The document provides an overview of schizophrenia, including its definition, signs and symptoms, causes, diagnosis, treatment and prognosis. Some key points: - Schizophrenia is a severe mental illness characterized by disturbances in thought, perception, emotions and behavior. It typically emerges during young adulthood. - Symptoms include positive symptoms like hallucinations and delusions, and negative symptoms such as reduced speech and emotional expression. - Causes are not fully known but involve genetic, neurological and environmental factors. - Diagnosis involves assessing psychotic symptoms, cognitive abilities and personality. Treatment includes antipsychotic medication and psychosocial support. Prognosis depends on several risk factors.

1. SCHIZOPHRENIA
By:
Sathish Rajamani
Professor
DSCON - CUTTACK
Professor Sathish Rajamani 1

2. Overview of Schizophrenia
• In Greek word ‘Schizein’ – ‘To Split’ and ‘Phren’ – ‘Mind’ “Splitting of the
Mind”.
• Schizophrenia is a serious mental illness that affects how a person thinks,
feels, and behaves.
• People with schizophrenia may seem like they have lost touch with reality,
which can be distressing for them and for their family and friends.
• People with schizophrenia require lifelong treatment.
• May – 24: World Schizophrenia Day
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3. Paul Eugen Bleuler
• Swiss psychiatrist
• He coined several psychiatric
terms including
Schizophrenia, Schizoid
& Autism.
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4. Definition
• A mental illness that is characterized by disturbances in thought
(as delusions), perception (as hallucinations), and behavior (as
disorganized speech or catatonic behavior), by a loss of emotional
responsiveness and extreme apathy, and by noticeable
deterioration in the level of functioning in everyday life.
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5. EPIDEMIOLOGY OF SCHIZOPHRENIA
• The usual age of onset for adult Schizophrenia is 15 to 25 years.
• Childhood-onset schizophrenia (COS) is a rare condition with onset
before the age of 13 years.
• According to a recent National Mental Health Survey (2015-2016)
conducted by NIMHANS, the prevalence of Schizophrenia in the
Indian population is 0.5 per cent for current and 1.4 per cent for a
lifetime experience.
• According to a study on mental patients arriving at the Institute
of Mental Health and Hospital in Agra, 7 per cent of all mental
patients have schizophrenia in various degrees of severity.
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6. EPIDEMIOLOGY OF SCHIZOPHRENIA
• Schizophrenia affects 20 million people worldwide. (Global Burden of
Disease, 2017)
• The annual number of new cases of schizophrenia is 1.5 per 10,000 people.
(Epidemiol Reviews, 2008)
• Schizophrenia is one of the top 15 leading causes of disability worldwide.
(Global Burden of Disease, 2016)
• Approximately 5% of people with schizophrenia die by suicide, usually
with a higher risk at the onset of the mental illness. (Archives of General
Psychiatry, 2005)
• About 20% of people with schizophrenia attempt suicide at least once. (The
Recovery Village, 2020)
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7. Co-occurring disorders and schizophrenia
• Depressive symptoms: 30%-54%
• Post-traumatic stress disorder: 29%
• Obsessive-compulsive disorder: 23%
• Panic disorder: 15%
(The Recovery Village, 2020)
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8. Gender and Schizophrenia
• Females are affected around 30
years of age.
• Onset of Schizophrenia is
earlier in males (around 20
years).
• In general males and females
are equally affected with
schizophrenia.
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9. Aetiology of Schizophrenia
• The exact causes of schizophrenia are unknown. Research suggests
a combination of physical, genetic, psychological and environmental
factors can make a person more likely to develop the condition.
1. Genetics: Schizophrenia tends to run in families, but no single
gene is thought to be responsible.
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10. Aetiology of Schizophrenia
1. Genetics (Cont)
• In identical twins, if a twin develops schizophrenia, the other twin
has a 1 in 2 chance of developing it, too. This is true even if they're
raised separately.
• In non-identical twins, who have different genetic make-ups, when
a twin develops schizophrenia, the other only has a 1 in 8 chance
of developing the condition.
