Schizophrenia

PREPARED & PRESENTED
BY
RICHARD OPOKU ASARE
MPHIL, B.ED (HONS) (HEALTH SCIENCE), RN (DIP)-RMN, CERT.
ED
SCHIZOPHRENIA
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1

OUTLINE OF PRESENTATION
Introduction
Definition(s)
Incidence
Aetiology
Prognostic factors
Clinical features
Subtypes
Other forms of psychotic disorders
Treatment
Nursing interventions
2
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INTRODUCTION TO
SCHIZOPHRENIA
Schizophrenia is a group of severe mental disorders
characterised by reality distortions resulting in
unusual thought patterns and behaviours.
Because there is often little or no logical
relationship between the thoughts and feelings of
a person with schizophrenia, the disorder has
often been called “split personality.” However, the
condition should not be confused with multiple
personality, which is a disorder in which the
individual has two or more distinct personalities
that dominate at different times (Mayor, 2013;
Miller & Mason, 2002). 3

INTRODUCTION TO SCHIZOPHRENIA –
CONT’D
Schizophrenia is considered the most
common and disabling of the psychotic
disorders. Although it is a psychiatric
disorder, it stems from a physiologic
malfunctioning of the brain. This
disorder affects all races, and is more
prevalent in men than in women. No
cultural group is immune and persons
with intelligence quotients of the
genius level are not spared.
4

INTRODUCTION TO SCHIZOPHRENIA
– CONT’D
Schizophrenia occurs twice as often in
people who are unmarried and divorced
people as in those who are married or
widowed. People with schizophrenia are
more likely to be members of lower
socioeconomic groups. In 1896 Emil
Kraepelin originally called schizophrenia
dementia praecox meaning “madness
of the young” to differentiate it from
manic-depressive psychosis due to the
presence of hallucinations and delusions.
5

CONT’D
The term schizophrenia was coined by a German
psychiatrist, Eugen Bleuler (1857–1939), in 1908
and was intended to describe the separation of
function between personality, thinking, memory,
and perception.
He defined the disorder through the presence of two
groups of symptoms:
Primary symptoms – with 4As (i.e., flattened
Affect, Autism, impaired Association of ideas
and Ambivalence), and
Secondary symptoms – include delusions,
hallucinations, and disorganized, idiosyncratic
speech. 6

CONT’D
Affective disturbance refers to the person’s
inability to show appropriate emotional responses.
Autistic thinking is a thought process in which the
individual is unable to relate to others or to the
environment.
Ambivalence refers to contradictory or opposing
emotions, attitudes, ideas, or desires for the same
person, thing, or situation.
Looseness of association is the inability to think
logically. Ideas expressed have little, if any,
connection and shift from one subject to another
(Shives, 2005). 7

CONT’D
Due to stigmatization against people
living with this disorder, in 2002 the
Japanese Society of Psychiatry and
Neurology changed the term for
schizophrenia from mind-split-
disease to Integration Disorder to
reduce stigma (Kim and Berrios,
2001).
8

DEFINITION(S)
 Schizophrenia is a disorder characterized by
disturbances, for at least 6 months, in the
thought content and form, perception, affect,
sense of self, volition, interpersonal
relationships, and psychomotor behaviour.
 Schizophrenia is a mental disorder
characterized by abnormalities in the perception
or expression of reality. It most commonly
manifests as auditory hallucinations, paranoid
or bizarre delusions, or disorganized speech and
thinking with significant social or occupational
dysfunction. 9

DEFINITION(S) – CONT’D
 Schizophrenia is any group of severe mental
disorders that have in common symptoms such
as hallucinations, delusions, blunted emotions,
disorganized thinking, and withdrawal from
reality (Britannica Concise Encyclopaedia,
1994-2008).
 It is a brain disorder that is characterised by
bizarre mental experience such as
hallucinations and severe decrement in social,
cognitive, and social functioning (McGraw-Hill
Concise Encyclopedia of Bioscience, 2002).
10

INCIDENCE
 Onset of symptoms typically occurs in late
adolescence or young adulthood.
 Schizophrenia occurs equally in males and
females, although typically appears earlier in
men—the peak ages of onset are 20–28 years for
males and 26–32 years for females.
 Around 1% of the population is affected.
Diagnosis is based on the patient's self-reported
experiences and observed behavior.
 No laboratory test for schizophrenia currently
exists (APA, 2000).
11

