M Sc Nursing Final
“it is type of functional psychosis
characterized mainly by disturbance in
thinking and associated disturbances in
psychomotor activity, affect, perception,
Emil Kraepelin: This illness develops relatively
early in life, and its course is likely deteriorating
and chronic; deterioration reminded dementia
(„Dementia praecox“), but was not followed by
any organic changes of the brain, detectable at
Eugen Bleuler: He renamed Kraepelin’s dementia
praecox as schizophrenia (1911); he recognized
the cognitive impairment in this illness, which he
named as a „splitting“ of mind.
Kurt Schneider: He emphasized the role of
psychotic symptoms, as hallucinations, delusions
and gave them the privilege of „the first rank
symptoms” even in the concept of the diagnosis of
Bleuler maintained, that for the diagnosis of
schizophrenia are most important the following four
◦ affective blunting
◦ Loosing of association (fragmented thinking)
◦ Autism(Social withdrawal)
◦ ambivalence (conflicting attitude )
These groups of symptoms, are called „four A’ s” and
Bleuler thought, that they are „primary” for this
The cause of schizophrenia is still uncertain. No
single factor can be implicated in the etiology
that include biological, psychological and
- Genetic, biochemical influences (dopamine,
neurotransmitters, serotonin, acetylcholine etc.)
viral infection, anatomical abnormilties and
physical conditions (head injuries, birth trauma,
pakinsonism, huntington disease).
- Insidious and gradual course.
- Onset is age of 15-20 yrs.
- More incidence in males.
- Disturbance in affect.
- Disturbance in thinking.
- Delusion & hallucination.
Disorganized / hebephrenic schizophrenia
- Early & insidious onset before age of 25yr.
- Contact with reality extremely poor.
- Affect is flat & inappropriate.
- Communication is consistently incoherent.
- Facial grimaces & bizzare mannerism.
- Personal appearance is generally neglected.
- Social impairment is extreme.
Marked abnormalities in motar behaviour & may be
manifested in the form of stupor & excitement.
Catatonic stupor :-
- Extreme psychomotor retardation.
- Mutism (absence of speech).
- Waxy flexibility
- Echolalia & Echopraxia.
- onset in late 20s & 30s.
- presence of delusion of persecution, grandeur.
- auditory hallucination.
- individual often tense, suspicious.
- argumentative , hostile & aggressive.
- social impairment minimal.
- negative symptoms like flat affect,
poverty of speech & poor activity.
Schizophrenia symptom do not meet the
criteria for any of the subtype or they may meet
the criteria for more than one subtype.
- Psychotic symptoms
- Delusion & hallucination.
- Onset late after 40yr of age.
- Bizzarre behaviour.
There is continuing evidence of the illness,
although there are no prominent psychotic
- Residual symptoms
Social isolation , impairment in personal
hygiene & grooming, eccentric behaviour ,
blunted & inappropriate affect, illogical
thinking, poverty or elaborate speech.
This disorder is manifested by
schizophrenic behaviour with a strong element
of symptomatology associated with the mood
disorder (Depression & mania).
The Criteria of Diagnosis
For the diagnosis of schizophrenia is necessary
presence of one very clear symptom - from point a) to d)
or the presence of the symptoms from at least two groups - from
point e) to h)
for one month or more:
a) the hearing of own thoughts, the feelings of thought withdrawal,
thought insertion, or thought broadcasting
b) the delusions of control, outside manipulation and influence, or the
feelings of passivity, which are connected with the movements of
the body or extremities, specific thoughts, acting or feelings,
c) hallucinated voices, which are commenting permanently the
behavior of the patient or they talk about him between themselves,
or the other types of hallucinatory voices, coming from different
parts of body
d) permanent delusions of different kind, which are inappropriate and
unacceptable in given culture
The Criteria of Diagnosis
e) the lasting hallucination of every form
f) blocks or intrusion of thoughts into the flow of
thinking and resulting incoherence and irrelevance
of speach, or neologisms
g) catatonic behavior
h) „the negative symptoms”, for instance the expressed
apathy, poor speech, blunting and inappropriatness
of emotional reactions
i) expressed and conspicuous qualitative changes in
patient’s behavior, the loss of interests, hobbies,
aimlesness, inactivity, the loss of relations to others
and social withdrawal
Content of thought:-
Delusion(Persecution, Grandeur, reference, control,
nihilistic, somatic paranoia ), Magical thinking.
form of thought:-
Associative looseness, neologism, concrete thinking, clang
association, word salad, circumstantiality, tangentiality,
Perception:- Hallucination(auditory, visual, tactile,
gustatory, olfactory), illusion.
Sense of self:- Echolalia, echopraxia &
Affect:- inappropriate, flat .
volition:- inability to initiate goal directed activity.
impaired interpersonal functioning & relationship with
the external world – autism, deteriorated appearance.
Psychomotar behaviour:- anergia(deficiency of energy),
Anhedonia( inability to experience pleasure).
Management of Schizophrenia
The treatment of schizophrenia can be discussed
under the following headings.
Psychosocial treatment & Rehabilitation.
It's extremely rare for patients with
schizophrenia to be offered ECT,“.
Most people are given ECT every two to
five days for a total of 6 to 12 sessions.
Psychosocial treatment &
Psychosocial treatment is an extremely important
component of the comprehensive management o
schizophrenia which involve a various type of
Psychosocial rehabilitation(social skills,
occupational & vocational guidance)