Schizophrenia.pptx

Schizophrenia Notes for Nursing Students

1. SCHIZOPHRENIA By: Sathish Rajamani Professor DSCON - CUTTACK Professor Sathish Rajamani 1

2. Overview of Schizophrenia In Greek word ‘ Schizein ’ – ‘To Split’ and ‘ Phren ’ – ‘Mind’ “Splitting of the Mind”. Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and for their family and friends. People with schizophrenia require lifelong treatment. May – 24: World Schizophrenia Day Professor Sathish Rajamani 2

3. Paul Eugen Bleuler Swiss psychiatrist He coined several psychiatric terms including S chizophrenia , S chizoid & A utism . Professor Sathish Rajamani 3

4. Definition A mental illness that is characterized by disturbances in thought (as delusions), perception (as hallucinations), and behavior (as disorganized speech or catatonic behavior), by a loss of emotional responsiveness and extreme apathy, and by noticeable deterioration in the level of functioning in everyday life. Professor Sathish Rajamani 4

5. EPIDEMIOLOGY OF SCHIZOPHRENIA The usual age of onset for adult Schizophrenia is 15 to 25 years. C hildhood-onset schizophrenia (COS) is a rare condition with onset before the age of 13 years . According to a recent National Mental Health Survey (2015-2016) conducted by NIMHANS, the prevalence of Schizophrenia in the Indian population is 0.5 per cent for current and 1.4 per cent for a lifetime experience. According to a study on mental patients arriving at the Institute of Mental Health and Hospital in Agra, 7 per cent of all mental patients have schizophrenia in various degrees of severity. Professor Sathish Rajamani 5

6. EPIDEMIOLOGY OF SCHIZOPHRENIA Schizophrenia affects 20 million people worldwide. (Global Burden of Disease, 2017) The annual number of new cases of schizophrenia is 1.5 per 10,000 people. ( Epidemiol Reviews , 2008) Schizophrenia is one of the top 15 leading causes of disability worldwide. (Global Burden of Disease, 2016) Approximately 5% of people with schizophrenia die by suicide, usually with a higher risk at the onset of the mental illness. ( Archives of General Psychiatry,  2005) About 20% of people with schizophrenia attempt suicide at least once. (The Recovery Village, 2020) Professor Sathish Rajamani 6

7. Co-occurring disorders and schizophrenia Depressive symptoms: 30%-54% Post-traumatic stress disorder: 29% Obsessive-compulsive disorder: 23% Panic disorder: 15% (The Recovery Village, 2020) Professor Sathish Rajamani 7

8. Gender and Schizophrenia Females are affected around 30 years of age. Onset of Schizophrenia is earlier in males (around 20 years). In general males and females are equally affected with schizophrenia. Professor Sathish Rajamani 8

9. Aetiology of Schizophrenia The exact causes of schizophrenia are unknown . Research suggests a combination of physical, genetic, psychological and environmental factors can make a person more likely to develop the condition. 1. Genetics: Schizophrenia tends to run in families, but no single gene is thought to be responsible. Professor Sathish Rajamani 9

10. Aetiology of Schizophrenia Genetics ( Cont ) In identical twins, if a twin develops schizophrenia, the other twin has a 1 in 2 chance of developing it, too. This is true even if they're raised separately.  In non-identical twins, who have different genetic make-ups, when a twin develops schizophrenia, the other only has a 1 in 8 chance of developing the condition. Professor Sathish Rajamani 10

11. Aetiology of Schizophrenia 2. Brain Structure and Function: Research shows that people with schizophrenia may be more likely to have differences in the size of certain brain areas and in connections between brain areas. Professor Sathish Rajamani 11

12. Aetiology of Schizophrenia 3 . Neurotransmitter: There's a connection between neurotransmitters and schizophrenia because drugs that alter the levels of neurotransmitters in the brain are known to relieve some of the symptoms of schizophrenia. Research suggests schizophrenia may be caused by a change in the level of 2 neurotransmitters: dopamine and serotonin. Professor Sathish Rajamani 12

