2. Psychosis
• Definition of Psychosis: A severe mental
condition in which there is disorganization of
the personality, deterioration in social
functioning, and loss of contact with, or
distortion of, reality. There may be evidence of
hallucinations and delusional thinking.
Psychosis can occur with or without the
presence of organic impairment.
3. Neuroses or psychoneurosis
• Neuroses or psychoneurosis is a mental
disorder that causes a sense of distress and
deficit in functioning.
• Neuroses are characterized by anxiety,
depression, feelings of unhappiness or distress
They may impair a person’s functioning in
nearly any area of his life, relationships, .
Neurotic pts.do not suffer from the loss of the
sense of reality.
4. SCHIZOPHRENIA
• The most debilitating mental illnesses, it is a
serious psychotic disorder which affects how a
person thinks, feels and acts
• Definition: The term schizophrenia comes
from Greek word meaning “split mind.”, which
means that a split occur between the
cognitive & emotional & behavioral aspects of
the personality
• Schizophrenia is a psychotic disorder (or a
group of disorders) marked by severely
5. Prevalence
♦ 1% of people develop schizophrenia at some time
during their lives, or about 2.2 million people in the
United States have schizophrenia.
♦ The prevalence of schizophrenia is the same
regardless of sex, race, and culture.
♦ Schizophrenia usually develops between the ages of
15 and 30. The illness may begin abruptly, but it
usually develops slowly over months or years.
♦ About 25 percent of people with schizophrenia
become symptom-free later in their lives .
6. Prevalence; continue
♦ 95% of sufferers – lasts a lifetime
♦ 1/3 of homeless suffer from Schizo
♦ 15% no respond to med;
♦ 75% partial effective
♦ 20-50% attempt suicide. 10% kill themselves
♦ 20% shorter life expectancy
♦ 25% experience secondary depression
7. Causes of Schizophrenia
Genetic factors influences:
• ♦ Identical twin affected 46-50%
• ♦ Fraternal twin affected 14-15%
• ♦ Both parent affected 35-46%
• ♦ One parent affected 15%
• ♦ Brother or sister affected 10%
• ♦ No affected relative 1-1.3%
8. Causes; cont.
♦ Chemical imbalance: Neurotransmitter;
Dopamine increased;
♦ Other Biochemical Hypotheses implicated in
the predisposition to schizophrenia are
abnormalities in the neurotransmitters
norepinephrine, serotonin, acetylcholine, and
gamma-aminobutyric acid. And in the
neuroregulators, such as prostaglandins and
endorphins, have been suggested.
9. Causes; cont.
• ♦ Physical abnormalities –brain structures
Increased ventricular brain ratios, Brain
atrophy, ↓ cerebral blood flow
♦ Biological factors – age, virus; influenza, …
Chemical structures change in the body;
Teenager onset ; Viral infection in a mother
during pregnancy
10. Causes; cont.
♦ Environmental factors – lower socio-
economic classes, chr. Life stressors,
emotional strains ; personality development
changes, dysfunctional families
♦ The more evidence is compiled to support the
concept of multiple causation in the
development of schizophrenia.
11. Schizophrenic Symptoms
• Kraepelin-dementia precox
• Bleuler-split between thought, emotion
and behavior in affected patients
• 4 A’s
– Ambivalence: is the presence of 2 opposed
feelings, attitudes, or desires towards a person
or a situation at the same time.
– Associations loosiness
– affect
– autism
12. Schizophrenia and DSM
• Disturbance of 6 months or more that
includes one month of 2 or more* of the
following active-phase symptoms
– Delusions
– Hallucinations in 75% of pts.at some point
– Disorganized Speech
– Grossly disorganized or catatonic behavior
– Negative symptoms
13. Signs & Symptoms of Schiz.
All of the symptoms of this illness can also be
found in other brain disorders.
For example; psychotic symptoms may be
caused by the use of drugs, may be present in
individuals with Alzheimer’s Disease, or may
be characteristics of a manic episode in
bipolar disorder.
14. Signs & Symptoms (cont.)
Problems in Cognitive Functioning:
♦ Thought broadcasting: thoughts are being
broadcast to the world so that other people
can hear them
♦ Thought insertion
♦ Thought withdrawal
♦ Delusions of being controlled: They may
believe that aliens are controlling their
thoughts
15. Signs & Symptoms; (cont.)
♦Grandiose delusions; “may believe that he is the
king of Jordan when he is not”
♦ Religious ,nihilistic, somatic delusions
♦ Delusion of persecution, that others, such as the
police, are plotting against him or spying on
them.
