MENTAL HEALTH &

PSYCHIATRIC NURSING I
(NSC 322)
SCHIZOPHRENIA

ONYEMACHI, B. C
INTRODUCTION
 Schizophrenia is a serious mental disorder in which people
interpret reality abnormally.

 Schizophrenia may result in some combination of

hallucinations, delusions, and extremely disordered
thinking and behavior that impairs daily functioning, and
can be disabling

 Schizophrenia involves a range of problems with thinking

(cognition), behavior and emotions
SYMPTOMS
 Signs and symptoms may vary, but usually involve
 delusions
 hallucinations
 disorganized speech
 Extremely disorganized or abnormal motor behavior
 Negative symptoms
Delusions. These are false beliefs that are not based on
reality
SYMPTOMS
 Hallucinations. False sensory perceptions experienced
without real external stimulus.

 These usually involve seeing or hearing things that don't

exist. Yet for the person with schizophrenia, they have the
full force and impact of a normal experience.

 Hallucinations can be auditory, visual, tactile and

olfactory
SYMPTOMS
 Disorganized thinking (speech). Disorganized thinking
is inferred from disorganized speech.

 Effective communication can be impaired, and answers

to questions may be partially or completely unrelated.

 Rarely, speech may include putting together

meaningless words that can't be understood, sometimes
known as word salad.
 SYMPTOMS
 Extremely disorganized or abnormal motor behavior. This
may show in a number of ways, from childlike silliness to
unpredictable agitation.

 Behavior isn't focused on a goal, so it's hard to do tasks.

 Behavior can include resistance to instructions,

inappropriate or bizarre posture, a complete lack of
response, or useless and excessive movement.
 SYMPTOMS
 Negative symptoms. This refers to reduced or lack of
ability to function normally.

 For example, the person may neglect personal hygiene

 Flat affect
 Alogia (poverty of speech)
 Also, the person may lose interest in everyday activities, socially
withdraw or lack the ability to experience pleasure. (anhedonia)
 Apathy- lack of interest
 Avolition- lack of motivation or ability to do tasks or activities
that have an end goal, such as paying bills or attending a school
function
RISK FACTORS
 Hereditary

 Environmental factors (war, stress, natural disaster)

 Birth trauma

 Social factors – (poverty, unemployment)

 Emotional/psychological factors

 Infection – meningitis, encephalitis

TYPES OF SCHIZOPHRENIA
Paranoid schizophrenia
 This is the most common type of schizophrenia. It may

develop later in life (30-40yrs) than other forms.

Symptoms include hallucinations and/or delusions.

 Suspicions, mistrust and feelings of inferiority

 Speech and emotions may not be affected.

 TYPES OF SCHIZOPHRENIA
Hebephrenic schizophrenia
 Also known as ‘disorganized schizophrenia’, this type of

schizophrenia typically develops between 15-25 years old.

 Symptoms include disorganized behaviours and thoughts,

alongside short-lasting delusions and hallucinations.

 Grossly inappropriate behaviour, wandering tendencies, bizarre

mannerisms, incoherent communication

 People living with disorganized schizophrenia often show little or

no emotions in their facial expressions, voice tone, or mannerisms.
 TYPES OF SCHIZOPHRENIA
Catatonic schizophrenia
 This is the rarest schizophrenia diagnosis. Characterized by

extreme motor retardation.

 The patient becomes mute, motionless, refuse to eat,

resistance to all instructions and attempts to be moved.

 Waxy flexibility (patient assumes a strange and bizarre

posture for a long time)

 Vacant facial expression and zero interest in environment.

Catatonic schizophrenia

 Urine and feaces are held for a long time

 Pre occupation with fantasies and delusions

 Negativism

 Attempts to do anything for the patient is met with resistance

Catatonic excitement
 Restlessness

 Talkactiveness

 Wild

 Impulsive

 Incoherent speech

 echololia
TYPES OF SCHIZOPHRENIA
Undifferentiated schizophrenia
 Signs of paranoid, hebephrenic or catatonic schizophrenia,

but it doesn’t obviously fit into one of these types alone.

