SCHIZOPHRENIA

Prepared by:
PHYLLICE A. BREBONERIA, MAN
JERIE ANN B.NAMINGIT
 01
DEFINITION
● The term Schizophrenia was
coined by the Swiss Psychiatrist
Eugen Bleuler.
● Derived from the Greek words
“skhizo”- split and “phren” mind
  Schizophrenia is a severe mental disorder
which is characterized by a wide range of
Schizophrenia unusual behaviors: hearing voices
(hallucinations) and distorted or false
perception, often bizarre beliefs.
 unable to distinguish between reality and
imaginative events. These unusual
experiences seem real to the person whereas
others assume that the person is lost in their
own world.
 ● not a homogeneous disease entity
with a single cause but results from a
Schizophrenia variable combination of genetic
predisposition, biochemical
dysfunction, physiological factors,
and psychosocial stress.
● there is not now and probably never
will be a single treatment that cures
the disorder
 PSYCHOSIS
A severe mental condition in which there is
disorganization of the personality, deterioration in
social functioning, and loss of contact with, or
distortion of, reality. There may be evidence of
hallucinations and delusional thinking.
 02
Pattern of
Development
 Phase I: The Premorbid Phase

Noted personality and

behavior include being patients had schizoid or
Indicates social mal-
very shy and withdrawn, schizotypal personalities
adjustment, social
having poor peer characterized as quiet,
withdrawal, irritability, and
relationships, doing passive, and introverted;
antagonistic thoughts and
poorly in school, and as children, they had few
behavior
demonstrating antisocial friends.
(Minzenberg,Yoon&
behavior. Acc.Sadock and Sadock
Carter,2008)
(2007)
 Phase II: The Prodromal Phase
the person experiences
substantial functional
This phase can be as brief impairment and
The prodrome of an illness nonspecific symptoms
as a few weeks or months,
refers to certain signs and such as a sleep
but most studies indicate
symptoms that precede disturbance, anxiety,
that the average length of
the characteristic irritability, depressed
the prodromal phase is
manifestations of the mood, poor
between 2 and 5 years
acute, fully developed concentration, fatigue,
illness. and behavioral deficits
such as deterioration in
role functioning and
social withdrawal.
 Phase III: Schizophrenia

In the active phase of Following are the Diagnostic and Statistical

the disorder, Manual of Mental Disorders, Fifth Edition (DSM-5)
psychotic symptoms (American Psychiatric Association [APA], 2013)
are prominent. diagnostic criteria.
DSM V
Criteria
DSM V Criteria for Schizophrenia
A. Two (or more) of the following, each present for a significant
portion of time during a 1-month period (or less if successfully
treated). At least one of these must be (1), (2), or (3):
1. Delusions(persecutory,grandiose,somatic)
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment
or incoherence)
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (i.e., diminished emotional
expression or avolition)
DSM V Criteria for Schizophrenia
B. For a significant portion of the time since the
onset of the disturbance, level of functioning in one or more
major areas, such as work, interpersonal relations, or self-care, is
markedly below the level achieved prior to the onset (or when the
onset is in childhood or adolescence, there is failure to achieve
expected level of interpersonal, academic, or occupational
functioning).
DSM V Criteria for Schizophrenia
C. Continuous signs of the disturbance persist for at
least 6 months. This 6-month period must include at
least 1 month of symptoms (or less if successfully
treated) that meet Criterion A (i.e., active-phase
symptoms) and may include periods of prodromal or
residual symptoms.
● D. Schizoaffective disorder and depressive or bipolar
disorder with psychotic features have been ruled out
because either (1) no major depressive or manic
episodes have occurred concurrently with the active-
phase symptoms; or (2) if mood episodes have occurred
during active-phase symptoms, they have been present
for a minority of the total duration of the active and
residual periods of the illness
DSM V Criteria for Schizophrenia
E. The disturbance is not attributable to the
physiological effects of a substance (e.g., a
drug of abuse, a medication) or another
medical condition.
F. If there is a history of autism spectrum
disorder or a communication disorder of
childhood onset, the additional diagnosis of
schizophrenia is made only if prominent
delusions or hallucinations, in addition to the
other required symptoms of schizophrenia, are
also present for at least 1 month (or less if
successfully treated).
Phase IV: Residual Phase

