SCHIZOPHRENIA

Schizophrenia
 Psychiatric syndrome or a disease of the brain, characterized by distorted
& bizarre thought, perceptions, emotions, movements and behaviors
TYPES

Paranoid type
 Characterized by persecutory ( feeling victimized or spied on ) or
grandiose delusions, hallucinations and occasionally excessive religiosity
or hostile and aggressive behavior
Disorganized type
 Characterized by grossly inappropriate or flat affect, incoherence, loose
association and extremely disorganized behavior
Catatonic type
 Characterized by marked psychomotor disturbance, either motionless or
excessive motor activity.
Undifferentiated type
 Characterized by mixed schizophrenic symptoms along with disturbances
of thought, affect and behavior
Residual type
 Characterized by at least one previous, though not a current, episode;
social withdrawal; flat affect and looseness of associations

RELATED DISORDERS

Schizophreniform disorder
 The clients exhibit the symptoms of schizophrenia but for less than 6
months necessary to meet the diagnostic criteria for schizophrenia
Schizoaffective disorder
 The clients exhibits the symptoms of psychosis and at the same time all
the features of the mood disorder either depression or mania

Dellusional disorder
 The client has one or more nonbizarre delusions, that is the focus of the
delusion is believable. Psychosocial functioning is not markedly impaired
and behavior is not obviously odd or bizarre

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 at least from 1 day to 1 month.
Shared psychotic disorder
 Two people share a similar delusion.The person with this dianosis
develops this delusion in the context of a close relationship with someone
who has psychotic delusions.

SIDE EFFECTS

Extrapyramidal side effects

 Are reversible movement disorders induced by neuroleptic medication.

Dystonic reactions
 To antipsychotic medications appear early in the course of treatment and
are characyterized by spasms in discrete muscle groups such as the neck
muscles or the eye muscles.

Pseudoparkinsonism
 Or neuroleptic-induced parkinsonism includes shuffling gait, masklike
facies, muscle stiffness or cogwheeling rigidity.
Akathisia
 Is characterized by restless movement, pacing, inability to remain still and
the client’s report of inner restlessness.

Tardive Dyskinesia
 A late appearing side effect of anti psychotic medications is characterized
by abnormal, involuntary movements such as smacking, tongue
protrusion, chewing, blinking, grimacing and choreiform movements of the
limbs and feet.

Seizures
 Are an infrequent side effect associated with antipsychotic medications
 \

Neuroleptic Malignant Syndrome

 is a serious and frequently fatal condition seen in those being treated
with antipsychotic medications.

POSITIVE OR HARD SYMPTOMS

Associative looseness
 Lack of connecting ideas in string of thought with impairment of logical
thinking
Delusions
 false fixed beliefs do not respond to reality input

Echopraxia ( actions )
 Client repeats or mimics the movements of the examiner.

Affective disturbance
 Affect impairment, feelings or emotions minimal, flat, blunted or
inappropriate
Ambivalence
 Co-existence of two opposite feelings
 Holding seemingly contradictory beliefs about the same person
Autism
 Exaggerated self centeredness; preoccupied with fantasy

Flight of ideas
 Client jumps from one subject to another accompanied by pressured
speech
 There is logical continuity in the ideas presented and each segment of
speech has logical content and structure.
Perseveration
 Repetition of speech, movement or an idea over which an individual has
no control.

NEGATIVE OR SOFT SYMPTOMS

Alogia
 tendency to speak very little or to convey little substance of meaning

Anhedonia
 feeling no joy or pleasure from life or any activities or relationship
Apathy
 feelings of indifference toward people, activities and events

Blunted affect
 Showing little expression, facial expression slow to respond
 Restricted range of emotional feeling, tone or mood
Catatonia
  Psycholpgically induced immobilioty occasionally marked by periods of
agitation or excitement; the client seems motionless

Flat affect
 Absence of facial expression that would indicate emotions
Lack of volition
 Absence of will, ambition or drive to take action


UNUSUAL SPEECH PATTERNS OF CLIENTS WITH SHIZOPHRENIA

Neologism
 Invented words that have meaning only for the client.
Clang association
 Are ideas that are related to one another based on sound or rhyming
rather than meaning.
Echolalia ( words )
 Client repeats the interviewer’s speech or questions
 Exclusively seen in schizophrenia

Verbigeration
 Is the stereotyped repetition of words or phrases that may or not have
meaning to the listener

Stilted language
 Is use of word or phrases that are flowery, excessive and pompous.

