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1. Schizophrenia Nuzhat sher Medicare College Of Nursing

2. Schizophrenia Chronic and severe mental disorder that affects how a person thinks, feels and behaves that causes significant impairment in role functioning.

3. Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions, movements, and behavior. It cannot be defined as a single illness; rather, schizophrenia is thought of as a syndrome or as disease process with many different varieties and symptoms, much like the varieties of cancer.

4. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women (American Psychiatric Association [APA], 2000).

5. DSM-IV Criteria A Characteristic Symptoms: at least two present for significant period of time during one month (unless successfully treated). Social/Occupational Dysfunction Delusions hallucinations disorganized speech grossly disorganized or catatonic behavior negative symptoms (affective flattening, alogia or avolition )

6. Symptoms Positive or hard symptoms Negative or soft symptoms

7. Positive or hard symptoms Delusions. Fixed false beliefs. Hallucinations. False sensory perceptions. Ambivalence. Holding contradictory beliefs. Associative looseness. Poorly related thoughts Echopraxia . Imitation of movements. Flight of ideas. Jumps rapidly

8. Types of Hallucinations

9. Cont … Ideas of reference. External events have special meaning. Perseveration. Persistent adherence to single idea.

10. Negative or Soft symptoms Alogia . Little talk Anhedonia . Feeling no joy Apathy. Feeling of indifference. Blunted affect. Restricted range of emotion Catatonia. Immobility Flat affect. Absence of facial expression Lack of volition. Absence of will

11. Types Schizophrenia paranoid : Feeling victimized, grandiosity, hallucinations, hostile behavior. Schizophrenia disorganized: Inappropriate or flat affect, incoherence, loose association.

12. Cont … Schizophrenia catatonic: Extreme psychomotor disturbance, negativism, mutism . Schizophrenia undifferentiated. Mixed symptoms of other types with disturbance of thought, behaviour .

13. Cont …. Schizophrenia residual : At least one previous episode, social withdrawal, flat affect, loose association. Schizoaffective disorder. is diagnosed when the client has the psychotic symptoms of schizophrenia and meets the criteria for a major affective or mood disorder

14. Etiology Genetic theories Neuroanatomic theories Neurochemical theories Biological theories

15. Genetic factors Primary genetic abnormality Abnormalities in transmitter genes Abnormalities in vesicular binding Abnormalities in transcription factors (hypothesized) Non-genetic prenatal or perinatal events Poor maternal nutrition Maternal infection Obstetric complications Urban birth Season of birth

16. Neuroanatomic factors Less brain tissue, less brain volume, less CSF

17. Enlarged ventricles Less glucose metabolism and oxygen supply.

18. Neurochemical factors Disturbance of Neuronal Networks Dopamine and serotonin plays vital roll.

19. Imunovirologic factors Cytokines

20. Clinical course Abrupt onset Immediate course Long term course.

21. Related disorder Schizopreniform disorder Symptoms less than six months and no functional impairment. Delusional disorder One or more delusions that are believable.

22. Cont …. Brief psychotic disorder At least one psychotic symptoms for one day to one month. Shared psychotic symptom Two people share similar delusions

23. Management Schizophrenia can be treated via the following ways:- Drug Treatment (medicinal) Humanistic Therapy (especially Client-Centred Therapy) Behaviour Therapy (Family Therapy) Cognitive Therapy (CBT)

24. Treatment Psychopharmacology

25. Side eefects Extra pyramidal side effects. Dystonic reactions

26. Pseudoparkinsonism

27. Akathasia

28. Tardive dyskinesia

29. AIMS AIMS

30. Seizures Neuroleptic malignant syndrome Agranulocytosis

31. Humanistic Therapy Throughout the 20 th century, many psychotherapists felt that psychological therapy was focussing to much on structures, like personality; losing sight of how the sufferers felt. Consequently, a number of Humanistic therapies developed: Client-Centred Therapy and Gestalt Therapy Key features of humanistic therapies include:- They were holistic therapies- considering the patient as a whole, and not just their particular psychopathological symptoms Therapy should help enable patients to make their own decisions and solve their problems, rather than imposing structured treatments or ways of thinking on to them

32. 3. Focus on the therapist-client relationship should be based on genuine care and empathy, rather than the limited, constrained type which professional specialists maintain . 4. Emotional awareness in patients need to be developed, before patients can face and resolve their life problems, as it helps alleviate psychological distress.

33. Client-Centred Therapy Carl Rogers (1902-87), a psychologist who developed client-centred therapy during the 1940s and 1950s It is also known as Person-Centred Therapy (PCT) and Rogerian Psychotherapy Crucial to this therapy is the creation of a therapeutic climate that allows the client to progress from a state of rigid self-perception to one which encourages the client to become independent, self-directed and who can pursue self-growth.

34. There are three core elements of practice in client-centred therapy: Empathy : being able to put yourself in the client’s shoes is the central important feature of any therapist-client relationship, as it helps guide the client to resolve their own life problems Unconditional Positive Regard : The therapist demonstrates that they value the client for who they are and refrain from judging them Congruence : Sharing a genuine, consistent rapport with the client, where therapists primarily act as an understanding listener who assists the client by offering advise only when asked

35. Behaviour Therapy During the 1940s and 1950s, dissatisfaction towards the unscientific approaches towards psychopathology was growing Psychologists looked towards experimental psychology for objective knowledge that might be used to inform treatment and therapy Conditioning the body of knowledge which psychologists gradually resorted to and this gave rise to the development of Behaviour Therapies

36. What is Group Therapy Therapy can be taken in groups as well as on a one-to-one basis Group therapies are found to be useful to treat individuals suffering from problems by sharing their ordeal with one another and having a facilitator guiding them towards finding ways of resolving their problems. Examples of Group therapies: Self-Help groups, Alcoholics Anonymous, Gamblers Anonymous and Family Therapy

37. 3.Cognitive Therapy Over the latter part of the 20 th Century, one of the most impressive developments in our understanding of psychopathology has been our evolving insight into cognitive factors that play important roles in causing and maintaining psychopathology

38. Key features of Cognitive Therapy include Cognitive therapy is all about learning how our thoughts create our moods. In CT we discover that we all have inherent tendencies to certain negative thoughts that evoke unhappiness and disturbance - especially in response to particular trigger situations. Once we accept that fact, we can learn to spot these negative thoughts as they arise, and then challenge and re-think them

39. Contemporary Cognitive Behaviour Therapy CBT came out from these earlier forms of Cognitive Therapies. CBT is an intervention for changing both thoughts and behaviour, representing an umbrella term for many different therapies that share the common aim of changing both cognitions and behaviour. CBT is generally perceived to be an evidence-based, cost-effective form of treatment that can be successfully applied to a broad range of psychopathologies, including Schizophrenia and Depression .

40. A CBT intervention usually possesses the following characteristics:- The client is encouraged to keep a diary noting the occurrence of significant events, associated feelings, moods and thoughts in order to demonstrate how these might be interlinked. With the help of the therapist, the client is urged to identify and challenge irrational, dysfunctional, or biased thoughts/assumptions

41. 3.Clients are given homework in the form of ‘behavioural experiments’ to test whether their thoughts and assumptions are accurate and rational. 4. Clients are trained in new ways of thinking, behaving and reacting in situations that may evoke their psychopathology.