This document provides an overview of schizophrenia including: - Definitions and classifications according to ICD-10 including paranoid, hebephrenic, catatonic, undifferentiated, residual, and simple schizophrenia. - Etiology including biological, psychological, and sociocultural theories. Biological theories discuss genetic and neurobiological factors. - Clinical features including positive symptoms like delusions and hallucinations and negative symptoms. - Management involves hospitalization if needed, pharmacotherapy primarily with antipsychotic medications, psychotherapy, and nursing care to address symptoms and promote self-care. - Nursing diagnoses may include altered thought processes, social isolation, and self-care deficits.

1. Dr. Jyoti Srivastava
Assistant professor
College of Nursing

3.  INTRODUCTION
 DEFINITION
 EPIDEMIOLOGY
 TYPES OR CLASSIFICATION
 ETIOLOGY
 CLINICAL FEATURES
 INVESTIGATION
 MANAGEMENT
 NURSING DIAGNOSIS
 PROGONOSIS
 SUMMARY

4.  SCHIZOPHRENIA IS A SERIOUS MENTAL DISORDER.
 In 1986,Emil kraepelin gave clinical description of
‘’DEMENTIA PRAECOX’’
 In 1911,Eugene Bleuler coined the term
SCHIZOPHRENIA.
 Word is derived from Greek word Schizo means split
and phren means mind so it is defined as split of mind

5. History
 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
detectable at that time.
 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
privilege of „the first rank symptoms” even in the concept
of the diagnosis of schizophrenia.

6. DEFINITION
 According to ICD 10
A group of disorder menifested by fundamental
disturbance or distortion in thinking, mood, and
behaviour, last for atleast a month of active phase
symptoms like delusion, hallucination, disorganised
speech , grossly disorganised or catatonic behaviour,
negative symptoms such as shallow or flat effect, alogia
or avolition and incongruous mood.

7. EPIDEMIOLOGY1. Eldest child is more vulnerable
2. 15-30years the peak incidence
3. Common in both sexes
4. Over crowding in slum area
5. Low socio economic group

8. TYPES OF SCHIZOPHRENIA
F20 Schizophrenia
F20.0 Paranoid schizophrenia
F20.1 Hebephrenic schizophrenia
F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia
F20.4 Post-schizophrenic depression
F20.5 Residual schizophrenia
F20.6 Simple schizophrenia
F20.8 Other schizophrenia
nonenonenonenone

9. F20.0 PARANOID SCHIZOPHRENIA
 Paranoid schizophrenia is characterized
mainly by delusions of persecution, feelings
of passive or active control, feelings of
intrusion, and often by megalomanic
tendencies also. The delusions are not
usually systemized too much, without tight
logical connections and are often combined
with hallucinations of different senses,
mostly with hearing voices.
 Disturbances of affect, volition and speech,
and catatonic symptoms, are either absent
or relatively inconspicuous.

10. F20.1HEBEPHRENICSCHIZOPHRENIA
 Hebephrenic schizophrenia is characterized by
disorganized thinking with blunted and inappropriate
emotions. It begins mostly in adolescent age, the
behavior is often bizarre. There could appear
mannerisms, grimacing, inappropriate laugh and
joking, pseudo philosophical brooding and sudden
impulsive reactions without external stimulation. There
is a tendency to social isolation.
 Usually the prognosis is poor because of the rapid
development of "negative" symptoms, particularly
flattening of affect and loss of volition. Hebephrenia
should normally be diagnosed only in adolescents or
young adults.
 Denoted also as disorganized schizophrenia

11. F20.2 CATATONIC SCHIZOPHRENIA
 Catatonic schizophrenia is characterized mainly by
motoric activity, which might be strongly increased
(hypekinesis) or decreased (stupor), or automatic
obedience and negativism.
 We recognize two forms:
 productive form — which shows catatonic excitement,
extreme and often aggressive activity. Treatment by
neuroleptics or by electroconvulsive therapy.
 stuporose form — characterized by general inhibition of
patient’s behavior or at least by retardation and slowness,
followed often by mutism, negativism, fexibilitas cerea or
by stupor. The consciousness is not absent.

12. F20.5 RESIDUAL SCHIZOPHRENIA
 A chronic stage in the development of
schizophrenia with clear succession from the
initial stage with one or more episodes
characterized by general criteria of
schizophrenia to the late stage with long-
lasting negative symptoms and deterioration
(not necessarily irreversible).

