SCHIZOPHRENIA

Introduction
Schizophrenia is a chronic, severe, and disabling brain disorder that has affected people
throughout history. Not everyone has the same risk of developing schizophrenia, however. By far
the most significant risk factors for developing schizophrenia have to do with family members.
This is the reason that scientists now believe that genetics are the most important factor in
developing schizophrenia. (National Comorbidity Survey, 2005)
People with the disorder may hear voices other people don't hear. They may believe other people
are reading their minds, controlling their thoughts, or plotting to harm them. This can terrify
people with the illness and make them withdrawn or extremely agitated.
People with schizophrenia may not make sense when they talk. They may sit for hours without
moving or talking. Sometimes people with schizophrenia seem perfectly fine until they talk
about what they are really thinking. (National Institutes of Mental Health).

Definition
According to Stuart
 Schizophrenia is an illness that results in psychotic behavior.
 The term Schizophrenia was introduced in 1911 by the Swiss Psychiatrist, Eugene
Bleuler. He believed that the Schizophrenias were multidimensional and organic in
nature. He also believed that these illnesses were strongly influenced and could be shaped
by psychological factors.
 Is a combination of two Greek words, schizein, “to split”, and phren, “mind”.

According to Videbeck
 Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions, movements,
and behavior.
 It cannot be defined as a single illness; rather, schizophrenia is thought of as syndrome or
disease process with many different varieties and symptoms.

Types of Schizophrenia
 Paranoid Type - Preoccupation with one or more delusions or frequent auditory
hallucinations.
 Catatonic Type – At least two of the following dominate the clinical picture: motoric
immobility as evidenced by catalepsy or stupor, excessive motor activity; extreme
negativism or mutism; peculiarities of voluntary movement as evidenced by posturing,
stereotyped movements, prominent mannerisms or prominent grimacing; echolalia or
echopraxia.
  Disorganized Type – All of the following are prominent: disorganized speech,
disorganized behavior, flat or inappropriate affect, and does not meet criteria for catatonic
type.
 Undifferentiated Type – Symptoms meeting the first general criteria for schizophrenia
are present, but criteria for other types are not met.
 Residual Type – Criteria for schizophrenia are not met, nor are those for any other
subtype. There is continuing evidence of the disturbance, indicated by negative
symptoms or attenuated presence of two or more symptoms included in the general
criteria.

Causes
Biochemical Theories

 Dopamine Hypothesis
 Increased dopamine synthesis, increased dopamine release, & increased in the
number and activity of dopamine receptors can cause excessive dopamine which
causes acute positive symptoms of schizophrenia. (Hallucinations, Delusions &
Thought Disorders)

 Serotonin
 Serotonin inhibits dopamine synthesis and release, therefore potentially increase
dopamine levels.

 Glutamate
 Reduced levels of glutamate, a product of Krebs Cycle – causative factor of
schizophrenia.

Neurostructural Theories

 Ventricular Brain Ratios

 Individuals with schizophrenia have enlarged ventricles; they have poor prognosis
and exhibit negative symptoms.

 Brain Atrophy
 Alzheimer described brain cell loss in schizophrenia. Limbic, hippocampal, and
thalamic structures; temporal lobes; the amygdale; and the substantia nigra are
specific lobes and nuclei found to have undergone neuropathologic changes.

 Cerebral Blood Flow

 Individuals with atrophic changes also have decreased cortical blood flow,
particularly in the prefrontal cortex, with a decrease in metabolic activity.
Cognitive demands, such as organizing, planning, learning from experience,
problem-solving, introspection, and critical judgment, are compromised.

Genetic Theories
  Familial Patterns
 First-degree relatives (including siblings and children) are 10 times more likely to
experience schizophrenia than are individuals in general population.
 Monozygotic twins have consistently shown a higher concordancy rate, meaning
both twins do or do not have symptoms of schizophrenia.

 Perinatal Risk Factors

 Stressors in perinatal period (starvation, poor nutrition, infections) and obstetrical
complications. Infants affected by these maternal stressors may have conditions
that create their own risk, such as low birth weight, short gestation, and early
developmental difficulties.

