most frequent diagnosis of patients
Pamela M. Veroy RN, MAN
Retrieved sources from: CRH (2008)
Last update 6/25/09 ajj
In this module we will cover
• What is schizophrenia
• Symptoms of schizophrenia
• Types of schizophrenia
• Some of the more common treatments for
What is schizophrenia?
• A chronic severe brain disorder; often they
hear voices, believe media are
broadcasting their thoughts to the world or
may believe someone is trying to harm
• In men it usually develops in teen years
and early 20s; in women it usually
develops in 20s and 30s.
• Currently there is no physical or lab test
that can absolutely diagnose
• A psychiatrist usually comes to the
diagnosis based on clinical symptoms.
• This is a common problem since
schizophrenia shares a significant number
of symptoms with other disorders.
• Per the Nat’l Depression & Bipolar
Support Alliance there is an average of 10
years from onset to correct diagnosis & tx.
Disorders that may appear like
• Schizoid personality
• Schizophreniform disorder
• Schizotypal personality
• Bipolar Disorder
• Asperger’s syndrome
Symptoms of Schizophrenia
• Profound disruption in cognition and
emotion, affecting the most fundamental
– Sense of self
• Those that appear to reflect an excess or
distortion of normal functions.
• Delusions. Those where the patient thinks
he is being followed or watched are
common; also the belief that people on
TV, radio are directing special messages
• Hallucinations. Distortions or
exaggerations of perception in any of the
• Often they hear voices within their own
thoughts followed by visual hallucinations.
• Disorganized thinking/speech.
• AKA loose associations; speech is
tangential, loosely associated or
incoherent enough to impair
• Grossly disorganized behavior.
• Difficulty in goal directed behavior (ADLs),
unpredictable agitation or silliness, social
disinhibition, or bizarre behavior.
• There is a purposelessness to behavior.
• Catatonic behavior.
• Marked decrease in reaction to immediate
environment, sometimes just unaware of
surroundings, rigid or bizarre postures,
aimless motor activity.
Other Positive Symptoms
• Inappropriate response
• Unusual motor behavior
• Somatic preoccupations
FYI: Positive Symptoms
• Positive symptoms are those that have a
positive reaction from some treatment.
• In other words, positive symptoms
respond to treatment.
• Those that appear to reflect a decline or
loss of normal functions.
• May be difficult to evaluate because they
are not as grossly abnormal as positive
• Affective flattening.
• Reduction in the range and intensity of
emotional expression, including facial
expression, voice tone, eye contact and
• Alogia (poverty of speech)
• Lessening of speech fluency and
productivity, thought to reflect slowing or
blocked thoughts; often manifested as
short, empty replies to questions.
• The reduction, difficulty or inability to
initiate and persist in goal-directed
behavior. Often mistaken for apparent
Examples of Avolition
• No longer interested in going out with
• No longer interested in activities that the
person used to show enthusiasm
• No longer interested in anything
• Sitting in the house for hours or days
• This one is somewhat new and may not
be considered valid.
• It is thought disorder, confusion,
disorientation and memory problems.
Summary of Negative Symptoms
• Lack of emotion
• Low energy
• Lack of interest in life
• Affective flattening
• Inappropriate social skills
• Inability to make friends
• Social isolation
• Persons are very suspicious of others and
often have grand schemes of persecution
at the root of their behavior.
• During this phase they may have
hallucinations and frequent delusions.
• AKA disorganized schizophrenia; characterized
by emotionless, incongruous, or silly behavior,
intellectual deterioration, frequently beginning
insidiously during adolescence.
• May be verbally incoherent and may have
moods and emotions that are not appropriate to
• Hallucinations not usually present.
• Person is extremely withdrawn, negative
• May have marked psychomotor
• Lacks motivation and interest in day-to-
• Person is not usually having delusions,
hallucinations or disorganized speech.
• There will be symptoms of schizophrenia
as well as mood disorder (depression,
bipolar, mixed mania).
• Conditions meeting the general diagnostic
criteria for schizophrenia but not
conforming to any of the previous types.
• Exhibits more than one of the previous
types without a clear dominance of one.
• Before a diagnosis the psychiatrist must
make a thorough evaluation including a
physical/medical exam, a mental status
exam, appropriate labs, and a full history.
• History includes changes in thinking,
behavior, movement, mood, etc. as seen
by the family.
• In general it may take up to 6 months for
medications to show consistent effects.
• The newest medication is Invega.
• Meds include atypicals: Abilify, Geodon,
Clozapine, Risperidone, Seroquel,
– [Remember: a giraffe can really see a zebra]
• These medications may have such
intolerable side effects that the patient will
stop the drugs.
• One study showed the average time the
meds were taken regularly was 3 months.
• Psychotherapy - an adjunct to meds and is very
useful to keep the patient on the meds.
• Group therapy
• Family therapy
• Community support groups
• Early detection and treatment has the best
results/response to treatment.
• Per patients, once you have schizophrenia
you have it for life. The best you can hope
for is control.
• Delusion = fixed beliefs that usually
involve a misinterpretation of experience.
“Client believes someone is reading his
• Several types: grandiose, nihilistic,
• Hallucinations = perceptual experiences
that occur in absence of actual sensory
stimuli; involves the 5 senses.
• Illusions = person misperceives or
exaggerates stimuli that actually exist in
the external environment.
• Affiliation =
Turning to others for help or support;
sharing problems with others without
implying that someone else is responsible.
Ex: An individual has a fight with spouse
and turns to their best friend for emotional
• Devaluation =
Attributing exaggerated negative qualities
to self or others.
Ex: A boy has been rejected by his long
time girlfriend. He tells his friends that he
realizes that she is stupid and ugly.
• Displacement =
Transferring a feeling about, or a response
to, one object onto another (usually less
threatening) substitute object
Ex: A child is mad at her mother for
leaving for the day, but says she is really
mad at the sitter for serving her food she
does not like.
• Confrontation =
Presenting the patient with a different
reality of the situation.
Ex: My best friend never calls. She hates
me. Nurse ‘I was in the room yesterday
when she called.’
• Doubt =
Expressing or voicing doubt when a
patient relates a situation.
Ex: My best friend hates me. Nurse ‘From
what you have told me, that does not
should like her. When did she last call