 schizophrenia -Regression in response to frustrations & conflict with

others.
• from the Greek word schizo, “to split” or “to
divide” and phren, “mind”. -Early interpersonal difficulties

• The disorder is primarily thought to affect History:

cognition, but it also usually contributes to
chronic problems with behavior and emotion. Emil Kraepelin & Eugene Bleuler – are the two key figures
in the history of schizophrenia.
 * A psychiatric diagnosis that describes a
mental illness characterized by impairments in Benedict Morel (1809-1873), a French Psychiatrist, used
the perception or expression of reality, most the term demense precoce for deteriorated patients
commonly manifesting as; whose illness had begun in the adolescence.

 Auditory EMIL KRAEPELIN (1856- 1926)

hallucinations,
- Latinized Morel’s term to dementia precox, a
 Paranoid or bizarre term that emphasized a distinct cognitive
delusions, or process deterioration (dementia) & the early
onset (precox) that is characteristic of the
 Disorganized disorder.
speech & thinking
- However, about 4% of his patients had complete
in the context of significant social or recoveries & 13% had significant remissions.
Hence the term dementia misrepresented the
occupational dysfunction. condition.

 Causes: EUGENE BLEULER (1857-1939)

Consider the effect of nature & nurture;
predisposing & precipitating factor. - Coined the term “schizophrenia”, in 1908 &
* Genetic replaced “dementia precox” in the literature.
* Prenatal
* Social - He conceptualized the term to signify the
* Substance Abuse presence of a schism (disunion) between
* Psychological thought, emotion & behavior.
* Neural
- However, the term is widely misunderstood, as
Dopamine Hypothesis. signifying a split personality.

Schizophrenia results from too much dopaminergic - Schizophrenic personality is not just split but
activity. totally disintegrated.

Neuropathology of the; - Split personality, now called Dissociative

identity disorder is entirely different.
* limbic system – because of its role in the control
of emotions. Bleuler described :

* basal ganglia – involved in the control of movement. A. Specific fundamental or primary

symptoms:
Psychoanalytic theories by Freud & Sullivan
* the 4 “A”s;
-Fixations in the development
- Association disturbance
-Ego defect (looseness)
 - Affective distirbance Ex. I file mile in profile.

- Autism You protect disconnect to detect

the effect.
- Ambivalence
Stilted language. done by homosexuals.
B. Accessory (secondary )symptoms
Stereotype – senseless repetition of speech & activity.
- Hallucinations (Auditory
being the most common, making Flight of ideas
it the 5th “A”
Looseness of association – stringing of unrelated topics
- Delusions with vague connection.

 Obsession – pathological persistence of an

irresistible thought or feeling that cannot be
 Symptoms: eliminated from consciousness by logical effort.
Positive (or Productive) Compulsion – repetitive behavior in response to
* Delusions – false belief, based on incorrect an obsession.
inference about external reality, that cannot be Catatonic excitement – agitated, purposeless
corrected by reasoning. motor activity, uninfluenced by external stimuli.
* Auditory hallucinations – false perception of Catatonic stupor – markedly slowed motor
sound, usually voices. activity, often to a point of immobility & seeming
* Thought disorder – thought that, generally, is unawareness of surroundings.
not understandable. Catatonic rigidity – voluntary assumption of a
* Disorganized speech rigid posture, held against all efforts to be
* Disorganized behavior moved