Psychodynamic Theories

 Developmental Theories of Schizophrenia

 Developmental Psychiatry is very significant, because the seeds of mental health
and illness are sown in childhood – early life experiences are crucial in the
development. (Psychoanalytic of Freud, Developmental Theory of Erikson and
Interpersonal of Sullivan and Peplau).

 Family Theories of Schizophrenia

 Family – the environment which most people grow is significant to the
development of mental health or illness. Lack of loving and nurturing primary
caregiver, inconsistent family behaviors, and faulty communication patterns are
thought to be responsible for mental problems in later life.
 Schizophrenogenic Mother – schizophrenogenic literally means to cause
schizophrenia.
 The Double Blind Theory wherein the child was damned if he did and damned if
he didn’t.

Symptoms of Schizophrenia
Positive (more overtly psychotic symptoms)- does not mean “good”, rather it refers to obvious
symptom that are not present in people with schizophrenia.

Delusions- strange beliefs are not based in reality and that the person refuses to give up, even
when presented with factual information.

Hallucinations-involve perceiving sensations that aren’t real, such as seeing things that aren’t
there, hearing voices, smelling strange odors, having a “funny” taste in the mouth, and feeling
sensations on your skin even though nothing is touching your body.

Disorganized speech-reflects the person’s inability to think clearly and respond appropriately.
Negative (potentially less overtly psychotic symptoms)-reflects the absence of certain normal behaviors in
people with schizophrenia.
  Loss of pleasure or interest in life (anhedonia)
 Lack of motivation
 Mood swings
 Catatonia-the person becomes fixed in a single position for a very long time
 Lack of emotion, expression, thoughts, and moods that do not fit the situation or event.

Diagnostic criteria for Schizophrenia (General Criteria)

To be diagnosed with schizophrenia, a person must meet the criteria spelled out in the Diagnostic
and Statistical Manual of Mental Disorders (DSM).

Diagnosis of schizophrenia involves ruling out other mental health disorders and determining
that symptoms aren't due to substance abuse, medication or a medical condition. In addition, a
person must:

 Have at least two of the common symptoms of the disorder for a significant amount of
time during one month: delusions, hallucinations, disorganized speech, grossly
disorganized or catatonic behavior, and negative symptoms.
 Experience significant impairment in the ability to work, attend school or perform normal
daily tasks

Have had symptoms for at least six months.

Treatment
Schizophrenia treatment involves medications and therapy to reduce the risk of future psychotic
episodes and improve relationships.

Medication
Antipsychotic medications
 Proven effective in treating acute psychosis and reducing risk of future psychotic
episodes.
 The cornerstone in the management of schizophrenia.

2 Phases in the treatment of Schizophrenia

Acute Phase- Higher doses might be necessary in order to treat psychotic symptoms,
followed by a

Maintenance Phase-Usually life-long, and dosage is gradually reduced to the minimum

required to prevent further episodes. If symptoms reappear on a lower dosage, a temporary
increase in dosage may help prevent a relapse.
Therapies
Psychosocial treatments help most in treating patients with schizophrenia when medications are
unsuccessful. Many useful treatment approaches have been developed to assist people suffering
from schizophrenia.

Individual psychotherapy-involves regular sessions between just the patient ana a therapist
focused on past or current problems.

Cognitive-behavioral therapy-a reality-based intervention that focuses on helping a client

understand and change patterns that tend to interfere with his or her ability to interact with others
and otherwise function. Except for people who are actively psychotic, CBT has been found to
help individuals with schizophrenia decrease symptoms and improve their ability to function
socially.

Family education-research has consistently shown that people with schizophrenia who have
involved families fare better than those who battle the condition alone. All family members
should be involved in the care of the patient.

Rehabilitation-may include job and vocational counseling, problem-solving, social skills,

training and education in money management. Thus, patients learn skills required for successful
reintegration into their community following discharge from the hospital.

