SCHIZOPHRENIA:

F20.9
 a psychotic disorder that lasts for at least six
months that includes at least a month of active
psychotic phase symptoms that impairs functioning
and that involved disturbances in feeling, thinking and
behavior.
 DSM 5 Diagnostic Criteria:
- 2 or more of the psychotic symptoms
- Level of functioning deterioration
- Not attributed to physiological effects of a
substance or other illness
 P O S I T I V E O R H A R D S Y M P TO M S
SCHIZOPHRENIA:

1. H a l l u c i n a t i o n s
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2. D e l u s i o n
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rsecution_mpeg4.mp4
3. Ambivalence
4. Associative looseness
 P O S I T I V E O R H A R D S Y M P TO M S
SCHIZOPHRENIA:

5. Echopraxia/ echolalia
6. Flight of ideas
7 . I d e a s o f re f e re n c e
8. Perseveration
9 . B i z a r re b e h a v i o r
10. Catatonia
 P O S I T I V E O R H A R D S Y M P TO M S
SCHIZOPHRENIA:

11 . O t h e r u n u s u a l s p e e c h p a t t e r n
- Clang association
- Neologism
- Ve r b i g e r a t i o n
- Stilted language
- Wo r d s a l a d
 P O S I T I V E O R H A R D S Y M P TO M S
SCHIZOPHRENIA:

1 2 . D i s t o r t e d t h o u g h t p ro c e s s a n d
content other than hallucinations and
delusion:
- T h o u g h t b l o c k i n g , b ro a d c a s t i n g ,
withdrawal, and insertion
- Ta n g e n t i a l i t y a n d c i rc u m s t a n t i a l i t y
 N E G AT I V E O R S O F T S Y M P TO M S
SCHIZOPHRENIA:
1. Anhedonia
2. Apathy
3. Alogia
4. Affective Flattening/ blunted
5. Asociality or Social withdrawal
6. Lack of volition-
 N E G AT I V E O R S O F T S Y M P TO M S
SCHIZOPHRENIA:onia
7. Catatonia
8. Inattention
9 . P s y c h o m o t o r re t a r d a t i o n
(fetal position)
Assessment of patient with Schizophrenia:

History:
- How the client functioned before the
disease development
- Age at the onset of schizophrenia
- Previous suicide attempt
- History of aggression
- Utilizing current support system
- Client’s perception of his/her
present situation
Clinical Course:

MALE FEMALE

SEX EQUAL EQUAL

ONSET 15- 25 Y.O. 25- 35 Y.O.

ADMISSION MORE THAN HALF ONLY A THIRD

IMPAIRMENT MORE IMPAIRED BY BETTER SOCIAL

THE (-) SYMPTOMS FUNCTIONING

OUTCOME WORST BETTER

Clinical Course:

1/3 to ½ of the patients relapse within

a year due to the following reasons:
- non- adherence to medication
- Persistent substance use
- Caregiver criticism
- negative attitude towards treatment
Immediate term course:

Two typical clinical patterns:

1. On going psychosis and
never recovers
2. Episode of psychotic
symptoms alternate with
complete recovery
Long term course:

Intensity of
psychosis
diminishes with
age
RELATED DISORDERS:

• Schizophreniform Disorder
• Schizoaffective Disorder
• Brief Psychotic Disorder
• Schizotypal PD
• Delusional Disorder
• Shared Psychotic Disorder
(folie a deux)
• Catatonia
SCHIZOPHRENIA
Etiology:
1. Genetic
• 1st degree relative10-12%
• 2nd degree relative5-6%
• One parent 15%
• Both Parents 35%
• DZ twin15%
• MZ twin 50%
• General Population 1%
• Born from fathers older than 60
Etiology:

2. Biological/neuro chemical factors

• -neurotransmitters
• Dopamine (Egan & Hyde, 2000)

• Serotonin (O’connor, 1998)

 Etiology:
2. Biological/ neuro anatomic
Factors:
• Lesser brain tissue and CSF
• CT scan- enlarge ventricles and
cerebral cortex atrophy
• PET Scan- diminished glucose and O2 metabolism-
(Flashman et al 2000)
• Decrease brain volume and temporal lobe function (+ s/s);
Frontal lobe (- s/s)- (Buchacan & Carpenter 2000)
• MRI- reduced volume of the hippocampus, amygdala, and
parahippocampal gyrus
Etiology:

3. Psychosocial and
Environmental Factors:
• Psychosexual Theory of Sigmund Freud
• Psychosocial Theory of Erik Erikson
• Over anxious mothering/dysfunctional
parenting or family dynamics Theory and
early interpersonal difficulties by Harry
Stack Sullivan
• Separation Individuation Theory
Margaret Mahler
Etiology:

3. Psychosocial and Environmental Factors:

• Learning Theories
• FAMILY DYNAMICS:
• Double bind Theories by Gregory
Bateson and Donald Jackson
• Schism and skewed families Theory by
Theodore Lidz
• Pseudomutual and pseudohostile families
by Lyman Wynne
• Expressed emotion
Etiology:

4. PSYCHODYNAMIC
THEORY- a regressive response to
overwhelming frustrations and conflict
with people in the environment
5. IMMUNOVIROLOGIC FACTORS-
Exposure to virus OR BODY’S IMMUNE
RESPONSE TO THE VIRUS
6. Perinatal infection-
Etiology:

