Schizoaffective

Disorder
GNRS 584
Azusa Pacific University
Colleen Duckworth & Marissa Philip
PICOT Question: In patients with schizoaffective
disorder (SAD), what is the effect of practicing
mindfulness techniques on reported symptoms and
adaptive function compared with the people of the
same population/disease who do not practice
Significance:
mindfulnessIndividuals with within
techniques SAD experience difficulties with
two weeks.
functioning, attitudes, and symptoms. Mindfulness has been
shown to improve symptoms of SAD and adaptive functioning.
Two weeks provides time to show results through patient reports
and standardized scales (Carsley, Khoury, Heath, 2013; Davis,
Lysaker, Kristeller, Salyers, Kovach, & Woller, 2015; Harper,
2013; Schuman-Olivier, Noordsy, & Brunette, 2013; Tabak,
Horon, & Green, 2015).
Dynamics of SAD
➢ Characterized by the presence of a
mood episode of major depression,
mania, or mixed depression and mania
among symptoms of schizophrenia (Halter,
2014).

Image Credit: Lifeskills South

Meet our patient
The patient is 56 year old, Caucasian, male who
recently finalized his divorce 2 months prior, and has
no children. At that time, he was admitted to the
Intensive Care Unit (ICU) for increased depression,
suicidal ideation (SI), and command auditory
hallucinations (CAH) to harm himself and be violent. He
was recently transferred to a less acute unit. Patient
has a active diagnosis of SAD. The patient presents
with a disheveled appearance, but a positive affect,
mannered behavior, hyperverbal with rapid and
Image Credit:
pressured speech, and interacts well with nursing staff. Dreamstime
He is vigilant and and keeps on eye on the hallway
and suspicious of strangers entering his room. Patient
Mental Status Exam (MSE)
Patient demographics
➢ Gender: Male
➢ Age: 56
➢ Religion: Catholic
➢ Cultural Background: Caucasian
➢ Marital Status: Recently divorced
➢ Residency: Senior Outpatient Facility
➢ Employment status: Currently unemployed (Hx of restaurant
cleaning jobs)

Hx of Present Illness
Patient was voluntarily transferred from ICU on 01/10/18 with
increased depression, suicidal ideation, and CAH, triggered by the
recent anniversary of his brother’s death and acceptance of his divorce.
He has been unable to sleep and eat due to the voices telling him “You
 Mental Status Exam (MSE)
Past Psychiatric Hx
Patient has hx of suicidal ideation for the last 2 years with an attempt
on July, 2017 by overdosing on “Trazodone and a handful of pills”. This
attempt was influenced by CAH, in which voices told him to kill himself,
and by his wife’s filing for divorce.
DSM V Diagnoses
Bipolar Disorder, Unspecified Bipolar and
Related Disorder 296.80
Depressive Disorder 296.20-296.36
Opioid Dependence 304.00
Schizoaffective Disorder 295.70
Suicidal Ideation, Unspecified, Recurrent
Episode 296.30
Image Credit: DSM-5: A Triumph for People With Out-of-Control
Pertinent MSE Findings
Behavior: Patient is hyperverbal with rapid and pressured speech.
He follows instructions well and is compliant with all medications
and staff requests.
Feelings: Patient displays prominent feelings of anxiety and fear,
he is hypomanic with intermittent periods of isolation throughout
the day. Patient enjoys interacting with other patients on the floor
during group therapy, pet therapy, psych group, and meal times.

Perception: Patient is aware of the auditory hallucinations and

vocalizes that he actively tries to ignore them.

Thinking: Patient claims to practice mindfulness and enjoys sitting

with his feet on the ground and listening to the water from the
 Medications
Medicatio Classification Action Dosage Side Effects Rationale for use in
n & Route this patient

Atypical Antagonizes 5 mg Extrapyramidal Treats the patient’s

antipsychotic; serotonin and sublingu symptoms, symptoms
serotonin dopamine receptors al qAM, dizziness, associated with
Asenapin antagonist; to reduce psychotic 10 mg headache, SAD, depressive
e antidepressan negative symptoms sublingu insomnia, disorder, and
t; antimanic al qPM somnolence bipolar disorder
with psychotic
symptoms

Centrally Diminishes tremor 1 mg PO Sedation, Reduces

acting and rigidity qPM constipation, dry extrapyramidal
Benztrop cholinergic associated with a mouth effects from
ine receptor dopamine deficiency Asenapine and
antagonist; Olanzapine.
antiparkinson

Anticonvulsan Inhibits release of 250 mg Dizziness, Treatment of the

Lamotrig t
(Halter, 2014; Lilley, Collins,
glutamine & & Snyder,
PO qAM,
2017;
ataxia, Shields, Fox, & bipolar
patient’s
 Medications
Medication Classification Action Dosage & Side Effects Rationale for
Route use in this
patient

Atypical Antagonizes 30 mg PO Weight gain, Reduces

antipsychotic; serotonin and qHS somnolence, manic and
antimanic dopamine dizziness, psychotic
receptors by headache, symptoms, for
Olanzapin inhibiting their agitation, the patient’s
e reuptake, insomnia, SAD and
antipsychotic nervousness, bipolar
hostility, disorder
extrapyramidal
symptoms