References:

Books and articles:

Gail Wiscarz Stuart & Sandra Sundeen (Fifth Edition)
Sheila L. Videbeck (Fourth Edition)
Norman L. Keltner (Fifth Edition)
Mary Ann Boyd (Fourth Edition)
Natiional Institutes of Mental Health articles and brochures on schizophrenia
National Comorbidity Survey, 2005

Internet Sites:
http://emedicine.medscape.com/article/288259
http://www.mayoclinic.com/health/schizophrenia/DS00196
http://www.medicines net.com/schizophrenia/page6.htm
 PATIENT’S PROFILE
NAME R.B.
AGE 31 YEARS OLD
GENDER FEMALE
BIRTHDAY JULY 24, 1974
ADDRESS PUROK 1, BULANAO, TABUK
NATIONALITY FILIPINO
CIVIL STATUS MARRIED
RELIGION ROMAN CATHOLICISM
EDUCATIONAL GRADE 5, ELEMENTARY
ATTAINMENT
DATE OF JUNE 24, 2009
ADMISSION
TIME OF 1: 45 PM
ADMISSION
CHIEF AGSAR-SARITA NGA MAY-
COMPLAINT MAYSA (NAGSASALITANG
MAG-ISA/ TALKING TO
HERSELF)
ATTENDING DR. JULIANA
PHYSICIAN
 MENTAL HEALTH AND
PSYCHIATRIC NURSING
ASSESSMENT
GENERAL INFORMATION
R.B is thirty one` years old; married; a Roman Catholic and a resident of Tabuk,
Kalinga. She was born on July 25, 1979 at Tabuk Kalinga. She is a Elementary
undergraduate.

A. PSYCHIATRIC NURSING HISTORY

1. MEDICAL/PSYCE HISTORY

As to medical history, the patient verbalized that she had episodes of

cough, colds and fever which were spontaneously resolved by over the counter
medications. There were no further discussions when asked about her
immunizations and her childhood diseases.

In psychiatric history, the patient narrated about her daughter who was
sold by her first husband but when asked about this her reaction was flat. But
according to the SO who brought Mrs. R to CVMC that was the incident that
triggered her to become disoriented. Her first-degree cousin reported Mrs. R’s
condition to a government agency in their place but their plea was not entertained
because of the patient’s husband’s family connections.

As a result, there was a delayed treatment that caused the patient’s

condition to worsen. These were manifested by her episodes of verbally
aggressiveness, hostile behavior and violent actions. The patient’s SO was even
alarmed when she talks to herself more often. This Ms. R’s worsening condition
gave a decision to her family to fight for Ms. R’s right for treatment in spite of his
husband’s family connection. These were made possible by giving threats to the
government agency that has a connection to her husband’s family that they will
forward what they are doing in the media.
 Through this action, it made a way for Ms. R to proceed in CVMC for her
treatment. She was accompanied by her second husband, two brothers, and her
cousin. She was put on an outpatient basis. After fourteen months the patient was
brought again in the institution because of her recurrent hostile behavior and
periods of talking to herself. She was accompanied by her two brothers and her
cousin. Thus, admitted in June 24, 2009.

The patient mentioned that her father was brought to Mandaluyong,

Manila mental hospital. When asked about the diagnosis of her father she
verbalized “Wala pong nabangit sa akin, hindi ko alam”. When validated to the
SO her father was diagnosed schizophrenia. The patient verbalized that the caused
of his father death is suicide due to cancel mind which means the good mind will
be lost, this cancel mind was performed by her mother by wiping a native coconut
oil because of this, the patient’s father became disoriented thus committed
suicide. But when validated with the SO we found out that there is some
inconsistency with the information given by the patient. The SO said that after
discharged from the institution the patient again committed suicide using a dagger
and this cause his death. The patient was still in her elementary years when this
incident happened.

2. SOCIAL FUNCTIONING

With regards to her family, she mentioned that her parents love her and
her two brothers treat her nicely. She also mentioned that her brothers always
protect her from people who want to harm her. She said that her husband
physically abuses her. Her children are closed to her and love her.