A residual phase usually follows an active phase of

Schizophrenia is the illness (symptoms described in Phase III).
characterized by During the residual phase, symptoms of the acute
periods of stage are either absent or no longer prominent.
remission and Negative symptoms may remain, and flat affect
exacerbation. and impairment in role functioning are common.
Residual impairment often increases between
episodes of active psychosis.
Cause and
Predisposing
Factors
The cause of schizophrenia is still
uncertain. Most likely no single
factor can be implicated in the
etiology; rather, the disease probably
results from a combination of
influences including biological,
psychological, and environmental
factors.
BIOLOGICAL FACTORS

GENETICS

TWIN STUDIES

ADOPTION STUDIES
 BIOCHEMICAL FACTORS DOPAMINE
HYPOTHESIS
Dopamine
Neurotransmitter: Dopamine is a type of monoamine neurotransmitter produced in
your brain.
Chemical Messenger: It communicates messages between nerve cells in your brain and
throughout your body.
Hormone: Dopamine is also released into your bloodstream
Catecholamines: It belongs to the catecholamine family, along with epinephrine and
norepinephrine

Functions of Dopamine:
o Movement: Dopamine is involved in motor control and coordination.
o Memory: It plays a role in memory processes.
o Reward and Motivation: Dopamine acts as the brain’s “reward center,”
driving pleasurable experiences and motivating behavior.
o Behavior and Cognition: It influences behavior, decision-making, and
cognitive functions.
o Attention: Dopamine helps regulate attention and focus.
o Sleep and Arousal: It affects sleep-wake cycles and arousal levels.
Mood: Dopamine contributes to mood regulation
o Learning: It facilitates learning processes.
o Lactation: Dopamine is involved in milk production during lactation.
The hypothesis suggests that excessive dopamine activity in certain
brain regions contributes to the positive symptoms of schizophrenia
(such as hallucinations and delusions).
Conversely, reduced dopamine function in other brain areas may
be linked to negative symptoms (such as social withdrawal and
cognitive deficits).
Having the right balance of dopamine contributes to
overall well-being and positive feelings. Dopamine is a
multifaceted molecule that influences both mind and
body. It’s essential for our survival, pleasure, and
motivation
PHYSIOLOGICAL FACTORS

VIRAL INFECTIONS

ANATOMICAL
ABNORMALITIES
PHYSICAL CONDITIONS
 PSYCHOLOGICAL FACTORS

These early theories implicated Early conceptualizations of

poor parent-child relationships schizophrenia focused on family
and dysfunctional family systems. relationship factors as major
influences in the development of
the illness
ENVIRONMENTAL FACTORS

STRESSFUL LIFE SOCIOCULTURAL

EVENTS FACTORS
 Types of
Schizophrenia and
Other Psychotic
Disorders
 Delusional Disorder
● Delusional disorder is characterized by the presence of
delusions that have been experienced by the individual
for at least 1 month (APA, 2013)
● The DSM-5 states that a specifier may be added to
denote if the delusions are considered bizarre (i.e., if
the thought is “clearly implausible, not
understandable, and not derived from ordinary life
experiences”
 Delusional Disorder: Subtypes

● Erotomanic Type- the individual believes that someone,

usually of a higher status, is in love with him or her.
Famous persons are often the subjects of erotomanic
delusions.
● Sometimes the delusion is kept secret, but some
individuals may follow, contact, or otherwise try to
pursue the object of their delusion.
 Example: Madam Sally is convinced that a famous actor, Piolo, is deeply in love
with her. Despite all evidence to the contrary—Piolo’s lack of communication, their
never having met, and the vast social gap between them—Madam Sally remains
steadfast in her belief. She interprets every public appearance Piolo makes, every
interview he gives, and even his movie roles as secret messages meant only for her.
In her mind, Piolo’s silence is merely a protective measure to keep their love hidden
from the world.
● Madam Sally behavior becomes increasingly obsessive. She follows Piolo’s social
media profiles, writes him heartfelt letters, and even tries to attend events where he
might appear. She is convinced that their love is real, despite Piolo’s complete
unawareness of her existence.
 Delusional Disorder: Subtypes
● Grandiose Type - Individuals with grandiose delusions have
irrational ideas regarding their own worth, talent,
knowledge, or power. They may believe that they have a
special relationship with a famous person, or even assume
the identity of a famous person (believing that the actual
person is an imposter).
 Examples:
● Special Powers: Evelyn is convinced that she has unique powers—perhaps telepathy,
telekinesis, or the ability to heal others. She believes she can influence events and
people through her supernatural abilities.
● Fame: Evelyn imagines herself as a renowned figure. She thinks she’s a famous artist,
a celebrated author, or a legendary musician. Despite lacking any evidence of her
fame, she insists that the world recognizes her talents.
● Wealth: In her mind, Evelyn is incredibly wealthy. She envisions luxurious mansions,
private jets, and extravagant lifestyles. She may even claim ownership of fictional
companies or vast estates.
● Divine Connection: Evelyn believes she has a direct link to a higher power. She
might think she’s a deity, an angel, or a chosen messenger. Her messages and
actions are guided by this perceived divine connection.
● Historical Relevance: Evelyn sees herself as historically significant. She might claim
to be a reincarnated historical figure, a lost royal heir, or the secret architect behind
major world events.
 Delusional Disorder: Subtypes

