MANIPAL COLLEGE OF NURSING
A Greek word splited as:
Termed by kraplein in 1896 as ‘Dementia
In 1908 Eugene bleuler coined it as
Schizophrenia occurs with regular
frequency nearly everywhere in the world
in 1 % of population and begins mainly in
young age (mostly around 16 to 25 years).
It is a psychotic condition characterized by
a disturbance in
thinking, emotions, volitions and faculties
in the presence of clear
consciousness, which usually leads to
It is a type of functional psychosis
characterized mainly by disturbance in
thinking and associated disturbances in
psychomotor activity, affect, perception
HEREDITARY:-Incidence high in univolvar twins
-Transmission through one or more
autosomal recessive genes
CHILD DEVELOPMENT AND PARENT CHILD
AGE-Peak in between 15-30 and also some
SEX-Equal in both sexes
7) SOCIAL ISOLATION-Predisposed unstable
9) OVERCROWDING SLUMS
10) PRECIPITATION-Stress, regarding ineffective
disease, pregnancy, family problem, etc.
11) ENDOCRINE-Excess of dopamine dependent
neuronal activity in brain
12) ASSOCIATED WITH OTHER DISEASESMore common in temporal lobe epilepsy
The exact cause of schizophrenia is still
Still there are some factors that are
considered as risk factors.
Immunologic factors e.g. Viral exposure in
High arousal level from stress , trauma, and
drugs e.g. bombardment.
Severe disease e.g. encephalitis.
Trauma from complication such as
obstetrical, head trauma, childhood accidents.
schizophrenia may be caused by an
neuronal activity in the brain.
Abnormalities in the neurotransmitters
epinephrine, serotonin, acetylcholine, an
d gamma-amino butyric acid and in the
neuroregulators such as prostaglandins
and endorphins have been suggested.
Autistic thinking-important feature
Considers two things identical
Disturbed thinking, emotions and behavior.
Patient appears absurd and bizarre
Social withdrawal from
religion, philosophy, science, sex, and power
Absence of links between ideas, crowding and
poverty of ideas, flight of ideas
h) Word are linked without meaning(word salad)
Emotional blunting or shallowness of affect
b. Inappropriate affect-patient laughs when he is
expected to cry and cries when he is expected
c. Hypersensitiveness or insensitiveness of
d. Ambivalence-experience of 2 opposite of
Irrelevant and inappropriate behavior
Rowdy, violent, assaultive(a person has a physical
or verbal violence), agitation
Suicidal and homicidal tendencies
Criminal and sexual over activity, pervasive
Reduction of drive and desire to carry out routine
b) Avoiding mixing in family and friends
c) Reduced efficiency and activity
d) Feeling of passivity(mind and thoughts controlled
by outside force
Hallucination –auditory and visual are
common, others are very rare.
Hallucinations are either structured(human or
animal voice) or unstructured(vague voices)
In catatonic, increased psychomotor
activity, stupor, negativism, stereotype, mutism,
verbegeration(repeating the same words)
Excessive day dreaming and fantasy
Spells of laughter and crying without reason
Patient passes urine and stool in his clothes
and plays with has own excreta
Makes lot of mistakes in work
ILLNESS OF AS A PHENOMENON OF
E.G- Reversal to infantile and childhood
patterns of psychological living a state of
organization where reality does not exist.
Thus the patient attempt to resolve his
psychological conflicts by denying the
harsh and painful reality world and living
in a fantasy would full of pleasures
Phase I - The schizoid personality
Phase II-The prodromal phase.
Phase III-Schizophrenia—active phase.
Phase IV- Residual phase
PARANOID SCHIZOPHRENIA: Early onset
‘Paranoia’ means ‘delusional’
It occurs between 25-30 yrs
Seen more in males than females
Delusion of suspiciousness, persecution and
Disorganization of speech and thought
Hallucinatory voices of threatening or
commanding, also voices of whistling and
Affect is usually of hostility, anger or
Negative symptoms like flat affect, poverty of
speech and poor activity
Prognosis is good
HEBEPHRENIC SCHIZOPHRENIA:Early and insidious onset
Occurs between the age of 20-25 yrs
Unpredictable, giggling and silliness
Poverty of ideas
Prognosis is poor
SIMPLE SCHIZOPHRENIA: Insidious and gradual course
Occurs between age of 15-20 yrs
More incidence in males
Disturbances in affect
Disturbances in thinking
Delusions and hallucinations are rare
Prognosis is poor
CATATONIC SCHIZOPHRENIA: Occurs between age of 20-25 yrs
Equal in both sexes
Disturbances of thinking, affect and behavior
Acute or sub-acute onset
Purposeless excitement and destructive
Delusion and hallucinations are common
Prognosis is good but reoccurs are common
CATATONIC STUPOR: Absence of speech
Maintenance of rigid posture against efforts to
Bizarre postures for longer period of time
Stuporous reaction towards surrounding
Ecolalia-mimicking of phrases and words
Echopraxia-mimicking of actions observed
RESIDUAL SCHIZOPHRENIA:Emotional blunting
A type of schizophrenia which has been at
least one episode in the past but without
prominent psychotic symptoms at present
UNDIFFERENTIATED SCHIZOPHRENIA:Late schizophrenia occurs after 40 yrs of age
Schizoaffective psychosis with symptoms of
depression and mania and also neurosis
Prognosis is poor.