During her stay at the psychiatry ward, she stated that she was able to
befriend some of the patients there; she also mentioned that she had a conflict
with patient R.P because of argument on religious belief. (TWO INCIDENT
REPORT)

3. HISTORY OF PRESENT ILLNESS

The patient’s chief compliant was talking to herself (Agsar-sarita nga

may-maysa/ nagsasalitang mag-isa) thus admitted to the institution. During the
assessment, she showed evidences of auditory hallucination, grandiose and
religious delusions basing from her stories and past experiences. These evidences
were positive symptoms of schizophrenia. The patient also manifested negative
symptoms such as catatonia (purposeless) and blunted affect. As a result, she was
diagnosed as Schizophrenia, undifferentiated, chronic, unstable.
 According to literature, undifferentiated schizophrenia has characteristic
symptoms (delusions, hallucinations, disorganized speech, grossly disorganized
or catatonic behavior, negative symptoms) are present but criteria for paranoid,
catatonic, or disorganized subtypes are not met. (Keltner, 2007 5th edition)

According to the patient, she was once brought in CVMC Psychiatric

Department by her second husband in the past but did not stay in the institution,
she said they only injected her medicine and she went home right away. But she
was admitted in June 24, 2009 due to the complaint: Nagsasalita mag-isa

4. DEVELOPMENTAL HISTORY

A. PRENATAL HISTORY

According to the patient, she was born through normal spontaneous

delivery. She said she does not have any birth deformities/trauma.

B. TODDLER or EARLY CHILDHOOD

The patient was not able to recall her early motor and teething
development. She cannot also remember when she began to speak. According to
her she does not heard any story from her mother regarding this. She mentioned
that she doesn’t experience stranger anxiety. In fact, she said that whenever she
saw a stranger she would run and hug them.

She also said her grandmother was also there taking care of them when
she was young. She experienced bedwetting but has not experienced recurrent
dreams or fantasies. She used to play alone in her mother’s side while working.
Her fears are snakes and those people who are not aware of who are they hurting
or going to harm.

C. MIDDLE CHILDHOOD

According to the patient she was a simple girl “Hindi ako maarte noon
ma’am simple lang ako manamit” as verbalized by the patient. She said she
played jackstone, badminton, and patintero with her friends.

During her school years, she mentioned that Mathematics was her favorite
subject. She also mentioned that she was included in their classroom’s honor roll.
Her involvement in games and activities are for fun rather than for competition.
 When it comes to her spirituality, she said that she learned the concept of
conscience when she entered her first religion (Roman Catholicism). Later on, she
was converted into Free believers (Pentecost).

D. LATER ADULTHOOD: (PUBERTY TO

ADOLESCENCE)

The patient mentioned that she had many close friends, she even learned
how to drink and smoke with them because she doesn’t want to disappoint them.
“Umiinom na lang ako ma’am baka sabihing wala akong pakisama” as
verbalized by the patient. She also said that she never gets angry and involved to a
fight. She also mentioned that she started to work for herself because her mother
died when she was 18 years old. She worked as a maid in a boarding house. She
does not have any eating problems.

E. PSCHOSEXUAL HISTORY

According to the patient, she had her menarche when she was 13 years
old. She said that she acquired knowledge and concepts about sex when she
became a member of Pentecost. In terms of her sexual relationship with her
husband she verbalized “Hinahayaan ko lang kung anung gawin sa akin ng
asawa ko pag nagtatalik kami, basta nakahawak lang ako sa kanya” as
verbalized by the patient.

But there came a time when the first cousin of his husband raped Rosita.
The patient’s SO suspected Rosita’s husband as the master mind of the incident
because the latter wasn’t concern of Rosita. The incident was known because the
patient was able to escape. She was seen running naked after the incident. Due to
this event she frequently talks to herself. As a result, her concerned SO gave a
small hut which is owned by her first cousin to unwind. During her stay in the
farm, he met a man named Mr. T who courted her. After sometime, they lived-in
and they want to get married but this decision was not permitted because she is
still married with Mr. A.

She also added that she had a homosexual relationship with her second
degree cousin. “Doon nga lang ako nasarapan ma’am eh. Basta ma’am magaling
siya” as verbalized by the patient. But this was not validated by her SO.
MENTAL STATUS EXAMINATION

A. HISTORY
According to the patient, she was first brought at CVMC Psychiatric Ward by
her husband in the past, but does not stay in the institution. When asked about the reason
behind it, the patient said, “Hindi ko alam, ang sabi nila baliw ako pero hindi naman” as
verbalized by the patient. She also added that she had attempted suicide in the past by
drinking “krudo”. Whem asked what are the presenting problems that lead her to do such
he verbalized that “Ang pinoproblema ko lang po eh yung lagi akong binubugbog ng
asawa ko, at yung anak ko na pinamigay ng asawa ko.”

