Schizophrenia is a serious mental disorder that causes distorted perceptions of reality. It has various symptoms that are divided into positive (hard) symptoms like delusions and hallucinations, and negative (soft) symptoms like lack of emotion and motivation. The causes are thought to involve genetic and neurological factors. Treatment involves antipsychotic medication and psychosocial therapies. Nursing care focuses on communicating respectfully, engaging the client in activities, and supporting their functioning and recovery.

1. PRESENTED BY:
.ATTIYA MARYAM
.BROHAN AHMED
.HANIA MUSHTIQ
.HUMA ASMAT
.INSHRAH KHALID
SUBMITTED TO :
MADAM KHADIJA
schizophrenia

2. Learning Objectives
 At the end of the session the learner will
able to :
Define schizophrenia.
Discuss clinical course and its etiology.
Describe positive and negative symptoms of
schizophrenia.
Discuss the related disorder of schizophrenia
Discuss treatment of schizophrenia.
Apply the nursing process to the care of client with
schizophrenia.
Explain delusions and hallucinations with their types.

3. Define schizophrenia
SCHIZOPHRENIA CAUSES DISTORTED and
bizarre thoughts, perceptions, emotions,
movements, and behavior. It cannot be defined
as a single illness; rather, schizophrenia is
thought of as a syndrome or as disease process
with many different varieties and symptoms,
much like the varieties of cancer.
Schizophrenia is a serious mental disorder in
which people interpret reality abnormally.
Schizophrenia may result in some combination of
hallucinations, delusions, and extremely
disordered thinking and behavior that impairs
daily functioning, and can be disabling.

4. Clinical Course
Onset:
Onset may be abrupt or insidious, but most clients slowly
and gradually develop signs and symptoms such as social
withdrawal, unusual behavior, loss of interest in school or
work, and neglected hygiene.
Immediate Course:
In the years immediately after the onset of psychotic
symptoms, two typical clinical patterns emerge:
In one pattern, the client experiences ongoing psychosis
and never fully recovers.
In another pattern, the client experiences episodes of
psychotic symptoms.
Long-Term Course:
The intensity of psychosis tends to diminish with age.
Many clients with long-term impairment regain some
degree of social and occupational functioning.

5. ETIOLOGY
 BiologicTheories:
-Genetic Factors
-Neuroanatomic and Neurochemical Factors
-Immunovirologic Factors

6. Symptoms of schizophrenia
 The symptoms of schizophrenia are divided
into two major categories:
 positive or hard symptoms/signs which
include delusions, hallucinations, and
grossly disorganized thinking, speech, and
behavior and
 negative or soft symptoms/signs, which
include flat affect, lack of volition,and social
withdrawal or discomfort.

7. POSITIVE OR HARD SYMPTOMS
Ambivalence: Holding seemingly contradictory beliefs or
feelings about the same person, event, or situation
Associative looseness: Fragmented or poorly related
thoughts and ideas
Delusions: Fixed false beliefs that have no basis in reality
Echopraxia: Imitation of the movements and gestures of
another person whom the client is observing
Flight of ideas: Continuous flow of verbalization in which
the person jumps rapidly from one topic to another
Hallucinations: False sensory perceptions or perceptual experiences
that do not exist in reality
Ideas of reference: False impressions that external events
have special meaning for the person
Perseveration: Persistent adherence to a single idea or
topic; verbal repetition of a sentence, word, or phrase; resisting
attempts to sentence, word, or phrase; resisting attempts to change
the topic.
Bizarre behavior : Outlandish appearance or clothing repetitive or
stereotype.

8. NEGATIVE OR SOFT SYMPTOMS
Alogia: Tendency to speak very little or to convey little substance of meaning
(poverty of content)
Anhedonia: Feeling no joy or pleasure from life or any activities or
relationships
Apathy: Feelings of indifference toward people, activities,
and events
Blunted affect: Restricted range of emotional feeling, tone,
or mood
Catatonia: Psychologically induced immobility occasionally
marked by periods of agitation or excitement; the client
seems motionless, as if in a trance
Flat affect: Absence of any facial expression that would indicate emotions or
mood
Lack of volition: Absence of will, ambition, or drive to take
action or accomplish tasks
Inattention: inability to concentrate or focus on a topic or activity .

9. RELATED DISORDERS OF SCHIZOPHRENIA

Schizophrenia in terms of presenting symptoms and the
duration or magnitude of impairment.
 Schizophrenia categorizes these disorders as follows:
• Schizophreniform disorder:The client exhibits the
symptoms of schizophrenia but for less than the 6 months
necessary to meet the diagnostic criteria for schizophrenia. Social
or occupational functioning may or may not be impaired.
• Delusional disorder: The client has one or more nonbizarre
delusions—that is, the focus of the delusion is believable.
Psychosocial functioning is not markedly impaired, and behavior is
not obviously odd or bizarre.
• Brief psychotic disorder: The client experiences the sudden
onset of at least one psychotic symptom, such as delusions,
hallucinations, or disorganized speech or behavior, which lasts
from 1 day to 1 month.The episode may or may not have an
identifiable stressor or may follow childbirth.
• Shared psychotic disorder (folie à deux): Two people
share a similar delusion.The person with this diagnosis develops
this delusion in the context of a close relationship with someone
who has psychotic delusions.

