Psychiatric Disorders

Definition

A mental condition is often identified as having a behavioral or mental pattern that may cause discomfort or a decreased capacity to operate in everyday life. A mental illness that has been diagnosed as a psychiatric condition and that profoundly affects your thinking, mood, and behavior is one that has been diagnosed by a mental health expert. Additionally, it greatly increases your chance of going through pain, suffering, passing away, or losing your freedom. The two psychological disorders are as follows:

• Acute psychiatric disorder.
• Chronic psychiatric disorder.

Acute Psychiatric Disorder

Severe and distressing symptoms of acute mental illness necessitate prompt medical intervention. The symptoms of an often recurring mental illness may be becoming worse, this may be the person's first mental health event, or it may be a recurrence. When treated, the symptoms often go swiftly or rapidly.

• Anxiety Disorders:People with anxiety disorders experience fear and dread in reaction to particular things or situations, as well as physical signs of anxiety or panic such a racing heartbeat and sweating. An anxiety disorder is recognized when a person's response is inappropriate for the situation, when they are unable to regulate their response, or when their anxiety interferes with their ability to do everyday chores. Anxiety disorders include, for example, panic disorders, social anxiety disorders, particular phobias, and generalized anxiety disorders.
• Mood Disorders: Continuous melancholy, overly cheerful episodes, or swings from great happiness to severe sadness are characteristics of these diseases, sometimes known as affective disorders. The three most prevalent mood disorders are depression, bipolar disorder, and cyclothymic disorder.
• Psychotic Disorders: In psychotic illnesses, the mind and consciousness are twisted. Two of the most common symptoms of psychotic illnesses are hallucinations and delusions, which are erroneous fixed beliefs that the ill individual accepts as true in spite of evidence to the contrary. Hallucinations are the perception of unreal pictures or sounds, such as hearing voices. Schizophrenia is one type of psychotic disease.
• Eating Disorders: Eating disorders are characterized by extreme thoughts, attitudes, and behaviors related to food and weight. Anorexia nervosa, bulimia nervosa, and binge eating disorder are the three eating disorders that are most common.
• Personality Disorders: People with personality disorders typically exhibit extreme and inflexible personality features that are upsetting to the individual and/or cause problems at work, in school, or in interpersonal interactions. Additionally, the individual's thought and behavior habits drastically differ from what society expects of them and are so inflexible as to limit their capacity for regular functioning. Examples include paranoid disorder, obsessive-compulsive disorder, and antisocial personality disorder.
• Obsessive-Compulsive Disorder (OCD): Patients with OCD are driven to do certain rituals or routines by persistent thoughts or worries. The words used to describe the unpleasant ideas and behaviors are obsessions and compulsions. An example would be someone who has an irrational fear of germs and is constantly hand-washing.
• Post-traumatic stress Disorder (PTSD): The onset of PTSD can be brought on by a traumatic or horrific incident, such as a physical or sexual attack, the untimely death of a loved one, or a natural disaster. People with PTSD usually have distressing memories and thoughts about the incident, as well as regular emotional numbness.

Chronic Psychiatric Disorder

Schizophrenia

Schizophrenia patients are thought to occupy 50% of all mental facilities. In 1908, the Swiss psychiatrist Eugen Bleuler coined the phrase "schizophrenia." The term was formed from the Greek words skhizo (split) and phren.

Definition

Schizophrenia is defined as a functional psychosis characterized b disturbances in thinking, emotion, volition, and perception. Finally, it results in a decline in personality. Changes in concept formation are indicative of disturbed thinking and may result in misinterpretations of reality, as well as occasionally delusions and hallucinations.

Epidemiology

• Occurrence: It has been noted that schizophrenia can occur anywhere and in any society. The proportion of people who have a schizophrenic reaction at some point in their lives ranges from 0.3% to 1%.
• Age: Uncommon in childhood. Age ranges from fifteen to forty-five. 30 is the ideal age.
• Sex ratio: Male and female incidence are almost equal.
• Social class: Compared to the upper socio-economic group, the incidence of schizophrenia is higher in the lower socio-economic status group. (1994, Kapoor)
• One odd observation is that, at least in the northern hemisphere, people with schizophrenia are more likely to have been born in the winter or spring.

Etiology

The precise reason for schizophrenia is still a mystery. However, the following explanations about how the disease spread are the most likely.