Antidepressant Blocks reuptake 250 mg PO Drowsiness, Treats the

of serotonin, qHS nervousness, dry patient’s
potentiating its mouth depressive
(Halter, 2014; Lilley,effects, causes
Collins, & Snyder, 2017; Shields, disorder
sedation,
Trazodone
 Nursing Diagnoses and Rationale
1. Danger to self, related to history of suicide attempts and
suicidal ideation, inadequate intake for nutritional requirements, and
ineffective sleep patterns, as evidenced by patient stating that CAH
tell him to kill himself, not eat, and not sleep. This patient presents
with difficulty coping with CAH, delusion management, and mood
management, which are risk factors for suicide and self harm (Ackley,
Ladwig, & Makic, 2017).
2. Danger to others, related to command auditory hallucinations,
as evidenced by patient stating the voices are very violent and tell
him to do things he wouldn’t normally do. The patient has alteration
in cognitive functioning, distorted thought self-control, and a history
of opioid abuse, which are risk factors for other-directed violence
(Ackley et al., 2017).
3. Self-neglect, related to psychosis as evidenced by patient’s
 Nursing Intervention 1
Intervention: Assess for risk of suicide or other self-damaging or
danger to others behaviors; observe all necessary suicide precautions
and safety precautions for others by constantly monitoring patient
activity and removing all potentially harmful objects from room and
surroundings; encourage adequate intake, and administer
medications to help with sleep. Provide tools to manage symptoms to
reduce risk of these harmful behaviors.
Rationale: These interventions ensure safety when a patient has
difficulties with coping with CAH, delusion management, and mood
management (Ackley et al., 2017). Lack of coping and functioning,
delusions, and symptoms of SAD and bipolar disorder contribute to
suicidal and harmful behaviors. Managing symptoms and maintaining
a safe environment reduce risks in this patient population (Carsley et
al., 2013; Tabak et al., 2015).
 Nursing Intervention 2
Intervention: Implement mindfulness techniques and measure
functioning and symptoms improvement with patient reported
feelings and standardized measurements to monitor progress over 2
weeks.
Rationale: Mindfulness interventions including schema focused
therapy (5 phases) and compassionate mind training are useful in patients
with psychosis and SAD, with an improvement in self-concept, higher
adaptive functioning, and feelings of depression, anxiety, and stress.
Providing a journal and using the Depression Anxiety Stress Scales (DASS)
and Clinical Outcomes Routine Evaluation (CORE) is useful in measuring
feelings, symptoms, well-being, problems, and functioning (Harper, 2013).
The Mindfulness Intervention for Rehabilitation and Recovery in
Schizophrenia (MIRRORS) increases persistence, and the Positive and
Negative Syndrome Scale (PANSS) and Mindfulness Fidelity Scale (MFS)
measure its effectiveness (Davis et al., 2015). The Behavioral Inhibition and
 Nursing Intervention 3
Intervention: Administer prescribed medications for psychotic,
depressive, and manic symptoms. Offer education about medications
and check patient’s understanding. Monitor for improvement of
symptoms that alter self-perception and activities of self-care,
motivation, and functioning after giving medications. Assist patient to
adopt positive health behaviors, including exercise, hygiene, sleep,
and eating, and monitor these behaviors with a “self-scan”.

Rationale: Knowledge about the patient’s medication will help

adherence. Psychotropic medications, in concurrence with
mindfulness techniques, can help improve symptoms, sense of well-
being, sleep, and functioning (Schuman-Olivier et al., 2013). Focusing on
self reduces anxiety, depression, and stress in patients with SAD
(Harper, 2013).
Conclusion
Patients with SAD commonly have issues with
adaptive functioning. According to research,
mindfulness techniques help improve functioning,
along with other symptoms associated with the
disorder (Carsley et al., 2013; Davis et al., 2015;
Harper, 2013; Schuman-Olivier et al., 2013; Tabak et
al., 2015). By implementing safety precautions and
mindfulness techniques, we can help improve this
patient’s functioning and symptoms associated with
his disorder. More research needs to be done on
individuals of this population with larger sample sizes,
 References
Ackley, B.J, Ladwig, G.B, & Flynn Makic, M.B. (2017). Nursing
diagnosis handbook: An evidence-based guide to planning
care (11th ed.). St. Louis, MO: Elsevier, Inc.

Carsley, D., Khoury, B., & Heath, N. L. (2013). Effectiveness of

mindfulness interventions for mental health in schools: A
comprehensive meta-analysis. Mindfulness, 150(1), 176-184.
doi:10.1007/s12671-017-0839-2

Davis, L. W., Lysaker, P. H., Kristeller, J. L., Salyers, M. P., Kovach, A.

C., & Woller, S. (2015). Effect of mindfulness on vocational
rehabilitation outcomes in stable phase schizophrenia.
Psychological Services, 12(3), 303-312.
doi:10.1037/ser0000028
 References
DSM-5: A Triumph for People With Out-of-Control Eating Issues.
(2018). Retrieved from
https://www.nationaleatingdisorders.org/blog/dsm-5-triumph-peop
le-out-control-eating-issues
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Harper, S. F. (2013). Integrating theories and concepts: Formulating

drive CBT for a client with a diagnosis of schizo-affective
disorder. Clinical Psychology & Psychotherapy, 20(1). 77-86.
doi:10.1002/cpp.771

Lilley, L. L., Collins, S.R., & Snyder J.S. (2017). Pharmacology and the
nursing process (8th ed.). St. Louis, MO: Elsevier, Inc.
 References
Lifeskills South Florida. (2017). Thought Disorder. Retrieved from
https://lifeskillssouthflorida.com/what-we-treat/thought-
disorders/

Schuman-Olivier, Z., Noordsy, D. L., & Brunette, M. F. (2013).

Strategies for reducing antipsychotic polypharmacy. Journal of
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doi:10.1080/15504263.2013.778767
Shields, K.M., Fox, K.M., & Liebrecht C. (2018). Pearson Nurse’s
Drug Guide. Hoboken, NJ: Pearson Education, Inc.

Tabak, N. T., Horan, W. P., & Green, M. F. (2015). Mindfulness in

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