INCIDENCE – CONT’D
 The average life expectancy of people with the
disorder is 10 to 12 years less than those
without, due to increased physical health
problems and a higher suicide rate (about 5%).
 Social stigma has been identified as a major
obstacle in the recovery of patients with
schizophrenia with a large number of people
believing that individuals with schizophrenia
were “very likely” to do something violent
against others.
12

INCIDENCE – CONT’D
Common in urban areas with those who
are unemployed, poor, and homeless.
Schizpohrenics form about half of the
patients occupying mental hospital beds.
The prognosis worsens with each acute
episode.
13

AETIOLOGY
1. Biological factors
a. Biochemical (neurochemical) changes: Increased
dopamine activity in the mesolimbic pathway of the
brain is consistently found in schizophrenic individuals.
The dopamine hypothesis posits that an excessive
amount of the neurotramsmitter dopamine allows
nerve impulses to bombard the mesolimbic pathway,
the part of the brain normally involved in arousal and
motivation. Normal cell communication is disrupted,
resulting in the development of hallucinations and
delusions.
Norepinephrine and serotonin systems have also been
implicated in the causation of schizophrenia. 14

AETIOLOGY – CONT’D
b. Endocrine factors: Changes in prolactin,
melatonin, and thyroid function have been
found in schizophrenia.
c. Brain structural changes: CT, MRI, and
postmortem studies have shown decreased
volume and density in limbic and frontal
areas in schizophrenic patients. Other medical
imaging studies have also revealed various
physical and physiological anomalies in some
patients. Other research has focused on
mistiming of neural responses to stimuli in
the brain. 15

d. Prenatal: Causal factors are thought to
initially come together in early
neurodevelopment to increase the risk
of later developing schizophrenia. One
curious finding is that people diagnosed
with schizophrenia are more likely to
have been born in winter or spring, (at
least in the northern hemisphere).
16

There is now evidence that prenatal exposure to
infections (i.e., prenatal exposure to influenza
during the second trimester) increases the risk
for developing schizophrenia later in life,
providing additional evidence for a link between
in utero developmental pathology and risk of
developing the condition.
Other gestational and birth complications, such as
Rh factor incompatibility, as well as prenatal
nutritional deficiencies, have been associated
with schizophrenia.
17

e. Vitamin deficiency: The vitamin
deficiency theory suggests that
persons, who are deficient in
vitamin B, namely B1, B6, and B12, as
well as in vitamin C, may become
schizophrenic as a result of a severe
vitamin deficiency.
18

f. Genetics: It has been noted that the
closer the biological relationship
between an individual and a person
considered to be schizophrenic, the
greater the disorder. This is based
on data from family studies.
19

AETIOLOGY – GENETICS (CONT’D)
 Family studies: A child born with one
schizophrenic parent has about a 50% chance
of developing schizophrenia. It is 100% if both
parents are schizophrenics. There is 50%
chance of developing the condition when a
sibling is schizophrenic, i.e., non-twin siblings.
Second degree relatives have 25% chances of
suffering the illness; when no relative is
affected with the illness, the chances are 2–3%
of a family member developing the condition.
20

AETIOLOGY – GENETICS (CONT’D)
Twin and Adoption studies: Twin studies
and adoption studies have suggested a high
level of heritability (the proportion of
variation between individuals in a
population that is influenced by genetic
factors). According to these studies if one of
the monozygotic (identical) twins suffers
schizophrenia, there is 100% chance of the
other twin also developing the condition. For
the dizygotic (non-identical) twins, there is
50% chance of the other catching the
condition.
21

AETIOLOGY OF SCHIZOPHRENIA –
CONT’D
2. Psychological Factors
a. Personality traits: Personality
characteristics of an individual, such as
withdrawn, extreme quietness and
shyness, highly dependent and obedient,
having temper tantrums, and always
looking sad and miserable, is a recipe for
schizophrenia.
22