• Genetic Theory: Research has shown that schizophrenia often runs in families and is inherited. Compared to a 1% chance in the general population, a child who has a single parent with schizophrenia has a 12% chance of also having the illness. In pairs of genetically identical twins, there is a 47% chance that both will be affected.
• Biochemical Theories: Abnormalities in the information-transmitting neurotransmitters, including dopamine and serotonin and its receptors. Dopamine neurotransmitters may be overexpressed in schizophrenia, or their activity may rise or decrease, causing a variety of symptoms.
• Psychological Theory: Schizophrenia is more likely to develop in introverted or schizoid people who are reclusive and have few social contacts. Schizophrenia is thought to be caused by ego boundary disturbance.
• Social or Environmental Factors: Due to the lack of a supportive family setting for healthy emotional development, both children and adults develop schizophrenia.

Clinical Features of Schizophrenia

Positive symptoms (those added in one's personality) of schizop are following:

• Delusions,
• Hallucinations,
• Unusual conduct,
• Aggression,
• Agitation,
• Suspiciousness,
• Hostility,
• Excitement,
• Grandiose, inflated assessments of one's company,
• Disorganization of the mind.

Negative symptoms (those deducted from one's persona schizophrenia are following:

• Apathy,
• Artificial motions or distance,
• Stereotypic behavior,
• Not being spontaneous,
• Blunted impact is completely flat.
• Decreased sensitivity to emotion,
• Avolition,
• Social isolation.

Diagnostic Criteria for Schizophrenia

• Characteristic Symptoms: Two or more of the folloeing, each present for a significant portion of time during a 1-month period (or less if successfully treated):
  • Delusions,
  • Hallucination,
  • Disorganized speech,
  • Grossly disorganized or catatonic behavior,
  • Negative symptoms: affecting flattening, alogia or avolition.

Note: Only on criteria A symptoms is required if delusions are bizarre or hallucinations consists of voice keeping up a running commentary on the person' behavior or thought or two or more voice conversing with each other

• Social/Occupational Dysfunction: For a sizable percentage of the period since the disturbance began, one or more areas of functioning, such as job, interpersonal relationships, or self-care, have fallen significantly short of the level attained before the disturbance began.
• Duration: The 6-month timeframe may encompass periods of prodormal or lingering symptoms but must contain at least one month of symptoms.
• Exclusion of Mood Disorder and Schizophrenia
• Exclusion of substances and general medical conditions: The disturbance is not brought on by a substance's immediate physiological effects or a general health issue.
• Associated with a Pervasive Developmental Disorder

Types of Schizophrenia

• Paranoid Schizophrenia.
• Catatonic Schizophrenia.
• Residusal Schizophrenia.
• Hebephrenic Schizophrenia.
• Undifferentiated Schizophrenia.
• Simple Schizophrenia.

General Management of Schizophrenia

• Prevent relapse: Continue medicine and follow up.
• Drug treatment: Antipsychotic drugs.
• Psychological Therapy.
  • Family therapy.
  • Behavioral therapy.
  • Group therapy.
• Individual psychotherapy,
• Social skill training,
• Psychosocial rehabilitation.

Nursing Management

• To help patient to recover from disease, decrease his symptoms, learn the importance of treatment.
  • To handle mild side effects, give appropriate counseling and oversight.
  • Pay attention to the impacts.
  • Following the "patient's rights," administer the medications that the physician has prescribed.
  • After taking medicine, note and report any patient changes.
  • If ECT is to be administered, inform the patient's family and prepare them for it.
•  To reduce delusions:
  • Find out what the patient's hallucination is and how it relates to his actions.
  • In the beginning, ignore the delusion and refrain from looking into the deluded content.
  • Encourage the patient and tell him or her not to worry about the illusion because the illness process is to blame.
  • Don't challenge the patient's illusions and don't try to dissuade them from validating them with reality.
  • Discuss the illusion with the sufferer and their family (it is the symptoms of disease condition, it will relieve after regular medication).
• To decrease or break hallucinations:
  • Review challenging circumstances with the patients.
  • Assist the patient with reality-checking and reframing incorrect assumptions.
  • To ensure restful sleep.
  • Encourage the patient to discuss the details of their hallucinations and how they relate to their specific ailment.
  • Telling the patient not to be alone when having hallucinations • Motivate the patient to engage in real life.
  • Create a secure environment (Suicidal precautions).
  • Never let a patient be left alone.
  • Keep a close eye on the patient's actions.
  • Room should be provided with adequate lighting and avoid isolating environment.

References

• Mandal G, text book of adult nursing,2nd edition:august,2013,Makalu publication house, dillibazar, Kathmandu
• myths-and-misconception-of-mental-healthillness
• nhs.uk/conditions/schizophernia/pages/causes.aspx
• nimh.nih.gov/health/topics/schizophernia/index.shtml
• wikipedia.org/wiki/mental_disorder