13. Aetiology of Schizophrenia 5. Pregnancy and Birth Complications: Research has shown people who develop schizophrenia are more likely to have experienced complications before and during their birth, such as: a low birthweight premature labour a lack of oxygen (asphyxia) during birth It may be that these things have a subtle effect on brain development. Professor Sathish Rajamani 13

14. Aetiology of Schizophrenia 4 . Environment: Research suggests that a combination of genetic factors and aspects of a person’s environment and life experiences may play a role in the development of schizophrenia. These environmental factors that may include living in poverty, stressful or dangerous surroundings, and exposure to viruses or nutritional problems before birth. Professor Sathish Rajamani 14

15. Aetiology of Schizophrenia 4 . Environment: Research suggests that a combination of genetic factors and aspects of a person’s environment and life experiences may play a role in the development of schizophrenia. These environmental factors that may include living in poverty, stressful or dangerous surroundings, and exposure to viruses or nutritional problems before birth. Professor Sathish Rajamani 15

16. SCHIZOPHRENIA SIGNS & SYMPTOMS Symptoms of schizophrenia are typically divided into positive symptoms and negative symptoms. Positive Symptoms of Schizophrenia are as follows: Hallucination Delusion Bizarre Behaviour Disorganized Thought Professor Sathish Rajamani 16

17. Positive Symptoms of Schizophrenia Hallucination – It is the false perception. Most common hallucination is auditory . Delusion – These are the false fixed strange beliefs that cannot be corrected on rational ground. Bizarre Behaviour – Odd, Strange or unexpected behavior which is usually out of the context for a given situation such as unpredictable or inappropriate emotional responses, lack of impulse control, shouting when expected to be remain quiet etc. Disorganized Thought – Patients with schizophrenia can have difficulty in concentrating and maintaining a train of thought. Patient may talk incoherently and respond to questions with unrelated answers. Professor Sathish Rajamani 17

18. Positive Symptoms of Schizophrenia Examples of Disorganized Thoughts includes. Loosening of association – Rapidly shifting between topics with no connections between topics. Perseveration – Repeating same things over and over again. Made up words – That only have meaning to the speaker. Use of rhyming – Words without meaning. Professor Sathish Rajamani 18

19. Negative Symptoms of Schizophrenia Negative symptoms are deficits of normal emotional responses. Negative are related to things like though blocking, poverty of speech. Professor Sathish Rajamani 19

20. Negative Symptoms of Schizophrenia Alogia (Poverty of Speech) – It occurs earlier to the psychotic symptoms. It refers to difficulty with speaking or the tendency to speak little due to brain impairment. Avolition – Severe lack of initative to accomplish purposeful tasks. Anhedonia – inability to feel pleasure in doing things that once made them happy. Asociality – Patent shows lack of a strong motivation to engage in social interaction with others in a social context. Affective Flattening – Patients shows little or no emotions on facial expressions, voice tones or mannerisms. Professor Sathish Rajamani 20

21. Cognitive Symptoms of Schizophrenia Impaired higher or executive functioning Impairment of memory (short – term) Attention deficit . Professor Sathish Rajamani 21

22. Eugen Bleuler’s 4 ‘A’s of Schizophrenia Ambivalence Autistic Thinking Affect Disturbances Association Disturbances Professor Sathish Rajamani 22

23. Eugen Bleuler’s 4 ‘A’s of Schizophrenia Ambivalence – It is the state of having the mixed feelings or contradictory ideas . Autistic Thinking – Thinking is directed inward and become subjective, leads to withdrawal in self, daydreaming and fantasies. Affect Disturbances – Disturbances of affect that involves the display of reactions that do not match the situation or subjective mood. Associative Disturbances – Rapidly shifting between topics with no connections between topics. Professor Sathish Rajamani 23

