve these feelings, regardless of thediscomfort involved.Orient client to real ity, as required. Point outElevated level of anxiety may contribute tosensory / environmental misperceptions, taking caredistortions in reality. Client may need helpnot to belittle client s fears or indicate disapprovaldistinguishing between re ality andmisperceptionsof verbal expressions.of the environment.Spend time with the client on a regular scheduleProvides a feeling of safety and security, while and provide frequent intermittent checks asalso conveying the message, I want to sp endtimeindicated in response to client needs.with you because I think you are a worthwhileperson. Provide structured schedule of activities thatStructured schedule provides feeling of securityincludes established rest periods throughout the day .for the client. Additional rest promotesrelaxationfor the agitated client.Provi de physical activities as a substitute forPhysical exercise provides a safe and effectivepurposeless hyperactivity (e.g., brisk walks,means of relieving pent-up tension.housekeeping chores, dance therapy, aerobics).Observe for effectiveness and evidence of adverseIndividual reactions to medications mayvary, andside eff ects of drug therapy (e.g., anticholinergicearly identification can assist with changes in[dry mouth, blurred vision], extrapyramidaldosage and / or drug choice , possibly preventing[tremors, rigidity, restlessness, weakness, facialclient fr om discontinuing drug therapyspasms]).prematurely with potential loss of control .CollaborativeAdminister medication, as indicated:Neuroleptics, e.g., chlorproma zine (Thorazine);Pharmacological interventions need to bedirectedat the presenti ng symptoms and used on a short-term basis. Antipsychotics may be effective inre ducing the hyperactivity associated withmania.May be combined with lithium or an tidepressantsand then gradually withdrawn.Antidepressants, e.g., imipramine (Tof ranil);Allows the accumulation of