♦ Ideas of reference
♦ Associative looseness; neologisms; concrete
thinking; echolalia; clang association; word salad
16. Signs & Symptoms; (cont.)
Problems in Cognition
• Memory: impaired short-time/long-term memory
• Difficulty in using stored memory
• Attention: difficulty maintaining attention , poor
concentration, distractibility
• Formal thought disorder(form & organization of
speech): loose association, circumstantial, illogical
tangential, incoherence/word salad/ neologism,
pressured distractible speech, poverty of speech
17. Signs & Symptoms (cont.)
• Perceptual Disorder
• Hallucinations: all types especially visual & auditory
• Cenesthetic: feeling of body functions such as blood
flow, food digestion, urine formation
• Kinesthetic: sensation of movement while standing
• Altered in Emotions: Mood is defined as extensive,
sustained feeling tone for few hours & years and
affect the person’s world view/ depressed, euphoric.
18. Symptoms of schiz.(cont.)
Positive Symptoms:
Delusions, hallucinations, thought disorder
disorganized speech, bizarre behavior, inappropriate
affect
Negative symptoms:
Affective flattening
Alogia =poverty of speech
A volition/ apathy= lack of energy & drive or motivation
Anhedonia: inability to experience pleasure or joy
A sociality, Attention deficit
19. Nursing Diagnosis
• Alterations in personal relationships ( a
socialization); inability to communicate
appropriately, loss of interests, deterioration
of social skills, poor personal hygiene &
paranoia, stigma related to withdrawal from
friends & family
• Alternations in activity: deteriorated
appearance, lack of persistence at work,
20. Nursing Diagnosis; (cont.)
• Repetitive or stereotyped behavior, aggression,
agitation & negativism,
• A volition = lack of ability & drive, abnormal gait
A praxia = difficulty carrying purposeful,
organized tasks
• Echopraxia= purposeless imitation of other’s
movements
• Anxiety, confusion, ineffective individual coping
• Ineffective family coping
21. Nursing Diagnosis (cont.)
Decisional conflict, hopelessness
Noncompliance with medication
Impaired verbal communication, impaired
social interaction,
Disturbed personal identity, social isolation
Impaired memory
Altered nutrition: less than body requirements
22. Nursing Diagnosis; (cont.)
• Risk for violence directed at self or others
• Self-care deficit: feeding, bathing, dressing/
grooming, toileting
• Self-esteem disturbance
• Altered thought processes
• Body image disturbance
• Disturbed thought process
23. Types of Schizophrenia
• Paranoid - preoccupied with one or more
delusion accompanied with hallucination,
mainly delusions of persecution or grandeur
and auditory hallucinations related to a single
theme.
• Disorganized (hebephrenia)- disorganized
speech, behavior; poor attention; flat or
inappropriate affect
• Catatonic - waxy flexibility or tupor, or
purposeless excessive motor activity, mutism,
24. Types of Schizophrenia (cont.)
Undifferentiated: behavior is clearly psychotic;
there is evidence of delusions, hallucinations,
incoherence, and bizarre behavior. The
symptoms cannot be easily classified into other
previously diagnostic categories.
• Residual- Chronic schizophrenic illness with
negative symptoms are present , criteria A are
present in attenuated form.
25. Other psychotic Disorders
• Schizoaffective disorder – Schizophrenic
symptoms are dominant (bizarre delusions,
prominent hallucinations, incoherent speech,
catatonic behavior, blunted or inappropriate
affect) + major manic or depressive
symptoms.
• Delusional disorder – delusions have basis in
reality, (being followed or poisoned) but never
met the criteria of schizophrenia
26. Other psychotic Disorders (cont.)
• Brief psychotic disorder: Presence at least one
delusions /hallu., disorganized speech or,
disorganized behavior. Psychosis lasts less
than 1 month.
• Schizophreniform: meets the criteria of
schizophrenia good occupational & social
functioning, lasts 1-6 months.
• Shared psychotic disorder: delusion develops
in someone with close relationship with
someone who has delusion.
27. Other psychotic Disorders (cont.)
Psychotic disorder due to a general medical
condition: features prominent are hallucinations and
delusions that can be directly attributed to a general
medical condition (APA, 2000).
