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A biochemical imbalance in the brain is believed to cause symptoms. Recent research reveals thatschizophrenia may be a result of faulty neuronal development in the fetal brain, which develops into full-blown illness in late adolescence or early adulthood. Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions, movement, and behavior. It cannot be defined as a single illness; rather thought as a syndrome or disease process with many different varieties and symptoms. It is usually diagnosed in late adolescence or early adulthood. Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women. The symptoms of schizophrenia are categorized into two major categories, the positive or hard symptoms which include delusion, hallucinations, and grossly disorganized thinking, speech, and behavior, and negative or soft symptoms as flat affect, lack of volition, and social withdrawal or discomfort. Medication treatment can control the positive symptoms but frequently the negative symptoms persist after positive symptoms have abated. The persistence of these negative symptoms over time presents a major barrier to recovery and improved the functioning of client¶s daily life. TYPES OF SCHIZOPHRENIA: The diagnosis is made according to the client¶s predominant symptoms:
Schizophrenia, paranoid type is characterized by persecutory (feeling victimized or spied on) or grandiose delusions, hallucinations, and occasionally, excessively religiosity (delusional focus) or hostile and aggressive behavior. Schizophrenia, disorganized type is characterized by grossly inappropriate or flat affect, incoherence, loose associations, and extremely disorganized behavior. Schizophrenia, catatonic type is characterized by marked psychomotor disturbance, either motionless or excessive motor activity. Motor immobility may be manifested by catalepsy (waxy flexibility) or stupor. Schizophrenia, undifferentiated type is characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior. Schizophrenia, residual type is characterized by at least one previous, though not a current, episode, social withdrawal, flat affect and looseness of associations.
ANATOMY AND PHYSIOLOGY: Structure and function of the nervous system I. Structures
1. and 5 sacral. It flows through the foramen of Monro into to the third ventricle. then through the aqueduct of Sylvius to the fourth ventricle. 3. 12 thoracic. Cerebrospinal fluid (CSF) forms in the lateral ventricles in the choroid plexus of the pia matter. CSF exits the fourth ventricle by the foramen of Magendie and the two foramens of Luska. 3. Function . The brain is covered by three membranes. II. The dura matter is a fibrous. The neurologic system consists of two main divisions. B. The autonomic nervous system (ANS) is composed of both central and peripheral elements. D. 2. It contains millions of nerve fibers. the central nervous system (CNS) and the peripheral nervous system (PNS). 5 lumbar. Fluid is absorbed by the arachnoid membrane. The PNS is composed of the 12 pairs of the cranial nerves and the 31 pairs of the spinal nerves. 1. bathing both the brain and the spinal cord. C. Its peripheral division is made up of visceral efferent and afferent nerve fibers as well as autonomic and sensory ganglia. connective tissue structure containing several blood vessels. The pia matter is a vascular membrane. The CNS is composed of the brain and spinal cord. 2. and it consists of 31 nerves ± 8 cervical. The ANS is comprised of visceral efferent (motor) and the visceral afferent (sensory) nuclei in the brain and spinal cord.A. and finally it circulates to the subarachnoid space of the spinal cord. It then flows into the cistema magna. The spinal cord extends from the medulla oblongata to the lower border of the first lumbar vertebrae. The arachnoid membrane is a delicate serous membrane.
sensory input. and motor activity. including the area for speech. each with specific functions. it also contains the centers for personality. Brain a The cerebrum is the center for consciousness. it consists of two hemispheres (left and right) and four lobes. thought. CNS 1. behavioral. memory. autonomic and intellectual functions and those for emotional and cardiac responses. i The frontal lobe controls voluntary muscle movements and contains motor areas.A. .
e The . libido. It also helps control pituitary secretion and stress reactions. and peripheral nerve discharges associated with certain behavior and emotional expression. iv The occipital lobe interprets visual stimuli.ii The temporal lobe is the center for taste. and for distinguishing between pleasant and unpleasant stimuli. controls smooth muscle movements. hearing and smell. temperature. coordinates sensory impulses with muscle activity. the hypothalamus is an automatic center that regulates blood pressure. d The cerebellum or hindbrain. sleeping patterns. and in the brain¶s dominant hemisphere. appetite. It also is responsible for primitive emotional responses. and maintains muscle tone and equilibrium. breathing. the center for interpreting spoken language. c Lying beneath the thalamus. b The thalamus further organizes cerebral function by transmitting impulses to and from the cerebrum. iii The parietal lobe coordinates and interprets sensory information from the opposite side of the body. such as fear.
