ICD-10 Criteria of Schizophrenia Spectrum Disorders (Nursing)

00:00 So, if we start thinking about this criteria of the ICD-10 criteria, and remember, ICD-10 is a way to categorize not only psychiatric diagnoses, but ICD-10 is used for all diagnoses.

00:16 And we as nurses are not going to make ICD-10 diagnoses.

00:23 We are going to perhaps look into the DSM-5 or the ICD-10 to look at the criteria just so that we have a better understanding of the disease process that our patient is going through.

00:35 The ICD-10 criteria for schizophrenia says that the person has an affected perception of reality.

00:44 And they may have the auditory tactile, visual, olfactory or gustatory delusions or disturbances.

00:53 They might have hallucinations.

00:57 This is part and parcel, this is a symptom of a disease, not a personal failing.

01:04 They also may have social emotional communication disorders.

01:08 So they are not able to actually engage with other people or let other people know what they're thinking or what they are feeling.

01:18 Also, they may have speech patterns that are very difficult to understand.

01:27 And because they can't connect with their talking, they might start withdrawing and we might see them going into isolation.

01:39 Well, that's a little different than Schizoaffective Disorder.

01:42 And it's very difficult for a nurse to try and make this determination between schizophrenia and schizoaffective disorder.

01:53 The ICD-10 criteria is going to be able to say when a mood disorder is no longer presenting symptoms, the symptoms of psychosis then, and hallucinations and delusions still persist.

02:08 So now they have a mood disorder.

02:12 We're not really seeing their diagnosis of the mood disorder but we're still seeing those hallucinations and delusions, those positive symptoms in that person.

02:23 They might be diagnosed with schizoaffective.

02:28 There might be a Schizophreniform Disorder that they might actually be diagnosed by the practitioner with.

02:37 And that is very similar to schizophrenia, only it's a duration that's much shorter, it's only 1-6 months long, and the schizophreniform.

02:49 And there's less, it's less debilitating for the person, then if a person has that chronic schizophrenia.

02:59 So for us, if the person comes in and has schizophreniform disorder, it makes no difference in the way we're going to look or treat that patient.

03:08 It depends on what that patient is experiencing in the moment they coming into the hospital.

03:13 Our nursing diagnosis is going to be specific to their needs.

03:18 A person might have a Delusional Disorder.

03:21 And if they have this delusional disorder, this is also chronic.

03:25 And it is not psychotic, it is usually seen in patients.

03:31 Well, some patients could have psychosis.

03:33 Some people may not have psychosis, but the delusion is the symptom that is prominent with them.

03:42 And so they have this delusion belief, and no matter what we say, just as any delusion, the evidence does not impact the belief.

03:53 And oftentimes, we're seeing this with a person who is very jealous, who believes that someone's cheating on them, even when there is ample evidence that that is not the truth.

04:05 Or perhaps they're getting persecuted unfairly, or they are being hunted down.

04:11 So it's jealousy, persecution and paranoia.

04:15 It can be one of them.

04:16 It can be all of them.

04:18 It's delusionary.

04:20 And so it's not actually happening in the real world.

04:25 But can you imagine how hard it is to have a normal activities of daily living, going through your routines if you are having these pervasive, intrusive thoughts of either jealousy about a partner, or that someone is out to get you, this impacts our daily living activities, and it is a disorder.

04:53 Again, it is a thought disorder.

04:55 This person cannot stop these terrible intrusive thoughts.

05:00 There's also something called a Brief Psychotic Disorder.

05:05 It is something that occurs and then resolves in less than 1 month.

05:11 So the duration for brief psychotic disorder is less than 1 month.

05:17 It has all the same kinds of signs and symptoms as presenting as though the person has schizophrenia.

05:25 And that is positive and negative symptoms.

05:29 But it's gone within a month.

05:33 Catatonia is one of those things that when you see it, you never forget the patient with catatonia.

05:44 We often see it, it's reflected in a person's loss of control over their posture and their movements.

05:51 So what we often see is that there is the problem and interference or decrease in their motor activities.

06:02 We also find that they are unable to speak.

06:05 So there is a level of mutism, inability to speak, mutism that occurs with our patients who have catatonia.

06:14 They also have increased negative speech and attitude.

06:20 So we're watching this decline of speech.

06:25 And then we have the Echopraxia.

06:28 Alright, so remember what we said echo is repeating, praxia is the movements.

06:34 So they have these mirroring movements, or echolalia, which is the mirroring speech.

06:44 Let's summarize a little bit.

06:46 Nursing diagnosis and the interventions are always client centered.

06:52 We don't worry about the diagnosis, we worry about the person in front of us and what their experience is with their disorder.

07:02 We want to know that there are different types of schizophrenia and it exists on a spectrum.

07:09 There are multiple different types of schizophrenia that we see.

07:13 One of the things, though, is that they all share some of these common signs and symptoms.

07:20 Now, establishing a therapeutic environment, and being able to have a therapeutic relationship.

07:28 These are extremely important factors, protective factors to help this patient to start on the road to recovery.

07:37 And yes, recovery is something that we think of for every patient, even those who has schizophrenia and who might actually have a long road, a chronic road in front of them.

07:50 And then the client and staff also have to see that there is an opportunity for interaction to be able to build some of those social skills that are very difficult to do on the outside where people may not be as open and welcoming.