Description

characterized by a disintegration of thought processes and of emotional responsiveness (Videbeck, 2004) Causes distorted and bizarre thoughts, perceptions, emotions, movements and behavior "multiple personality disorder" or "split personality cognitive

Incidence
affects men about one and a half times more

commonly than women Usually diagnosed in late adolescence or early adulthood Peak incidence of onset: 15-25 for men, 2535 for women Prevalence is at 1% of the total population

Onset
rarely occurs before age 10 or after age 40

Diagnosis
No specific biomarker based on observed behavior and the

patient's reported experiences

Risk Factors
Genetics Early environment Neurobiology Psychological Social processes

 Etiology

Genetics
Identical twins 48% Fraternal twins 17% Parents 6%

Siblings 9%
Children 13%

 Neuroanatomic / Neurochamical Findings: less brain tissue and CSF

Enlarged ventricles of the brain and cortical atrophy Glucose metabolism and O2 diminished in the frontal

cortical structures (PET) Dopamine excess

 Environment living environment drug use prenatal stressors (hypoxia and infection, or stress and malnutrition in the mother) urban environment during childhood or as an adult has consistently been found to increase the risk of schizophrenia by a factor of two Social isolation and immigration related to social adversity, racial discrimination, family dysfunction, unemployment, and poor housing conditions Childhood experiences of abuse or trauma

HISTORY
In 1911 Dr Eugene Bleuler, from Europe, identified the behaviors typical of people with schizophrenia. He renamed it-schizophreniameaning splitting of the mind. The patient is split off from reality, not a split personality. Emil Kraeplin, a European doctor, first described it in 1896.

SYMPTOMS

SYMPTOMS:

Positive / hard - symptoms that involve an excess of normal bodily functions

Ambivalence contradictory feelings
Associative looseness unrelated thoughts Delusions false beliefs

Echopraxia imitation of movements

Flight of ideas jumps from 1 topic to another Hallucinations false sensory perceptions

Ideas of reference all related me

Perseveration adherence to a topic

Negative / soft - symptoms that involve a decrease in normal bodily functions

Alogia poverty of content Anhedonia no pleasure Apathy - indifference Blunted affect no emotion Catatonia Flat affect no facial expression Lack of volition

Cognitive
* * * * * Word salad Circumstantiality Tangentiality Mutism Preseveration

Perceptual
* Hallucinations Auditory Tactile Gustatory Olfactory * Impaired Sensory Filtering

Affective
Inappropriate affect

Behavioral

* Impaired interpersonal functioning Bland or Flat affect * Social isolationApathy aloof * Emotional Anhedonia detachment Overreactive affect * Poor personal appearance * Inadequate social skills

The four As of Bleuler:

Affect- the feelings reflected on our faces, in our expressions, and by our demeanor or behavior. Associations Autism Ambivalence

STAGES OF SCHIZOPHRENIA

Prodromal Stage
refers to the year before the illness appears
early symptoms and signs of an illness that come

before the characteristic symptoms appear Usually appears in the period of adolescence symptoms for many disorders overlap isolation Increasingly withdraws from socializing, dull and non responsive

Acute stage
active phase indicates full development of

the disorder psychosis including paranoia, delusion & hallucinations occur greatly interfering with the person's ability to function Hospitalization is often required Goal: EARLY TREATMENT

Residual stage
features of the residual phase are very

similar to the prodromal stage Patients do not appear psychotic but may experience some negative symptoms such as lack of emotional expression or low energy continue to experience strange beliefs lingering issues such as lack of energy, diminished emotional expression and strange insecurities or fears, however, they do not interfere with day to day functioning. These may diminish in time or become ingrained into the person's personality

TYPES

Schizophrenia, Paranoid type

Characterized by persecutory or grandiose

delusions, hallucinations and excessive religiosity or hostile and aggressive behavior

Schizophrenia, disorganized type

Characterized by grossly inappropriate or

flat affect, incoherence, loose associations and extremely disorganized behavior hebephrenic schizophrenia thought disorder and flat affect are present together