 Negative (or deficit)  Catatonic posturing – voluntary assumption of

* Flat or blunted affect – absence or near an inappropriate or bizarre posture, generally
absence of any signs of affective expression; maintained for long periods of time.
voice monotonous, face immobile. Cerea flexibilitas (waxy flexibility) – the person
* Alogia – poverty of speech. can be molded into a position that is then
* Anhedonia – loss of interest in & withdrawal maintained.
from all regular & pleasurable activities. Hyperkinesis – restless, aggressive, destructive
* Avolition – lack of motivation or volition. activity, often associated with some underlying
brain pathology.
 Disorganization syndrome Echopraxia – pathological imitation of
* Chaotic speech, thought, and behavior. movements of one person by another.
Neologism – new word created by the patient.
Ex. Baduy, Laspag
Word salad – incoherent mixture of words &  Delusions:
phrases.
Verbigeration – meaningless repetition of Bizarre delusion – an absurd, totally implausible, strange
specific words or phrases. false belief. ( Ex. Invaders from space have implanted
Echolalia – repeating of words or phrases of electrodes in his brain.)
another person.
Mutism Systematized delusion – beliefs united by a single event or
Pressured speech theme. ( Ex. He is being persecuted by the CIA, the FBI, the
Mafia, or the boss.)
Clang Association – words similar in sound but not
meaning. Nihilistic delusion – feeling that self, others , or the world
is nonexistent or ending.
Delusions of poverty – one is bereft or will be deprived of 1. Paranoid type
all material possessions.
* Preoccupation with 1 or more delusions
Somatic delusion – involves functioning of one’s body. (Ex. (grandeur & persecution) or frequent hallucination.
Belief that one’s brain is rotting or melting.)
* Typically, they are tense, suspicious, guarded &
Delusion of persecution – one is being harassed, cheated, reserved.
or persecuted.
* they can also be hostile & aggressive.
Delusion of grandeur – exaggerated conception of one’s
importance, power, or identity. 2. Disorganized type: “hebephrenic” in the ICD,

Delusion of reference – the behavior of others refers to * Grossly inappropriate or flat affect.
oneself. (Ex. People on TV or radio are talking to or about
Emotional responses are
him)
inappropriate. They often burst out laughing without
Delusion of self-accusation – feeling of remorse & guilt. apparent reason.

Delusion of control – feeling that one’s will, thoughts, or * Characterized by marked regression to
feelings are being controlled by external forces. primitive, disinhibited, & inorganized behavior. (enuresis,
encopresis)
Delusion of infidelity – belief that one’s lover is unfaithful
* Personal appearance & social behavior are
Erotomania – belief that someone is deeply in love with delapidated.
them
* Grinning & grimacing are common
( also known as Clerambault-Kandinsky complex)
3. Catatonic Type: Disturbance in motor function.

Catatonic Stupor Catatonic

 Diagnosis Excitement
1. Self-reported experiences of the person.
Motionless Excessive
2. Abnormalities in behavior reported by
motor activity
significant others.
3. Secondary signs observed by the health
Waxy flexibilty Echopraxia
team.
Negativism & mutism Echolalia

 DSM IV – TR Criteria: Posturing Stereotypes

1. Characteristic symptoms – two or more of the
following, each present for a significant portion Sometimes the pt. shows a rapid alteration between
of time during a one-month period (or less, if extremes of excitement & stupor.
successfully treated.
4. Undifferentiated type: psychotic symptoms are present
* delusions
& are clearly schizophrenic but the criteria for paranoid,
* hallucinations
disorganized, or catatonic types have not been met.
* disorganized speech and/or
behavior. 5. Residual type: Had a history of schizophrenia but in a
* Negative symptoms currently state of remission. Positive symptoms are
2. Social/occupational dysfunction. present at a low intensity only.

 Subtypes: The ICD–10 recognizes a further 2 subtypes:

The DSM contains 5 sub-classifications;

 • Post-schizophrenic depression: a depressive Atypical antipsychotic
episode arising in the aftermath of a
schizophrenic illness where some low-level - Newer
symptoms may still be present.
- Exert blocking effects at the dopamine 2 &
• Simple shizophrenia: insidious but progressive serotonin 2 postsynaptic receptors.
development of negative symptoms.
- Improve both positive & negative symptoms.
Phases of Schizophrenia:
- Rarely cause EPS.
Phase I The Schizoid Personality (Premorbid phase)
- Costly.
* Loner, indifferent to social
Typical antipsychotic
relationship, limited range of emotional
experience & expression.
- Older or conventional.
Phase II The Prodromal phase
- Predominantly dopamine antagonist.

