SCHIZOPHRENIASCHIZOPHRENIA

What is Schizophrenia?What is Schizophrenia?

Schizophrenia is a chronic mental Schizophrenia is a chronic mental illness with symptomatic illness with symptomatic manifestations of hallucinations, manifestations of hallucinations, delusions, and social withdrawal.delusions, and social withdrawal.

It usually begins before age 25 and it It usually begins before age 25 and it persists throughout life and affects persists throughout life and affects persons of all social classes.persons of all social classes.

HISTORYHISTORY

Benedict Morel (1809-1873)Benedict Morel (1809-1873)

He had used the term He had used the term demence demence precoce precoce for deteriorated patients for deteriorated patients whose illness began in adolescence.whose illness began in adolescence.

Emil Kraepelin (1856-1926)Emil Kraepelin (1856-1926)

He translated Morel’s demence He translated Morel’s demence precoce into Dementia Praecox, a precoce into Dementia Praecox, a term that emphasized the distinct term that emphasized the distinct cognitive process (dementia) and cognitive process (dementia) and early onset (praecox) of the disorder.early onset (praecox) of the disorder.

Patients with dementia praecox Patients with dementia praecox were described as having a long-were described as having a long-term deteriorating course and the term deteriorating course and the common clinical symptoms of common clinical symptoms of hallucinations and delusions.hallucinations and delusions.

Eugen Bleuler (1857-1939)Eugen Bleuler (1857-1939)

He coined the term He coined the term schizophrenia schizophrenia which replaced the term dementia which replaced the term dementia praecox in literature.praecox in literature.

He stressed that schizophrenia need He stressed that schizophrenia need not have a deteriorating course. not have a deteriorating course.

His term schizophrenia has become His term schizophrenia has become the internationally accepted label for the internationally accepted label for the disorder.the disorder.

Bleuler’s Four A’sBleuler’s Four A’s

Associations, LooseAssociations, Loose

Affect, BluntedAffect, Blunted

AutismAutism

AmbivalentAmbivalent

MeyerMeyer The founder of Psychobiology.The founder of Psychobiology. He saw Schizophrenia as reaction to He saw Schizophrenia as reaction to

life stresses and called the syndrome life stresses and called the syndrome a schizophrenic reaction.a schizophrenic reaction.

SullivanSullivan Emphasized social isolation as a Emphasized social isolation as a

cause and a symptom of cause and a symptom of schizophrenia.schizophrenia.

LangfeldtLangfeldt Classified patients with major Classified patients with major

psychotic symptoms into two groups:psychotic symptoms into two groups:

1. Those with true 1. Those with true SchizophreniaSchizophrenia

2. Those with a Schiozophrenia-2. Those with a Schiozophrenia-like like psychosis psychosis

Gender and AgeGender and Age

Schizophrenia is equally prevalent Schizophrenia is equally prevalent in men and women.in men and women.

It usually begins before age 25, and It usually begins before age 25, and persists throughout life and affects persists throughout life and affects persons of all social classes.persons of all social classes.

FallacyFallacy

Schizophrenia is Split Schizophrenia is Split PersonalityPersonality

In reality, split personality is Dissociative In reality, split personality is Dissociative Identity Disorder according to DSM IV TRIdentity Disorder according to DSM IV TR

It differs completely from Schizophrenia.It differs completely from Schizophrenia.

Schizophrenic Thought Content

Subtypes of SchizophreniaSubtypes of Schizophrenia

Paranoid SchizophreniaParanoid Schizophrenia

It is characterized by preoccupation It is characterized by preoccupation with one or more delusions or frequent with one or more delusions or frequent auditory hallucinationsauditory hallucinations

Characterized by the presence of Characterized by the presence of delusions of persecution and grandeurdelusions of persecution and grandeur

They are typically tense, suspicious, They are typically tense, suspicious, guarded, sometimes hostile or guarded, sometimes hostile or aggressiveaggressive

Their intelligence remains intact.Their intelligence remains intact.

A Schizophrenic Paranoid Patient

Nursing ResponsibilitiesNursing Responsibilities

Do not whisperDo not whisper Provide sealed meal rationsProvide sealed meal rations Establish rapportEstablish rapport Provide a calm environmentProvide a calm environment Medicate on timeMedicate on time Encourage to sleep on timeEncourage to sleep on time Provide reading materialsProvide reading materials

Disorganized SchizophreniaDisorganized Schizophrenia

Is characterized by a marked regression Is characterized by a marked regression to primitive, disinhibited, and to primitive, disinhibited, and unorganized behavior.unorganized behavior.

