Schizophrenia and Psychotic Disorders - Concept Map
Psychosis: Loss of Contact with Reality
Related concepts
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
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
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
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
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
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
Concept connections
- SchizophreniaPositive SymptomsClinical manifestation of dopamine excess in mesolimbic pathways
- SchizophreniaNegative SymptomsClinical manifestation of dopamine deficit in mesocortical pathways
- HallucinationsSafety AssessmentCommand hallucinations require immediate risk evaluation for self-harm or harm to others
- DelusionsTherapeutic CommunicationDon't argue/agree; acknowledge feeling and redirect to reality to build trust
- AntipsychoticsDopamine D2 BlockadeMechanism of action that reduces positive symptoms
- Typical AntipsychoticsExtrapyramidal Side EffectsHigh potency agents (haloperidol, fluphenazine) cause more EPS due to strong dopamine blockade in motor pathways
- Atypical AntipsychoticsNegative Symptom ImprovementBetter efficacy for negative symptoms due to balanced serotonin-dopamine effects
- Atypical AntipsychoticsMetabolic Side EffectsWeight gain, hyperglycemia, dyslipidemia more common with atypicals, especially olanzapine and clozapine
- Acute DystoniaBenztropineAnticholinergic agent that immediately reverses acute dystonic symptoms (within 15-30 minutes)
- Tardive DyskinesiaPreventionOnly effective strategy since TD is often irreversible; use lowest effective antipsychotic dose
- Neuroleptic Malignant SyndromeMedical EmergencyLife-threatening reaction with hyperthermia, rigidity, autonomic instability, altered mental status; requires immediate antipsychotic cessation and intensive care
- ClozapineAgranulocytosisMost effective antipsychotic but carries serious WBC risk; mandatory weekly/extended interval monitoring and client education about infection signs
- Medication AdherenceRelapse PreventionNoncompliance is the leading cause of relapse; long-acting injectables improve adherence outcomes
- Family InvolvementRecovery-Oriented CarePsychoeducation and family support improve outcomes and reduce expressed emotion
- RA 11036 Mental Health ActCommunity-Based CareMandates recovery-oriented, rights-based, community-integrated approach to schizophrenia management
- Safety AssessmentCommand HallucinationsAuditory hallucinations directing self-harm or violence to others are the highest safety priority
- Psychiatric Nursing DiagnosisRisk for Violence Self-Directed or Other-DirectedPrimary diagnosis in acute psychosis with command hallucinations or delusional content
- Psychiatric Nursing DiagnosisDisturbed Sensory Perception AuditoryNANDA diagnosis for hallucinations; interventions focus on reality orientation and symptom management
- Psychiatric Nursing DiagnosisImpaired Social InteractionRelated to negative symptoms and social withdrawal; addressed through skills training and family involvement
- Medication MonitoringMetabolic SurveillanceWeight, fasting glucose, lipid panel essential baseline and regularly with atypical antipsychotics
Diagrams
Schizophrenia and Psychotic Disorders: Comprehensive Concept Map
Comprehensive mind map showing all major concepts in schizophrenia and psychotic disorders, organized hierarchically from definitions and symptoms through pharmacological management and nursing interventions. This map illustrates how positive and negative symptoms manifest differently, how medications work through dopamine blockade, the spectrum of adverse effects requiring monitoring, and the nursing role in recovery-oriented care under RA 11036.
Extrapyramidal Side Effects (EPS): Identification and Management Protocol
Step-by-step flowchart for identifying and managing extrapyramidal side effects based on onset time and clinical presentation. Shows critical decision points including the airway emergency of laryngeal dystonia, and emphasizes that tardive dyskinesia prevention requires the lowest effective antipsychotic dose since it is often irreversible and anticholinergics do not help.
Neuroleptic Malignant Syndrome (NMS): Emergency Recognition and Response
Emergency recognition and management flowchart for neuroleptic malignant syndrome, a life-threatening reaction to antipsychotics. Emphasizes the four cardinal features (hyperthermia, rigidity, autonomic instability, mental status change), immediate stopping of the antipsychotic, aggressive supportive care with cooling and hydration, and pharmacological intervention with dantrolene and/or bromocriptine. This is critical NLE knowledge.
Therapeutic Communication: Managing Hallucinations and Delusions
Detailed therapeutic communication protocol for managing hallucinations and delusions, based on psychiatric nursing best practices. Distinguishes between the two symptom types, provides specific assessment questions including screening for command hallucinations (safety priority), and outlines clear do's and don'ts for each. Emphasizes using concrete language, building trust, and recognizing that arguing or agreeing with delusions worsens outcomes.
Antipsychotic Selection: Typical vs. Atypical Agents
Decision-making flowchart for antipsychotic selection, comparing typical and atypical agents. Shows that atypicals are preferred for most patients due to lower EPS risk and better treatment of negative symptoms, with special protocols for clozapine's agranulocytosis risk in treatment-resistant cases. Includes monitoring parameters and the use of long-acting injectables for adherence problems.
Nursing Care Progression in Schizophrenia: From Acute Episode to Recovery
State diagram illustrating the nursing care trajectory from acute psychotic episode through long-term recovery and maintenance. Shows normal progression through safety-focused acute phase, early stabilization with medication adjustment, stabilization, rehabilitation, and discharge to community recovery, while also highlighting critical emergency pathways (safety escalation, EPS management, NMS alert) and the relapse cycle. This reflects RA 11036's emphasis on recovery-oriented, community-based care.