schizophrenia disorder to know about the details about patient disease and management

In this you will get to know about schizophrenia condition their types sign and symptoms and management

1. SCHIZOPHRENIA GARGI YADAV PG TUTOR NARAINA NURSING COLLEGE

2. Content Introduction Definition Classification Epidemiology Types of Schizophrenia Etiology Clinical Features Diagnostic Evaluation Treatment Nursing management

3. INTRODUCTION The word 'Schizophrenia' was coined by the Swiss psychiatrist Eugen Bleuler in 1908. It is derived from the Greek words skhizo (split) and phren (mind).

4. DEFINITION Schizophrenia is a psychotic condition characterized by a disturbance in thinking, emotions, and faculties in the presence of clear consciousness, which usually leads to social withdrawal. A severe mental condition in which there is disorganization of the personality , deterioration in social functioning and loss of contact with reality. There may be evidence of hallucinations and delusional thinking. Psychosis can occur with or without the presence of organic impairment.

5. EPIDEMIOLOGY It has been estimated that patients diagnosed as having schizophrenia occupy 50% of all mental hospital beds About three to four per 1000 in every community suffer from schizophrenia. Schizophrenia is equally prevalent in men and women. The peak ages of onset are 15 to 25 years 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

6. ETIOLOGY Many authorities suggest that multiple factors causes schizophrenia, because no single theory satisfactorily explains the disorder. The cause of schizophrenia is still uncertain. Most likely no single factor can be implicated in the etiology; rather, the disease probably results from a combination of influences including biological, psychological, and environmental factors.

7. Biological Factors -Genetics Twin studies -Adoption studies Biochemical factor -The dopamine hypothesis Physiological factors -Viral infection -Anatomical abnormalities -Histological changes - Physical conditions

8. -Psychological Factors - Environmental influences -Socio-cultural factors -Stressful life events

9. CLINICAL FEATURES Symptoms of schizophrenia may appear suddenly or develop gradually overtime. Tension, the inability to concentrate, insomnia, withdrawal or cognitive deficits may precede the first psychotic episode. Eugene Bleuler (1857-1939) cited symptoms referred to as Bleuler's Ambivalence Autistic thinking Affective disturbance e l Associative looseness

10. Affective disturbance: Inability to show appropriate emotional responses, blunted or flattened affect Autistic thinking: It is a thought process in which the individual is unable to relate to others or to the environment. Preoccupation with the self, with little concern for external reality Ambivalence: It refers to contradictory or opposing emotions, attitudes, ideas or desires for the same person, thing or situation simultaneous opposite feelings Associative looseness: Inability to think logically. The stringing together of unrelated topics

11. The predominant clinical features in acute schizophrenia are delusions, hallucinations and interference with thinking. Features of 1. Hearing one's thoughts spoken aloud (audible thoughts or thought echo) 2. Hallucinatory voices in the form of statement and reply (the patient hears voices discussing him in the third person) 3. Hallucinatory voices in the form of a running commentary (voices commenting on one's action) 4. Thought withdrawal (thoughts cease and subject experiences them as removed by an external force.

12. Positive symptoms of schizophrenia Delusions Hallucinations Excitement or agitation Hostility or aggressive behavior Suspiciousness, Ideas of reference. Possible Suicidal tendencies Negative symptoms of schizophrenia Affective flattening or blunting. Avolition- apathy (lack of initiative) Attentional impairment Anhedonia (inability to experience pleasure) Alogia (lack of Speech output)

13. There can be either an increase or decrease in psychomotor activity. Mannerisms, grimacing, decreased self-care and poor grooming are common features. Other Features are Decreased functioning in work , social relations and self-care , as compared to earlier life. Loss of ego boundaries Loss of insight. Poor judgment Suicide can occur due to the presence of associated depression, command hallucinations, impulsive behavior, or return of insight that causes the patient to comprehend the devastating nature of the illness and take his life.

14. CLINICAL TYPES Schizophrenia can be classified into the following subtypes: 1. Paranoid 2. Hebephrenic (disorganized) 3. Catatonic 4. Residual 5. Undifferentiated 6. Simple 7. Post-schizophrenic depression

15. Paranoid Schizophrenia It is Most common form of Schizophrenia. It is characterizes by following Features- Delusion of Persecution Delusion of reference Delusion of jealousy Delusion of Grandiosity Hallucinatory voices

16. Catatonic Schizophrenia -It is characterized by marked disturbance of Motor behavior. -This take form of Catatonic Stupor , Catatonic excitement & Catatonia alternating b/w excitement & Stupor. -Increased Psychomotor activity -Increased Speech production -Loosening of association & frank incoherence.

17. Residual Schizophrenia Symptoms of Residual Schizophrenia include Emotional blunting, eccentric behavior, illogical thinking, social withdrawal, and loosening of associations. This category is used when there has been at least one episode of Schizophrenia in the past but without prominent psychotic symptoms at present.

18. Hebephrenic(disorganized) Schizophrenia The essential features include Marked thought disturbance , Incoherence, Severe loosening of associations & Extreme social impairment, Delusion & hallucinations are fragmentary & changeable. Senseless giggling, Mirror gazing , Grimacing, Mannerism. It has worst prognosis among all the Subtypes.

19. Undifferentiated Schizophrenia This category is diagnosed either when features of no Sub type are fully present or features of more than one subtype are exhibited.

20. Simple Schizophrenia There is an insidious & progressive development of Negative Symptoms with no history of psychotic Episodes. Features include Wandering tendency, self-observed idleness, and aimless activity. The Prognosis is very poor.

21. Post Schizophrenic Depression Depressive features develop in the presence of residual or active features of Schizophrenia & are Associated with an Increased risk of Suicide.

22. Diagnosis No diagnostic test definitively confirms Schizophrenia, tests may be ordered to rule out disorders that cause psychosis, including vitamin deficiencies, uremia & electrolyte Imbalances. CT Scan & MRI show enlarge ventricles.

23. Treatment Modalities Pharmacology Typical & Atypical Antipsychotics like- Haloperidol 5-100mg/day PO Clozapine 25-450 mh /day PO Olanzapine 10-20 mg/day PO Quetipine 150-750 mg/day PO ECT - 8-10 ECT

24. Psychological Therapies Group Therapy Behavior therapy Family Therapy Social Skill training Cognitive therapy

25. Nursing Management

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