National University of science and Technology / College of

Nursing
Psychiatric and Mental Health Nursing Department
Lecture Psychiatric Nursing

)Schizophrenia(

Schizophrenia
INTRODUCTION:

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 a syndrome or as a disease process with many
different varieties and symptoms, much like the varieties of cancer. Many people
believed that those with schizophrenia needed to be locked away from society and
institutionalized. Only recently has the mental health community come to learn and
educate the community at large that schizophrenia has many different symptoms
and presentations and is an illness that medication can control. many clients with
schizophrenia live successfully in the community. Clients whose illness is
medically supervised and whose treatment is maintained often continue to live and
sometimes work in the community with family and outside support. Schizophrenia
is usually diagnosed in late adolescence or early adulthood. Rarely does it manifest
in childhood. The peak incidence of onset is 15 to 25 years of age for men and 25
to 35 years of age for women. The symptoms of schizophrenia are divided into two
major categories: positive or hard symptoms/signs, which include delusions,
hallucinations, and grossly disorganized thinking, speech, and behavior, and
negative or soft symptoms/signs, which include flat affect, lack of volition, and
social withdrawal or discomfort.

Positive and Negative Symptoms of Schizophrenia

1. Positive or Hard Symptoms:

Ambivalence: Holding seemingly contradictory beliefs or feelings about the same

person, event, or situation.

Associative looseness: Fragmented or poorly related thoughts and ideas.

Delusions: Fixed false beliefs that have no basis in reality.

Echopraxia: Imitation of the movements and gestures of another person whom the
client is observing.

Flight of ideas: Continuous flow of verbalization in which the person jumps

rapidly from one topic to another.

Hallucinations: False sensory perceptions or perceptual experiences that do not

exist in reality.

Ideas of reference: False impressions that external events have special meaning
for the person.

Perseveration: Persistent adherence to a single idea or topic; verbal repetition of a

sentence, word, or phrase; resisting attempts to change the topic

Bizarre behavior: Outlandish appearance or clothing; repetitive or stereotyped,

seemingly purposeless movements; unusual social or sexual behavior.

2. Negative or Soft Symptoms:

Alogia: Tendency to speak little or to convey little substance of meaning (poverty

of content).
Anhedonia: Feeling no joy or pleasure from life or any activities or relationships.
Apathy: Feelings of indifference toward people, activities, and events.

Asociality: Social withdrawal, few or no relationships, lack of closeness.

Blunted affect: Restricted range of emotional feeling, tone, or mood.

Catatonia: Psychologically induced immobility occasionally marked by periods of

agitation or excitement; the client seems motionless, as if in a trance.
 Flat affect: Absence of any facial expression that would indicate emotions or
mood.

Avolition or lack of volition: Absence of will, ambition, or drive to take action or

accomplish tasks.

Inattention: Inability to concentrate or focus on a topic or activity, regardless of

its importance.

Medication may control the positive symptoms, but frequently, the negative
symptoms persist after the positive symptoms have abated. The persistence of
these negative symptoms over time presents a major barrier to recovery and
improved functioning in the client’s daily life.

CLINICAL COURSE

Although the symptoms of schizophrenia are always severe, the long-term course
does not always involve progressive deterioration. The clinical course varies
among clients.

Onset

Onset may be abrupt or insidious, but most clients slowly and gradually develop signs
and symptoms such as social withdrawal, unusual behavior, loss of interest in school or
at work, and neglected hygiene. The diagnosis of schizophrenia is usually made when
the person begins to display more actively positive symptoms of delusions,
hallucinations, and disordered thinking (psychosis). Regardless of when and how the
illness begins and the type of schizophrenia, consequences for most clients and their
families are substantial and enduring. When and how the illness develops seems to
affect the outcome. Age at onset appears to be an important factor in how well the
client fares; those who develop the illness earlier show worse outcomes than those who
develop it later. Younger clients display a poorer premorbid adjustment, more
prominent negative signs, and greater cognitive impairment than do older clients.
Those who experience a gradual onset of the disease (about 50%) tend to have a poorer
immediate- and long-term course than those who experience an acute and sudden
onset. Approximately one-third to one-half of clients with schizophrenia relapse within
1 year of an acute episode. Higher relapse rates are associated with nonadherence to
medication, persistent substance use, caregiver criticism, and negative attitude toward
treatment (Wade, Tai, Awenot, & Haddock, 2017).