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11. Aetiology of Schizophrenia
2. Brain Structure and Function:
• Research shows that people with schizophrenia may be more
likely to have differences in the size of certain brain areas and in
connections between brain areas.
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12. Aetiology of Schizophrenia
3. Neurotransmitter:
• There's a connection between neurotransmitters and
schizophrenia because drugs that alter the levels of
neurotransmitters in the brain are known to relieve some of the
symptoms of schizophrenia.
• Research suggests schizophrenia may be caused by a change in the
level of 2 neurotransmitters: dopamine and serotonin.
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13. Aetiology of Schizophrenia
5. Pregnancy and Birth Complications:
Research has shown people who develop schizophrenia are more
likely to have experienced complications before and during their
birth, such as:
• a low birthweight
• premature labour
• a lack of oxygen (asphyxia) during birth
• It may be that these things have a subtle effect on brain
development.
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14. Aetiology of Schizophrenia
4. Environment:
• Research suggests that a combination of genetic factors and
aspects of a person’s environment and life experiences may play a
role in the development of schizophrenia.
• These environmental factors that may include living in poverty,
stressful or dangerous surroundings, and exposure to viruses or
nutritional problems before birth.
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15. Aetiology of Schizophrenia
4. Environment:
• Research suggests that a combination of genetic factors and
aspects of a person’s environment and life experiences may play a
role in the development of schizophrenia.
• These environmental factors that may include living in poverty,
stressful or dangerous surroundings, and exposure to viruses or
nutritional problems before birth.
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16. SCHIZOPHRENIA SIGNS & SYMPTOMS
• Symptoms of schizophrenia are typically divided into positive
symptoms and negative symptoms.
Positive Symptoms of Schizophrenia are as follows:
1. Hallucination
2. Delusion
3. Bizarre Behaviour
4. Disorganized Thought
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17. Positive Symptoms of Schizophrenia
1. Hallucination – It is the false perception. Most common
hallucination is auditory.
2. Delusion – These are the false fixed strange beliefs that cannot be
corrected on rational ground.
3. Bizarre Behaviour – Odd, Strange or unexpected behavior which is
usually out of the context for a given situation such as unpredictable or
inappropriate emotional responses, lack of impulse control, shouting
when expected to be remain quiet etc.
4. Disorganized Thought – Patients with schizophrenia can have
difficulty in concentrating and maintaining a train of thought. Patient may
talk incoherently and respond to questions with unrelated answers.
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18. Positive Symptoms of Schizophrenia
Examples of Disorganized Thoughts includes.
1. Loosening of association – Rapidly shifting between topics with no
connections between topics.
2. Perseveration – Repeating same things over and over again.
3. Made up words – That only have meaning to the speaker.
4. Use of rhyming – Words without meaning.
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19. Negative Symptoms of Schizophrenia
Negative symptoms are deficits of normal emotional responses.
Negative are related to things like though blocking, poverty of speech.
5 A’s of
Negative
Symptoms
Alogia
Avolition
Asociality
Anhedonia
Affective
Flattening
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20. Negative Symptoms of Schizophrenia
1. Alogia (Poverty of Speech) – It occurs earlier to the psychotic
symptoms. It refers to difficulty with speaking or the tendency to
speak little due to brain impairment.
2. Avolition– Severe lack of initative to accomplish purposeful tasks.
3. Anhedonia– inability to feel pleasure in doing things that once
made them happy.
4. Asociality – Patent shows lack of a strong motivation to engage in
social interaction with others in a social context.
5. Affective Flattening – Patients shows little or no emotions on facial
expressions, voice tones or mannerisms.
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21. Cognitive Symptoms of Schizophrenia
1. Impaired higher or executive functioning
2. Impairment of memory (short – term)
3. Attention deficit .
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22. Eugen Bleuler’s 4 ‘A’s of Schizophrenia
• Ambivalence
• Autistic Thinking
• Affect Disturbances
• Association Disturbances
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23. Eugen Bleuler’s 4 ‘A’s of Schizophrenia
1. Ambivalence – It is the state of having the mixed feelings or
contradictory ideas.
2. Autistic Thinking – Thinking is directed inward and become
subjective, leads to withdrawal in self, daydreaming and
fantasies.