CONT’D
b. Cognitive biases: that have been identified in
those with a diagnosis or those at risk, especially
when under stress or in confusing situations
include:
 excessive attention to potential threats,
 jumping to conclusions,
 making external attributions,
 impaired reasoning about social situations and
mental states,
 difficulty distinguishing inner speech from
speech from an external source, and difficulties
with early visual processing and maintaining
concentration.
23

CONT’D
Some cognitive features may reflect
global cognitive deficits in memory,
attention, problem-solving, executive
function or social cognition, while others
may be related to particular issues and
experiences.
24

CONT’D
3. Environmental/Social Factors
a. Recreational drug use: Although about half of all
patients with schizophrenia use drugs or alcohol,
a clear causal connection between drug use and
schizophrenia has been difficult to prove. The
two most often used explanations for this are
“substance use causes schizophrenia” and
“substance use is a consequence of
schizophrenia”, and they both may be correct
(Ferdinand, Sondeijker, van der Ende, Selten,
Huizink, and Verhulst, 2005).
25

CONT’D
b. Childhood experiences of abuse or
trauma have also been implicated as
risk factors for a diagnosis of
schizophrenia later in life. Parenting is
not held responsible for schizophrenia
but unsupportive dysfunctional
relationships may contribute to an
increased risk.
26

CONT’D
c. Social: Living in an urban environment has
been consistently found to be a risk factor for
schizophrenia. Social disadvantage found to be
a risk factor, include:
 poverty,
 migration related to social adversity,
 racial discrimination,
 family dysfunction,
 unemployment
 poor housing conditions. 27

CONT’D
 Developmental factors – complication of the foetus
during pregnancy may result in the condition, e.g.,
malnutrition, maternal drug use/alcoholism, asphyxia,
infections, forceps delivery, etc.
 Double bind theory – Schizophrenia is a
consequence of abnormal patterns in family
communication or a person is given mutually
contradictory signals by another person.
28

DOUBLE BIND AS A THEORY
Bateson et al. (1956) proposed that schizophrenic symptoms are an
expression of social interactions in which the individual is
repeatedly exposed to conflicting injunctions, without having the
opportunity to adequately respond to those injunctions, or to
ignore them (i.e., to escape the field). For example, if a mother
tells her son that she loves him, while at the same time turning
her head away in disgust, the child receives two conflicting
messages about their relationship on different communicative
levels, one of affection on the verbal level, and one of animosity
on the nonverbal level. It is argued that the child's ability to
respond to the mother is incapacitated by such contradictions
across communicative levels, because one message invalidates
the other. Because of the child's vital dependence on the mother,
Bateson et al. argue that the child is also not able to comment
on the fact that a contradiction has occurred, i.e., the child is
unable to metacommunicate (Bateson et al., 1956).
29

DOUBLE BIND AS A THEORY – CONT’D
 Mother: One of the things that bothers me very much is way in
which you curse. I don't like that at all.
 Daughter: I get mad. Kids do it in school, so I get it from them.
 M: I don't care whether they do it in school or not. I don't want you
to do it at home.
 D: And you do it too, so why -
 M: So what! I am not 14 years old.
 D: Well, you still do it.
 M: Well, If I'm just going to be something that can be cursed at
and so what etc. etc., the message I'm getting is that you could
care less whether I'm there or not. And I have been vehemently
screaming about the fact that I feel that you're trying to take my
place in this family.
(Minuchin & Fishman, 1981, p. 135)
30

DOUBLE BIND AS A THEORY – CONT’D
The essential hypothesis of the double bind theory
is that the ‘victim’—the person who becomes
psychotically unwell—finds him or herself in a
communicational matrix, in which messages
contradict each other, the contradiction is not
able to be communicated on and the unwell
person is not able to leave the field of interaction.
31

PROGNOSTIC FACTORS
Prognosis indicates the likelihood of recovery from a
disease. Factors which are responsible for a good
prognostic outcome of schizophrenia are:
oAge of the patient – The older the patient, the more
favorable the prognosis.
oThe duration of illness – The shorter the duration
prior to treatment, the better the outcome.
oThe rapidity of development of the symptoms –
Surprisingly, it has been found that the more speedily
the symptoms develop, the faster do they respond to
treatment; a very slow, insidious, and gradual onset of
illness suggests a final poor outcome.
32
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PROGNOSTIC FACTORS – CONT’D
 A patient who had close friendships and multiple
relationships prior to illness has a brighter chance
with few or no such relationships.
 Life stress prior to onset – An episode brought on by a
major identifiable life stress will respond more
quickly than an episode without any obvious cause.
 Marital history – A patient with a stable and helpful
marital partner has a favorable prognosis as
compared to an unmarried patient.
 Educational history – The higher the level of
education, the more are the chance of a patient
coming rapidly to terms with the illness and handling
the post-illness sequence.
33