● Jealous Type - The content of jealous delusions centers on

the idea that the person’s sexual partner is unfaithful. The
idea is irrational and without cause, but the individual with
the delusion searches for evidence to justify the belief.
Example:
Carlos is deeply convinced that his partner, Maria, is unfaithful to him. Despite Maria’s
reassurances, Carlos believes that she is secretly involved with someone else. Here are some
aspects of his jealous delusion:
● Obsessive Monitoring: Carlos constantly checks Maria’s phone, text messages, emails, and
social media accounts. He interprets innocent interactions as evidence of her infidelity.
● Imagined Betrayal: Carlos imagines scenarios where Maria meets someone behind his
back. He becomes fixated on any interaction she has with colleagues, friends, or
acquaintances, convinced that she is hiding an affair.
● False Evidence: Even when Maria explains her actions or provides logical reasons for her
behavior, Carlos dismisses it as a cover-up. He believes that Maria is intentionally deceiving
him.
 Delusional Disorder: Subtypes

● Somatic Type - Individuals with somatic delusions believe

they have some type of general medical condition.
Example
● Parasitic Infestations: An individual believes that their body is infested with
parasites—tiny creatures that crawl under their skin, causing discomfort and
distress. Despite no evidence of actual infestations, they remain convinced.
● Body Dysmorphia: Someone perceives their physical appearance as severely
flawed or irregular. For instance, they might believe their nose is grotesquely
large or their skin is disfigured, even when others see no such abnormalities.
 ● Unwavering Mouth Odor: A person firmly believes they have chronic bad breath
(halitosis), even if no one else notices or confirms it. They may obsessively use
mouthwash, chew gum, or avoid social interactions due to this perceived issue.
● Bizarre vs. Non-Bizarre Delusions:
o Bizarre Somatic Delusion: This involves an imagined situation that could
never occur in real life. For instance, someone claims their organs were
secretly harvested despite having no surgical scars.
o Non-Bizarre Somatic Delusion: In this case, the scenario is unlikely but
possible under normal circumstances. For example, a person hears voices
where there are none, believing they originate from their body

● Remember, somatic delusions can significantly impact an individual’s well-being and are
often associated with conditions like schizophrenia, major depression, and bipolar disorder.
 ● Mixed Type - When the disorder is mixed, delusions are prominent,
but no single theme is predominant.
Example:
• Alex believes that they are a secret agent working undercover to
prevent an alien invasion (a grandiose delusion).
• Simultaneously, Alex also believes that their neighbor is plotting to
poison them (a persecutory delusion).
• These delusions coexist without one theme dominating over the other.
 Brief Psychotic Disorder

