Schizophrenia - Symptoms, Causes, and Treatments

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Schizophrenia
Introduction
Schizophrenia is earlier known as Dementia Precox
The word schizophrenia was discovered by Swiss psychiatrist Eugen bleuler in 1908.
Schizophrenia is a psychological disorder.
Schizophrenia is derived from a Greek word
Schizo - means split

Phrenic - means mind.
Incidence - 1/1000 populations.
Definition
Schizophrenia is a group of mental disorders in which disturbance of thinking, emotion and behaviour.
Schizophrenia is referred to as a mental illness characterized by disturbance of mood, thinking and motor
activity.
Schizophrenia is characterized by the inability to separate reality from and a non-reality.
Incidence
Schizophrenia is equally prevalent in men and women.
Schizophrenia is most commonly present in lower socio-economic groups.
Onset 15 - 25 year for men and 25 - 35 year for women.
Cause and etiology

Biological cause - Increase the dopamine neurotransmitter level.
Chromosome abnormality.
47% risk of monozygotic child.
8% risk of any relative has mental disorder.
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12% risk in a dizygotic child.
70% schizophrenia problem by genetic factors.
Psychological cause - maternal deprivation.
Lack of love and affection with mother.
Death of mother in childhood.
Over protection of children.
Over strictness with children.
Social isolation and broken family.
Disorganisation of family.
Overcrowding.
Unhealthy relationship between parents and child.
Precipitatory Cause - Sudden or acute onset when a person tries to control self-emotion after death of
close relative but unable to succeed and Express abnormal behaviour.
Socio cultural cause - domestic violence
Technological change
Financial crisis
Family dispute.
Perinatal risk factors - maternal influenza
Severe childhood abuse
Birthday wearing winter session
Immunological factors.

Other cause - poverty
Head injury
Accident.
Types of Schizophrenia
Typical Schizophrenia - intensity of symptoms is high.
Recovery slow.
Atypical schizophrenia - intensity of symptom is low.
Recovery fast.
Typical
Simple schizophrenia
Hebephrenic schizophrenia
Paranoid schizophrenia
Undifferentiated Schizophrenia
Catatonic schizophrenia.
2. Atypical
Residual schizophrenia
Juvenile or childhood schizophrenia
Late schizophrenia

Latent schizophrenia.
1.A. Simple schizophrenia
Onset 15 - 20 year of age.
Negative symptoms are present.
Positive symptoms are absent.
ECT is not effective in simple schizophrenia.
Prognosis is very poor.
More incidence in male.
B. Hebephrenic schizophrenia
Also known as disorganised schizophrenia.
Onset 20 - 25 year old.
It is grossly disorganised behaviour, inappropriate expression flat or or inappropriate emotional reaction.
Patient behaves as child - eg.
Finger biting
Masturbation of sex organs
Exhibition of sex organs
Bizarre behaviour
Irresponsible behaviour
Lack of hygiene
Urine and stool passing in clothes.
Stuttering or odd speech.
Positive symptoms of Schizophrenia the most commonly present.
ECT is not effective.

C. Catatonic schizophrenia
Catatonic schizophrenia is an acute onset disorder in which disturbance of psychomotor behaviours.
On set 15 - 25 years.
The word catatonic means = cata - disturbed
Tonic - muscles tone.
ECT is most effective in catatonic schizophrenia.
Recovery is possible rapidly.
Catatonic schizophrenia types
Catatonic excitement - In these types, patients show the manic patient like symptoms.
Example - increased psychomotor activity
Patient injured to self or others.
Flight of ideas.
Delusion of grandiosity.
Catatonic stupor - In these types, patients or depression like symptoms.
Example - suicidal tendency
Auditory hallucination.
Loss of muscle tone.
D. Paranoid schizophrenia
Paranoid schizophrenia is also known as chronic schizophrenia.
Paranoid schizophrenia is a mostly common type of Schizophrenia.
Delusional thinking abnormalities are mostly commonly present in these types of schizophrenia.

Onset 30 year of age group.
Patients are always suspected by others.
ECT is less effective.
E. Undifferentiated schizophrenia
Undifferentiated schizophrenia is differ from other schizophrenia.
2.A. Residual schizophrenia
Residual schizophrenia involves only one episode of Schizophrenia.
Residual schizophrenia is when there are low level positive symptoms but psychotic symptoms are present.
B. Juvenile or childhood schizophrenia
Schizophrenia occurs before 14 year of age
C.Late Schizophrenia
Onset after 40 year of age.
D. Latent schizophrenia
Intensity of symptoms is very low.
Sign and symptoms of Schizophrenia

Primary and secondary symptoms.
Positive and negative symptoms.
First rank symptoms of schizophrenia.
Primary symptoms of schizophrenia
Primary symptoms of schizophrenia are also known as - basic symptoms of schizophrenia.