 Occupational history – A patient with a good stable
occupation or business prior to onset of illness will
respond better than a patient who is jobless and
economically unsound.
 Family’s attitude towards the returning patient –
Hostile behaviour by family members, or vice versa,
excessive care and attention by them can undermine
the patient’s sense of confidence and hamper
recovery.
34

 Social support systems – A patient with a joint family
and a staunch circle of friends who are ready lend a
helping hand, is much better off than a lone man
afflicted with the illness, whose relatives are in some
far off land, and who has no one to turn to.
 Organic brain damage – Presence of concurrent
obvious brain damage (mental retardation, epilepsy,
head injury, etc.) hinders the final adequate recovery
from schizophrenia.
35

However, factors which may indicate a poor or bad prognosis
include:
-Earlier age of onset
-Being a male
-A higher number of negative symptoms
-A family history of schizophrenia
-A low level of functioning prior to onset
-Poor or no support system
-A history of substance abuse
36

RISK FACTORS
Certain factors seem to increase the risk of developing or
triggering schizophrenia, including:
Having a family history of schizophrenia
Exposure to viruses, toxins or malnutrition while in the
womb, particularly in the first and second trimesters
Stressful life circumstances
Older paternal age
Taking psychoactive drugs during adolescence and young
adulthood
37

CLINICAL FEATURES
 Positive/Active Symptoms
The term positive symptom refers to symptoms
that most individuals do not normally
experience but are present in schizophrenia.
They include delusions, hallucinations
(auditory), thought disorder, and disorganized
behaviour, and these are typically regarded as
manifestations of psychosis.
38

CLINICAL FEATURES – CONT’D
 Negative/Deficit symptoms
These are things that are not present in schizophrenic
persons but are normally found in healthy persons, that
is, symptoms that reflect the loss or absence of normal
traits or abilities. Common negative symptoms include
flat or blunted affect and emotion, poverty of speech
(alogia), inability to experience pleasure (anhedonia),
lack of desire to form relationships (asociality), isolation
(social withdrawal) and lack of motivation (avolition).
39

CLINICAL FEATURES (NEGATIVE
SYMPTOMS) CONT’D
Negative symptoms contribute more to poor quality of
life, functional disability, and the burden on others
than do positive symptoms.
 A third symptom grouping, the disorganization
syndrome, is sometimes described, and includes
chaotic speech, thought, and behavior.
40

CLINICAL FEATURES (COGNITIVE
SYMPTOMS) CONT’D
However, Mayo (2013) described third symptom as the
Cognitive symptom. Cognitive symptoms involve problems with
thought processes. These symptoms may be the most disabling in
schizophrenia because they interfere with the ability to perform
routine daily tasks. A person with schizophrenia may be born with
these symptoms. They include:
•
Problems with making sense of information
•
Difficulty paying attention
Memory problems
41

COMPLICATIONS FOR SCHIZOPHRENIA
Because of disordered thought processes,
the schizophrenic patient often neglects
personal hygiene or ignores health needs.
As a result, the patient has a shorter life
expectancy than the general population.
Ten percent of schizophrenic patients
commit suicide. 42

COMPLICATIONS FOR SCHIZOPHRENIA –
CONT’D
Other complications include:
Aggression
Violence
Violence against others
Increased risk of substance abuse (exacerbating
symptoms in some patients)
Complications of schizophrenia from disease database
include:
Auditory hallucinations
Delusions
Mood alteration
43

SUBTYPES OF SCHIZOPHRENIA
 Paranoid type:
 delusions and hallucinations are present
 but thought disorder, disorganized behavior,
and affective flattening are absent.
 The individual is often tense, suspicious, and
guarded,
 may be argumentative, hostile, angry and
aggressive.
 At the workplace, he has the false notion that
co-workers talk about him behind his back and
laugh quietly as he passes by. 44

