PPT-SCHIZOPHRENIA schizophrenia schiz.pdf

Schizophrenia

1. SCHIZOPHRENIA
Course:B.ScNursing
Subjectname:MentalHealthNursing
Unitnumberwithtittle:UnitNo:VI
Topicheading:Nursingmanagementofpatientwith
schizophreniaandotherpsychoticdisorders.
Prepared by:
Mrs.K.Banupriya. M.sc (N),
Tutor
KVCN.

2. 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
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3. 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

4. INTRODUCTION TO SCHIZOPHRENIA
Theword“Schizophrenia”wascoinedbytheSwiss
psychiatristEugenBleulerin1908.Itisderivedfromthe
GreekwordsSkizhomeanssplitandphrenmeansmind.
So,Schizophreniaisasplitofmind.
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5. Cont…..
Schizophreniaoccurstwiceasoftenin
peoplewhoareunmarriedanddivorced
peopleasinthosewhoaremarriedor
widowed.Peoplewithschizophreniaaremore
likelytobemembersoflowersocioeconomic
groups.In1896EmilKraepelinoriginallycalled
schizophreniadementiapraecox meaning
“madnessoftheyoung”todifferentiateitfrom
manic-depressivepsychosisduetothe
presenceofhallucinationsanddelusions.
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6. DEFINITION
Schizophreniaispsychoticconditioncharacterized
byadisturbanceinthinking,emotions,volitionsand
facultiesinthepresenceofclearconsciousness,
whichusuallyleadstosocialwithdrawal.

7. 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.
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8. CLASSIFICATION
Subtypes
•Paranoid
•Catatonic
•Disorganized
Signs and Symptoms
•Positive symptoms
•Negative symptoms
•Cognitive symptoms
•Mood symptoms

9. 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

10. EPIDEMIOLOGY
•About15%ofnewadmissionsinmental
hospitalsareschizophrenicpatients.
•Schizophreniaisequallyprevalentinmenand
women.
•Thepeakagesofonsetare15to25yearsfor
menand25to35yearsforwomen.
•Abouttwo-thirdsofcasesareintheagegroupof
15to30years.
•Thediseaseismorecommoninlower
socioeconomicgroups
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11. 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
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12. ETIOLOGY –GENETICS
•Thediseaseismorecommonamongpeopleborn
ofconsanguineousmarriages.Studiesshowthat
relativesofschizophrenicshaveamuchhigher
probabilityofdevelopingthediseasethanthe
generalpopulation.
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13. Genetics(cont’d)
Theprevalencerateamongfamilymembersof
schizophrenicsisasfollows:
•Childrenwithoneschizophrenicparent:12%
•Childrenwithbothschizophrenicparents:40%
•Siblingsofschizophrenicpatient:8%
•Second-degreerelatives:5-6%
•Dizygotictwinsofschizophrenicpatients:12%
•Monozygotictwinsofschizophrenicpatients:
47%
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14. STRESS-DIATHESIS MODEL
Accordingtothe stress-diathesismodel forthe
integrationofbiological,psychosocialand
environmentalfactors,apersonmayhaveaspecific
vulnerability(diathesis)that,whenactedonbyastressful
influence,allowsthesymptomsofschizophreniato
develop.Inthemostgeneralstress-diathesismodel,the
diathesisorthestresscanbebiological,environmentalor
both.Theenvironmentalcomponentagaincanbeeither
biological(e.g.aninfection)orpsychological(e.g.stressful
familysituation).Thebiologicalbasisofadiathesiscanbe
furthershapedbyepigeneticinfluencessuchassubstance
abuse,psychosocialstressandtrauma.
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15. Biochemical Factors
Dopaminehypotheses:Thistheorysuggests
thatan excessofdopamine-dependent
neuronalactivityinthebrainmaycause
schizophrenia.
Otherbiochemicalhypotheses:Variousother
biochemicalshavebeenimplicatedinthe
predispositiontoschizophrenia.Theseinclude
abnormalitiesintheneurotransmitters
norepinephrine,serotonin,acetylcholineand
gamma-aminobutyricacid(GABA),andneuro-
regulatorssuchasprostaglandinsand
endorphins.

16. PSYCHOLOGICAL FACTORS
Familyrelationshipsactasmajorinfluenceinthe
developmentofillness:
•Mother-childrelationship:Earlytheorists
characterizedthemothersofschizophrenicsas
cold,over-protective,anddomineering,thus
retardingtheegodevelopmentofthechild.
•Dysfunctionalfamilysystem: Hostility
betweenparentscanleadtoaschizophrenic
daughter(maritalskewandschism).
•Double-bindcommunication (Batesonetal,
1956):Parentsconveytwoormoreconflicting
andincompatiblemessagesatthesametime.
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17. 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
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18. RISKFACTORS
Certainfactorsseemtoincreasetheriskofdevelopingor
triggeringschizophrenia,including:
•Havingafamilyhistoryofschizophrenia
•Exposuretoviruses,toxinsormalnutritionwhileinthe
womb,particularlyinthefirstandsecondtrimesters
•Stressfullifecircumstances
•Olderpaternalage
•Takingpsychoactivedrugsduringadolescenceand
youngadulthood
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19. 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

20. Potential Early Symptoms: Pre-psychotic
•Withdrawal
•Depressed/Anxious
•Phobias
•Obsessions And Compulsions
•Difficulty Concentrating
•Preoccupation With Religion,
Self
•Dissociative Symptoms

21. SIGNS AND SYMPTOMS OF SCHIZOPHRENIA

22. CLINICAL FEATURES
Eugene Bleuler (1857-1939)
Kurt Schneider (1959)
Positive & Negative Symptoms
Other features
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23. EUGENE BLEULER (1857-1939)
1.Affective disturbance
2.Autistic thinking
3.Ambivalence
4.Associative looseness
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24. KURT SCHNEIDER IN 1959
1.Thought echo
2.Auditory hallucination
3.Thought withdrawal
4.Thought insertion
5.Thought broadcasting
6.Delusional perception
7.Somatic passivity
8.Made volition
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25. SYMPTOMS OF SCHIZOPHRENIA
•Positive Symptoms
–Hallucinations
–Delusions
–Bizarre Behavior
–Paranoia
•Negative Symptoms
–Apathy
–Flat Affect
–Alogia; Poverty Of
Speech
–Avolition; Lack Of
Motivation
–Anhedonia
–Poor Social
Functioning

26. 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

27. Positive Symptoms:
Alterations In Speech
•Associative Looseness
•Neologisms
•Echolalia
•Clang Association
•Word Salad

28. Positive Symptoms:
Alterations In Perception
•Hallucinations: Sensory Perceptions For Which
No External Stimulus Exists
–Auditory
–Visual
–Olfactory
–Tactile

29. Positive Symptoms:
Alterations In Behavior
•Extreme Motor Agitation
•Stereotyped Behaviors
•Waxy Flexibility
•Stupor

30. Negative Symptoms
•Affective Blunting
•Anergia
•Anhedonia
•Avolition
•Poverty Of Content Of Speech
•Thought Blocking
•Flat Affect/Inappropriate Affect

31. Cognitive Symptoms
•Inattention, Easily Distracted
•Impaired Memory
•Poor Problem-solving Skills,
executive functioning
–Poor Decision-making Skills
–Illogical Thinking
–Impaired Judgment

32. Depression And
Other Mood Symptoms
•Dysphoria
•Suicidal Ideation
•Hopelessness

33. OTHER FEATURES
•Decreased functioning in work, social relations,
and self care
•Loss of ego boundaries
•Multiple somatic symptoms
•Insight absent
•Poor judgement
•Suicidal Ideation
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