● This disorder is identified by the sudden onset of psychotic symptoms

that may or may not be preceded by a severe psychosocial stressor.
These symptoms last at least 1 day but less than 1 month, and there is
an eventual full return to the premorbid level of functioning (APA,
2013).
● The individual experiences emotional turmoil or overwhelming
perplexity or confusion. Evidence of impaired reality testing may
include incoherent speech, delusions, hallucinations, bizarre behavior,
and disorientation.
 Substance/Medication-Induced
Psychotic Disorder
● The prominent hallucinations and delusions
associated with this disorder are found to be directly
attributable to substance intoxication or withdrawal
or to exposure to a medication or toxin. This
diagnosis is made when the symptoms are more
excessive and more severe than those usually
associated with the intoxication or withdrawal
syndrome (APA, 2013)
Substance/Medication-Induced
Psychotic Disorder
 Psychotic Disorder Due to Another
Medical Condition
● The essential features of this disorder are
prominent hallucinations and delusions that can
be directly attributed to another medical condition
(APA, 2013). The diagnosis is not made if the
symptoms occur during the course of a delirium.
 Schizophreniform Disorder
● The essential features of schizophreniform disorder are
identical to those of schizophrenia, with the exception
that the duration, including prodromal, active, and
residual phases, is at least 1 month but less than 6
months (APA, 2013).
● If the diagnosis is made while the individual is still
symptomatic but has been so for less than 6 months, it
is qualified as “provisional.” The diagnosis is changed
to schizophrenia if the clinical picture persists beyond
6 months.
 Schizoaffective Disorder
● This disorder is manifested by schizophrenic behaviors, with
a strong element of symptomatology associated with the
mood disorders (depression or mania). The client may
appear depressed, with psychomotor retardation and suicidal
ideation, or symptoms may include euphoria, grandiosity,
and hyperactivity.
● The decisive factor in the diagnosis of schizoaffective
disorder is the presence of hallucinations and/or delusions
that occur for at least 2 weeks in the absence of a major
mood episode (APA, 2013)
 Positive and
Negative
Symptoms of
Schizophrenia
Content of
Thought
 Delusions:
● Delusions are false personal beliefs that are inconsistent with the
person’s intelligence or cultural background.
● The individual continues to have the belief in spite of obvious
proof that it is false or irrational.
● Delusion of Persecution. The individual feels threatened and
believes that others intend harm or persecution toward him or her
in some way (e.g., “The FBI has ‘bugged’ my room and intends to
kill me.” “I can’t take a shower in this bathroom; the nurses have
put a camera in there so that they can watch everything I do”).
 Delusions:
● Delusion of Grandeur. The individual has an exaggerated feeling
of importance, power, knowledge, or identity (e.g., “I am Jesus
Christ”).
● Delusion of Reference. All events within the environment are
referred by the psychotic person to him or herself (e.g., “Someone
is trying to get a message to me through the articles in this
magazine [or newspaper or TV program]; I must break the code
so that I can receive the message”).
 Delusions:
● Delusion of Control or Influence. The individual believes
certain objects or persons have control over his or her behavior
(e.g., “The dentist put a filling in my tooth; I now receive
transmissions through the filling that control what I think and
do”).
● Somatic Delusion. The individual has a false idea about the
functioning of his or her body (e.g., “I’m 70 years old and I will
be the oldest person ever to give birth. The doctor says I’m not
pregnant, but I know I am.”).
● Nihilistic Delusion. The individual has a false idea that the self,
a part of the self, others, or the world is nonexistent (e.g., “The
world no longer exists.” “I have no heart.”).
● Religiosity is an excessive demonstration of or obsession with
religious ideas and behavior. The individual with schizophrenia may
use religious ideas in an attempt to provide rational meaning and
structure to his or her behavior.
An example of religiosity is the individual who believes the voice he or
she hears is God and incessantly searches the Bible for interpretation.
● Paranoia Individuals with paranoia have extreme suspiciousness of
others and of their actions or perceived intentions (e.g., “I won’t eat
this food. I know it has been poisoned.”).
● Magical Thinking With magical thinking, the person believes that
his or her thoughts or behaviors have control over specific situations
or people (e.g., the mother who believed if she scolded her son in
any way he would be taken away from her). Magical thinking is
common in children (e.g., “It’s raining; the sky is sad.” “It snowed
last night because I wished very, very hard that it would.”).
Form of Thought
● Associative Looseness Thinking is characterized by speech in
which ideas shift from one unrelated subject to another. With
associative looseness, the individual is unaware that the topics
are unconnected. When the condition is severe, speech may be
incoherent

● (e.g., “We wanted to take the bus, but the airport

took all the traffic. Driving is the ticket when you
want to get somewhere. No one needs a ticket to
heaven. We have it all in our pockets.”).
● Neologisms The psychotic person invents
new words, or neologisms, that are
meaningless to others but have symbolic
meaning to the psychotic person (e.g.,
“She wanted to give me a ride in her new
uniphorum.”).
● Concrete Thinking Concreteness, or literal
interpretations of the environment, represents a
regression to an earlier level of cognitive
development. Abstract thinking is very difficult.

