Schizophrenia Session 11

SCHIZOPHRENI
Sehrish Naz
RN, Post RN, MSN
Lecturer, INS,KMU
To Know Schizophrenia is to know
Psychiatry
 The most devastating
(upsetting) illness that
psychiatrist treat.
 One of the most challenging
disease in medicine
 1% of population has
Schizophrenia.
 An enormous economic burden
 A major health concern
DEFINITION
Schizophrenia is defined as functional
psychotic condition characterized by
disturbances in thinking, emotion and
perception in presence of clear
consciousness, which usually leads to
social withdrawal.
 Psychotic mental disorder of
unknown Aetiology characterized
by disturbances in
 Thinking (e.g. distortion of reality,
delusions and hallucinations)
 Mood (e.g. ambivalence,
inappropriate affect)
 Behaviour (e.g. Apathetic
withdrawal, bizarre activity)
 at least 6 months
 Bizarre activity
Aetiology
Unreliable; however there is
evidence for several risk factors.
Several models which can be
grouped into….
Aetiology – Bio
 Genetics Consideration
 1st degree & 2nd degree relative
 Environmental
 Abnormalities of pregnancy and delivery [2%]
 Fetal Malnutrition [2%]
 Low Socioeconomic Class birth [1.1%]
Social
 Studies have shown an excess of schizophrenic
patients in lower socioeconomic groups and
increased in urban areas.
Psychological
 Abnormalities in processing
sensory information, in
separating “signal from
background noise”, or in
manipulating abstract
information
Pathophysiology
 Disorder of dopaminergic function:
 Related to increased dopamine activity
in certain neuronal tracts.
 Other neurotransmitter abnormalities

implicated in schizophrenia:
 Elevated serotonin.
 Elevated norepinephrine.
 Decreased gamma- amino butyric acid
(GABA).
Major Divisions of Symptoms
 Positive Symptoms
 Negative Symptoms
 Psychomotor Symptoms
Positive / Hard symptoms.
 Characterized as a pathological excess because the symptoms
in this group add to a person’s behavior rather than subtract
from a person’s behavior.
 Ambivalence: Holding seemingly contradictory beliefs or
feelings about the same person, event, or situation
 Associative looseness: Fragmented or poorly related thoughts
and ideas
 Delusions: Fixed false beliefs that have no basis in reality
 Echopraxia: Imitation of the movements and gestures of
another person whom the client is observing
 Flight of ideas: Continuous flow of verbalization in which
the person jumps rapidly from one topic to another
 Hallucinations: False sensory perceptions or perceptual
experiences that do not exist in reality
 Ideas of reference: False impressions that external events
have special meaning for the person
 Perseveration: Persistent adherence to a single idea or topic;
verbal repetition of a sentence, word, or phrase; resisting
attempts to change the topic
Negative /Soft symptoms
 Characterized as pathological deficits.
 Alogia: Tendency to speak very little (poverty of content)
 Anhedonia: Feeling no joy or pleasure from life or any
activities or relationships
 Apathy: Feelings of indifference toward people,
activities, and events(lethargy)
 Blunted affect: Restricted range of emotional feeling,
tone, or mood
Cont…
 Flat affect: Absence of any facial expression that
would indicate emotions or mood
 Lack of volition: Absence of will, ambition, or
drive to take action
 Catatonia: Psychologically induced immobility
the client seems motionless, as if in a
trance(dream)
 Inattention
 Inability to concentrate or focus on a topic
activity.
 A sociality
 Social withdrawal few or no relationship lack of
closeness.
Psychomotor symptoms.
 Lastly, the
category of psychomotor symptoms
involve awkward movements, repeated gestures,
and even catatonia.
 Waxy flexibility: They maintain any position in
which they are placed, even if the position is
awkward or uncomfortable.
Delusions & Hallucinations.
 Delusions (fixed, false
beliefs with no basis in
reality) in the psychotic
phase of the illness. Client
is very sure about that
thinking.
 Grandiose delusions
 Religious delusions
 Somatic delusions
 Referential delusions
 Sexual delusions
Hallucination.
 false sensory perceptions,
or perceptual experiences
that do not exist in
reality.
 Auditory.
 Visual
 Olfactory
 Tactile.
Thought process abnormalities.
 Clients may suddenly stop talking in the middle of a
sentence and remain silent for several seconds to 1
minute (thought blocking).
 They also may state that they believe others can hear
their thoughts (thought broadcasting);
 that others are taking their thoughts (thought
withdrawal); or
 that others are placing thoughts in their mind against
their will (thought insertion).
 Tangential thinking, which is swinging onto
unrelated topics and never answering the original
question.
 Depersonalization in which the client feels
detached from her or his behavior. Although the
client can state her or his name correctly, client
feels as her or his body belongs to someone else
or that her or his spirit is detached from the body.
Nursing intervention for the client with
Schizophrenia
Establishing therapeutic relationship by
establishing trust.
Promoting safety to client and give privacy and
dignity.
Use therapeutic communication techniques
to(clarifying feeling and statements when clients
speech and clarify thoughts or if patient are
confused.
 Nursing intervention for the client with
Delusions
 Do not openly confront the delusions or argue with
the patient.
 Establish and maintain reality for the client.
 Teach the patient positive self talk ,positive
thinking and to ignore delusional thoughts.
 Nursing intervention for the client with
Hallucinations
 Help present and maintain reality by frequent
contact and communication with client.
 Elicit description of hallucination to protect client
and others.
 The nurse’s understanding of the hallucination
helps him or her know how to calm or reassure the
client.
 Engage client in reality-based activities such as
card playing, occupational therapy, or listening to
music.
DIAGNOSIS
CRITERIA OF
SCHIZOPHREN
IA
The diagnosis of schizophrenia is

based entirely on the clinical
presentation – history and
examination.
DSM-IV diagnostic criteria
A. Characteristic symptoms.
At least 2 of the following; F. Social/occupational
each for 1- month period: dysfunction
G. Continuous signs of the
a. delusions disturbance persists for at
least six months
b. hallucinations
c. disorganized speech
d. grossly disorganized or
catatonic behavior
e. negative symptoms,
(poverty of speech)

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SCHIZOPHRENI

 Other neurotransmitter abnormalities

The diagnosis of schizophrenia is

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