The diagnosis is not made if the symptoms occur
during the course of a delirium or chronic,
progressing dementia.
29. Pharmacological Treatment of Acute
Schizophrenia
• Antipsychotic medications are effective to
decreae the severity of psychotic symptoms
• Nearly all patients on antipsychotic
medications will experience some burden
from side effects
• Antipsychotics are relatively ineffective for
negative symptoms and cognitive impairment
30. Long-term treatment of schizophrenia
• Antipsychotic medications are effective for
preventing relapse in stabilized patients
• Effective nonpharmacological treatments
include patient and family education, skills
training, supported employment, cognitive
behavior therapies, and psychotherapies
• For most individuals, antipsychotic
medications control the symptoms while non-
pharmacological treatments address the
impairments in social, vocational, and
educational functioning
31. Clinical Challenges
• Substance use disorders are common in
people with schizophrenia
• Insight can be impaired leading people with
schizophrenia to refuse treatment
• Adherence to treatments can be irregular
32. Nursing Intervention
♦Principles of Nursing Intervention in
Schizophrenic Disorder:
-Acceptance & respect of the client.
- Authenticity ()املصداقية
-Self awareness.
- Understanding and trusting relationship.
- The nurse should be educationally prepared.
33. Nursing Intervention (cont.)
• Management of Hallucinations:
• 1. Assess underlying unmet needs. Establish trust
• 2. Encourage the well effective part of the pt.
• 3. Express doubt tactfully.
• 4. Discuss reality based issues
• 5. Protect the pt. from self harm
• 6. Reduce stimuli
• 7. Communicate in concrete, direct, specific term
34. Nursing Intervention (cont.)
• Management of Delusions:
• 1. Provide sensitivity
• 2. Avoid supporting or reinforcing the delusion
• 3. Don't attack the delusion directly
• 4. Express doubt tactfully
• 5. Recognize the client's perception of the
environment
• 6. Focus on reality & avoid judging the pt.
• 7. Use empathy; help him to deal with his feelings in
35. Nursing Intervention (cont.)
• NURSING INTERVETION:
1.Provide a safe environment by:
● Briefly explain procedures, routines, and tests.
● Protect the client from self harm.
2. Monitor self needs by:
● Maintain adequate nutrition& hydration.
● Care & monitor for elimination.
36. Nursing Intervention (cont.)
3.Decrease withdrawn behavior by:
● Spend more time with the client.
● Don't make unrealistic promises.
●Teach the client that his feelings are valid.
● Limit the client environment & maintain staff
consistency.
● Begin with one-one relationship, then progress
to small groups.
● Establish a daily routine
37. Nursing Intervention (cont.)
●4. Increase the client self esteem by:
● Provide attention, offer praise, avoid trying to
response to the client worth verbally
● Assist with daily living activities
● Orient the client to reality
●5. Help the client to establish ego boundaries by:
● Validate the client's real perceptions and correct
misperception in a fact manner
38. Nursing Intervention (cont.)
●☻Don't Argue
● Stay with the frightened client, Discuss simple topics
● Provide activities that maintain contact with reality
6. Maintain a safe environment for other clients
when the client is dangerous:
● Remove the client from the group when necessary
● Help other pts. to accept the pt.'s behavior
39. Nursing Intervention (cont.)
● Make sure that one staff member is with other
clients
● Explain that the pt.'s behavior is a result of his
illness
7. Help the client to work through regressive
behavior by:
●Assess the presence level of functioning and
communicate with the pt. at that level
40. Nursing Intervention (cont.)
● Encourage more adult behavior
● Help to identify unmet needs
● Set realistic goals & expectations
● Initially make choices for the pt.
● Gradually let the client make decisions and be
responsible.
41. Nursing Intervention (cont.)
● 8. Reduce bizarre behavior, anxiety and agitation
by:
● Set limits on behavior
● Reduce excessive stimuli
● Give medication as needed
● Provide simple activities and a structural
environment
● Assess signs of increase fears, anxiety & agitation.
42. Nursing Intervention (cont.)
● Intervene appropriately with medication,
seclusion or one –one relationship
● Don't trap the pt. and don't insist on questioning
● Help the pt. express feelings, & help him to deal
with guilt
● Help him to deal with possible recurrent
hallucinations.
43. Evaluation:
• Evaluation:
• 1. Document progress
• 2. Be realistic, expect change to be low
• 3. Modify the care plan as needed
• 4. Complete a self evaluation