Supervised chiefly by the hypothalamus. respiration. Differences in nervous system response. F. 1. III. E. The sympathetic nervous system serves as an emergency preparedness system. The spinal cord ends at 13 in the neonate. or asymmetry of reflexes may indicate pathology. persistence. The development of handedness before 1 year of age may signify a neurologic lesion. Absence. The PNS connects the CNS to remote body regions and conducts signals to and from these areas and the spinal cord. disappearing by 1 year of age. dilation of the heart and voluntary muscle blood vessels. and medulla oblongata. As myelinization progresses. G. but one of the last systems to develop during childhood. The nervous system is one of the first systems to form in utero. 2. the ANS contains two divisions. the ³flight-for-fight´ response. which includes the mesencephalon. C. The child¶s brain constantly undergoes organization in function and myelinization. Accuracy and completeness of the neurologic assessment is limited by the child¶s development. Sympathetic stimuli are mediated by norepinephrine. D. B. peripheral blood vessel constriction. Therefore. The parasympathetic nervous system is the dominant controller for most visceral effectors for most of the time. C. 2. This affects the site of lumbar puncture. relays nerve impulses between the brain and spinal cord. B. A. instead of L1-L2 where it terminates in the adult. The ANS regulates body functions such as digestion. Sympathetic impulses increase greatly when the body is under physical or emotional stress causing bronchiole dilation.brain stem. so does the child¶s fine motor control and coordination. decreased peristalsis. The peripheral nerves are not fully myelinated at birth. stronger and faster heart contractions. and increased perspiration. Several primitive reflexes are present at birth. pons. Parasympathetic impulses are mediated by acetylcholine. The spinal cord forms a two-way conductor pathway between the brain stem and the PNS. . and cardiovascular function. the full impact of insult may not be immediately apparent and may take years to manifest. Early signs of increased intracranial pressure (ICP) may not be apparent in infants because open sutures and fontanelles compensate to a limited extent. It is also the reflex center for motor activities that do not involve brain control.
Once the acute stage of a psychotic episode has passed. RPR. there are many first-generation antipsychotic medications available that may still be prescribed. Minimizing the impact of disease depends mainly on early diagnosis and. A comprehensive treatment program can include: y y y y y y Antipsychotic medication Education & support. Brief psychiatric rating scale TREATMENTS AND MEDICATIONS: Currently. CT scan. there is no method for preventing schizophrenia and there is no cure. No laboratory findings have been identified that are diagnostic of schizophrenia. A person with schizophrenia should leave the hospital or outpatient facility with a treatment plan that will minimize symptoms and maximize quality of life. liver function tests. Children have 65 to 140 ml of CSF compared to 90 to 150 ml in the adult. 3.H. Mild or moderate episodes may be appropriately addressed by intense outpatient treatment. even though some or all of the symptoms do. Hospitalization may be required to stabilize ill persons during an acute episode. wilson¶s disease. This is because vulnerability to psychosis doesn¶t go away. appropriate pharmacological and psycho-social treatments. HIV test. in which the body retains excessive amounts of copper). for both ill individuals and families Social skills training Rehabilitation to improve activities of daily living Vocational and recreational support Cognitive therapy Medication is one of the cornerstones of treatment. Rating scale assessment: y o o o Scale for the assessment of negative symptoms. serum ceruloplasmin ( rules out an inherited disease. 2. PET scan. A doctor will prescribe the medication that is the most effective for the ill individual . Routine battery of laboratory test may be useful in ruling out possible organic etiologies. including CBC. most people with schizophrenia will need to take medicine indefinitely. Clinical diagnosis is developed on historical information and thorough mental status examination. The need for hospitalization will depend on the severity of the episode. 4. Scale for the assessment of positive symptoms. urinalysis. In North America. and MRI. thyroid function test. PATHOPHYISOLOGY DIAGNOSTIC TEST: 1. However. atypical or second generation antipsychotic medications are the most widely used.
they can help ill individuals effectively manage their disorder. test and activities to patient before starting them Promoting socialization y y y y y y Encourage patient to talk about feelings in the context of a trusting. Use supportive. Determine the need for external control. designed to promote integration and recovery. supportive relationship. supportive housing. Talking with your treatment team will ensure you are aware of all available programs and medications. Combined with medication. emphatic approach to focus on patient¶s feelings about troubling events or conflicts. including seclusion or restraints. family member. and/or skills development programs. Provide opportunities for socialization and encourage participation in group activities. Help patient to identify behaviors that alienate significant others and family members. . Avoid challenging the content of patient¶s behavior Focus interactions on patient¶s behavior.Another important part of treatment is psychosocial programs and initiatives. Explain all procedures. Establish consistent limits on patients behavior and clearly communicate these limits to patients. Frequently monitor the patient within guidelines of facility¶s policy on restrictive devices and assess the patients level of agitation. and health care providers. Be aware of personal space and use touch judiciously. Collaborate patient to identify anxious behaviors as well as causes. Administer drugs as prescribed while monitoring and documenting patient¶s response to drug regimen. NURSING INTERVENTIONS: Strengthening differentiation y y y y y y Provide patient with honest and consistent feedback in a non threatening manner. Secure all potential weapons and articles from patients room and the unit environment that could be used to inflict injury. Communicate the decision to patient and put plan into action. Allow patient to reveal delusions to you without engaging in power struggle over the content or the entire reality of the delusions. persons living with schizophrenia may have access to or qualify for income support programs/initiatives. In addition. Use simple and clear language when speaking with the patient. Ensuring safety: y y y y y y Monitor patient for behaviors that indicate increased anxiety and agitation.
.y When patient¶s level of agitation begins to decrease and self control regained. establish a behavioral agreement that identifies specific behaviors that indicate self control against are escalation agitation.