24. TYPES OF SCHIZOPHRENIA F 20.0– Paranoid Schizophrenia F20.1 – Heberphrenic Schizophrenia F20.2 – Catatonic Schizophrenia F20.3 – Undifferentiated Schizophrenia F20. 4– Post – Schizophrenic Depression F20. 5 – Residual Schizophrenia F20. 6 – Simple Schizophrenia F20. 8 – Other types of Schizophrenia F20. 9 – Schizophrenia Unspecified Professor Sathish Rajamani 24

25. PARANOID SCHIZOPHRENIA Most common type Onset is late and has good prognosis Client’s can perform ADL and have good social interactions Hallucination and Delusions are seen peculiarly With earlier treatment, good prognosis is seen. Delusion of persecution Delusion of reference Delusion of jealousy Delusion of grandiosity Professor Sathish Rajamani 25

26. HEBEPHRENIC SCHIZOPHRENIA Disorganized Schizophrenia Behaviour is aimless and not goal directed Inappropriate and incongruent thoughts are seen Early and insidious onset is associated with poor premorbid personality Hallucination and Delusions are not prominent Disorganized speech Disorganized behavior Inappropriate affect Professor Sathish Rajamani 26

27. CATATONIC SCHIZOPHRENIA Catatonia is a motor disorder that impairs a person’s movement, speech and response to an outside stimuli. Cata means disturbed. When excited patient will injure themselves or others Patients are sometimes immobile and mute Increased Physical activity (Hyperkinesis) or decreased (Stupor) Professor Sathish Rajamani 27

28. CATATONIC SCHIZOPHRENIA TYPES Professor Sathish Rajamani 28

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30. SIMPLE SCHIZOPHRENIA Characterized by prominent negative symptoms Positive symptoms are absent Social functioning gets reduced Onset is early and insidious Course is progressive and prognosis is worst Amotivation Apathy Social Withdrawal Blunt Affect Professor Sathish Rajamani 30

31. RESIDUAL SCHIZOPHRENIA A subtype of schizophrenia in which the individual has suffered an episode of schizophrenia but there are no longer any delusions, hallucinations, disorganized speech or behavior . Professor Sathish Rajamani 31

32. UNDIFFERENTIATED SCHIZOPHRENIA Undifferentiated schizophrenia is an outdated term describing a subtype of schizophrenia that the medical community no longer recognizes. It cannot be classified into any of the five defined subtypes. People who are diagnosed with undifferentiated schizophrenia exhibit symptoms of more than one type of schizophrenia. Professor Sathish Rajamani 32

33. DIAGNOSING SCHIZOPHRENIA Assessment Scales to Identify Psychotic Symptoms Brief Psychiatric Rating Scale (BPRS) Scale for Assessment of Negative Symptoms (SANS) Positive and Negative Syndrome Scale (PANSS) Assessment Scales to Identify Cognitive Deficits Stroop test Trail making test Wisconin card sorting test Wechsler Adult Intelligence Scale (WAIS) Assessment Scales to Identify Personality Related Problems in Schizophrenia. Rorschach Inkblot Test Minnesota Multiphasic Personality Inventory (MMPI) Professor Sathish Rajamani 33

34. DIFFERENTIAL DIAGNOSIS OF SCHIZOPHRENIA Schizoaffective disorder Delusional disorder Post traumatic disorder Hypochondriasis Mood disorders with psychotic symptoms Psychotic disorders due to general medical conditions Schizophreniform disorder Professor Sathish Rajamani 34

35. PROGNOSIS OF SCHIZOPHRENIA Factors Good Prognosis Poor Prognosis Onset Acute / Abrupt Insidious Age of Onset Late Early Duration < 6 Months > 2 Years Episode First episode Previous H/O Schizophrenia Gender Female Male Stressor Absent Present Depression Absent Present Symptoms Positive symptoms Negative Symptoms Social Support Good Poor Professor Sathish Rajamani 35

