Lecture 5

Mental Health Nursing-NUR 417

Schizophrenia
Introduction

 The word schizophrenia is derived from

the Greek words skhizo (split) and phren
(mind).
Introduction (cont.)

 More than any other mental illness,

schizophrenia probably causes more
 Lengthy hospitalizations
 Chaos in family life
 Exorbitant costs to people and governments
 Fears
Nature of the Disorder

 Schizophrenia:
A serious mental disorder characterized by:
 Disorganized and delusional thinking (Thought
processes)
 Disturbed perceptions/hallucinations
 Inappropriate emotions and actions (affect)

 With schizophrenia, there is a severe deterioration

of social and occupational functioning
Etiological Implications
Schizophrenia is probably caused by a

combination of factors, including

 Biological and Heritability predisposition
 Biochemical Causes
 Physiological factors
 Psychosocial stress
 Environmental factors
Etiological Implications
 Biological and Heritability predisposition
Genetics plays an important role in the
development of schizophrenia.

 Biochemical Causes
Dopamine Hypothesis: schizophrenia is
caused by excessive dopamine activity.
Predisposing Factors (cont.)
 Physiological influences
Examples of Various physical conditions
 Epilepsy
 Birth trauma
 Head injury
 Alcohol abuse
 Cerebral tumor
Predisposing Factors (cont.)

 Psychosocial influences
 Deeply disrupted family.
 Stressful life events.

 Environmental influences
 Viral epidemics: associated with viral diseases
 Low-socioeconomic
Diagnosis

 Schizophrenia is diagnosed based on

talking with the patient, and looking at his
or her behaviour and experiences.
Diagnosis – Examples of Important Tests
 MRI (Magnetic resonance imaging)
 Identifies brain changes

 PET (Positron emission tomography) (is a nuclear medicine imaging)

 Determines brain activity

 EEG )Electroencephalography(
 An electrophysiological monitoring method to record electrical
activity of the brain

 Neurologic examination

 Neuropsychologic tests
Types of Schizophrenia

 Catatonic schizophrenia
Characterized by marked psychomotor disturbance

 Catatonic stupor: characterized by extreme

psychomotor retardation; patient usually mute

 Catatonic excitement: Extreme psychomotor

agitation; purposeless movements that must be
curtailed to prevent injury to client or others
Types of Schizophrenia

 Disorganized schizophrenia
 Inappropriate affect
 Extremely disorganized behavior
 Social interaction impaired
Types of Schizophrenia
 Paranoid schizophrenia
 Characterized by hallucinations, delusions,
and persecutory (feeling victimized) or
grandeur
 Client may be argumentative, and aggressive
Types of Schizophrenia

 Residual schizophrenia
 Used to diagnose a person who has a history
of at least one episode of schizophrenia with
prominent psychotic symptoms
Types of Schizophrenia

 Schizoaffective disorder
 Schizophrenic symptoms accompanied by a
strong element of symptomatology associated
with mood disorders, either manic or
depressive
Types of Schizophrenia

 Brief psychotic disorder

 Sudden onset of psychotic symptoms

following a severe psychosocial stressor

 Symptoms persist less than 1 month

Types of Schizophrenia

 Schizophreniform disorder

 Same symptoms as schizophrenia.

 The duration of the disorder has been at least

1 month but fewer than 6 months
Types of Schizophrenia

 Undifferentiated schizophrenia
 Characterized by mixed schizophrenic
symptoms (of other types) along with
disturbances of thought, affect, and behavior
Nursing Process: Assessment

Content of thought
 Delusions: False personal beliefs

 Religiosity: Excessive demonstration of obsession with

religious ideas and behavior

 Paranoia: Extreme suspiciousness

of others
Nursing Process: Assessment (cont.)
Content of thought (cont.)

 Word salad: Group of words put together

in a random fashion

 Magical thinking: Idea that if one thinks something, it

must be true

 Mutism: Inability or refusal to speak

Nursing Process: Assessment (cont.)
Form of thought
 Associative looseness: Shift of ideas from one unrelated topic to another

 Neologisms: Made-up words that have meaning only to the person who
invents them

 Perseveration: Persistent repetition of the same word or idea in response to

different questions
Nursing Process: Assessment (cont.)
Perception

 Hallucinations: False sensory perceptions

not associated with real external stimuli

 Illusions: Misperceptions of real external

stimuli
Nursing Process: Assessment (cont.)
 Affect: Emotional tone
 Inappropriate affect: Emotions are
incongruent with circumstances

 Apathy: Lack of interest in environment

 Emotional ambivalence: Coexistence of

opposite emotions toward same object
Nursing Process: Assessment (cont.)