● For example: the client with schizophrenia would

have great difficulty describing the abstract
meaning of sayings such as “I’m climbing the
walls” or “It’s raining cats and dogs.”
● Clang Associations Choice of words is
governed by sounds. Clang associations
often take the form of rhyming.

● For instance, “It is very cold. I am cold and

bold. The gold has been sold.”
● Word Salad a group of words that are put
together randomly, without any logical
connection
● (e.g., “Most forward action grows life double

plays circle uniform).

Circumstantiality
the individual delays in reaching the point of a
communication because of unnecessary and tedious
details. The point or goal is usually met but only
with numerous interruptions by the interviewer to
keep the person on track of the topic being discussed .
● Tangentiality differs from circumstantiality in
that the person never really gets to the point of
the communication. Unrelated topics are
introduced, and the focus of the original
discussion is lost.
● Mutism is an individual’s inability or refusal to
speak.
● Perseveration The individual who exhibits
perseveration persistently repeats the same
word or idea in response to different questions
Perceptions
● Hallucinations false sensory perceptions not
associated with real external stimuli, may involve any
of the five senses.
Types of hallucinations include the following:
1.Auditory hallucinations are false perceptions of sound. Most commonly
they are of voices, but the individual may report clicks, rushing noises,
music, and other noises. Command hallucinations may place the individual
or others in a potentially dangerous situation. “Voices” that issue
commands for violence to self or others may or may not be heeded by the
psychotic person.
 Auditory hallucinations are the most common type in
psychiatric disorders.
● Visual These are false visual perceptions. They may
consist of formed images, such as of people, or of
unformed images, such as flashes of light.
● Tactile hallucinations are false perceptions of the sense
of touch, often of something on or under the skin. One
specific tactile hallucination is formication, the
sensation that something is crawling on or under the
skin
 Gustatory This type is a false perception of taste.
Most commonly, gustatory hallucinations are
described as unpleasant tastes.
 Olfactory hallucinations are false perceptions of
the sense of smell.

Illusions are misperceptions or misinterpretations
of real external stimuli
Sense of Self
 Sense of self describes the uniqueness and
individuality a person feels. Because of
extremely weak ego boundaries, the individual
with schizophrenia lacks this feeling of
uniqueness and experiences a great deal of
confusion regarding his or her identity
● Echolalia The client with schizophrenia may repeat words
that he or she hears, which is called echolalia. This is an
attempt to identify with the person speaking.

● (For instance, the nurse says, “John, it’s time for

lunch.” The client may respond, “It’s time for lunch,
it’s time for lunch” or sometimes, “Lunch, lunch,
lunch, lunch”).
Echopraxia The client who exhibits echopraxia may
purposelessly imitate movements made by others.
Identification and Imitation , which occurs on an
unconscious level, and imitation, which occurs on a conscious
level, are ego defense mechanisms used by individuals with
schizophrenia and reflect their confusion regarding self-
identity
● Depersonalization The unstable self-identity of
an individual with schizophrenia may lead to
feelings of unreality
● (e.g., feeling that one’s extremities have changed in
size; or a sense of seeing oneself from a distance).
 Negative
Symptoms
AFFECT
describes the behavior
associated with an
individual’s feeling state
or emotional tone
● Inappropriate Affect. Affect is inappropriate when the
individual’s emotional tone is incongruent with the circumstances
(e.g., a young woman who laughs when told of the death
of her mother).
● Bland or Flat Affect. Affect is described as bland when
the emotional tone is very weak. The individual with flat
affect appears to be void of emotional tone (or overt
expression of feelings).
Apathy The client with schizophrenia often
demonstrates an indifference to or disinterest in the
environment. The bland or flat affect is a
manifestation of the emotional apathy
Volition
● Impaired volition has to do with the inability to initiate goal-directed
activity. In the individual with schizophrenia, this may take the form of
inadequate interest, motivation, or ability to choose a logical course of
action in a given situation.

