֍ Schizophrenia ֎

-------- « Karim Raafat » --------

Introduction & Definition of Schizophrenia :

- The term “Schizophrenia” was derived from Greek “Schizo” (split) and “phrenia” (mind).
- Schizophrenia is a serious mental disorder in which people interpret reality abnormally.
- Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered
thinking and behavior that impairs daily functioning, and can be disabling.
- People with schizophrenia require lifelong treatment.
- Early treatment may help get symptoms under control before serious complications develop and may
help improve the long-term outlook.

Schizophrenia :
- it is a psychotic condition characterized by a disturbance of thinking, emotions, perceptions, mood
and behavior in the presence of clear consciousness which usually leads to social dysfunction.
- it is a serious mental disorder that distorts the way a person thinks, acts, expresses emotions,
perceives reality and relates to others.

Incidence of Schizophrenia :

- The annual worldwide incidence is between 10 and 20 per 100,000 of the population.
- In men, schizophrenia usually begins between the ages of 15 and 35.
- In women, the mean age of onset of the disorder is later.
- The prevalence of schizophrenia is higher in socioeconomically deprived areas (homeless people).

Cause of Schizophrenia :

Exact cause of schizophrenia is still uncertain. The disease probably results from combination of influences
including biological, psychological and environmental factors.

1) Genetic factors : It is believed that the genetic factor may pass on from one generation to the next
generation. It is found that children with one or both parents with schizophrenia have higher
incidence of schizophrenia than the general population.

2) Biochemical factors : patients may have an imbalance of dopamine in the brain. They may be either
very sensitive to or produce too much of dopamine. An imbalance in dopamine affect way the brain
reacts to certain stimuli, such as sounds, smell, and sight and can lead to hallucination and delusion.

3) Environmental factors : The environmental factors such as, viral infection during pregnancy, poor
social interaction or highly stressful life situations may trigger schizophrenia in people who have
inherited a tendency to develop the disorder.

4) Psychological factors : Poor parent-child relationships, cold and overprotective mothers, arrested
ego development of the child and dysfunctional family system are the cause of schizophrenia.

5) Sociocultural factors : More individuals from the lower socio-economic classes experience symptoms
associated with schizophrenia than those from the higher socio-economic groups. This may occur as
a result of the conditions associated with living in poverty, such as inadequate nutrition, absence of
prenatal care, and feeling of hopelessness and stressful life events
Symptoms of Schizophrenia :

A) Positive Symptoms :

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

2. Hallucinations ‫ هﻼوس‬: False sensory perceptions or perceptual experience.
3. Disorganized thinking and behavior ‫التفك والسلوك غ المنظم‬.

B) Negative Symptoms :

1. Alogia ‫ ع النطق‬: Tendency to speak very little or to convey little substance of meaning.
2. Anhedonia ‫ انعدام التلذذ‬: Feeling no joy or pleasure from life or any activities or relationships.
3. Apathy ‫ الﻼم اﻻة‬: Feeling of indifferent toward people, activities, and events.
4. Affective Flattening ‫ سطح المزاج‬: Absence of facial expression that indicate emotions or mood.
5. Avolition ‫ انعدام اﻹرادة‬: Absence of will or drive to take action or accomplish tasks.

Diagnostic Criteria of Schizophrenia :

The widely used diagnostic criteria are those in the Diagnostic and Statistical Manual of Mental Disorders
(DSM-4). These systems include the following :

1. At least 2 of the following signs and symptoms must be present for at least 1 month …
- Hallucination – Delusion – Disorganized thought- Disorganized behavior- Negative symptoms
2. Signs & symptoms should be present at least 6 months for the disorder to be confirmed.

Phases of Schizophrenia :

Phase 1 |The Schizoid Personality Phase :

- The individual is indifferent to social relationships
- The individual has a very limited range of emotional experience and expression.

Phase 2 | The Prodromal Phase :

 Characteristic of this phase include …
- Social withdrawal.
- Impairment in role functioning.
- Neglect of personal hygiene & grooming.
- Blunted or inappropriate affect.
- Disturbance in communication.
- Bizarre ideas.
- Unusual perceptual experiences.
- Lack of initiative, interests and/or energy.

 The length of this phase is highly variable and may last for many years before deteriorating to the
schizophrenic state.

Phase 3 | Schizophrenia Phase :

 In the active phase of the disorder psychotic symptoms are prominence.
 The symptoms of schizophrenia are divided into two major categories
- Positive or hard symptoms/signs. - Negative or soft symptoms/signs.