Fundamental symptoms of schizophrenia.
"4 A" symptoms of schizophrenia.
"4 A" symptoms are introduced by "Eugen bleuler”.
Ambivalence - It is an emotional related disorder and abnormality.
Conflict feeling towards others.
At the same time in the same person two opposite emotions occur.
Eg. A girl told his father "I like you or I hate you."
Affective disturbance
Affective disturbance is also an emotional related disorder.
Patient in ability to show appropriate emotion according to situation.
Eg. - Patients start laughing, after the death of a loved one.
Association disturbance
Association disturbance is thinking and thought related disorder.
Patients suddenly shift from one topic to another topic that are not associated with each other.
Autistic thinking
Autistic thinking abnormality commonly present in toddler (1 - 3 year).
Autism is a social and communicable problem.
2. Secondary symptom of schizophrenia
Disturbance of perception - Perceptual disorder involves abnormality in sense organ experience.
Disturbance of perception is - hallucination.
Illusion.

Hallucination is a fast perception and misinterpretation in the absence of external stimuli.
Illusion is a false perception and misinterpretation in the presence of external stimuli.
Disturbance of thinking
(1). Thought preservation - patients give some answers about different questions asked by doctors.
Eg. - What is your name = Mohan

What is your father's name = Mohan
Where are you live = Mohan
(2). Word salad - patient speak the irrelevant words.
(3). Neologism - patient formation of meaningless words, patients only understand them.
(4). Thought blocking - Patients give answers to questions asked by healthcare providers but patients
suddenly stop and are unable to give the reason.
(5). Tangentially - Patients provide unnecessary information about the topic but are unable to reach on a
topic at least.
(6). Circumstantiality - patient unnecessary travel around the topic but reach on topic at last.
Disturbance of motor activity
(1). Automatism - involuntary repetition of activity.

Echolalia - imitation of words spoken by others.
Echopraxia - imitation of activity and posture of others.
(2). Waxy flexibility - maintaining position for a long time period.
(3). Ataxia - loss of balance.
(4). Dystonia - Unco-ordinate spastic movements of the body.
(5). Negativism - the opposite action and activity of others.
(6). Stereotype movement - needless, purposeless, repetitive same activity by the client.
(7). Tics - abnormal movements used by small amounts of muscles.

Eg. - Eye blinking.
Disturbance of emotions

Patients express the opposite emotion according to the demand of the situation.
Eg. - Patient laughing after the death of a loved one.
Disturbance of attention
Patient unable to focus on a particular object.
3. Positive symptoms of schizophrenia
Hallucination
Delusion
Delusion of grandiosity
Magical thinking
Agitated behaviour.
4. Negative symptoms of schizophrenia
Anhedonia - a patient unable to express feelings of pleasure.
Aviolation - lack of motivation.
Apathy - lack of emotion.
Flat affect - patients look blank or empty by the expression.
Blunt affect - emotions are changed very slowly.
Labile affect - emotional change is faster than normal change.
5. First rank symptoms of schizophrenia
Through broadcasting - patient belief how other people know about his thoughts without sharing with
others.
Delusion of perception - normal perception is converted into delusion thought or patient belief
someone brings a secret message of God or other for him.

Hallucination of voice - patient belief he is discussed by others and discussion heard by him.
Thought insertion
Thought withdrawal.
Management of schizophrenia
Nurses maintain a trusting relationship with patients.
Avoid the arguments with the patients.
Nurses provide protection from injury.
Nurses encourage patients to face reality.
Do not share false information.
Pharmacotherapy - antipsychotics - chlorpromazine
Haloperidol
Trifluoperazine.
Commonly use atypical antipsychotics are
Clozapine, Risperidone
Olanzapine, Quetiapine.
ECT therapy - ECT is effective for - catatonic stupor
Catatonic excitement
Drugs side effects.
Psychological therapies - group therapy

