Schizophrenia is a psychotic disorder characterized by disturbances in thinking, emotions, and behavior. There are several proposed causes including genetic, biochemical, and environmental factors. Symptoms are classified as positive (e.g. delusions, hallucinations) or negative (e.g. reduced speech, lack of motivation). Schizophrenia is further classified into subtypes based on symptoms such as paranoid, disorganized, or catatonic. Prognosis depends on factors like symptom severity, onset age, and social support. Nursing diagnoses for those with schizophrenia may include disturbances in thought processes and difficulties with self-care.

1. Schizophrenia And
Other Psychotic
Disorders

2. SCHIZOPHRENIA

5. DEFINITION
Schizophrenia is a psychotic
condition characterized by a
disturbance in thinking,
emotions, volitions (faulty act )
and faculties in the presence of
clear consciousness, which
usually leads to social
withdrawal.
(faculties- the power of imagination, recognition, and
appreciation, and is responsible for processing feelings
and emotions, resulting in attitudes and action)

6. CLASSFICATION

7. I. Biological
Theories
II. Psychodynamic
Theories
III. Social
Factor
a. Biochemical
theories
b. Neurostructural
theories
c. Genetic theories
d. Perinatal risk
factors
a. Developmental
theories
b. Family theories
Predisposing factors

8. I. Biological Theories
a. Biochemical theories
- dopamine hypothesis- excess of dopamine
dependent neuronal activity in the brain
- Other biochemical hypotheses
abnormalities in the neurotransmitters
norepinephrine, gamma-aminobutyric
acid

9. b. Neurostructural theories
- Prefrontal cortex and limbic cortex may never
fully develop in brains of person with
schizophrenia
- MRI and CT studies of brain structure shows :-
1. Decreased brain volume
2. Larger lateral and third ventricles
3. Atrophy in the frontal lobe, cerebellum and
limbic structures
4. Increased size of sulci on the surface of the
brain

10. C. Genetic theory
- More common among people
born of consanguineous
marriages
d. Perinatal risk factors
- Maternal influenza
- Complications of pregnancy
particularly during labor and
delivery

11. a.

12. b. Family theories
1. Mother-child relationship
- Over protective
- Domineering
2. Dysfunctional family system
- Hostility between parents can lead to a schizophrenic
daughter
3. double-blind communication
- Parents convey two or more conflicting and
incompatible messages at the same time.
(a double bind is a communication dilemma that comes
from a conflict between two or more messages)

13. III. Social factors
• More prevalent in areas of high
social mobility and disorganization
especially among members of very
low social classes.
• Stressful life events also can
precipitate the disease in individuals.

14. 1.

15. • Affective disturbance- inability to show
appropriate emotional responses, blunted or
flattened affect.
• Autistic thinking- it is thought process in
which the individual is unable to relate to
others or to the environment e.g day
dreaming
• Ambivalence- it refers to contradictory or
opposing emotions, attitude, ideas or desires
for the same person, thing or situation
simultaneous opposite feelings.

16. • Associative looseness- inability to think
logically.
• Ex- we wanted to take the bus, but the
airport took all the traffic. Driving is the
ticket when you want to get somewhere
no one needs a ticket to heaven. We
have it all in our pockets

17. 2. Schineiders 1st Rank Symptoms
• Hearing one’s thought s spoken aloud (audible
thoughts or thought echo)
• Hallucinatory voices in the form of statement and
reply
• Thought withdrawal
• Thought insertion
• Delusional perception
ex- a person sees a red car and knows that this
means their food is being poisoned by the
police

18. • Made volition or acts(ones own acts are
experienced as being under the control of
some external force the subject being like
robot)
• Made impulses (the subject experiences
impulses as being imposed by some external
force)
• Thought broad casting (the belief that others
can hear or are aware of an individual's
thoughts)

19. 3. Symptoms
Positive
• Delusions
• Hallucinations
• Excitement or
agitation
• Aggressive behavior
• Suspiciousness
• Suicidal tendencies
Negative
• Affective flattening
• Avolition - lack of motivation
• Apathy – lack of initiative
• Attentional impairment
• Alogia- lack of person speech
output
• Anhedonia – inability to
experience pleasure

20. TYPES OF SCHIZOPHRENIA
• Paranoid
• Hebephrenic (disorganized)
• Catatonic schizophrenia
• Residual schizophrenia
• Undifferentiated schizophrenia
• Simple schizophrenia
• Post- schizophrenic depression

21. • The commonest type.
• Predominantly delusions, perceptual
disturbances and hallucinations (most
common auditory)
• Personality is usually stable but often
paranoid.
• Late onset schizophrenia.
• Good prognosis.
• F20.0 Paranoid Schizophrenia

22. 1. Paranoid Schizophrenia
• The word ‘paranoid means
delusional’
• preoccupation with delusions
or hallucinations.

