SCHIZOPHRENIA

Dr. Wilfredo C. Ramos

 Schizophrenia- What is it?
• A thought disorder – primary feature
• Dementia praecox – original name by Emil Kraeplin
• A mental disturbance that feature withdrawal, affective
problems, and interrupted thought processes.
• Schizophrenia – coined by Eugen Bleuler
• Split mind – lack of integration of the patient’s function
• Not characterized by changing personality; rather by
deteriorating personality
Signs and Symptoms
7. catatonia – immobility
8. concrete thinking – inability to explain
abstract ideas
9. thought blocking – inability to recall
information for a time
10. poverty of thought – lacking any opinions or
ideas. Vocabulary is limited
Positive/Hard Symptoms
1.4. delusion of influence – belief that he can

control events through telepathy

Magical thinking - belief that events can happen simply

because one wishes them too.

Thought insertion- belief that others are placing thoughts/

ideas into one’s head

Thought withdrawal- belief that others can take thoughts out of one’s head

Thought broadcasting-belief that others can hear his thoughts

2. Hallucination – a sensory perception that takes place
without external stimuli. A hallmark symptom.

TYPES OF HALLUCINATION
1. auditory – hears voices not audible to others
2. visual – sees images that do not exist at all
3. olfactory – smells odor that seem to be
emanating from their bodies
4. tactile – sensations
5. gustatory – taste lingering in the mouth
 Stages of Hallucination
1. comforting stage – person is experiencing a hallucination that
is familiar /comforting/ friendly to them
2. condemning stage – with a more angry, accusatory nature
which make the person feel guilty, isolated and uncomfortable.
3. threatening stage – hallucination becomes stronger,
threatening and begins to affect all aspects of the person’s
functioning.
4. controlling stage – person has no ability to control any of the
behavior and actions.
3. Loose association – stringing together of unrelated topics
with a vague connection
4. inappropriate affect – affect maybe intense but
inconsistent with patient’s thought or speech
5. flight of ideas – rapid process with fragmented movements
from one unconnected topic to another
6. ambivalence – refers to conflicting feelings
7. ideas of reference – false impression that events have
special meanings for the person
8. perseveration – persistent adherence to a single idea or
topic; verbal repetition of a word, phrase or sentence
9. Peculiarities in speech
a. echolalia – patient repeats whatever he hears
b. clang association (rhyming) – patient respond by
rhyming
c. neologism – coining of new words
d. word salad – random jumble of words and phrases
apparently meaningless and aimless
e. verbigeration – stereotyped repetition of words or
phrases that may or may not have meaning
10. Bizarre behavior
a. stereotype or repetitious movement
b. echopraxia
11. Illusions – misinterpretation of real external
sensory experience
12. depersonalization – feeling of unreality
Types of Schizophrenia
1. paranoid – systematized delusion of persecution,
auditory hallucination
2. disorganized type (hebephrenic) – severe
personality disorganization. Marked incoherence,
loosening of association, flat or inappropriate affect.
Use of word salad, neologism
3. catatonic – manifest phases of stupor alternating
with sudden periods of great excitement. Shows waxy
flexibility. Exhibits echolalia, echopraxia
 Forms of Catatonia
1. catatonic stupor/mutism – marked decrease in reactivity to
the environment or reduction in spontaneous movement
2. negativism – motiveless resistance to all instructions or
attempts to be moved
3. catatonic rigidity – maintenance of a rigid posture
4. catatonic posturing – assumption of inappropriate or bizarre
posture
5. catatonic excitement – excessive motor activity, apparently
purposeless and not influenced by external stimuli
4. undifferentiated type – characterized
by mixed schizophrenia symptoms with
disturbance of thought, affect, and
behavior
5. residual type – patient is in remission
from active psychosis but display
symptom of residual phase. (social
withdrawal, flat affect, looseness of
association)
 Etiology
1. Genetic
• 10% - immediate family member
• 40% - if disease affect both parents or an identical twin
• 25% - to those with 22qI deletion syndrome
2. Biochemical and neurostructural theory
- dopamine hypothesis – excessive dopamine allows nerve impulses to
bombard the brain
- enlarged ventricles; less brain tissues ( CT scans)
- diminished glucose metabolism and oxygen in the frontal cortical
structures of the brain
- limbic, hypothalamic structure have neuropathological changes. Low
cortical gray matter, blood flow.
-MAO theory – decrease platelet monoamine oxidase
3. Immunologic factors - altered brain pathology could be
caused by exposure to a virus
4. Perinatal theory – developing fetus or newborn is
deprived of oxygen or if mother suffers from
malnutrition or starvation during the 1st trimester of
pregnancy
5. Psychodynamic theory
The child who is deprived of a nurturing, loving
environment, neglected, rejected is vulnerable to
mental disturbances. (Trust vs. mistrust)
6. Diathesis stress theory/combination theory
• Individuals develop schizophrenia based on the
interaction of a number of factors: genetics,
environmental, anatomic, functional system and the
contribution of stressors.
To be considered schizophrenic:
1. 2 or more symptoms (positive/negative) present
during a 1-month period
2. Social/occupational dysfunction
3. Continuous signs of disturbances persist for at
least 6 months.
 Treatment

1. psychopharmacology
2. individual and group therapy
3. family education and therapy
 Nursing Management
1. general appearance/motor behavior
• Psychomotor retardation
• Speech pattern
• Latency of response
2. mood/affect
3. Thought process
4. Delusions
5. Sensorium
6. Judgement and insight
7. Self-concept
8. Roles/relationship
9. Self-care consideration
 Nursing Interventions
1. Promote safety of client and others
2. Establish a therapeutic relationship
3. Provide reality testing
4. Help identify stressors
5. Avoid competitive activities
6. Interventions for hallucination
a. Decrease environmental stimuli
b. Attempt to identify precipitating stressors
c. Engage client in reality-based activity
7. Intervention for delusion
a. Don’t argue with delusions
b. Don’t reinforce
c. Don’t touch patients without warning them
d. Avoid whispering or laughing when patients are
unable to hear all of the conversation
e. Distraction techniques - watching TV
8. Promote social interaction
9. Establish community support system and care
Thank
You!