13. F20.3 UNDIFFERENTIATED SCHIZOPHRENIA
 Psychotic conditions meeting the general
diagnostic criteria for schizophrenia but not
conforming to any of the subtypes in F20.0-
F20.2, or exhibiting the features of more than
one of them without a clear predominance
of a particular set of diagnostic
characteristics.
 This subgroup represents also the former
diagnosis of atypical schizophrenia.

14. F20.6 SIMPLE SCHIZOPHRENIZ
 Simple schizophrenia is characterized by
early and slowly developing initial stage with
growing social isolation, withdrawal, small
activity, passivity, avolition and dependence
on the others.
 The patients are indifferent, without any
initiative and volition. There is not expressed
the presence of hallucinations and delusions.

15. F20.4POSTSCHIZOPHRENICDEPRESSIO
 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.

16. ETIOLOGY
BIOLOGIC
AL
FACTOR
PSYCHOLOGIC
ALTHEORY
SOCIOCULTURAL
THEORY

17. DIAGNOSTIC
CRITERIAAccording to DSM-IV-TR,to be diagnosed with schizophrenia,three
diagostic criteria
Must be met:
1. Characteristic symptom’s:- to or more of the following each present
for much of the time during a one month period (or less, if symptom
permitted with tretment).
Delusion
Hallucination
Disorganized speech ,which is manifestation of functional disorder
Grossly disorganized behaviour
Negative symptoms-affective flattening(lack of decline in emotional
response), alogia or avolition
Social occupation dysfunction

18. TYPES OF
SCHIZOPHRENIA

19. BIOLOGICAL THEORY
GENETIC
THEORY
BIOCHEMICAL
THEORY
NEUROPATHOL
OGY

20. NEUROPATHOLOGY
 Schizophrenia
 Evidence for neurological abnormalities
Negative symptoms
 Schizophrenics with negative symptoms have
similar symptoms as those with fromtal lobe
damage.
 Frontal lobe size
 Ventrical size
 Cerebral gray matter decreases

21. NEUROPATHOLOGY

22. CLINICAL MANIFESTATION
 PRIMARY SYMPTOMS(bleuler’s 4 A)
 SECONDARY SYMPTOMS
 FIRST RANK SYMPTOMS
 SECOND RANK SYMPTOMS
 POSITIVE SYMPTOMS
 NEGATIVE SYMPTOMS

23. MANAGEMENT
 HOSPITALISATION
 PHARMACOTHERAPY
 PSYCHOTHERAPY
 SOMATIC THERAPY
 NURSING MANAGEMENT

24. HOSPITALISATION
 Hospitalisation is indicated if there
is
1-nelect of food and water intake
2-danger to self and for others
3-poor treatment adherence
4-significant neglect of self care
5-lack of social support

25. PHARMACOTHERAP
Y ANTIPSYCHOTIC DRUG
 Phenothiazines e.g.chlorpromazine
 Butyrophenones e.g.haloperidol
 Diphenylbutylpiperidines e.g.pimozide
 Thioxanthines e.g.flupenthixol
 ATYPICAL NEW ANTIPSYCHOTIC
 chlorepromazine 100mg
 prochlorperazine 100mg
 pimozide 20mg
 haloperidol 100mg
 clozapine 900mg

26. First generation antipsychotic
side-effects
 Extrapyramidal side-effects – Parkinson
symptoms, dystonia, restlessness
 Sedation
 Weight gain
 Dry mouth, constipation
 Cardiac toxicity
 Postural hypotension

27. Second generation
antipsychotic
side-effects
Weight gain
Increase blood sugar –
diabetes
Increased lipids
Sedation

28. PSYCOTHERAPY
 Individual therapy
 Family therapy
 group therapy
 milieu therapy
 Cognitive therapy
 vocational therapy

29. INDIVISUAL THERAPY

30. GROUP THERAPY

31. Somatic therapy
 Usually 8-12 ECT are needed administered 2-3 times a
week
 INDICATION-
Catatonic stupor

32. Electroconvulsive therapy

33. NURSING
MANAGEMENT

34. NURSING DIAGNOSIS
Altered throught process
related to hallucination
Social isolation related to
inability to concentrate
Self care deficit related to
impaired thought processes

35. GOOD PROGNOSTIC
FACTOR
ONSET-Acute or abrupt
onset, after 35 yr of age
Presence of precipitating
stressors
Good premorbid
adjustment.
Short duration less than 6
months
History of mood disorder
1st episode
BAD PROGNOSTIC
FACTOR
Insidious ,before 20 yr of age.
Absence of stressors.
Poor premorbid adjustment.
Chronic course more than 2
yrs
History of schizophrenia
Past history of schizophrenia

36. CONCLUSION