RELATED DISORDERS

1. Schizophreniform disorder: The client exhibits an acute, reactive psychosis for

less than the 6 months necessary to meet the diagnostic criteria for schizophrenia. If
symptoms persist over 6 months, the diagnosis is changed to schizophrenia. Social or
occupational functioning may or may not be impaired.

2. Catatonia: Catatonia is characterized by marked psychomotor disturbance, either

excessive motor activity or virtual immobility and motionlessness. Motor immobility
may include catalepsy (waxy flexibility) or stupor.

3. Delusional disorder: The client has one or more non-bizarre delusions - that is, the
focus of the delusion is believable. The delusion may be persecutory, erotomanic,
grandiose, jealous, or somatic in content. Psychosocial functioning is not markedly
impaired, and behavior is not obviously odd or bizarre.

4. Brief psychotic disorder: The client experiences the sudden onset of at least one
psychotic symptom, such as delusions, hallucinations, or disorganized speech or
behavior, which lasts from 1 day to 1 month. The episode may or may not have an
identifiable stressor or may follow childbirth.
5. Shared psychotic disorder (folie à deux): Two people share a similar delusion.
The person with this diagnosis develops this delusion in the context of a close
relationship with someone who has psychotic delusions, most commonly siblings,
parent and child, or husband and wife.

6. Schizotypal personality disorder: This involves odd, eccentric behaviors,

including transient psychotic symptoms. Approximately 20% of persons with this
personality disorder will eventually be diagnosed with schizophrenia.

ETIOLOGY

Whether schizophrenia is an organic disease with underlying physical brain pathology

has been an important question for researchers and clinicians for as long as they have
studied the illness. In the first half of the 20th century, studies focused on trying to find
a particular pathologic structure associated with the disease, largely through autopsy.
Such a site was not discovered. In the 1950s and 1960s, the emphasis shifted to
examination of psychological and social causes. However, some therapists still believe
that schizophrenia results from dysfunctional parenting or family dynamics. Newer
scientific studies began to demonstrate that schizophrenia results from a type of brain
dysfunction. In the 1970s, studies began to focus on possible neurochemical causes,
which remain the primary focus of research and theory today. These
neurochemical/neurologic theories are supported by the effects of antipsychotic
medications, which help control psychotic symptoms, and neuroimaging tools such as
computed tomography, which have shown that the brains of people with schizophrenia

differ in structure and function from those of control subjects.

TREATMENT
 Psychopharmacology:

In the past, electroconvulsive therapy, insulin shock therapy, and psychosurgery were
used, but since the creation of chlorpromazine (Thorazine) in 1952, other treatment
modalities have become all but obsolete. Antipsychotic medications, also known as
neuroleptics, are prescribed primarily for their efficacy in decreasing psychotic
symptoms. They do not cure schizophrenia; rather, they are used to manage the
symptoms of the disease. The conventional, or first-generation, antipsychotic medications
are dopamine antagonists. The atypical, or second-generation, antipsychotic medications
are both dopamine and serotonin antagonists. Second-generation antipsychotics not only
diminish positive symptoms but also lessen the negative signs of lack of volition and

motivation, social withdrawal, and anhedonia for many clients.

Nursing Interventions:

1. Be sincere and honest when communicating with the client. Avoid vague or evasive
remarks.

2. Be consistent in setting expectations, enforcing rules, and so forth.

3. Encourage the client to talk with you, but do not pry for information.

4. Interact with the client on the basis of real things; do not dwell on the delusional
material.

5. Do not be judgmental or belittle or joke about the client’s beliefs.

6. Never convey to the client that you accept the delusions as reality.

7. Explain procedures and try to be sure the client understands the procedures before
carrying them out.

Lecturer
Dr. Huda.sh.abbas