The onset is generally early before age The onset is generally early before age 2525

Thought disorder is pronounced and Thought disorder is pronounced and contact with reality is poor.contact with reality is poor.

Behavior is silly, fatuous and collective.Behavior is silly, fatuous and collective. Appearance is dilapidated and behavior Appearance is dilapidated and behavior

is inappropriate.is inappropriate.

Disorganized Schizophrenic Client

Nursing ResponsibilitiesNursing Responsibilities

Supervise hygieneSupervise hygiene Monitor patient belongingsMonitor patient belongings Provide calm environmentProvide calm environment Medicate on timeMedicate on time Encourage sleeping on timeEncourage sleeping on time Administer restraints as orderedAdminister restraints as ordered

Catatonic SchizophreniaCatatonic Schizophrenia

They have marked disturbance in They have marked disturbance in motor function.motor function.

This disturbance may involve stupor, This disturbance may involve stupor, rigidity, excitement, and positioning.rigidity, excitement, and positioning.

Associated features are stereotypies, Associated features are stereotypies, mannerisms, and waxy flexibility.mannerisms, and waxy flexibility.

Mutism is particularly common.Mutism is particularly common. Patients need careful supervision Patients need careful supervision

during catatonic stupor or excitement.during catatonic stupor or excitement.

Nursing ResponsibilitiesNursing Responsibilities

Provide nutritionProvide nutrition Provide safetyProvide safety Provide restraints as orderedProvide restraints as ordered Provide calm environmentProvide calm environment Medicate on timeMedicate on time Encourage to sleep on timeEncourage to sleep on time

Residual SchizophreniaResidual Schizophrenia

Characterized by a continuing Characterized by a continuing evidence of schizophrenic disturbance evidence of schizophrenic disturbance in the absence of a complete set of in the absence of a complete set of active symptoms.active symptoms.

Emotional blunting, social withdrawal, Emotional blunting, social withdrawal, eccentric behavior, illogical thinking eccentric behavior, illogical thinking and mild loosening of associations and mild loosening of associations commonly appear with this type.commonly appear with this type.

Nursing ResponsibilitiesNursing Responsibilities

Medicate on timeMedicate on time Encourage to sleep on timeEncourage to sleep on time Encourage client to join art and Encourage client to join art and

occupational therapy in order to find occupational therapy in order to find one’s aesthetic skillsone’s aesthetic skills

Encourage client to verbalize Encourage client to verbalize feelings.feelings.

Provide calm environmentProvide calm environment

Schizophrenia Schizophrenia UndifferentiatedUndifferentiated

These patients are clearly These patients are clearly schizophrenic but cannot be easily schizophrenic but cannot be easily fitted into one or another type.fitted into one or another type.

Nursing ResponsibilitiesNursing Responsibilities

Medicate on time Medicate on time Encourage to sleep on timeEncourage to sleep on time Encourage verbalization of feelingsEncourage verbalization of feelings

Anti- Psychotic MedicationsAnti- Psychotic Medications

Lower end:Lower end: Chlorpromazine (thorazine/Laractyl)Chlorpromazine (thorazine/Laractyl) HaloperidolHaloperidol LevomepromazineLevomepromazine

Anti-psychotic MedicationsAnti-psychotic Medications

Higher endHigher end OlanzapineOlanzapine Risperidone (Risperdal)Risperidone (Risperdal) Amisulpride (Solian)Amisulpride (Solian) Clozapine (Leponex)Clozapine (Leponex)

Depot MedicationsDepot Medications

Fluphenazine (Shrizine)Fluphenazine (Shrizine) Haloperidol (HALDOL) DecanoasHaloperidol (HALDOL) Decanoas Risperidone ConstaRisperidone Consta

TranquilizersTranquilizers

Haloperidol 5mg/mlHaloperidol 5mg/ml

- For restraining the client - For restraining the client chemicallychemically

Anti-EPS:Anti-EPS: Biperiden (Akineton)Biperiden (Akineton)

- Available in tablet and in vial- Available in tablet and in vial