 Paranoid – cont’d
 Patient may refuse to eat meals served of the suspicion
that the food is secretly poisoned. He may appeal to
authorities for help.
 Grandiose delusions may also dominate the clinical
picture. For instance, he believes himself anointed
with holy oil, trumpets blared forth his appearance as
a prophet. He has a message that will save the world,
and sets about spreading it. 45

 Disorganized type: Named hebephrenic
schizophrenia in the ICD.
 thought disorder and flat affect are present together.
 Onset of symptoms is usually before age 25 years, and
the course is commonly chronic.
 delusions and hallucinations are present, they are
relatively minor.
 bizarre behaviour, loosened associations, and
 inappropriate affect with periods of caricature of
childish silliness and incongruous giggling (laughter).
46

SUBTYPES OF SCHIZOPHRENIA –
CONT’D
Disorganized type (continued)
 Facial grimaces and bizarre mannerisms
are common,
 communication is consistently incoherent.
 Personal appearance is generally
neglected,
 social impairment is extreme.
47

CONT’D
Catatonic type:
 The patient may be almost immobile, or
 exhibit agitated, purposeless movement.
 Patient may scream, howl, beat his sides
repeatedly, jump up, hop about or skitter
back and forth.
 Words and phrase may be repeated
hundreds of times (echolalia).
 He remains most part withdrawn, making
little or no effort to interact with others. 48

CONT’D
 Catatonic type (cont’d)
Symptoms can include:
1. catatonic stupor: this is extreme immobility without
evidence of absent or decreased consciousness.
The patient is also rigid and mute and only appears to
be conscious as the eyes are open and follow
surrounding objects (Gelder, Mayou and Geddes 2005).
Example: The patient sits immobile in a chair for sixteen
hours, staring fixedly, apparently unaware of other
people or his own bodily needs.
49

CONT’D
 Catatonic type – symptoms (cont’d)
2. waxy flexibility: the patient remains in any
position that s/he is placed.
The patient is nearly or completely unresponsive to
stimuli and remains immobile for long periods of
time.
Example: A schizophrenic man stands stock-still near
his bed. When a psychiatrist lifts the man’s arm, it
remains in the exact same position for hours after
she lets go.
50

CONT’D
o Catatonic type – symptoms (cont’d)
3. catatonic excitement: this involves purposeless motor
activity and agitation.
The patient shows impulsivity, destructive behaviour which
urgently require physical and medical control because
s/he is often destructive and violent to others, and his/her
excitement can cause him/her to injure him/herself or to
collapse from complete exhaustion.
Pernicious or acute lethal catatonia is the other name
used to describe excited catatonia.
Example: The patient runs aimlessly through the dining
hall due to an episode of catatonic excitement, knocking
over objects without apparent regard, and ignoring all
outside attempts to stop or redirect her.
51

CONT’D
Undifferentiated type
 Psychotic symptoms are present
but the criteria for paranoid,
disorganized, or catatonic types
have not been met.
52

CONT’D
 Residual type
 positive symptoms are present at a low intensity only.
 This diagnostic category is used when the individual has
a history of at least one previous episode of
schizophrenia.
 At this stage, there is continuing evidence of the illness,
although there are no prominent psychotic symptoms.
 symptoms may include social isolation, eccentric
(strange/unusual) behaviour, impairment in personal
hygiene and grooming, blunted or inappropriate affect,
poverty of or overly elaborate speech, illogical thinking
or apathy. For most part, however, the patient does
little to attract any attention. 53

CONT’D
The ICD-10 defines two additional subtypes.
 Post-schizophrenic depression
 The client may express depressed and manic behaviours
with psychomotor retardation and suicidal ideation, as
well as euphoria, grandiosity, and hyperactivity.
 To diagnose this disorder, the individual in addition to
the above symptoms should exhibit delusions,
hallucinations, incoherent speech, catatonic behaviour, or
blunted or inappropriate affect.
 This disorder is also known as schizoaffective disorder
 (NB: Schizoaffective disorder: People with this illness
have symptoms of both schizophrenia and a mood
disorder, such as depression or bipolar disorder). 54