7. Socio-cultural
• - Poverty- lack of
• nutrients/ food
• - Industrial country-
• drugs, alcohol,
substances that can
damage the brain cells,
• advanced countries.
 TYPES OF SCHIZOPHRENIA:
1. PA R A N O I D T Y P E ( PA R A P H R E N I A )
- delusion
-hallucinations
- e x c e s s i v e re l i g i o s i t y, h o s t i l e
a n d a g g re s s i v e b e h a v i o r
 TYPES OF SCHIZOPHRENIA:
2 . D i s o r g a n i z e d Ty p e ( H e b e p h re n i a )
- disorganized speech
- d i s o r g a n i z e d / b i z a r re b e h a v i o r
- f l a t o r g ro s s l y i n a p p ro p r i a t e a f f e c t
 TYPES OF SCHIZOPHRENIA:
3 . C a t a t o n i c Ty p e
- motor immobility

- excessive motor activity

 TYPES OF SCHIZOPHRENIA:
4 . U n d i f f e re n t i a t e d t y p e
p re s e n c e o f m i x t u re o f s y m p t o m s
 TYPES OF SCHIZOPHRENIA:
4. Residual type
at least one previous psychotic episode but not
current, social withdrawal; flat affect; looseness of
associations
NURSING INTERVENTION:
1. Promoting the safety of the client and others
Client maybe paranoid and suspicious
- Approach client in a non threatening manner
- No demands, don’t be authoritative
- Give client ample personal space; enhances self
security
Client has the potential to hurt self and others
NURSING INTERVENTION:
- Observe for signs of building agitation
and escalating behavior
- Institute intervention to protect client,
nurse, and others in the environment
administering medications
moving the client to a quiet less
stimulating environment
temporarily using seclusion and restraints
NURSING INTERVENTION:
2. Establishing a therapeutic relationship:
- Trust, Genuine interest, Positive regard, empathy,
acceptance
3. Using therapeutic communication when patient is
psychotic
- clarifying feelings and statement
- non verbal communication; spend time
with the client, lengthy period of silence ***
NURSING INTERVENTION:
- aim for patient’s contact with reality; presence,
calling the client by name, making references to the
day and time and commenting, active friendliness
4. Intervention for delusion
- do not argue, orient to reality, divert attention,
teach to ignore delusional belief, positive self talk,
and positive thinking
5. Intervention for hallucinations
- acknowledge the symptom, present and maintain
reality
-
NURSING INTERVENTION:
- Elicit description of the symptom
- Divert attention, engage in reality based activities
(playing cards, O.T., and listening to music
6. Coping with inappropriate behavior
- redirect away from present situation
- non judgmental, matter of fact
- reassure other clients that the behavior is not his/
her fault
- reintegrate client into the tx milieu
NURSING INTERVENTION:
- do not make the patient feel punished or
shunned for the behavior
- teach social skills; educate, model, and
practice
- client and family teaching
- establish community support system and
care
TREATMENT: Primary: PSYCHOPHARMACOLOGY

Conventional Atypical
(dopamine (dopamine and
anyagonist): serotonin
antagonist:
-Delusion -Lack of volition
and motivation

-Hallucinations - Social
Withdrawal
-Disturbed thinking
-Anhedonia
- Other + psychotic
symptoms - Alogia
Antipsychotic Drugs, Usual Daily Dosages
TREATMENT: Maintenance Therapy

Depot injection forms antipsychotic:

• Fluphenazine (Prolixin) in decanoate and
enanthate preparations
• Haloperidol (Haldol) in decanoate
• Risperidone (Risperdal Consta)
• Paliperidone (Invega Sustenna)
• Olanzapine (Zyprexa Relprevv)
• Aripiprazole (Abilify Maintena)
 SIDE EFFECTS:
Neurologic side effects:
SIDE EFFECTS OF
ANTIPSYCHOTIC DRUGS –
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Extrapyramidal side effects 1.
acute dystonia
2. akathisia
3.parkinsonism
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4. Tardive dyskinesia
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Neuroleptic malignant
syndrome
Non- neurologic side effects:
Weight gain
Sedation
Photosensitivity
Anticholinergic symptoms
(dry mouth, blurred vision,
constipation, urinary
retention)
Orthostatic hypotension
Agranulocytosis (Clozapine)
Seizure
ADJUNCTIVE TREATMENT

Individual,
Structured milieu
group, and
therapy
family therapy

Community Client/ family

support education and
programs support
EARLY SIGNS OF RELAPSE:
- Impaired cause and effect reasoning
- Impaired information processing
- Poor nutrition, lack of sleep and exercise
- Fatigue, poor social skills, social isolation,
loneliness
- Interpersonal difficulties
- Lack of control, irritability, mood swings
- Ineffetive medication management
- Low self concept
- Looks and acts differently
EARLY SIGNS OF RELAPSE
- Hopeless feelings, loss of motivation
- Anxiety and worry, disinhibition
- Increased negativity, neglecting appearance,
forgetfulness
CLIENT AND FAMILY EDUCATION:
-
CLIENT AND FAMILY EDUCATION: