Compare and contrast schizoaffective disorder from schizophrenia. For this discussion, you will need to place particular emphasis on comprehensive assessment.
Schizophrenia is a leading cause of disability in the U.S. and is a disorder which involves psychosis and can present with multiple symptoms, including delusions, hallucinations, disorganized behavior, and lack of awareness of the disease (Fowler et al., 2021). The first-episode psychosis involves the first time the patient has a psychotic episode and recovery. The goal for treatment of the schizophrenic patient is symptom control and relapse prevention. These patients experience psychotic symptoms such as unawareness of illness, poor memory, depression, paranoid delusions, and hallucinations (Fowler et al., 2021). Poor adherence to treatment has led to higher rates of violence, hospital admissions, substance abuse and increased risk of death. The provider must measure patient adherence, such as self-reporting, direct visualization, biomarkers and metabolites, pharmacy prescription data, and medication event-monitoring systems (Fowler et al., 2021).
Schizoaffective disorder is a mental illness which contains characteristics of schizophrenia in the presence of major depressive episodes, with or without bipolar mania. The DSM-5 criteria of schizoaffective disorder include an uninterrupted duration of illness during which the patient has a major mood episode (mania or depression) and schizophrenia; the major depressive episode must include a depressed mood (Fowler et al., 2021). The schizoaffective disorder differs from schizophrenia in that they show higher rates of suicidality and more hospitalizations to prevent suicide and higher anxiety disorder comorbidities; however, with proper treatment they have better outcomes (Seldin et al., 2017).
Discuss unique features associated with interviewing a patient who is experiencing a psychotic disorder. Emphasis should be placed on nonverbal behavioral assessment, and a description of your approach to the clinical interview.
The American Psychiatric Association (APA) recommends with the initial evaluation to include the reason the patient is presenting for evaluation. It is important to complete a review of psychiatric symptoms, a history including any trauma and the patients goals and preferences for treatment (APA, 2021). It is important to not underestimate the psychiatric evaluation as it serves as the basis for a therapeutic relationship and is crucial to help make decisions about treatment and to formulate differential diagnoses.
The approach to the interview will depend on a lot of factors including the patients ability to communicate, level of insight, illness severity, degree of cooperation, and ability to recall historical details (Saddock, Sadock, & Ruiz, 2017). The patients health literacy and cultural background also play a role in the interview. Open ended empathetic questions about the patients current life circumstances and reasons for evaluation serves as a way of establishing rapport.
Emphasis should also be placed on patient goals, their view of the illness and preferences for treatment. Family members, friends and other individuals are also important. Those with a psychotic disorder requires a clear mental status examination as part of the initial assessment. Behavioral assessment such as inquiries into hallucinations and delusions will help identify psychotic experiences as well. Negative symptoms can be difficult to differentiate from lack of interest or reduced motivation due to depression, medication side effects, neurological, and substance use (APA, 2021).
Insight is also a significant proportion of individuals with psychotic disorders. Inquiring about the patients degree of insight and judgement will provide some relevant information for risk assessment, treatment outcomes, and adherence (APA,2021).
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