 The behavior is clearly psychotic

 There is evidence of delusion, hallucination, incoherence

and bizarre behavior but insufficient specific symptoms to
permit a precise classification.
TYPES OF SCHIZOPHRENIA
Residual schizophrenia
 You may be diagnosed with residual schizophrenia if you

have a history of psychosis, but only experience the

negative symptoms (such as slow movement, poor
memory, lack of concentration and poor hygiene).

 There is continuing evidence of the illness with no

prominent psychotic symptoms such as delusions and
hallucinations.
TYPES OF SCHIZOPHRENIA
Simple schizophrenia
 Negative symptoms (such as slow movement, poor

memory, lack of concentration and poor hygiene) are

most prominent early and worsen

 while positive symptoms (such as hallucinations,

delusions, disorganized thinking) are rarely experienced.

 The patient shows a progressive mental deterioration

occurring at the time of puberty with increase apathy,
lack of initiation and a decline in total performance
TYPES OF SCHIZOPHRENIA
Schizoaffective disorder
 The person experiences a combination of schizophrenia

symptoms, such as hallucinations or delusions, and mood

disorder symptoms, such as depression or mania

 The patient may appear depressed with psycho motor

retardation, hopeless sad, ideation etc.

 Or may present with manic symptoms of hyperactivity,

euphoria, grandiosity with characteristics of schizophrenic
symptoms of delusion, hallucination, disorganized thinking.
Management
 Schizophrenia requires lifelong treatment, even when
symptoms have subsided.

 Treatment with medications and psychosocial therapy

can help manage the condition.

 In some cases, hospitalization may be needed.

 Management
Medications
 Medications are the cornerstone of schizophrenia
treatment, and antipsychotic medications are the most
commonly prescribed drugs.

 They're thought to control symptoms by affecting the brain

neurotransmitter dopamine.

 The goal of treatment with antipsychotic medications is to

effectively manage signs and symptoms at the lowest
possible dose.
Management
 Second-generation antipsychotics
 These newer, second-generation medications are generally

preferred because they pose a lower risk of serious side

effects than do first-generation antipsychotics. Second-
generation antipsychotics include:
 Aripiprazole (Abilify)
 Asenapine (Saphris)
 Brexpiprazole (Rexulti)
 Cariprazine (Vraylar)
 Clozapine (Clozaril, Versacloz)
 Iloperidone (Fanapt)
Management
First-generation antipsychotics
 These first-generation antipsychotics have frequent and

potentially significant neurological side effects, including the

possibility of developing a movement disorder (tardive
dyskinesia) that may or may not be reversible. First-
generation antipsychotics include:
 Chlorpromazine

 Fluphenazine

 Haloperidol

 Perphenazine

 These antipsychotics are often cheaper than second-

generation antipsychotics
 Management
Long-acting injectable antipsychotics
 Some antipsychotics may be given as an intramuscular or

subcutaneous injection.
 Aripiprazole (Abilify Maintena, Aristada)
 Fluphenazine decanoate
 Haloperidol decanoate
 Paliperidone (Invega Sustenna, Invega Trinza)
 Risperidone (Risperdal Consta, Perseris)
Management
 Psychosocial interventions
Once psychosis recedes, in addition to continuing on
medication, psychological and social (psychosocial)
interventions are important. These may include:

 Individual therapy. Psychotherapy may help to

normalize thought patterns. Also, learning to cope with
stress and identify early warning signs of relapse can
help people with schizophrenia manage their illness.
 Management
 Social skills training. This focuses on improving
communication and social interactions and improving the
ability to participate in daily activities.

 Family therapy. This provides support and education to

families dealing with schizophrenia.

 Vocational rehabilitation and supported

employment. This focuses on helping people with
schizophrenia prepare for, find and keep jobs.
Management
Hospitalization
 During crisis periods or times of severe symptoms,

hospitalization may be necessary to ensure safety,

proper nutrition, adequate sleep and basic hygiene.

Electroconvulsive therapy
 For adults with schizophrenia who do not respond to

drug therapy, electroconvulsive therapy (ECT) may be

considered. .