23. Delusions (false beliefs)
• Delusions of
Persecution
• Delusions of
Grandeur

24. Disturbed Perceptions
• hallucinations- sensory experiences
without sensory stimulation.

25. 2. Disorganized Schizophrenia
• Also called Hebephrenic
schizophrenia
• disorganized speech or behavior, or
flat or inappropriate emotion.
• Worst prognoses
• Poor premorbid personality

26. Essential features include :-
- Thought Disorder
- Sever loosening of
associations
- Social impairment
- Delusion and hallucination
fragmentary and changeable
- Senseless giggling, mirror
gazing, grimacing and
mannerisms

27. 3. Catatonic Schizophrenia
• Characterized by marked disturbance of
motor behavior
a. Catatonic stupor
b. Catatonic excitement
c. Catatonia alternating between
excitement and stupor

28. Clinical Features Of Excited Catatonia
• Increase in psychomotor
activity (restlessness,
agitation, excitement and
aggressiveness
• Increase in speech production
• Loosening of associations and
frank incoherence

29. Clinical Features Of Retarded
Catatonia (catatonic stupor)
• Mutism - absence of speech
• Rigidity- maintenance of rigid posture against
efforts to be moved
• Negativism- doing just opposite
• Stupor- does not react to surrounding
• Echolalia- repetition or mimicking of phrases
or words heard

30. • Echopraxia- repetition or mimicking of
actions observed
• Waxy flexibility- position will be
maintained for long time
• Ambitendency – a conflict to do or not to
do
• Automatic obedience- obeys every
command irrespective of their nature

31. 4. Residual Schizophrenia
At least one episode of schizophrenia in the past
but without prominent psychotic symptoms at
present
• Emotional blunting
• Illogical thinking
• Social withdrawal
• Loosening of associations

32. 5. Undifferentiated Schizophrenia
• Diagnosed either when
features of no subtype
are fully present or
features of more than
one subtype are
exhibited

33. 6. Simple Schizophrenia
• Differs from residual schizophrenia in that there
never has been an episode with all the typical
psychotic symptoms
• Early and insidious onset,
• progressive course, and presence of characteristic
negative symptoms,
• vague hypochondriacal features,
• wandering tendency,
• self absorbed idleness and aimless activity.

34. 7.

35. 7. Post – Schizophrenic Depression
•The patient hashad a
schizophrenic illness within past 12
months.
•The depressive symptoms are
prominent and distressing:
fulfilling the criteria for
depressive episode(F32.-) and has
been present for atleast 2 weeks.

36. PROGNOSTIC FACTOR
Good Prognostic Factor
• Acute onset
• Presence of precipitating factor
• Good premorbid personality
• Paranoid and catatonic
subtypes
• Short duration (< 6 months)
• Positive symptoms
• Good social support
• Married
• Outpatient treatment
Poor Prognostic Factor
• Insidious onset
• Absence of precipitating
factor
• Poor premorbid
personality
• Long duration (<2 years)
• Negative symptoms
• Poor social support
• Single, divorced or
widowed
• Institutionalization

45. NURSING DIAGNOSIS
• Disturbed thought process related to
inability to trust or panic anxiety
• Altered nutrition less than body
requirements related to trust or extreme
suspiciousness
• Self- care deficit related to withdrawal,
panic anxiety, cognitive impairment,
inability to trust

48. e.g., an individual’s belief that a stranger has removed his or
her internal organs and replaced them with someone else’s
organs without leaving any wounds or scars)
BIZARRE DELUSION- Delusions that express a loss of control
over mind or body are generally considered to be bizarre

51. (turmoil- disturbance /confuse)

61. Bibliography
• Townsend C Mary. Psychaitric Mental Health Nursing . 6th
Edition. Jaypee Brothers Publication.New Delhi.
• R Sreevani. A guide to mental health and psychiatric nursing
,3rd eddition, Jaypee. New delhi, 2010
• Neeraj Ahuja, “Post graduate text book of psychiatry”. Volume
1 & 2.
• Kapoor Bimla. Textbook Of Psychaitric Nursing . Volume I,
II,Kumar Publishing house. New Delhi ;2009