The document discusses schizophrenia including its definition, classification, epidemiology, etiology, risk factors, signs and symptoms, and nursing management. Schizophrenia is a psychotic disorder characterized by disturbances in thinking, emotions, perception and behavior. Genetic and environmental factors are involved in its etiology. Positive and negative symptoms include hallucinations, delusions, flat affect, and apathy.
The document discusses schizophrenia including its definition, classification, epidemiology, etiology, risk factors, signs and symptoms, and nursing management. Schizophrenia is a psychotic disorder characterized by disturbances in thinking, emotions, perception and behavior. Genetic and environmental factors are involved in its etiology. Positive and negative symptoms include hallucinations, delusions, flat affect, and apathy.
The document discusses schizophrenia including its definition, classification, epidemiology, etiology, risk factors, signs and symptoms, and nursing management. Schizophrenia is a psychotic disorder characterized by disturbances in thinking, emotions, perception and behavior. Genetic and environmental factors are involved in its etiology. Positive and negative symptoms include hallucinations, delusions, flat affect, and apathy.
The document discusses schizophrenia including its definition, classification, epidemiology, etiology, risk factors, signs and symptoms, and nursing management. Schizophrenia is a psychotic disorder characterized by disturbances in thinking, emotions, perception and behavior. Genetic and environmental factors are involved in its etiology. Positive and negative symptoms include hallucinations, delusions, flat affect, and apathy.
Subject name: Mental Health Nursing Unit number with tittle: Unit No: VI Topic heading: Nursing management of patient with schizophrenia and other psychotic disorders. Prepared by: Mrs.K.Banupriya. M.sc (N), Tutor KVCN. OBJECTIVES At the end of the class learner can able to • define schizophrenia • identify the etiological factors • classify the types of schizophrenia • list out the clinical manifestations • analyze the treatment modalities • explain the nursing management of patients with schizophrenia
2 CONTENT OVERVIEW/ INTRODUCTION
• Classification: ICD10 • Etiology, psycho-pharmacology, types, clinical manifestations, diagnosis • Nursing assessment: History, physical & mental status assessment • Treatment modalities & nursing management of patients with schizophrenia and other psychotic disorders • Geriatric considerations • Follow-up , home care and rehabilitation INTRODUCTION TO SCHIZOPHRENIA
The word “Schizophrenia” was coined by the Swiss
psychiatrist Eugen Bleuler in 1908. It is derived from the Greek words Skizho means split and phren means mind. So, Schizophrenia is a split of mind.
3 Cont…..
Schizophrenia occurs twice as often in
people who are unmarried and divorced people as in those who are married or widowed. People with schizophrenia are more likely to be members of lower socioeconomic groups. In 1896 Emil Kraepelin originally called schizophrenia dementia praecox meaning “madness of the young” to differentiate it from manic-depressive psychosis due to the presence of hallucinations and delusions.
5 DEFINITION
Schizophrenia is psychotic condition characterized
by a disturbance in thinking, emotions, volitions and faculties in the presence of clear consciousness, which usually leads to social withdrawal. CLASSIFICATION ICD -10 F20-29: Schizophrenia, schizotypal and delusional disorders. F20: Schizophrenia F20.0: Paranoid Schizophrenia F20.1: Hebephrenic Schizophrenia F20.2: Catatonic Schizophrenia F20.3: Undifferentiated Schizophrenia F20.4: Post-schizophrenic depression F20.5: Residual Schizophrenia F20.6: Simple Schizophrenia F21: Schizotypal disorders. 7 CLASSIFICATION Subtypes • Paranoid • Catatonic • Disorganized Signs and Symptoms • Positive symptoms • Negative symptoms • Cognitive symptoms • Mood symptoms FACTS ABOUT SCHIZOPHRENIA
• Late Teens To Early Thirties
– Early 20’s For Men / Late 20’s For Women • 1 In 100 Adults • 1 In 40,000 Children EPIDEMIOLOGY
• About 15% of new admissions in mental
hospitals are schizophrenic patients. • Schizophrenia is equally prevalent in men and women. • The peak ages of onset are 15 to 25years for men and 25 to 35 years for women. • About two-thirds of cases are in the age group of 15 to 30 years. • The disease is more common in lower socioeconomic groups
10 ETIOLOGY
The cause of schizophrenia is still uncertain. Some
of the factors involved may be: Genetic Factors Stress-Diathesis Model Biochemical Factors Psychological Factors Social Factors
11 ETIOLOGY – GENETICS
• The disease is more common among people born
of consanguineous marriages. Studies show that relatives of schizophrenics have a much higher probability of developing the disease than the general population.