● Emotional Ambivalence Ambivalence in the client with

schizophrenia refers to the coexistence of opposite emotions toward the
same object, person, or situation. These opposing emotions may interfere
with the person’s ability to make even a very simple decision

(e.g., whether to have coffee or tea with lunch). Underlying the ambivalence
is the difficulty the client with schizophrenia has in fulfilling a satisfying
human relationship. This difficulty is based on the need- fear dilemma—the
simultaneous need for and fear of intimacy.
● Deteriorated Appearance Personal grooming and self- care
activities may be neglected. The client with schizophrenia
may appear disheveled and untidy and may need to be
reminded of the need for personal hygiene.
Interpersonal Functioning and
Relationship to the
External World
● Impairment in social functioning may be reflected in social isolation,
emotional detachment, and lack of regard for social convention.

● Impaired Social Interaction Some clients with acute

schizophrenia cling to others and intrude on the personal
space of others, exhibiting behaviors that are not socially
and culturally acceptable.

● Social Isolation Individuals with schizophrenia sometimes

focus inward on themselves to the exclusion of the
external environment.
Psychomotor Behavior
● Anergia is a deficiency of energy. The individual with
schizophrenia may lack sufficient energy to carry out activities
of daily living or to interact with others.
● Waxy Flexibility describes a condition in which the client with
schizophrenia allows body parts to be placed in bizarre or uncomfortable
positions. Once placed in position, the arm, leg, or head remains in that
position for long periods, regardless of how uncomfortable it is for the
client.
● For example, the nurse may position the client’s arm in an outward position
to take a blood pressure measurement. When the cuff is removed, the client
may maintain the arm in the position in which it was placed to take the
reading.
● Posturing This symptom is manifested by the
voluntary assumption of inappropriate or bizarre
postures.
● Pacing and Rocking Pacing back and forth and
body rocking (a slow, rhythmic, backward-and-forward
swaying of the trunk from the hips, usually while
sitting) are common psychomotor behaviors of the
client with schizophrenia.
Associated Features
● Anhedonia is the inability to experience pleasure.
This is a particularly distressing symptom that compels
some clients to attempt suicide.
● Regression is the retreat to an earlier level of
development. Regression, a primary defense
mechanism of schizophrenia, is a dysfunctional
attempt to reduce anxiety. It provides the basis for
many of the behaviors associated with schizophrenia.
Treatment Modalities for
Schizophrenia and Other
Psychotic Disorders
Psychological Treatments
1. Individual Psychotherapy is a Reality-oriented individual
therapy is the most suit- able approach to individual
psychotherapy for schizophrenia. The primary focus in all cases
must reflect efforts to decrease anxiety and increase trust.
 Individual psychotherapy for clients with schizophrenia is seen
as a long-term endeavor that requires patience on the part of
the health-care provider, as well as the ability to accept that a
great deal of change may not occur.
 The goals of such individual psychotherapy are to improve
medication compliance, enhance social and occupational
functioning, and prevent relapse.
2.Group therapy for persons with schizophrenia
generally focuses on real-life plans, problems, and
relationships. Some investigators doubt that dynamic
interpretation and insight therapy are valuable for
typical patients with schizophrenia. But group
therapy is effective in reducing social isolation,
increasing the sense of cohesiveness, and improving
reality testing for patients with schizophrenia .
3.Behavior Therapy
 Behavior modification has shown qualified success in reducing
maladaptive behaviors and increasing appropriate ones.
 Key features include clearly defined goals, reinforcement
strategies, and the use of simple, concrete instructions.
 Behavior therapy can be a powerful treatment tool for helping
clients change undesirable behaviors. In the treatment setting,
the health-care provider can use praise and other positive
reinforcements to help the client with schizophrenia reduce the
frequency of maladaptive or deviant behaviors.
4.Social Skills Training:
 Social skills training is widely used to address social
dysfunction, a hallmark of schizophrenia.
 Focuses on teaching specific skills through role-playing,
addressing nonverbal and verbal behaviors, and interactive
balance.
 Gradual progress is tailored to the client's needs, emphasizing
small units of behavior and functional skills relevant to daily
life
 The health-care provider may serve as a role
model for some behaviors.
For example, “See how I sort of nod my head up
and down and look at your face while you talk.”
This demonstration is followed by the client’s role-
playing. Immediate feedback is provided regarding
the client’s presentation.
2. Social Treatments