B. GENERAL APPEARANCE AND MOTOR BEHAVIOR

During the first meeting, the patient wore a white colored shirt and a mini skirt.
The patient always wore t-shirt and shorts on the next meeting. Her hair was always tied
up and she doesn’t want to use make up because she believes that it does not suit her.
There was a time when we saw her manifested catatonic, she demonstrated a purposeless
movement. She appears on her stated age. There were times, she failed to take a bath and
at times she has an unpleasant smell.

C. SPEECH
The patient talks non stop at some point. She did not perseverate. Her responses
were elaborated thoroughly. She had audible voice which enables her SN to understand it
clearly what she was saying. The client also uses neologism such as: “Cancel Mind”

D. MOOD AND AFFECT

The patient has a blunted affect. She was somewhat inactive; she doesn’t
manifest mood swings. She looks always sad, she moves slow at all times.

E. THOUGHT AND PROCESS CONTENT:

The patient manifested religious delusions. She said that she and others believes
that she is Christ. She also manifested thought insertion, “Napupunta yung mga isipan
nila sa akin dyan sa loob kaya nagagalit ako at nananakit” as verbalized by the patient.
F. ASSESSMENT OF SUICIDE OR HARM TOWARDS
OTHER
When asked about any plans of committing suicide, she stated “Wala ma’am,
gusto ko lang umuwi, ay pero noon maam eh tinangka kong magpakamatay basta
matagal nay un di ko na matandaan basta nuoong bago pa ako dinala dito”. And when
asked about any plans of committing suicide at present the vernbalized “Wala na
ma’am.masaya naman po ako dito pero minsan nababagot at malungkot ako kasi gusto
ko din magkatrabaho at maadami akong nagiging kaaway ngayon dito kaya gusto ko ng
lumabas pero hindi ko naman naiisip magpakamatay dahil dun ma’am.”

She admitted that she is capable of hurting the other patients. Based on her chart,
she had an incident wherein she punched the face of a patient in the ward and when asked
about it, she admitted it.

G.SENSORIUM AND INTELLECTUAL PROCESS

1. MEMORY

Patient R.B was able to remember all the things she did the other day. She can
also remember her birthday and can give the names of her parents.

2. ABILITY TO CONCENTRATE

The patient was able to count 1-30 and count it backwards as well.

3. ABSTRACT AND INTELLECTUAL ABILITIES

When asked to interpret the meaning of this proverb, “Kung ano ang puno ay
siya rin ang bunga”, the patient said “Yung puno ma’am eh yung magulang tapos yung
bunga eh mga anak, kaya kung ano yung klase ng magulang meron ka, ay ganon din
yung anak” as verbalized by the patient.

4. SENSORY PERCEPTUAL ALTERATIONS

The patient manifested auditory hallucination. She said “Merong nagbubulong sa

akin na parusahan ko daw ang mga makasalan” as verbalized by the patient.

5. JUDGEMENT AND INSIGHT

 When asked what she’ll do if she sees a wallet on the ground she verbalized,
“Pulutin ko ah ma’am tapos itatago ko, tapos kung may maghahanap ibibigay ko pero
kung wala akin na lang”

6. SELF CONCEPT

When asked about her self-concept, she answered, ”Hindi ko alam ma’am wala
akong masasabi sa sarili ko, yung ibang tao lang nakakaalam”

7. ROLES AND RELATIONSHIP

According to the patient she is the youngest among the three siblings and the
only girl. Her father committed suicide when she was still young. She has a pleasant
relationship with her mother and grandmother. “Sila Mama at Lola ko ang laging nag-
aalaga sa akin, si mama lagi niya akong binubuhat” as verbalized by the patient.

She also mentioned that her two brother were close to her “Pinoprotektahan nila
ako ma’am, yung mga gusting umaway sa akin eh dumadaan muna sila sa mga kuya ko”
as verbalized by the patient.