* Avoidance of social interaction,

- Improve positive symptoms.
isolation.
- With broad side effects.
* Can last for many years.
- Less expensive.
Phase III Schizophrenia
 Examples
* Period when acute signs & symptoms
are present. Atypical

Phase IV Residual impairment Clozapine (Clozaril)

* Period of remission. Signs & Risperidone (Risperdal)

symptoms are relieved or can be controlled by the person
Olanzapine (Zyprexa)

Quetiapine (Serquel)

Treatment: Ziprasidone (Geodon)

 3 phases of Treatment: Aripiprazol (Abilify)

1. Acute phase (6 – 12 weeks) Typical

- eliminate the symptoms. Phenothiazines

2. Continuation phase (4 – 9 months) Chlorpromazine (Thorazine)

- prevent the return of symptoms & to Thioridazine (Mellaril)

promote recovery.
Mesoridazine (Serentil)
3. Maintenance phase
Perphenazine (Trilafon)
- prevent recurrence or a new episode
Trifluoperazine (Stelazine)
of illness.
Fluphenazine (Prolixin)
 1. Medication
Butyrophenone Benzodiazepines

Haloperidol (Haldol) Pseudoparkinsonism – robot-like movement,

masklike facies, shuffling gait, cogwheel rigidity, fine
How medications work: tremor, muscle stiffness.

1. Excess neurotransmitter. Tardive Dyskinesia

Medicine blocks the uptake of neurotransmitter by • A late appearing side effect.

blocking the neuro receptors of neuron.
• Abnormal involuntary movements such as
2. Few neurotransmitter: tongue protrusion, lip smacking, chewing,
blinking, grimacing.
Medicine interfere with the re-uptake mechanism,
leaving more neurotransmitter for action. • Irreversible

Biological Basis for Psychopharmacology: • Progression can be decreased once meds had
stopped.
Dysregulation (imbalance) in the complex process of
brain structures communicating with each other through • Treatment: Dosage or drug can be
neurotransmitters. changed.

Psychosis – involve excessive dopamine & serotonin Seizure

dysregulation.
Hypotension
Mood Disorder – disruption of norepinephrine & serotonin
& other neurotransmitter. Hypersensitivity

Anxiety – dysregulation of GABA (Gamma-aminobutyric Neuroleptic Malignant Syndrome

Acid) & other neurotransmitters.
* Serious & fatal condition.
Alzheimers – dysregulation of acetylcholine & other
neurotransmitters. * muscle rigidity, high fever, increased muscle
enzyme, & leukocytosis.
Drug Side Effects
Treatment:
Extapyramidal symptoms (EPS) – reversible movement
disorder induced by neuroleptic medication. Stopping the medication

Dystonia – spasm of major muscle groups of Use another type of drug

neck, back & eyes causing * torticollis, * oculogyric crisis, *
 Prognosis:
protrusion of tongue, * dysphagia, * laryngeal &
pharyngeal spasm.
Most people find that their symptoms improve
with medication, and some achieve substantial control of
- reaction is sudden,
their symptoms overtime.
frigthening, & painful.
Factors associated with better prognosis:
Treatment: Diphenhydramine (IM, IV)
1. Acute onset.
Cogentin
2. Treatment started early.
Akathisia – cannot remain still. There is inner
restlessness, leg aches & are relieved by movement.
3. Intelligent individual

Treatment: Beta blockers (Propranolol)

4. Available support system
 5. Predominantly positive symptom.

6. Female

Nursing Diagnosis:

1. Disturbed thought process r/t physiological brain

dysfunction/ imbalance neurotransmitter.

2. Impaired verbal communication r/t thought

disorder.

3. Disturbed sensory perception r/t physiological

brain dysfunction.

4. Impaired social interaction r/t inadequate social

skills

5. Risk for injury (self-directed/directed to others)

r/t hallucinatory or delusionary exp.