21 Genetics (cont’d)
The prevalence rate among family members of
schizophrenics is as follows: • Children with one schizophrenic parent: 12% • Children with both schizophrenic parents: 40% • Siblings of schizophrenic patient: 8% • Second-degree relatives: 5-6% • Dizygotic twins of schizophrenic patients: 12% • Monozygotic twins of schizophrenic patients: 47% 13 STRESS-DIATHESIS MODEL
According to the stress-diathesis model for the
integration of biological, psychosocial and environmental factors, a person may have a specific vulnerability (diathesis) that, when acted on by a stressful influence, allows the symptoms of schizophrenia to develop. In the most general stress-diathesis model, the diathesis or the stress can be biological, environmental or both. The environmental component again can be either biological (e.g.an infection) or psychological (e.g. stressful family situation). The biological basis of a diathesis can be further shaped by epigenetic influences such as substance abuse, psychosocial stress and trauma.
14 Biochemical Factors Dopamine hypotheses: This theory suggests that an excess of dopamine-dependent neuronal activity in the brain may cause schizophrenia. Other biochemical hypotheses: Various other biochemicals have been implicated in the predisposition to schizophrenia. These include abnormalities in the neurotransmitters norepinephrine, serotonin, acetylcholine and gamma-aminobutyric acid (GABA), and neuro- regulators such as prostaglandins and endorphins. PSYCHOLOGICAL FACTORS Family relationships act as major influence in the development of illness: • Mother-child relationship: Early theorists characterized the mothers of schizophrenics as cold, over-protective, and domineering, thus retarding the ego development of the child. • Dysfunctional family system: Hostility between parents can lead to a schizophrenic daughter (marital skew and schism). • Double-bind communication (Bateson et al, 1956): Parents convey two or more conflicting and incompatible messages at the same time. 25 SOCIAL FACTORS Living in an urban environment has been consistently found to be a risk factor for schizophrenia. Social disadvantage found to be a risk factor, include: • Poverty, • Migration related to social adversity, • Racial discrimination, • Family dysfunction, • Unemployment • Poor housing
27 RISK FACTORS Certain factors seem to increase the risk of developing or triggering schizophrenia, including: •Having a family history of schizophrenia •Exposure to viruses, toxins or malnutrition while in the womb, particularly in the first and second trimesters •Stressful life circumstances •Older paternal age •Taking psychoactive drugs during adolescence and young adulthood 37 PHASES IN COURSE OF SCHIZOPHRENIA 1. Acute Phase – Positive Symptoms And Negative Symptoms 2. Maintenance Phase – Acute Symptoms Are Less Severe 3. Stabilization Phase – Remission Of Symptoms Potential Early Symptoms: Pre-psychotic
• Withdrawal • Depressed/Anxious • Phobias • Obsessions And Compulsions • Difficulty Concentrating • Preoccupation With Religion, Self • Dissociative Symptoms SIGNS AND SYMPTOMS OF SCHIZOPHRENIA CLINICAL FEATURES
Eugene Bleuler (1857-1939)
Kurt Schneider (1959) Positive & Negative Symptoms Other features
1. Thought echo 2. Auditory hallucination 3. Thought withdrawal 4. Thought insertion 5. Thought broadcasting 6. Delusional perception 7. Somatic passivity 8. Made volition
24 SYMPTOMS OF SCHIZOPHRENIA
• Positive Symptoms • Negative Symptoms
– Hallucinations – Apathy – Delusions – Flat Affect – Bizarre Behavior – Alogia; Poverty Of – Paranoia Speech – Avolition; Lack Of Motivation – Anhedonia – Poor Social Functioning Positive Symptoms: Alteration In Thinking • Delusions: False, Fixed Beliefs That Cannot Be Corrected By Reasoning – Ideas Of Reference – Persecution – Grandiosity – Somatic Sensations – Jealousy – Control – Thought Broadcasting – Thought Insertion – Thought Withdrawal Positive Symptoms: Alterations In Speech
• Associative Looseness • Neologisms • Echolalia • Clang Association • Word Salad Positive Symptoms: Alterations In Perception
• Hallucinations: Sensory Perceptions For Which
No External Stimulus Exists – Auditory – Visual – Olfactory – Tactile Positive Symptoms: Alterations In Behavior