SUBTYPES OF SCHIZOPHRENIA – CONT’D
The ICD-10 defines two additional subtypes (cont’d).
 Simple schizophrenia
 Insidious and progressive development of
prominent negative symptoms with no history
of psychotic episodes, i.e., hallucinations and
delusions may be absent.
55

OTHER FORMS OF PSYCHOTIC DISORDERS
 Brief Psychotic Disorder
People with this illness have sudden, short periods
of psychotic behavior, often in response to a very
stressful event, such as a death in the family.
Recovery is often quick -- usually less than a
month.
 Schizophreniform Disorder
People with this illness have symptoms of
schizophrenia, but the symptoms last more than
one month but less than six months. 56

– CONT’D
 Delusional Disorder
People with this illness have delusions involving
real-life situations that could be true, such as
being followed, being conspired against, or having
a disease. These delusions persist for at least one
month.
 Shared Psychotic Disorder
This illness occurs when a person develops
delusions in the context of a relationship with
another person who already has his or her own
delusion(s).
57

– CONT’D
 Psychotic Disorder due to a General
Medical Condition
Hallucinations, delusions, or other symptoms may
be the result of another illness that affects brain
function, such as a head injury or brain tumor.
 Substance-Induced Psychotic Disorder
This condition is caused by the use of or
withdrawal from some substances, such as
alcohol and crack cocaine, that may cause
hallucinations, delusions, or confused speech.
58

– CONT’D
Paraphrenia
This is a type of schizophrenia that
starts late in life and occurs in the
elderly population.
59

TREATMENT
 Antipsychotic medication,
e.g., Haldol, Thorazine/Largactil, Stelazine, etc., and
newer medications (often called atypicals) such as
Clozaril, Risperdal, and Zyprexa.
 Education & support, for both ill individuals and
families
 Social skills training
 Rehabilitation to improve activities of daily living
 Vocational and recreational support
 Cognitive therapy
60

NURSING INTERVENTIONS FOR
SCHIZOPHRENIA
 Assess the patient’s ability to carry out the activities
of daily living, paying special attention to his
nutritional status. Monitor his weight if he is not
eating. If he thinks that his food is poisoned, allow
him to fix his own food when possible, or offer him
foods in closed containers that he can open. If you
give liquid medication in a unit-dose container,
allow the patient to open the container.
 Maintain a safe environment, minimizing stimuli.
Administer medication to decrease symptoms and
anxiety. Use physical restraints according to the
hospital’s policy to ensure the patient’s safety and
that of others.
61

SCHIZOPHRENIA CONT’D
 Adopt an accepting and consistent approach with
the patient. Do not avoid or overwhelm him. Keep in
mind that short, repeated contacts are best until
trust has been established.
 Avoid promoting dependence. Meet the patient’s
needs, but only do for the patient what he cannot do
for himself.
 Reward positive behavior to help the patient
improve his level of functioning.
62

 Engage the patient in reality-oriented activities
that involve human contact: inpatient social
skills training groups, outpatient day care, and
sheltered workshops. Provide reality-based
explanations for distorted body images or
hypochondriacal complaints.
 Clarify private language, autistic inventions, or
neologisms, explaining to the patient that what
he says is not understood by others. If necessary,
set limits on inappropriate behavior. 63

 If the patient is hallucinating, explore the content of
the hallucinations. If he has auditory hallucinations,
determine if they are command hallucinations that
place the patient or others at risk. Tell the patient
you do not hear the voices but you know they are
real to him. Avoid arguing about the hallucinations;
if possible, change the subject.
 Do not tease or joke with the patient. Choose words
and phrases that are unambiguous and clearly
understood. For instance, a patient who’s told, “That
procedure will be done on the floor”, may become
frightened, thinking he is being told to lie down on
the floor.
64

 Do not touch the patient without telling him first
exactly what you are going to do. For example,
clearly explain to him, I’m going to put this cuff on
your arm so I can take your blood pressure. If
necessary, postpone procedures that require
physical contact with hospital personnel until the
patient is less suspicious or agitated.
 Remember, institutionalization may produce new
symptoms and handicaps in the patient that are
not part of his diagnosed illness, so evaluate
symptoms carefully. 65