CHILDHOOD OR JUVENILE
SCHIZOPHRENIA: Not common but seen between age of 5-10
yrs and 12-14 yrs
Onset is acute or gradual
Prognosis is poor
I. SCHIZOAFFECTIVE PSYCHOSIS: Symptoms of schizophrenia associated with
symptoms of depression and mania
PSEUDO-NEUROTIC SCHIZOPHRENIA: Core of illness is schizophrenia but presenting
symptoms are suggestive of neurotic symptoms
like anxiety state, phobic reactions, obsessive
compulsive neurosis or hysteria
Treatment such as psychotherapy, abreactive
therapy or drug therapy is not satisfactory
Careful psychiatric examination done through
repeated interview, reveals the true nature of
A depressive episode, which may be
prolonged, arising in the aftermath of a
schizophrenic illness. Some schizophrenic
symptoms, either „positive“ or
„negative“, must still be present but they no
longer dominate the clinical picture.
These depressive states are associated
with an increased risk of suicide.
Duration of illness:Shorter duration carries better prognosis
2) Type of schizophrenia:Catatonic and paranoid type carries good
prognosis. simple, hebephrenic, juvenile, pseudoneurotic types do not carry good prognosis.
3) Personality:Non schizoid and stable
personality respond better
Precipitating factor:Presence of precipitating factor carries
Age:20-30 yrs of age carries better
prognosis than other ages.
Type of onset:Acute onset carries better prognosis
than gradual onset.
A MENTAL STATUS
OFFICIAL DIAGNOSIS IS
BASED ON ICD 10
Conventional antipsychotics are now
used less frequently, because of
their only partial efficacy and
The following are the drugs given to
-Fluphenazine decanoate:2025mg IM every 1-3 wks
Commonly used atypical antipsychotics;
Other drugs used in schizophrenia are mood
depressants, benzodiazepines, etc.
ELECTROCONVULSIVE THERAPY(ECT):Indications are catatonic stupor, catatonic
Severe side effects with drugs
Usually 8-10 ECT’s are required to be given
About 8-10 convulsions spread over a period
of 4-6 weeks
PSYCHOLOGICAL THERAPIES:Cognitive therapy, group therapy, behavior
therapy, family therapy
Responsibility while dealing with disease
Non compliance to management
Explain the management to patient shortly
or as you required.
Develop therapeutic relationship with the
Develop trust with the patient.
Listen any complain of patient carefully.
Don’t ignore anything that related to
Set the diet according to the drugs.
Give medicine regularly
Check the blood level regularly to maintain
adequate drug level.
Assess the level of orientation.
• Allow the patient to talk about
• Avoid reinforcing the hallucination.
• Avoid saying that you are wrong.
• Support the patient in initial stage by
saying that you are just thinking but the
reality is just opposite.
• Remove all the injurious thing.
• Diversion of activity.
Asses the pattern of sleep.
Provide calm and quite environment.
Isolate the disturbing patient.
Provide a glass of warm milk before sleep.
Provide a warm bath before sleep.
Maintain a daily routine of sleeping and
Put off the light in around at 100 clock every
Provide comfort measure as pillow ,back rub.
Give p.r.n as prescribed.
Impaired Bowel and Bladder activity
Assess the type of alteration of b/b.
In case of constipation encourage high fiber diet
Increase fluid intake
Food Intake should be frequently.
Take the choice of food to patient.
Serve the food in attractive manner.
Encourage patient to take proper sleep or rest.
Encourage for light exercise or walking jogging.
If the patient not taking food than explain politely that food is
compulsory for recovery.
impaired thought process
Assess the level of thought process.
Convey acceptance of the patient’s need for
false belief but that you do not share.
Do not argue .
Do not force.
Do not say you are wrong.
Use same language in front of patient.
Avoid physical contact in form of touch.
Avoid laughing ,whispering there.
Avoid competitive activities.
Reinforce focus on reality.
impaired physical activity
Assess the level of activity pattern of patient.
Give high calories diet.
Remove all things near to bed.
Maintain calm and quite environment.
Avoid argument with the patient.
Give the medicine timely to maintain drug
Avoid talking excessively.
Give some simple task to do the patient.
Encourage for light rest in day as well as night.
Asses the level of anxiety.
Maintain therapeutic relationship.
Explain everything before doing .
• Hold the hand of patient if patient threatened (if
• Explain queries of patient clearly.
• Don’t ignore patient .
• Stay with patient.
• Use same language in front of patient.
• Ask patient to explain his/her anxiety more and
• Give tranquilizer as prescribed.
• Provide safe environment.
Use relaxation technique if possible.
Assess the level of perception.
Provide a safe environment.
Ask the patient to express impaired
Help the patient to get oriented.
Focus on reality.
Assess the level of nutrition.
Provide calories according to activity.
Find out patient like and dis like.
Provide 6-8 glass water (if not contraindicated).
Maintain accurate record of intake and out put.
Supplement diet with vitamin and mineral.
Walk or sit with the patient.
Serve food attractively.
Instruct to relatives to take food with patient if
suspiciousness is there.
Maintain therapeutic relationship with
Encourage patient to talk with other
people or patient.
Encourage to play with other patient.
Offer patient for group activity.
Give a positive reinforcement for
Other nursing problems
Self care deficit.
Impaired family coping.
OTHER PSYCHOTIC DISORDERS
Psychosis is defined as gross
impairment in reality testing, marked
disturbance in personality with impaired social
and occupational functioning and presence of
characteristic symptoms like delusions and
Persistent delusional disorders
Non- bizarre type delusions
Persistent at least for 3 months
Absence of significant hallucinations
Absence of organic mental
disorders, schizophrenia and mood
Acute and transient
Neither follow the course of schizophrenia
or mood disorders.
Abrupt, acute onset, and associated with
identifiable acute stress.
Several type of hallucinations, delusions
changing in both type and intensity from
day to day or within same day.
Emotional turmoil ( ecstasy to anxiety and
Do not fulfill the criteria of schizophrenia.
Sharing of delusion between usually two
or more persons who usually have a
closely knit emotional bond.