Cognitive behaviour therapy
Social skill training
Family therapy
Adjuvant therapy.
Note
Schizophrenia patients use rationalization, projection and denial defence mechanism.
Key Points
Schizophrenia was discovered by the - Eugen bleuler in 1908
Group of mental disorders in which disturbance of thinking, emotion and behaviour is called - Schizophrenia
disorder
Schizophrenia most commonly affects the - Low socio economic group
Simple schizophrenia affects the age group peoples - 15 - 20 year
Disorganised schizophrenia is known as - Hebephrenic schizophrenia
Patients behave as children in which schizophrenia - Hebephrenic schizophrenia
ECTis most effective in which type Schizophrenia - Catatonic schizophrenia
Which type of Schizophrenia involved disturbance of psychomotor behaviour - Catatonic schizophrenia

Catatonic excitement Schizophrenia patient show - Manic patient like symptoms
Catatonic stupor Schizophrenia patient show - Depression patient like symptoms
Most common type of Schizophrenia is - Paranoid schizophrenia
Another name of paranoid schizophrenia is - Chronic schizophrenia
Fundamental symptoms of schizophrenia are - "4A" symptoms
At same time, in the same person two opposite emotions occur is known - Ambivalence
In which disorder patients show appropriate emotion according to situation demand - Affective disturbance
In which disorder patients give some answer about all questions - Thought preservation
Patient imitation of words spoken by others is known - Echolalia
Patient imitation of the activity and posture of another person is known - Echopraxia
Patient loss of balance and movement in which disorder - Ataxia
Patients provide unnecessary travel around the topic but reach on topic at least - Tangentially
Most common positive symptoms of schizophrenia is - Hallucination and delusion

What is the meaning of anhedonia - Patient unable to express feeling or pleasure (lack of pleasure)
What type of therapy is used in the management of autism - Play therapy
Early indicator sign of schizophrenia is - Auditory hallucination
Most common form of delusion is - Delusion of persecution
Which type of delusion disorder in which a patient believes his life partner is not faithful to him / her is -
Delusion of jealousy
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www.missionnursing.in www.missionnursing.in www.missionnursing.

Schizophrenia is a psychological disorder.

Schizophrenia is derived from a Greek word

Schizo - means split

Incidence - 1/1000 populations.

Schizophrenia is characterized by the inability to separate reality from and a non-reality.

Schizophrenia is most commonly present in lower socio-economic groups.

Onset 15 - 25 year for men and 25 - 35 year for women.

Cause and etiology

47% risk of monozygotic child.

8% risk of any relative has mental disorder.

www.missionnursing.in www.missionnursing.in www.missionnursing.in

12% risk in a dizygotic child.

70% schizophrenia problem by genetic factors.

Psychological cause - maternal deprivation.

Lack of love and affection with mother.

Death of mother in childhood.

Over protection of children.

Over strictness with children.

Social isolation and broken family.

Unhealthy relationship between parents and child.

Socio cultural cause - domestic violence

Perinatal risk factors - maternal influenza

Severe childhood abuse

Birthday wearing winter session

www.missionnursing.in www.missionnursing.in www.missionnursing.in

Other cause - poverty

Typical Schizophrenia - intensity of symptoms is high.

Atypical schizophrenia - intensity of symptom is low.

Juvenile or childhood schizophrenia

www.missionnursing.in www.missionnursing.in www.missionnursing.in

1.A. Simple schizophrenia

Onset 15 - 20 year of age.

Negative symptoms are present.

Positive symptoms are absent.

ECT is not effective in simple schizophrenia.

Prognosis is very poor.

More incidence in male.

Also known as disorganised schizophrenia.

Onset 20 - 25 year old.

It is grossly disorganised behaviour, inappropriate expression flat or or inappropriate emotional reaction.

Patient behaves as child - eg.

Masturbation of sex organs

Exhibition of sex organs

Urine and stool passing in clothes.

Stuttering or odd speech.

Positive symptoms of Schizophrenia the most commonly present.

ECT is not effective.

www.missionnursing.in www.missionnursing.in www.missionnursing.in

Catatonic schizophrenia is an acute onset disorder in which disturbance of psychomotor behaviours.

The word catatonic means = cata - disturbed

Tonic - muscles tone.

ECT is most effective in catatonic schizophrenia.

Recovery is possible rapidly.

Catatonic schizophrenia types

Example - increased psychomotor activity

Patient injured to self or others.

Catatonic stupor - In these types, patients or depression like symptoms.

Example - suicidal tendency

Loss of muscle tone.

Paranoid schizophrenia is also known as chronic schizophrenia.

Paranoid schizophrenia is a mostly common type of Schizophrenia.