 Mobilize community resources to provide a support
system for the patient and reduce his vulnerability
to stress. Ongoing support is essential to his
mastery of social skills.
 Encourage compliance with the medication regimen
to prevent relapse. Also monitor the patient
carefully for adverse effects of drug therapy,
including drug-induced parkinsonism, acute
dystonia, akathisia, tardive dyskinesia, and
malignant neuroleptic syndrome. Make sure you
document and report such effects promptly. 66

AGITATION, HALLUCINATIONS, AND
DELUSIONS
Agitation
 Remove client from, or avoid, situations known to cause
agitation.
 Decrease stimulants such as caffeine, bright lights, and loud
noise or music.
 Avoid display of anger, discouragement, or frustration when
interacting with client.
 Avoid criticism and do not argue with client.
 Set limits and follow through with consequences if a violation
occurs.
 Monitor for physical discomfort such as pain or physical
illness.
 Administer prescribed medication as ordered.
67

DELUSIONS
Hallucinations
 Decrease environmental stimuli such as loud music,
extremely bright colors, or flashing lights.
 Attempt to identify precipitating factors by asking the
client what happened prior to the onset of
hallucinations.
 Monitor television programs to minimize external
stimuli that may precipitate hallucinations.
 Monitor for command hallucinations that may
precipitate aggressive or violent behavior.
 Administer prescribed medication as ordered.
68

DELUSIONS
Delusions
 Do not whisper or laugh in the presence of the client.
 Do not argue with the client or attempt to disprove
delusional or suspicious thoughts.
 Explain all procedures and interventions, including
medication management.
 Provide for personal space and do not touch the client
without warning.
 Maintain eye contact during interactions with client.
 Provide consistency in care and assigned caregivers to
establish trust.
69

CLIENTS WHO ARE SUSPICIOUS AND
RUDE
 Form professional relationships; can be considered a
threat if too friendly.
 Be careful with the touch as it can be regarded as a
threat.
 Give as much control and autonomy to client within the
therapeutic limits.
 Create a sense of trust through brief interactions that
communicate caring and respect.
 Describe any treatment, medication and laboratory tests
before the start.
70

CLIENTS WHO ARE SUSPICIOUS AND RUDE –
CONT’D
 Do not focus or strengthen the suspicion or delusional
ideas.
 Identify and respond to the emotional needs of the
underlying suspicion or delusional thoughts
 Intervene when the client shows signs of increasing
anxiety and potentially express an unconscious
behavior.
 Be careful not to behave in a way that could be
misinterpreted by the client. 71

THE NURSE’S ROLE DURING MEDICATION
MANAGEMENT
 Administering medication,
 Monitoring responses to the prescribed
medication, and
 reporting any adverse effects.
The nurse also plays a major role in developing a
therapeutic relationship and educating the
client and family about prescribed medication
to promote compliance.
72

PREVENTION OF SCHIZOPHRENIA
 Seek early treatment (to control symptoms before
complications develop and to improve long-term
outlook)
 Stick to treatment plan (to prevent relapses or
worsening of schizophrenia symptoms)
 Learn about risk factors may lead to earlier diagnosis
and earlier treatment
 Avoid illegal drug and alcohol use
 Reducing stress
73

PREVENTION OF SCHIZOPHRENIA –
CONT’D
 Getting enough sleep
 Avoid social isolation
 Plan your pregnancy (have a child when you want one,
and don’t have a child if you don’t want one)
 Eat a healthy diet with a lot of vegetables, fish with
omega 3 fatty acids.
 Avoid head injuries
 Vitamin D supplements
74

CHALLENGES OF THE MENTALLY ILL AT
HOME
 Poverty
 Homelessness
 Unemployment
 Denial of benefits
 Excluded from insurance cover
 Vulnerable to exploitation
 Inability to cope with everyday life issues
 Unsympathetic treatment by healthcare givers
 Refusal to pay claims by insurance companies
75

CHALLENGES OF THE MENTALLY ILL AT
HOME – CONT’D
 Conflict with law enforcement agencies (due to
petty property crimes)
 Self medication
 Drug abuse
 Barrier to education
 Reduced promotion opportunities
 Additional cost of medication
 Sexually abuse/promiscuity
 Lack of family support
 Isolation/withdrawn
76

END OF LECTURE
THANK YOU
77

Schizophrenia

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