3. INTRODUCTION
The word ‘Schizophrenia’ was
coined by the swiss psychiatrist
Eugen Bleuler in 1908. It is
derived from the Greek Words
Schizo( Split) and
Phren ( mind).
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
5. INTRODUCTION TO SCHIZOPHRENIA –
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
6. INTRODUCTION TO SCHIZOPHRENIA –
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
7. DEFINITION(S)
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
8. INCIDENCE
8
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).
9. INCIDENCE – CONT’D
9
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.
10. INCIDENCE – CONT’D
10
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 eachacute
episode.
11. 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
12. 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. 12
13. AETIOLOGY – CONT’D
with schizophrenia.
d. Prenatal:-
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
17
14. AETIOLOGY – CONT’D
14
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.
15. AETIOLOGY – CONT’D
15
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.
16. AETIOLOGY – GENETICS (CONT’D)
16
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.
17. AETIOLOGY – GENETICS (CONT’D)
Twin and Adoption studies: 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
18. 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 cause for
schizophrenia.
22
19. AETIOLOGY OF SCHIZOPHRENIA –
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:
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.
23
20. AETIOLOGY OF SCHIZOPHRENIA –
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
21. AETIOLOGY OF SCHIZOPHRENIA –
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
25
22. AETIOLOGY OF SCHIZOPHRENIA –
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
23. AETIOLOGY OF SCHIZOPHRENIA –
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
24. AETIOLOGY OF SCHIZOPHRENIA –
CONT’D
24
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.
25. PROGNOSTIC FACTORS
25
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.
26. PROGNOSTIC FACTORS – CONT’D
26
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.
27. PROGNOSTIC FACTORS – CONT’D
27
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, excessive care
and attention by them can undermine the patient’s
sense of confidence and hamper recovery.
28. PROGNOSTIC FACTORS – CONT’D
28
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.
29. PROGNOSTIC FACTORS – CONT’D
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
29
30. RISK FACTORS
37
adulthood
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
31. Positive and Negative Symptom
Positive Symptoms Negative Symptoms
Content of Thought:-
Delusions
Magical Thinking
Religiosity
Paranoia
Form Of Thought:-
Associative looseness
Neologism
Concrete thinking
Clag associations
Word salad
Circumstantiality
Tangentiality
Mutism
Perseveration
Sence Of Self:-
Echolalia
Echopraxia
Identification and imitation
Depersonalization
Perception:-
Hallucinations
Illusions
Affect:-
Inappropriate affect
Flat affect
Apathy
Volition:-
Inability to initiative goal-directed
activity
Emotional ambivalence
Deteriorated appearance
Interpersonal functioning and
relationship to the external world:-
Impaired social interaction
Social isolation
Psychomotor Behaviour:-
Anergia
Waxy flexibility
Posturing
Pacing and rocking
Associated Features:-
Anhedonia
Regression
32. 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
33. 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
commit suicide.
patients
42
34. 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
35. SUBTYPES OF SCHIZOPHRENIA(F20)
1. Paranoid type (F20.0)
2: Hebephrenic / Disorganized type (F20.1)
schizophrenia in the ICD.
3.Catatonic type: (F20.2)
4.Undifferentiated type (F20.3)
5.Post-schizophrenic depression (F20.4)
6.Residual type (F20.5)
7.Simple schizophrenia (F20.6)
Key- PHC,UP, RS 44
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46. NURSING INTERVENTIONS FOR
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
47. NURSING INTERVENTIONS FOR
SCHIZOPHRENIA CONT’D
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 o
6
4
n
the floor.
48. NURSING INTERVENTIONS FOR
SCHIZOPHRENIA CONT’D
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