Schizophrenia, Catatonic type

Characterized by marked psychomotor

disturbance, either motionless or excessive motor activity Cataplexy (waxy flexibility) / stupor Extreme negativism, mutism, peculiarities of volutary movement, echolalia, echopraxia Purposeless motor activity

Schizophrenia, undifferentiated type

Mixed schizophrenic symptoms along with

disturbances of thought, affect and behavior Psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types have not been met

Schizophrenia, Residual type

have little interest in life and will not engage

in eye contact or conversation lasts for one year and is characterized by negative symptoms

TREATMENT

Drug and psychosocial interventions for the symptoms of schizophrenic disorders contribute to a lower incidence and prevalence of schizophrenia (Falloon et.al, 1996)

Medical management

Types of medications used for schizophrenia treatment

Typical Atypical The typical antipsychotics are the oldest antipsychotic medications and have a successful track record in the treatment of hallucinations, paranoia, and other psychotic symptoms. However, they are prescribed less frequently today because of the neurological side effects, known as extrapyramidal symptoms, they often cause.

 atypical antipsychotics produce fewer extrapyramidal side effects than the typical antipsychotics, they are recommended as the first-line treatment for schizophrenia

EPS for Typical Aps

EPS for Atypical APs

Psychosocial
Tip 1 get involved in treatment Dont buy into the stigma of schizophrenia. Communicate with your doctor. Pursue therapies that teach you how to manage and cope with your symptoms. Set and work toward life goals.

Tip 2 Build a strong support system

Turn to trusted friends and family

members. Take advantage of support services in your area.

Tip 3 Put medication in its place

Medication is not a cure for

schizophrenia. Medication only treats some of the symptoms of You should not have to put up with disabling side effects. Never reduce or stop medication on your

Tip 4 - Make healthy lifestyle choices

Manage stress. Try to get plenty of sleep. Avoid alcohol and drugs. Get regular exercise. Do things that make you feel good about

yourself.

Tip 5 Explore options in your community

Nursing care

Assessment
Assessing mood and cognitive state
Assessing potential for violence Assessing social support

Assessing knowledge

 Nursing

Diagnosis

1. Disurbed thought process related to biochemical imbalances, as evidenced by hypervigilence, distractibility, por concentration, disordered thought sequencing, inappropriate responses, and thinking not based in reality. 2. Disturbed sensory perception( auditory/visual) related to biochemical imbalances, as evidencd by auditory or visual hallucinations. 3. Risk for other- directed or self directed violence related to delusional thoughts and hallucinatory commands, history of childhood abuse, or panic,as evidencedby overt aggressive acts, threatening stances, pacing, or suicidal ideation or plan. 4. Social isolation related to alterations in mental status and an ability to engage in satisfying personal relationships, as evidenced by sad, flat affect, absence of supportive significant others, withdrawal, uncommunicativeness and inability to meet the expectations of others. 5. Noncompliance with medication regimen related to health beliefs and lack of motivation, as evidenced by failure to adhere to medication schedule. 6. Ineffective coping related to disturbed thought process as evidenced by inability to meet basic needs. 7. Interrupted family process related to shift in health status of a family member and situational crisis, as evidenced by changes in the family's goals, plans, and activities and changes in family pattern and rituals. 8. Risk for ineffective family management of therapeutic regimen related to knowledge deficit and complexity of client,s healthcare needs.

Implementation
Disturbed thought process Convey acceptance of client's need for false belief but that you do not share the belief Do not argue or deny the belief Reinforce and focus on reality If client is suspicious Consistent staff Honest, keep all promises

 Disturbed Sensory Perception

Auditory/Visual
Observe for signs of hallucinations Avoid touching client without warning

Do not reinforce the hallucination - let the client

know that you do not share the perception "Even though I know the voices are real to you, I do not hear them" Help client understand connection between anxiety and hallucinations Try to distract

 Social Isolation Convey accepting attitude by making brief, frequent contacts. Show unconditional positive regard Offer to be with client during group activities that he/she finds frightening Give recognition and positive reinforcement for client voluntary interactions with others

 Self Care Deficit Provide assistance as appropriate Encourage independence - positive reinforcement concrete communications

 Impaired verbal communication Seek validation and clarification Consistent staff Verbalizing the implied Orient to reality