Schizophrenia

Prepared by:
Mary Ruth V. Enriquez, RN MAN
Schizophrenia
Seems to strike adolescents and young adults .
Between the ages of 16 to 35 years old
Peak onset for men is 15 to 25 years of age, for women 25 to 35 years of age.
Rare in young children
The term schizophrenia (which means SPLIT MIND) was first used by Swiss
psychiatrist, Eugene Bleuler.
Schizophrenia

Is a serious psychiatric disorder

People w/ schizophrenia have a split between their thoughts and
their feelings and between their reality and societys reality.
The person may have issues concerning confused gender identity.
People who have schizophrenia may not be able to differentiate
between what is theirs and what is everybody elses with respect to
social functioning.
Poor self-esteem
It is a surprise to many students that these individuals are generally
highly intelligent.
Is said to have an insidious onset.
Early symptoms of quietness and withdrawal in an adolescent may be
shrugged off a just a stage.
Signs and symptoms must be present for 6 months or more before a
positive diagnosis can be made.

Bleuler used a system of 4 As to define SCHIZOPHRENIA

1. ASSOCIATIVE disturbance: or Associative looseness, the patient
typically exhibits three main behaviors:
Making up words (neologisms)
Rambling from topic to topic ( word salad)
Using revolving words and syllables that may associate to a specific word but
are out of context with conversation. Bleuler tells the story of a woman

who asked to list her family members. She answered father ,

son....and the Holy Ghost making up words that rhyme with other
words is another behavior that is sometimes observed.( clang
association)
2. AFFECTS: is the outward expression of emotion.
People with schizophrenia generally called a flat, or blunted, affect. This
means that they rarely show signs of any emotion.
There may also be inappropriate or incongruent affect, such as laughing
when the patient states that he or she feels sad or depressed; the outward
expression of the mood does not match the stated feeling.
3. AUTISM: is an emotional detachment. People who display autistic behavior are
preoccupied with the self and show little concern for any reality outside their own
world.
4. AMBIVALENCE: means having opposite feelings about one person or situation at
the same time.
Ex. Is the love/hate relationships sometimes seen in jobs or marriages.
Be cautioned that not all people who have a love/hate relationship with their
jobs are schizophrenics.
Schizophrenia display other common symptoms:
1. Delusion : are fixed, false beliefs that cannot be changed by logic.
ex. Patients resist any factual proof that their beliefs do not exist. Typically patients
exhibit delusions of grandeur, persecution, or guilt.
2. Hallucinations: are false sensory perceptions that can affect any of the five
senses.
3. Illusions: are mistaken perceptions of reality.
Something is there; it is just perceived incorrectly.
Types of Schizophrenia:

Paranoid type
Catatonic type
Disorganized type (Hebephrenic)
Undifferential type
Residual type

Paranoid schizophrenia

Person exhibits unusual suspiciousness and fear.

May also exhibit hostile and aggressive behavior.
The main symptom is suspiciousness. Some of the absent symptoms
include catatonia, incongruent affect, and loose associations in speech.
Patients tend to have delusions of persecutions and grandeur.
Patients state that they are tormented and followed by people. The
patient with delusion of grandeur may state that he or she is God
or the the President

Catatonic schizophrenia

Is seen less frequently than some other forms, largely as a result of

effective medications.
The motor activity of the patient is disturbed. People with catatonic
schizophrenia vacillate between extreme muscle rigidity and
agitation. The rigidity can affect the whole body or just certain limbs or
muscle groups.
The symptoms present quickly and can change quickly, especially if
stimulated by a loud noise or a sudden movement in the
environment.
Rigid state ( sometimes referred to as Catatonic stupor),the person may
not change position and may stare into space for hours or even days.

Catatonic excitement:

Echolalia : repetition of words the patient may hear.

For ex., if the nurse is passing medications and tells Mr. Brown that it is time
for your pills, a person experiencing echolalia may repeat, your pills.... Your
pills....your pills... over and over.
Echopraxia : is the same kind of repetition, except that the patient
repeats an action.
The patient with Echopraxia may mimic the nurses action of handling the
medication to Mr. Brown by pretending to hand a pill to someone who is
probably not there.

Disorganized schizophrenia

Involves disorganized speech and behaviors as well as flat or

inappropriate affect; associative disturbances are common.

a. The individual may have odd mannerisms, exhibit extreme social withdrawal,
or neglect hygiene and appearance.
b. Onset usually occurs before age 25, and the course may be chronic.

c. The individual demonstrates aggressive behavior with poor social interaction

and poor reality contact.
Undifferentiated schizophrenia

The essential features are delusions, hallucinations, incoherent

speech, and disorganized behaviors; this classification is used when
criteria for other types are not met.

Residual schizophrenia

Is identified by the current absence of acute symptoms, but a history

of past episodes, negative symptoms ( marked social isolation,
withdrawal, and impaired role functioning) may be present.

Medical treatment
Current opinion holds that schizophrenia is not curable (because no cause
can be isolated) but it is certainly treatable.
Medications , ECT (electroconvulsive therapy), and psychotherapy are
indicated.
Medications prescribed: antipsychotics. These create decreased dopamine
level, which lead to extrapyramidal side effects.
Some common antipsychotic medications:
Risperidone (Risperdal)
Olangzapine (Zyprexa)
Clozapine (Clozaril)
Haloperidol (Haldol)
Chlorpromazine (Thorazine)
Psychotherapy : includes individual , group, and family therapy.
ECT: used in severe cases or difficult to treat and is not used until all other methods
of therapy have failed.
Nursing Interventions
1. Never reinforce hallucinations, delusions , or Illusions: it is necessary to
keep the patient in reality as the nurse knows it.

2. Never whisper or laugh when the patient cannot hear the whole conversation:
it is important, especially with patients who have paranoid
schizophrenia, to avoid any situation that might encourage
suspiciousness.
3. Avoid placing the patient in situations of competition or embarrassment: people
with schizophrenia do not usually have the emotional stability to handle
stressful situations. Patient s may revert to former behaviors or refuse to
participate in therapy if they feel embarrassed.
4. Trust : it is crucial for a trusting relationship to exist between the nurse
and patient. Keep promises, be honest and consistent in all aspects of the
patients treatment plan.
5. Milieu:
the treatment setting must be calm and conducive to making progress.
It must be structured in a way that helps promote healthy behaviors and
minimize anxiety.
Providing written instructions or information boards can help promote
reality and self responsibility behavior.
Furnishing the treatment area in colors that are considered calming, such
as blues and greens, may be helpful.
Setting limits on noise, physical activity, and types of music in the
treatment area may help to provide a setting in w/c patients can focus on
healing.