Nursing management of patient with schizophrenia and other psychotic disorder.

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UNIT:-6
Nursing management of patient
with schizophrenia and other
psychotic disorders.
By:-Ayush kumar
(B.Sc nursing)

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3. SCHIZOPHENIA
Introduction
●The word schizophrenia was coined by the swiss
psychiatrist Eugen Bleuler in 1908. It was derived
from Greek word schizo means split and phrem
means mind.
●It was previously known as dementia praecox. 02

4. DEFINITION
Schizophrenia is a psychotic condition characterized
by disturbance in thinking emotions, volition and
faulty orientation which usually lead to social
withdrawal.
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INCIDENCE
●It occurred in all societies.
●Most commonly occur in age
between 15-45 years.
●It is equally occur in both male
and female.
●About 50%of admission in mental
hospital is schizophrenia,

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Etiology:-
There is no
definite etiology of schizophrenia.
◘Genetic factor:
●Monozygotic twins have four times higher
chances of developing schizophrenia.
●children of schizophrenia patient are more
prone to develop schizophrenia than children
of other person.
●The disease is more common among people
born of consanguineous marriage.
◘Biochemical factor:
●Increase activity of dopamine leads to the
occurrence of schizophrenia.

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◘Neuro structure factor:
●According to studies the prefrontal cortex
and limbic cortex may never fully develop in
the brain of person with schizophrenia.
◘Perinatal risk factor:
●It include maternal illness and complication
of pregnancy during labor and delivery.
◘Vitamin deficiency theory:
●A patient with vitamin B1,B6,B12 and vitamin
C deficiency may become schizophrenia.
◘Psychosocial factor:
●It includes defect in mother child
relationship, pathological communication and
pathogic family interaction.

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CLINICAL
FEATURE:-
THE clinical features are divided
into two.
◘primary/fundamantal symptom:-
these are symptom which are present in every
cases of schizophrenia.
It includes,
●Affective disturbance:-Inability to show
appropriate emotional responses.
●Autistic thinking:-The individual is withdrawn
to self.
●Ambivalence:-In this two contradictory ideas
coming simultaneously.

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◘Secondry/accessory symptom:-these
are symptom which may or may not be present
It include,
●Disorder of perception.
●Disorder of thought.
●Deteriorated appearance and manner.
●Disturbance in attention.
●Insight is absent.

11. TYPE OF
SCHIZOPHRENIA:
●Paranoid schizophrenia:-The word
paranoid means delusional. It is the most
common form of schizophrenia. It is
characterized by delusion of persecution,
delusion of jealously grandiosity,
hallucination voice and disturbance of affect,
speech of motor behavior. It has good
prognosis if treated early.
●Catatonic schizophrenia:-It is characterized
by marked disturbance of motor behavior. This may
take the form of catatonic stupor, catatonic
excitement and catatonic alternating between
excitement and stuper.

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●Residual schizophrenia:-It is a chronic form
of schizophrenia in which the symptom persist after
the acute phase. But the patient can do his routine
work as he has attained a social recovery. This
category should be used when there has been
atleast one episode of schizophrenia in the past but
without prominent psychotic symptom at present.
●undifferentiated schizophrenia:-this
category is diagnosed either when features of no
subtype are fully present or feature of more than one
subtype are exhibited.
●Simple schizophrenia:-It is characterized by
vague hypochondrial features, wandering tendency,
self absorbed idleness and aimless activity. the
prognosis is very poor
●Post schizophrenia depression:-
Depressive features develop in the presence of
schizophrenia and associated with an increased
with an increased risk of suicide.

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DIAGNOSIS:
●Mental status examination.
●Psychiatric history.
●Careful clinical observation
●Rule out physical disorders,
substance induced psychosis
and mood disorder.
●CT-Scan and MRI

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TREATMENT:-
◘Pharmacotherapy
●Typical and atypical antipsychotics are used
to control the sign and symptom of
schizophrenia.
●Typical antipsychotic include
chlorpromazine, haloperidol, trifluoperazine
etc.
●Atypical antipsychotic include risperidone,
olanzapine, clozapine, amisulpride etc

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◘Electro convulsive therapy:-
The treatment is used for patient with
severe schizophrenia. Drug and
psychotherapy and to be continued.
Usually 8-12 ECTs are needed.
◘Psychotherapies:-
●Group therapy
●Behavior therapy
●Social skill training
●cognitive therapy
●Family therapy

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NURSING DIAGNOSIS:
◘Disturbed thought process related inability to
trust, panic anxiety evidence by delusional
thinking, extreme suspiciousness of other.
GOALS:
●Eliminate pattern of delusional thinking.
●Demonstrate trust in others.
●Decrease anxiety level.
INTERVENTION
●Assess the content of the delusion.
●Assess the intensity, frequency and duration
of the delusion.
●Discourage the discussion about the irrational
thinking.
●encourage the patient to express feeling.
●patient participation is encourage in providing
care.

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◘Self care deficit related to withdrawal,
regression, panic anxiety, inability to trust
evidenced by difficulty in carrying out tasks
associated with hygiene, dressing, grooming,
eating, sleeping, and toileting.
GOALS:
●Demonstrate increased interest in self care .
●Complete daily activity with minimum assistance.
●Demonstrate adequate personal hygiene skills.
INTERVENTION:
●Assess patientʼs ability to meet self care activities.
●Develop a structured schedule for patientʼs routine
for hygiene, toileting.
Role model appropriate behavior and explain any
task in short simple step.

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◘Risk for self inflicted injury related to
command hallucination evidenced by suicidal
ideas, plans, or attampts.
GOALS:
●Patient will not harm self.
INTERVENTION:
●Assess the nature and severity of
hallucinations.
●Create a self environment for the patient.
●Keep the patient near the nurses station.
●Do not allow the patient to put the bolt on his
side of the door of bathroom.

19. OTHER
PSYCHOTIC
DISORDES

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◘Persistent delusional disorder:-
It is stable and chronic course characterized by
presence of well systemized delusions. The main
clinical features persistent delusion present for
atleast 3month, absence of hallucination and
absence of OBS. schizophrenia and mood disorder.
◘Acute and transient psychotic
disorders:
these disorders neither follow the couse of
schizophrenia nor resemble mood disorders in
clinical picture and usually have a better prognosis.
A complete recovery usually occurs within 2-3
months.

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◘Induced delusional disorder:-
This is an uncommon delusion disorder
characterized by a sharing of delusion between
usually two persons. Only one person has the
genuine delusion due to psychiatric illness on
separation of the two, while the dependent
individual may give up his delusions, the patient
with the genuine delusions should then be treated
appropriately.
◘Schizoaffective disorder:-
In this disorder, the symptoms of schizophrenia and
mood disorders and prominently present within the
same episode.
Types,
●schizoaffective disorder:-depressed type.
●schizoaffective disorder:-manic type
●schizoaffective mixed type

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◘Capgras syndrome[The delusion of
doubles]:-
This condition was first described by joseph
Capgras. It is characterized by delusional
conviction that other person in the
environment is not their real selves but is their
own doubles.

23. Thank
You!