36. PROGNOSIS OF SCHIZOPHRENIA Factors Good Prognosis Poor Prognosis Types Acute Catatonia Paranoid has intermediate prognosis Disorganized, Simple and Undifferentiated Relapse of Symptoms Absent Present Drug adherence Present Absent Nature of treatment Outpatient and Community basis In patient and Hospitalization CT Scan Normal Enlargement of ventricles Premorbid functioning Good Poor Professor Sathish Rajamani 36

37. PHASES OF SCHIZOPHRENIA Professor Sathish Rajamani 37 Schizophrenia has 3 phases.

38. PHASES OF SCHIZOPHRENIA Professor Sathish Rajamani 38 Prodomal Phase Active Phase Residual Phase Decline in adoptive functioning Repeated episodes of psychotic symptoms Negative psychotic symptoms Increased emotional and behavioual problems Lasts for atleast one month Cognitive problems Social withdrawal Last for weeks to decades Last for several days or months

39. COMPLICATIONS OF SCHIZOPHRENIA Suicidal tendency Self-injury Depression Anxiety disorder Obsessive-compulsive disorder Abuse of drugs, alcohol, and tobacco Inability to perform any work or studies Social isolation Aggressive behavior Difficulty to stay in a relationship Can get involved in violent crimes Lack of personal hygiene causing other complications Being victimized Professor Sathish Rajamani 39

40. TREATMENTS Professor Sathish Rajamani 40

41. HOSPITALIZATION Following are the indications for hospitalization in schizophrenic patients. Patient who were resistant to treatment Dangerous to self and others Active state of delusions or hallucinations Poor Social Support Diagnostic evaluation of patient Emergency such as Extrapyramidal Syndrome Professor Sathish Rajamani 41

42. MEDICATIONS & PSYCHOLOGICAL TREATMENT Antipsychotic medications: Typical antipsychotics – Chlorpromazine, Haloperidol, Fluphenazine Atypical antipsychotics – Risperidone, Olanzapine, Clozapine and Aripiprazole Professor Sathish Rajamani 42

43. MEDICATIONS & PSYCHOLOGICAL TREATMENT Psychosocial Treatments Psychoeducation Social Skill training Cognitive therapy Supportive psychotherapy Behavior therapy Family therapy Professor Sathish Rajamani 43

44. MEDICATIONS & PSYCHOLOGICAL TREATMENT Community Support and Rehabilitation Family education Home care Self – help groups Rehabilitation Professor Sathish Rajamani 44

45. MEDICATIONS & PSYCHOLOGICAL TREATMENT Community Support and Rehabilitation Family education Home care Self – help groups Rehabilitation Professor Sathish Rajamani 45

46. NURSING DIAGNOSIS - 1 Impaired Social Interaction related to mistrust of others as evidenced by fearful or anxious around others. Nursing Interventions: Assess their perceptions and feelings toward social interaction. Determine family and support patterns. Observe speech, nonverbal gestures, and body language. Develop a trusting relationship. Provide positive reinforcement. Encourage group activities. Refer to specialists for social skills training. Professor Sathish Rajamani 46

47. NURSING DIAGNOSIS - 2 Disturbed Sensory Perception (Auditory/Visual) related to severe stress as evidenced by talking or laughing to self Nursing Interventions: Assess medication adherence. Assess contents of hallucinations. Monitor for increasing agitation or anxiety. Remove the client from chaotic environments. Provide safety. Aid distraction. Help the patient recognize triggers. Professor Sathish Rajamani 47

48. NURSING DIAGNOSIS - 3 Risk For Self/Other-Directed Violence, related to delusional thinking. Nursing Interventions: Assess for a plan for suicide or violence. Observe for early cues of distress. Maintain and convey a calm attitude. Maintain distance from the patient. Keep the patient safe. Administer tranquilizers. Apply restraints. Professor Sathish Rajamani 48

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