 Sense of Self: The uniqueness and

individuality a person feels

 Echolalia: Repeating words that are heard

 Echopraxia: Repeating movements that are

observed
Nursing Process: Assessment (cont.)
 Impaired interpersonal functioning and
relationship to the external world

 Autism

 Deterioration in appearance: Impaired

personal grooming and self-care activities
Nursing Process: Assessment (cont.)

 Psychomotor behavior (cont.)

 Anergia: Deficiency of energy

 Posturing: Voluntary assumption of

inappropriate or bizarre postures

 Pacing and rocking: Pacing back

and forth and rocking the body
Nursing Process: Assessment (cont.)

 Positive and negative symptoms

 Positive symptoms: Excess or distortion of

normal functions

 Negative symptoms: Deficit or loss of

normal functions
List of Nanda Nursing Diagnosis for Schizophrenia

 Ineffective role performance

 Powerlessness
 Risk for injury
 Risk for other-directed violence
 Risk for self-directed violence
 Social isolation
 Imbalanced nutrition: Less than body requirements
 Impaired home maintenance
 Impaired social interaction
 Impaired verbal communication
 Ineffective coping
List of Nanda Nursing Diagnosis for Schizophrenia

 Disturbed personal identity

 Disturbed sensory perception (auditory, visual)
 Disturbed sleep pattern
 Disturbed thought processes
 Dressing or grooming self-care deficit
 Fear
 Anxiety
 Bathing or hygiene self-care deficit
 Disabled family coping
 Disturbed body image
 Disturbed personal identity
Planning
 The client
 Demonstrates an ability to relate to others satisfactorily
 Recognizes distortions of reality
 Has not harmed self or others
 Perceives self realistically
 Demonstrates ability to perceive the environment correctly
 Maintains anxiety at a manageable level
 Demonstrates ability to trust others
 Uses appropriate verbal communication in interactions with
others
 Performs self-care activities independently
Implementation
 Nursing interventions for the client with
schizophrenia are aimed at:
 Decreasing anxiety and establishing trust
 Assisting client to define and test reality
 Encouraging interaction with others
 Ensuring safety of client and others
 Meeting client’s self-care needs
 Promoting adaptive family coping
Implementation -Client/Family Education

 Management of illness
 Appropriate medication management
 Side effects of medications
 Importance of not stopping medications
 When to contact healthcare provider
 Relaxation techniques
 Social skills training
 Daily living skills training
Treatment Modalities

 Schizophrenia requires treatment that is

comprehensive and presented in a
multidisciplinary effort.

 Psychological treatments
 Individual psychotherapy: Long-term
therapeutic approach difficult because of
client’s impairment in interpersonal functioning
Treatment Modalities (cont.)
 Psychological treatments (cont.)
 Group therapy: Some success if
participating over long-term course of the
illness; less successful in short-term
treatment

 Behavior therapy

 Occupational therapy
Treatment Modalities (cont.)

 Psychological treatments (cont.)

 Social skills training: Use of role play to
teach client appropriate eye contact,
interpersonal skills, posture, and so on, aimed
at improving relationship development

 Electroconvulsive therapy
Treatment Modalities (cont.)

 Social treatment
 Milieu therapy: a type of inpatient therapy,
involving prescription of particular activities
and social interactions according to a
patient's emotional and interpersonal needs

 Family therapy: Aimed at helping family

members cope with long-term effects of
illness
Treatment Modalities (cont.)
 Psychopharmacology
 Antipsychotics: Used to decrease agitation
and psychotic symptoms

 Antiparkinsonian agents

 Others: example:
 Diazepam (used to treat anxiety disorders, or
muscle spasms.)
 Propranolol (used to treat tremors, angina (chest
pain), hypertension, heart rhythm disorders, and
other heart or circulatory conditions.)
Treatment Modalities (cont.)
 Side effects for Antipsychotics (e. x:)
 Nausea; GI upset; weight gain
 Sedation
 Decreased libido
 Gynecomastia; amenorrhea

 The client should

 Not stop taking the drug abruptly
 Not consume other medications (including
over-the-counter drugs) without the physician’s
knowledge
Evaluation
 Evaluation questions
 Has client established trust with at least one staff
member?
 Is anxiety level maintained at a manageable level?
 Is delusional thinking still prevalent?
 Is client able to interrupt anxiety with adaptive
coping mechanisms?
 Is client easily agitated?