Mrs. R and her husband first met in Dagupan, Kalinga Apayao. Then, they
decided to get married after one year. They were blessed with four children.But when
validated to the SO the patient have 5 children (3 boys and 2 girls) At first, her
relationship with her husband was intimate. Then, there were moments in their marriage
wherein her husband physically abused her. “Lagi niya akong sinasaktan ma’am hindi
ko naman alam ang dahilan” as verbalized by the patient. But patient tolerated such
abused. When her husband intentionally sells their fourth child, she wasn’t able to cope
up with the problem that led a gap in their marriage and also made an effect on her
mental status. Because of this, she became violent to others. According to her SO, the
patient is aware that her husband had a previous relationship and had children in his first
family.

Patient R.B had a second relationship with Mr. T. They did not get married but
they lived together with no children. Mr. T is a widow. They got separated because
patient R.B had episodes of violent actions.

She also added that her children were close to her and loves them. According to
her she got separated with her husband. She said, she had many relationships with
another man. Now, she claims that her husband is “N.M” who was a patient also in
psychiatric ward.
8. PHYSIOLOGIC AND SELF CARE

The patient eats thrice a day with snacks in between. She does not complain
about the foods being served in the ward. She was able to sleep well but sometimes not
because of some patient who were very noisy. She always combs her hair and tied it up.
She doesn’t like using make-up. She always takes her medication. She also said that she
takes a bath everyday.
 ANATOMY AND
PHYSIOLOGY OF THE
NERVOUS SYSTEM
Human Neurology

 The nervous system is essentially a biological information highway, and is responsible for
controlling all the biological processes and movement in the body, and can also receive
information and interpret it via electrical signals which are used in this nervous system
 It consists of the Central Nervous System (CNS), essentially the processing area and the
Peripheral Nervous System which detects and sends electrical impulses that are used in the
nervous system

The Central Nervous System (CNS)

 The Central Nervous System is effectively the centre of the nervous system, the part of it that
processes the information received from the peripheral nervous system.
 The CNS consists of the brain and spinal cord.
 It is responsible for receiving and interpreting signals from the peripheral nervous system and
also sends out signals to it, either consciously or unconsciously. This information highway called
the nervous system consists of many nerve cells, also known as neurones.

The Nerve Cell

 Each neurone consists of a nucleus situated in the cell body, where outgrowths called processes
originate from. The main one of these processes is the axon, which is responsible for carrying
outgoing messages from the cell. This axon can originate from the CNS and extend all the way to
the body's extremities, effectively providing a highway for messages to go to and from the CNS
to these body extremities.
 Dendrites are smaller secondary processes that grow from the cell body and axon. On the end of
these dendrites lie the axon terminals, which 'plug' into a cell where the electrical signal from a
nerve cell to the target cell can be made. This 'plug' (the axon terminal) connects into a receptor
on the target cell and can transmit information between cells.

Classification of Neurones

 Interneurones - Neurones lying entirely within the CNS

  Afferent Neurones - Also known as sensory neurones, these are specialised to send impulses
towards the CNS away from the peripheral system

 Efferent Neurones - These nerve cells carry signals from the CNS to the cells in the peripheral
system

Brain Divisions

 There are three main components of the brain, namely the brainstem, cerebellum and the
forebrain.

 The Brainstem - The brainstem is the connection between the rest of the brain and the
rest of the central nervous system. It is primarily concerned with life support and
basic functions such as movement.

 The Cerebellum - Consisting of two hemispheres, the cerebellum is primarily

concerned with movement and works in partnership with the brainstem area of the
brain and focuses on the well being and functionality of muscles. The structure can be
found below the occipital lobe and adjacent to the brainstem.

 The Forebrain - The forebrain lies above the brainstem and cerebellum and is the
most advanced in evolutionary terms.

The Forebrain

 The forebrain has many activities that it is responsible for and is divided into many component
parts.

 The Hypothalamus - A section of the brain found next to the thalamus that is involved
in many regulatory functions such as osmoregulation and thermoregulation. The
hypothalamus has a degree of control over the pituitary gland, another part of the
brain situated next to it, and also controls sleeping patterns, eating and drinking and
speech. The hypothalamus is also responsible for the secretion of ADH (Anti-Diuretic
Hormone) via its neurosecretory cells.