3. Affect Disturbances – Disturbances of affect that involves the
display of reactions that do not match the situation or subjective
mood.
4. Associative Disturbances – Rapidly shifting between topics with
no connections between topics.
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24. TYPES OF SCHIZOPHRENIA
1. F 20.0– Paranoid Schizophrenia
2. F20.1 – Heberphrenic Schizophrenia
3. F20.2 – Catatonic Schizophrenia
4. F20.3 – Undifferentiated Schizophrenia
5. F20. 4– Post – Schizophrenic Depression
6. F20. 5 – Residual Schizophrenia
7. F20. 6 – Simple Schizophrenia
8. F20. 8 – Other types of Schizophrenia
9. F20. 9 – Schizophrenia Unspecified
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25. PARANOID SCHIZOPHRENIA
1. Most common type
2. Onset is late and has good
prognosis
3. Client’s can perform ADL
and have good social
interactions
4. Hallucination and Delusions
are seen peculiarly
5. With earlier treatment, good
prognosis is seen.
• Delusion of persecution
• Delusion of reference
• Delusion of jealousy
• Delusion of grandiosity
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26. HEBEPHRENIC SCHIZOPHRENIA
1. Disorganized Schizophrenia
2. Behaviour is aimless and not
goal directed
3. Inappropriate and incongruent
thoughts are seen
4. Early and insidious onset is
associated with poor premorbid
personality
5. Hallucination and Delusions
are not prominent
• Disorganized speech
• Disorganized behavior
• Inappropriate affect
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27. CATATONIC SCHIZOPHRENIA
1. Catatonia is a motor disorder that impairs a person’s movement,
speech and response to an outside stimuli.
2. Cata means disturbed.
3. When excited patient will injure themselves or others
4. Patients are sometimes immobile and mute
5. Increased Physical activity (Hyperkinesis) or decreased (Stupor)
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28. CATATONIC SCHIZOPHRENIA TYPES
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29. Professor Sathish Rajamani 29

30. SIMPLE SCHIZOPHRENIA
1. Characterized by prominent
negative symptoms
2. Positive symptoms are absent
3. Social functioning gets
reduced
4. Onset is early and insidious
5. Course is progressive and
prognosis is worst
• Amotivation
• Apathy
• Social Withdrawal
• Blunt Affect
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31. RESIDUAL SCHIZOPHRENIA
A subtype of schizophrenia in which the individual has
suffered an episode of schizophrenia but there are no longer
any delusions, hallucinations, disorganized speech or
behavior.
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32. UNDIFFERENTIATED SCHIZOPHRENIA
Undifferentiated schizophrenia is an outdated term describing a
subtype of schizophrenia that the medical community no longer
recognizes.
It cannot be classified into any of the five defined subtypes. People
who are diagnosed with undifferentiated schizophrenia exhibit
symptoms of more than one type of schizophrenia.
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33. DIAGNOSING SCHIZOPHRENIA
• Assessment Scales to Identify Psychotic Symptoms
• Brief Psychiatric Rating Scale (BPRS)
• Scale for Assessment of Negative Symptoms (SANS)
• Positive and Negative Syndrome Scale (PANSS)
• Assessment Scales to Identify Cognitive Deficits
• Stroop test
• Trail making test
• Wisconin card sorting test
• Wechsler Adult Intelligence Scale (WAIS)
• Assessment Scales to Identify Personality Related Problems in
Schizophrenia.
• Rorschach Inkblot Test
• Minnesota Multiphasic Personality Inventory (MMPI)
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34. DIFFERENTIAL DIAGNOSIS OF
SCHIZOPHRENIA
• Schizoaffective disorder
• Delusional disorder
• Post traumatic disorder
• Hypochondriasis
• Mood disorders with psychotic symptoms
• Psychotic disorders due to general medical conditions
• Schizophreniform disorder
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35. PROGNOSIS OF SCHIZOPHRENIA
Factors Good Prognosis Poor Prognosis
Onset Acute / Abrupt Insidious
Age of Onset Late Early
Duration < 6 Months > 2 Years
Episode First episode Previous H/O Schizophrenia
Gender Female Male
Stressor Absent Present
Depression Absent Present
Symptoms Positive symptoms Negative Symptoms
Social Support Good Poor
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36. PROGNOSIS OF SCHIZOPHRENIA
Factors Good Prognosis Poor Prognosis
Types Acute Catatonia
Paranoid has intermediate prognosis
Disorganized, Simple and
Undifferentiated
Relapse of Symptoms Absent Present
Drug adherence Present Absent
Nature of treatment Outpatient and Community basis In patient and Hospitalization
CT Scan Normal Enlargement of ventricles
Premorbid functioning Good Poor
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37. PHASES OF SCHIZOPHRENIA
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• Schizophrenia has 3 phases.