Phase 4 | Residual Phase :

 Schizophrenia is characterized by periods of remission and exacerbation.
 A residual phase usually follows an active phase of the illness.
 Symptoms during the residual phase are similar to those of the prodromal phase.
Types of Schizophrenia :

A - Paranoid Schizophrenia :

 Paranoid schizophrenia is the most common type.

 These patients are extremely suspicious.
 They are preoccupied with irrational false belief about being persecuted or being punished by someone.
 They may have delusion of persecution, delusion of grandeur and delusion of reference.
 They have hallucination of threatening voices, voices directing him to do something and warning voices.

B - Disorganized Schizophrenia :

 It begins usually in early adolescence before the age 25.

 The patient …
- May show childish behavior. - May have somatic delusion
- May show inappropriate effect. - May have somatic hallucination.
- May show regression. - May eat with fingers.
- May show silence. - May masturbate openly
- May show incoherent communication. - May urinate and defecate in the bed.
 They have disorganized behavior that may disrupt their ability to perform normal daily activities.

C - Catatonic Schizophrenia :

 The symptoms of this type of schizophrenia are mostly physical.

 Patients are …
- Immobile. - Unresponsive to the world around them.
- Mute. - Very rigid.
- Preoccupied. - Stiff.
- Inattentive. - Unwilling to move.
 Occasionally, these patients may …
- Make movements like grimacing
- Assume bizarre postures.
- Repeat a word or phrase just spoken by another person.
- Refuse to move, eat or dress.
 People with catatonic schizophrenia are at increased risk of malnutrition, exhaustion or self- injury.

D - Residual Schizophrenia :

 In this type, the severity of schizophrenia symptoms has decreased.

 Hallucination, delusion or other symptoms may still be present but are less severe than when
schizophrenia was originally diagnosed.
 The patients may have neglect of personal hygiene, inappropriate effect, lack of interest, bizarre ideas
and social withdrawal.

E - Undifferentiated Schizophrenia :

 The diagnosis may have some signs of paranoid, hebephrenic or catatonic schizophrenia, but it doesn’t
obviously fit into one of these types alone.
Management of Schizophrenia :

 While there is no 100% cure for schizophrenia, it is a highly treatable and manageable illness.

 Indications of hospitalization :
- Neglect of food and water intake
- Danger to self or others
- Poor drug compliance
- Severe delusions or hallucinations or severe problems with drugs.

 Psychopharmacology :
- The main treatment is pharmacological, in the form of the antipsychotic medications.
- Positive symptoms respond better than negative symptoms to drug treatment.
- Majority of patients require maintenance treatment with antipsychotic to prevent relapses.

 Psychotherapy :
- Various psychotherapies can help in solving behavioral, psychological, social, and occupational
problems associated with the illness, the psychotherapies include:
o Cognitive Behavior Therapy :
 It is a type of psychotherapy that focuses on the patient’s thinking and behavior.
 The therapist helps the patient to test the reality of their thoughts and perception.
 It can reduce the symptoms severity and reduce the risk of schizophrenia relapse.
o Individual Psychotherapy : It can help the patient to better understand his illness and learn
coping skills and problem solving skills.
o Family Therapy : This can help family members to deal more effectively with the
schizophrenic patient and help them to know about the disease.
o Self-help Groups : These groups are formed of patients or recovering patients. They can
provide continuing mutual support.

 Nursing Intervention for Disturbed Thought Process :

1. Convey acceptance of client’s needs for false belief, but indicate you don’t share that belief.
2. Don’t argue or deny the belief.
3. Use reasonable doubt as a therapeutic technique: I find that hard to believe.
4. Reinforce and focus on reality, discourage long ruminations about the irrational thinking talk about
real events and real people.
5. If the client is highly suspicious following actions:
o Use same staff as much as possible.
o Be honest and keep all promises.
o Avoid physical contact,
o Avoid laughing, whispering, or talking quietly where client can see but cannot hear what is said.

 Nursing Intervention for Disturbed Sensory Perception:

1. Maintain low level of stimuli in client’s environment i.e. low lighting, few people, simple décor and
low noise level.
2. Keep client in constant observation.
3. Remove all potential dangerous objects from client’s surroundings.
4. Redirect aggressive and violent behavior with physical outlets for the anxiety.
5. Maintain calm attitude towards the client.
6. Administer tranquilizer (sedative) as ordered by psychiatrist.
7. Maintain sufficient number of staff to show strength to client if it is required.