 The Cerebrum - The cerebrum is the largest part of the human brain, and the part
responsible for intelligence and creativity, and also involved in memory. The 'grey
matter' of the cerebrum is the cerebral cortex, the centre that receives information
from the thalamus and all the other lower centres in the brain.

Two Hemispheres

 Left Hemispehres
o Controls the right side of the body
o The center for l;ogical reasoning and analytic functions such as reading,
writing, and mathematical tasks.
 Right Hemisphere
o Controls the left side of the body
 o The center for creative thinking, intuition, and artistic abilities.

 The Cerebral Cortex - Part of the cerebrum, this part of the brain deals with almost all
of the higher functions of an intelligent being. It is this part of brain that deals with
the masses of information incoming from the periphery nervous system, furiously
instructing the brain of what is going on inside its body and the external environment.
It is this part that translates our nervous impulses into understandable quantifiable
feelings and thoughts. So important is the cerebral cortex that it is sub-divided into 4
parts, explained below :

1. Frontal Lobe - Found at the front of the head, near the temples and forehead,
the frontal lobe is essential to many of the advanced functions of an evolved
brain. It deals with voluntary muscle movements and deals with more intricate
matters such as thought and speech.

2. Parietal Lobe - Situated behind the frontal lobe, this section deals with spatial
awareness in the external environment and acts as a receptor area to deal with
signals associated with tough.

3. Temporal Lobe - The temporal lobes are situated in parallel with the ears, they
serve the ears by interpreting audio signals received from the auditory canal.

4. Occipital Lobe - This is the smallest of the four lobe components of the
cerebrum, and is responsible in interpreting nerve signals from the eye at the
back of the brain.
The Spinal Cord
 conducts sensory information from the peripheral nervous system (both somatic and autonomic)
to the brain
 conducts motor information from the brain to our various effectors
o skeletal muscles
o cardiac muscle
o smooth muscle
o glands
 Serves as a minor reflex center.
 31 pairs of spinal nerves arise along the spinal cord. These are "mixed" nerves because each
contains both sensory and motor axons. However, within the spinal column,
 All the sensory axons pass into the dorsal root ganglion where their cell bodies are
located and then on into the spinal cord itself.
 All the motor axons pass into the ventral roots before uniting with the sensory axons
to form the mixed nerves.
 It connects a large part of the peripheral nervous system to the brain. Information (nerve
impulses) reaching the spinal cord through sensory neurons are transmitted up into the
brain. Signals arising in the motor areas of the brain travel back down the cord and leave
in the motor neurons.
 The spinal cord also acts as a minor coordinating center responsible for some simple
reflexes like the withdrawal reflex.

The Peripheral Nervous System

The Spinal Nerves
 Consists of 31 pairs: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal.
 Formed by junction of a dorsal (sensory) root and a ventral (motor) root.
 Shortly after a spinal nerve is formed from a dorsal and ventral root, it branches into:
 A meningeal ramus.
 A dorsal ramus, serving muscles and skin of the back of head, neck, and trunk.
 A ventral ramus, serving ventral part of these structures as well as upper and lower
extremities.

The Cranial Nerves

 Are 12 pairs of symmetrically arranged nerves attached to the brain.

Number Name Superficial Exit From Skull Function

Origin
I Olfactory Extends from Cribriform plate Sensory: olfactory
nasal mucosa to of ethmoid (smell)
olfactory bulb
II Optic Extends from Optic foramen Sensory: Vision
retina to optic
 chiasm
III Oculomotor Midbrain Superior orbital Motor: external
fissure muscles of eyes
except lateral
rectus and
superior oblique;
levator palpebrae
superioris.
Parasympathetic:
sphincter of pupil
and ciliary muscle
of lens
IV Trochlear Roof of midbrain Superioir orbital Motor: superior
fissure oblique muscle
V Trigeminal Sensory: cornea;
Opthalmic branch Ventral surface Superior orbital nasal mucous
of pons fissure membrane; skin
of face and scalp

