NLE Psychiatric Disorders — Schizophrenia and Psychotic DisordersConcept Map

Concept

Definition and Classification

Sub Concepts

• Schizophrenia (chronic, 6+ months)
• Schizoaffective Disorder (psychosis + mood episode)
• Brief Psychotic Disorder (<1 month)
• Schizophreniform Disorder (1–6 months)
• Delusional Disorder (non-bizarre delusions only)

Relationship To Central

Defines the spectrum of psychotic conditions

Concept

Symptomatology

Sub Concepts

• Positive Symptoms (added/excess): Hallucinations, Delusions, Disorganized Speech/Behavior
• Negative Symptoms (loss/absence): Affective Flattening, Alogia, Avolition, Anhedonia, Asociality

Relationship To Central

The clinical presentation of psychotic loss of reality

Concept

Nursing Assessment & Communication

Sub Concepts

• Safety Assessment (command hallucinations, suicide/homicide risk)
• Hallucination Management (ask directly, don't argue, present reality)
• Delusion Management (acknowledge feeling, don't agree/argue, redirect)
• Building Trust and Therapeutic Relationship

Relationship To Central

Therapeutic strategies to engage the client in psychosis

Concept

Pharmacological Management

Sub Concepts

• Typical (First-Generation) Antipsychotics: Haloperidol, Chlorpromazine, Fluphenazine
• Atypical (Second-Generation) Antipsychotics: Risperidone, Olanzapine, Quetiapine, Clozapine, Aripiprazole
• Mechanism: Dopamine D2 Receptor Blockade

Relationship To Central

Medication to restore dopamine balance and manage symptoms

Concept

Adverse Effects & Complications

Sub Concepts

• Extrapyramidal Side Effects (EPS): Acute Dystonia, Akathisia, Pseudoparkinsonism, Tardive Dyskinesia
• Neuroleptic Malignant Syndrome (NMS): Medical Emergency
• Metabolic Effects: Weight Gain, Hyperglycemia, Dyslipidemia
• Agranulocytosis (Clozapine-Specific)
• Anticholinergic Effects, Orthostatic Hypotension, Photosensitivity

Relationship To Central

Critical safety monitoring during antipsychotic therapy

Concept

Nursing Interventions & Care

Sub Concepts

• Medication Adherence Support
• Symptom Management & Early Relapse Detection
• Psychoeducation & Family Involvement
• Community-Based Care (RA 11036, Mental Health Act)
• Social Skills & Self-Care Promotion

Relationship To Central

Holistic recovery-oriented nursing approach

To

Positive Symptoms

From

Schizophrenia

Strength

strong

Relationship

Clinical manifestation of dopamine excess in mesolimbic pathways

To

Negative Symptoms

From

Schizophrenia

Strength

strong

Relationship

Clinical manifestation of dopamine deficit in mesocortical pathways

To

Safety Assessment

From

Hallucinations

Strength

strong

Relationship

Command hallucinations require immediate risk evaluation for self-harm or harm to others

To

Therapeutic Communication

From

Delusions

Strength

strong

Relationship

Don't argue/agree; acknowledge feeling and redirect to reality to build trust

To

Dopamine D2 Blockade

From

Antipsychotics

Strength

strong

Relationship

Mechanism of action that reduces positive symptoms

To

Extrapyramidal Side Effects

From

Typical Antipsychotics

Strength

strong

Relationship

High potency agents (haloperidol, fluphenazine) cause more EPS due to strong dopamine blockade in motor pathways

To

Negative Symptom Improvement

From

Atypical Antipsychotics

Strength

strong

Relationship

Better efficacy for negative symptoms due to balanced serotonin-dopamine effects

To

Metabolic Side Effects

From

Atypical Antipsychotics

Strength

strong

Relationship

Weight gain, hyperglycemia, dyslipidemia more common with atypicals, especially olanzapine and clozapine

To

Benztropine

From

Acute Dystonia

Strength

strong

Relationship

Anticholinergic agent that immediately reverses acute dystonic symptoms (within 15-30 minutes)

To

Prevention

From

Tardive Dyskinesia

Strength

strong

Relationship

Only effective strategy since TD is often irreversible; use lowest effective antipsychotic dose

To

Medical Emergency

From

Neuroleptic Malignant Syndrome

Strength

strong

Relationship

Life-threatening reaction with hyperthermia, rigidity, autonomic instability, altered mental status; requires immediate antipsychotic cessation and intensive care

To

Agranulocytosis

From

Clozapine

Strength

strong

Relationship

Most effective antipsychotic but carries serious WBC risk; mandatory weekly/extended interval monitoring and client education about infection signs

To

Relapse Prevention

From

Medication Adherence

Strength

strong

Relationship

Noncompliance is the leading cause of relapse; long-acting injectables improve adherence outcomes

To

Recovery-Oriented Care

From

Family Involvement

Strength

moderate

Relationship

Psychoeducation and family support improve outcomes and reduce expressed emotion

To

Community-Based Care

From

RA 11036 Mental Health Act

Strength

strong

Relationship

Mandates recovery-oriented, rights-based, community-integrated approach to schizophrenia management

To

Command Hallucinations

From

Safety Assessment

Strength

strong

Relationship

Auditory hallucinations directing self-harm or violence to others are the highest safety priority

To

Risk for Violence Self-Directed or Other-Directed

From

Psychiatric Nursing Diagnosis

Strength

strong

Relationship

Primary diagnosis in acute psychosis with command hallucinations or delusional content

To

Disturbed Sensory Perception Auditory

From

Psychiatric Nursing Diagnosis

Strength

strong

Relationship

NANDA diagnosis for hallucinations; interventions focus on reality orientation and symptom management

To

Impaired Social Interaction

From

Psychiatric Nursing Diagnosis

Strength

moderate

Relationship

Related to negative symptoms and social withdrawal; addressed through skills training and family involvement

To

Metabolic Surveillance

From

Medication Monitoring

Strength

strong

Relationship

Weight, fasting glucose, lipid panel essential baseline and regularly with atypical antipsychotics