10. TREATMENT
Psychopharmacology
MaintenanceTherapy
Six antipsychotic are available as long acting injections ,formerly called
depot injection .
PsychosocialTreatment
Individual and group therapy sessions are often supportive in nature, giving the
client an opportunity for social contact and meaningful relationships with other
people.
Clients with schizophrenia can improve their social competence with social skill
training, which translates into more effective functioning in the community.
Cognitive adaptation training using environmental supports is designed to
improve adaptive functioning in the home setting.
A new therapy, cognitive enhancement therapy (CET), combines computer-
based cognitive training with group sessions that allow clients to practice and
develop social skills.
Family education and therapy are known to diminish the negative effects of
schizophrenia and reduce the relapse rate

12. Side effects

13. Nursing intervention
Be sincere and honest when communicating with the client.
Avoid vague or evasive remarks.
Be consistent in setting expectations, enforcing rules,
and so forth.
Do not make promises that you cannot keep.
Encourage the client to talk with you, but do not pry for information.
Explain procedures, and try to be sure the client understands the
procedures before carrying them out.
Give positive feedback for the client’s successes
Recognize the client’s delusions as the client’s perception of the
environment.
Initially, do not argue with the client or try to convince
the client that the delusions are false or unreal.
Interact with the client on the basis of real things; do
not dwell on the delusional material.

14. Continue…
Engage the client in one-to-one activities at first, then
activities in small groups, and gradually activities in
larger groups.
Recognize and support the client’s accomplishments
(projects completed, responsibilities fulfilled,
interactions initiated).
Show empathy regarding the client’s feelings; reassure
the client of your presence and acceptance.
Do not be judgmental or belittle or joke about the client’s
beliefs.
Never convey to the client that you accept the delusions as
reality.
Directly interject doubt regarding delusions as soon
as the client seems ready to accept this (e.g., “I find
that hard to believe.”).
Do not argue but present a factual account of the situation as
you see it.
Ask the client if he or she can see that the delusions
interfere with or cause problems in his or her life

15. Continue…

16. delusion
A delusion is a fixed false belief
based on an inaccurate interpretation
of an external reality despite evidence
to the contrary.
Clients with schizophrenia usually
experience delusions (fixed, false
beliefs with no basis in reality) in the
psychotic phase of the illness.

17. Types of delusion
Persecutory/paranoid delusions involve the client’s belief that “others” are
planning to harm the client or are spying, following, ridiculing, or belittling the client in
some way. Sometimes the client cannot define who these “others” are.
Examples:The client may think that food has been poisoned or that rooms are bugged
with listening devices. Sometimes the “persecutor” is the government, FBI, or other
powerful organization. Occasionally, specific individuals, even family members, may be
named as the “persecutor.”
Grandiose delusions are characterized by the client’s claim to association with
famous people or celebrities, or the client’s belief that he or she is famous or capable of
great feats.
Examples:The client may claim to be engaged to a famous movie star or related to
some public figure, such as claiming to be the daughter of the president of the United
States, or he or she may claim to have found a cure for cancer.
Religious delusions often center around the second coming of Christ or another
significant religious figure or prophet.These religious delusions appear suddenly as part
of the client’s psychosis and are not part of his or her religious faith or that of others.
Examples: Client claims to be the Messiah or some prophet sent from God; believes that
God communicates directly to him or her or that he or she has a “special” religious
mission in life or special religious powers.
Nihilistic delusion are the client’s belief that his or her organ aren’t functioning or are
rotting away.

18. Continue
Somatic delusions are generally vague and unrealistic beliefs
about the client’s health or bodily functions. Factual information or
diagnostic testing does not change these beliefs.
Examples: A male client may say that he is pregnant, or a client may
report decaying intestines or worms in the brain.
Referential delusions or ideas of reference involve the client’s belief that
television broadcasts, music, or newspaper articles have special meaning for
him or her.
Examples:The client may report that the president was speaking directly to
him on a news broadcast or that special messages are sent through
newspaper articles.
Sexual delusion involve the client’s belief that his or her sexual behavior is
known to others ;that the client is a rapist ,prostitude, or phedophile or is
pregnant

19. Hallucinations
Hallucinations (false sensory
perceptions, or perceptual experiences
that do not exist in reality).
Hallucinations can involve the five
senses and bodily sensations.
Hallucinations are distinguished from
illusions,
which are misperceptions of actual
environmental stimuli.

20. Types of Hallucinations
The following are the various types of hallucinations:
Auditory hallucinations, the most common type,
involve hearing sounds, most often voices, talking to or
about the client.There may be one or multiple voices; a
familiar or unfamiliar person’s voice may be speaking.
Command hallucinations are voices demanding that the
client take action, often to harm self or others, and are
considered dangerous.
Visual hallucinations involve seeing images that do not
exist at all, such as lights or a dead person, or distortions
such as seeing a frightening monster instead of the
nurse.They are the second most common type of
hallucination.
Olfactory hallucinations involve smells or odors.They
may be a specific scent such as urine or feces or a more
general scent such as a rotten or rancid odor. Inaddition
to clients with schizophrenia, this type of hallucination
often occurs with dementia, seizures, or cerebrovascular
accidents.

21. Continue
Gustatory hallucinations involve a taste lingering in the
mouth or the sense that food tastes like something else.
The taste may be metallic or bitter or may be represented as a
specific taste.
Cenesthetic hallucinations involve the client’s report that
he or she feels bodily functions that are usually undetectable.
Examples would be the sensation of urine
forming or impulses being transmitted through the
brain.
Kinesthetic hallucinations occur when the client is motionless but
reports the sensation of bodily movement.
Occasionally, the bodily movement is something unusual, such as
floating above the ground
Tactile hallucinations refer to sensations such as electricity
running through the body or bugs crawling on the skin.
Tactile hallucinations are found most often in clients
undergoing alcohol withdrawal; they rarely occur in clients
with schizophrenia.