Maxillary branch Ventral surface Foramen Sensory: skin of

of pons rotundum face; mucous
membrane of
mouth and nose;
teeth

Mandibular branch Ventral surface Motor: muscles of

of pons Foramen ovale mastication
Sensory: skin of
face, mucous
membrane of
mouth; teeth
VI Abducens Lower margins Superior orbital Motor: lateral
of pons fissure rectus muscle
VII Facial Lower margin of Stylomastoid Motor: muscles of
pons foramen facial expressions
Sensory: taste,
anterior two-
thirds of tongues
Parasympathetic:
lacrimal;
submandibular,
and sublingual
glands
VIII Vestibulocochlear
Vestibular Groove between Internal auditory Sensory:
pons and meatus equilibrium
 medulla
oblongata
Cochlear Internal auditory Sensory: hearing
Groove between meatus
pons and
medulla
oblongata
IX Glosopharyngeal Medulla Jugular foramen Motor:
Oblongata stylopharyngeus
muscle
Sensory: taste,
posterior one-
third of tongue;
pharynx; branch
of the carotid
sinus and carotid
body
Parasympathetic:
parotid gland
X Vagus Medulla Jugular foramen Sensory: external
Oblongata meatus, pharynx,
larynx, aortic
sinus, and
thoracic and
abdominal viscera
Motor: pharynx
and larynx
Parasympathetic:
thoracic and
abdominal viscera
XI Accessory Medulla Jugular foramen Motor: trapezius
oblongata and and
upper 5 cervical sternocleidomasto
segments of id muscles;
spinal cord muscles of
pharynx and
larynx
XII Hypoglossal Anterior lateral Hypoglossal Motor: muscles of
sulcus between canal tongue
olive and
pyramid

The Neurotransmitters
 Type Function Increase or Decrease
CHOLINERGICS
Acethylcholine  A major effector Increase:
chemicals in the ANS,  Depression
located in the brain, Decrease:
spinal cord, and PNS  Alzheimer’s disease
 Functions include: sleep,  Hungtinton’s chorea
arousal, pain perception,  Parkinson’ disease
modulation and  Myasthenia gravis
coordination of
movement, and memory
acquisition and reyention
MONOAMINES
Norepinephrine  It is the most prevalent Increase:
neurotransmitter in the  Anxiety disorders
CNS, and is located  Mania
primarily at the brain  schizophernia
stem. Decrease:
 Functions include the  memory loss
regulation of mood,  social withdrawal
cognition, perception,
 depression
cardiovascular
functioning, locomotion,
fight or flight response,
and sleep and arousal.
Dopamine  Located primarily in the Increase:
brain stem  Mania
 Functions of Dopamine  Shcizophrenia
include regulation of Decrease:
complex movements and  Parkinson’s disease
coordination, emotions,  Depression
sensory integration, and
voluntary decision-
making ability and
inhibit the release of
prolactin
Serotonin  Found only in the brain Increase:
 Plays a role in sleep and  Anxiety states
arousal, appetite, mood, Decrease:
aggression, pian, ability  Depression
to pursue goal-directed
behaviour.
 Contributes to the
delusion, hallucination,
and withdrawn behaviour
in schizophernia
Histamine  Highest concentration is Decrease:
found in various regions  Depression
 of the hypothalamus
Amino Acids
Gamma-aminobulytic acid  Wide-spread distribution Decrease:
(GABA) in the CNS  Huntington’s chorea
 Prevents postsynaptic  Anxiety disorders
excitation=interrupts the  Schizophrenia
progression of electrical  Various forms of
impulse at the synapse epilepsy
 Functions include: slow
down of bodily functions
and modulates other
neurotransmitters
Glycine  Found in spinal cord and Increase:
brain stem  Glycine encephalopathy
 Functions in the (brain and CSF)
recurrent inhibition of Decrease:
motor neurons and the  Spastic motor
regulation of spinal and movements
brain stem reflexes
Glutamate and aspartate  Found in all cells of the Increase:
body; in the synaptic  Huntington’s chorea
vesicles in the CNS  Temporal lobe epilepsy
 Glutamate is the primary  Spinal cerebbellar
neurotransmitters of the degeneration
auditory nerve
 It control the opening of
calcium channels in the
neuron
 Functions include the
regulation of various
motor and spinal reflexes