Prodomal
Phase
Active
Phase
Residual
Phase

38. PHASES OF SCHIZOPHRENIA
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Prodomal Phase Active Phase Residual Phase
Decline in adoptive functioning Repeated episodes of psychotic
symptoms
Negative psychotic symptoms
Increased emotional and
behavioual problems
Lasts for atleast one month Cognitive problems
Social withdrawal Last for weeks to decades
Last for several days or months

39. COMPLICATIONS OF SCHIZOPHRENIA
• Suicidal tendency
• Self-injury
• Depression
• Anxiety disorder
• Obsessive-compulsive disorder
• Abuse of drugs, alcohol, and tobacco
• Inability to perform any work or studies
• Social isolation
• Aggressive behavior
• Difficulty to stay in a relationship
• Can get involved in violent crimes
• Lack of personal hygiene causing other complications
• Being victimized
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40. TREATMENTS
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Medications
and
Psychological
treatment
Community Support
and Rehabilitation
Hospitalization

41. HOSPITALIZATION
• Following are the indications for hospitalization in schizophrenic
patients.
• Patient who were resistant to treatment
• Dangerous to self and others
• Active state of delusions or hallucinations
• Poor Social Support
• Diagnostic evaluation of patient
• Emergency such as Extrapyramidal Syndrome
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42. MEDICATIONS & PSYCHOLOGICAL
TREATMENT
• Antipsychotic medications:
• Typical antipsychotics – Chlorpromazine, Haloperidol, Fluphenazine
• Atypical antipsychotics – Risperidone, Olanzapine, Clozapine and Aripiprazole
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43. MEDICATIONS & PSYCHOLOGICAL
TREATMENT
• Psychosocial Treatments
• Psychoeducation
• Social Skill training
• Cognitive therapy
• Supportive psychotherapy
• Behavior therapy
• Family therapy
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44. MEDICATIONS & PSYCHOLOGICAL
TREATMENT
• Community Support and Rehabilitation
• Family education
• Home care
• Self – help groups
• Rehabilitation
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45. MEDICATIONS & PSYCHOLOGICAL
TREATMENT
• Community Support and Rehabilitation
• Family education
• Home care
• Self – help groups
• Rehabilitation
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46. NURSING DIAGNOSIS - 1
Impaired Social Interaction related to mistrust of others
as evidenced by fearful or anxious around others.
Nursing Interventions:
1. Assess their perceptions and feelings toward social interaction.
2. Determine family and support patterns.
3. Observe speech, nonverbal gestures, and body language.
4. Develop a trusting relationship.
5. Provide positive reinforcement.
6. Encourage group activities.
7. Refer to specialists for social skills training.
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47. NURSING DIAGNOSIS - 2
Disturbed Sensory Perception (Auditory/Visual) related
to severe stress as evidenced by talking or laughing to
self
Nursing Interventions:
1. Assess medication adherence.
2. Assess contents of hallucinations.
3. Monitor for increasing agitation or anxiety.
4. Remove the client from chaotic environments.
5. Provide safety.
6. Aid distraction.
7. Help the patient recognize triggers.
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48. NURSING DIAGNOSIS - 3
Risk For Self/Other-Directed Violence, related to
delusional thinking.
Nursing Interventions:
1. Assess for a plan for suicide or violence.
2. Observe for early cues of distress.
3. Maintain and convey a calm attitude.
4. Maintain distance from the patient.
5. Keep the patient safe.
6. Administer tranquilizers.
7. Apply restraints.
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