Word Salad
 Is a combination of jumbled words and phrases that are disconnected or
incoherent and make no sense to the listener.

Loose Association
 Disorganized thinking that jumps from idea to another with little or no
evident relation between the thoughts

Circumstantiality
 Clients answers the questions being asked but only after an excessive
amount of unnecessary detail is given.
 Early sign of thorough disorder.
Tangentiality
 Client wanders off the topic and never provides the

Mood
 A client’s pervasive and enduring emotional state
Affect
 An outward expression of client’s emotional state
Euthymism
 Normal mood subsequently defined by patient which appears
appropriate to the current situation.
Depression
 Sadness, helplessness
Euphoria
 Bubbly, enthusiastic, joyfulness
 Accompanied by irritability and low frustration tolerance
Labille mood
 Unpredictable & rapid mood, swing from depressed crying to euphoria.

Elated
 Elevated extreme feelings.
Depersonalization
 client feels loose reality of self
Derealization
 sense of reality to his surrounding or situations
Illusions
 Distortions of real sensory stimuli
Hallucinations
 False sensory perceptions, perceptual experiences that do n

Auditory ( hearing )
 complete auditory hallucinations when more than one voice
Visual ( seeing )
 Demons, animals
Olfactory ( smell )

Gustatory ( taste ) temporal lobe affected

Tactile ( skin )
 FORMICATION common alcoholic/ cocaine withdrawal

Cenesthetic
 Involve the client’s report that he feels bodily functions that are
usually undetectable.
Kinesthetic
 Occur when the client is motionless but reports the sensation of
bodily movement

Persecutory / Paranoid delusions

 Involve the client’s belief that “others” are planning to harm the
clientor are spying etc…

Ideas of reference
 believe being talk in radio; “ feels world revolves in him “

Religious delusions
 often center around the second coming of christ or anther significant
religious figure or prophet.

Nursing Diagnoses:

Anxiety r/t unconscious conflict with reality

Chronic Sorrow r/t chronic mental illness

Deficient Diversional activity r/t social isolation, possible regression

Disturbed Sensory perception r/t biochemical imbalances for sensory distortion

(illusions, hallucinations)

Disturbed Thought processes r/t inaccurate interpretations of environment

Fear r/t altered contact with reality

Imbalanced Nutrition: less than body requirements r/t fear of eating, lack of
awareness of hunger, disinterest toward food

Impaired Home maintenance r/t impaired cognitive or emotional functioning,

insufficient finances, inadequate support systems

Impaired Social interaction r/t impaired communication patterns, self-concept

disturbance, disturbed thought processes
Impaired verbal Communication r/t psychosis, disorientation, inaccurate
perception, hallucinations, delusions

Ineffective Coping r/t inadequate support systems, unrealistic perceptions,

inadequate coping skills, disturbed thought processes, impaired communication

Ineffective Health maintenance r/t cognitive impairment, ineffective

individual and family coping, lack of material resources

Ineffective family Therapeutic regimen management r/t chronicity and

unpredictability of condition

Insomnia r/t sensory alterations contributing to fear and anxiety

Interrupted Family processes r/t inability to express feelings, impaired

communication

Readiness for enhanced Hope: expresses desire to enhance interconnectedness

with others and problem-solve to meet goals

Readiness for enhanced Power: expresses willingness to enhance participation

in choices for daily living and health and enhance knowledge for participation
in change

Risk for Caregiver role strain: Risk factors: bizarre behavior of client,
chronicity of condition

Risk for compromised human Dignity: Risk factor: stigmatizing label

Risk for impaired Religiosity: Risk factors: ineffective coping, lack of security

Risk for Loneliness: Risk factor: inability to interact socially

Risk for Post-trauma syndrome: Risk factor: diminished ego strength

Risk for Powerlessness: Risk factor: intrusive, distorted thinking

Risk for self- and other-directed Violence: Risk factors: lack of trust, panic,
hallucinations, delusional thinking

Risk for Suicide: Risk factor: psychiatric illness

Self-care deficit r/t loss of contact with reality, impairment of perception

Sleep deprivation r/t intrusive thoughts, nightmares

Social isolation r/t lack of trust, regression, delusional thinking, repressed

fears

Spiritual distress r/t loneliness, social alienation