Milieu Therapy:
 Some clinicians consider milieu therapy suitable for
schizophrenia, especially when used alongside
psychotropic medication.
 Emphasizes group and social interaction, rules
mediated by peer pressure, and patient rights with
freedom of movement.
 Effective in outpatient settings like day and partial
hospitalization programs
 Individuals with schizophrenia who are treated
with milieu therapy alone require longer hospital
stays than do those treated with drugs and
psychosocial therapy
Program of Assertive Community Treatment (PACT):
 PACT is a team-based, community-oriented approach
for serious and persistent mental illnesses like
schizophrenia.
 Provides comprehensive psychiatric treatment,
rehabilitation, and support tailored to each client.
 Emphasizes vocational expectations, substance abuse
treatment, psychoeducation, family support, and 24/7
availability
 Responsibilities are shared by multiple team members, including
psychiatrists, nurses, social workers, vocational rehabilitation
therapists, and substance abuse counselors.
The National Alliance on Mental Illness [NAMI] I (2013) lists the primary goals
of Assertive Community Treatment(ACT) as follows:
 To meet basic needs and enhance quality of life
 To improve functioning in adult social and employment roles
 To enhance an individual’s ability to live independently in his or her
own community
 To lessen the family’s burden of providing care
 To lessen or eliminate the debilitating symptoms of mental illness
 To minimize or prevent recurrent acute episodes of the illness
Family Therapy:
 Schizophrenia is viewed not just as an individual illness
but one affecting the entire family.
 Psychoeducational programs focus on family as a
resource, reducing stress, improving coping, and
preventing relapse.
 Family therapy involves education about schizophrenia,
reducing conflict, improving communication, and
problem-solving
Recovery Model:
 Recovery from schizophrenia is seen as achievable,
with functional and process recovery.
 Functional recovery focuses on life functioning, and
process recovery is an ongoing, collaborative
journey.
 The process recovery model recognizes that
recovery does not guarantee remission but involves
setting and working towards meaningful life goals
 3. Organic Treatment
Psychopharmacology:
 Chlorpromazine (Thorazine) was initially used for surgical
anesthesia but later recognized for its antipsychotic properties
in 1954.
 Antipsychotic medications, also known as neuroleptics or
major tranquilizers, effectively treat acute and chronic
schizophrenia symptoms and aid in maintenance therapy.
 Without continuous medication, about 72% of individuals
with a psychotic episode relapse within a year; medication
reduces this rate to about 23%
 Prognosis and Treatment Response:
 Schizophrenia prognosis often follows a paradigm of
thirds: one third achieves significant improvement,
one-third experiences intermittent relapses, and one-
third faces severe and permanent incapacity.
 Women tend to respond better to antipsychotic
medications than men
Adjunct Psychosocial Therapy:
 Antipsychotic efficacy is enhanced by psychosocial
therapy.
 Psychotic symptoms subside with medication use,
increasing client cooperation with psychosocial
therapies.
 Educating clients and families about the delayed onset
of antipsychotic effectiveness is crucial
Typical Antipsychotic Agents (First Generation; Conventional)
Chlorpromazine
Fluphenazine
Haloperidol (Haldol)
Loxapine
Perphenazine
Pimozide (Orap)
Prochlorperazine
Thioridazine
Thiothixene (Navane)
Trifluoperazine
Typical antipsychotics
 work by blocking postsynaptic dopamine receptors in the
basal ganglia, hypothalamus, limbic system, brainstem, and
medulla. They also demonstrate varying affinity for
cholinergic, alpha1-adrenergic, and histaminic receptors.
Antipsychotic effects may also be related to inhibition of
dopamine-mediated transmission of neural impulses at the
synapses.
Contraindications/Precautions:
 Typical antipsychotics are contraindicated in clients with
known hypersensitivity (cross-sensitivity may exist among
phenothiazines).
 They should not be used in comatose states or when central
nervous system (CNS) depression is evident; when blood
dyscrasias exist; in clients with Parkinson’s disease or
narrow angle glaucoma; in those with liver, renal, or
cardiac insufficiency; in individuals with poorly-controlled
seizure disorders; or in elderly clients with psychosis
related to neurocognitive disorder.
TYPICAL SIDE EFFECTS
1.Dry mouth
*Provide the client with sugarless candy or gum, ice, and frequent sips of water.
*Ensure that client practices strict oral hygiene
*Ensure that client practices strict oral hygiene.
2.Blurred vision
*Explain that this symptom will most likely subside after a few weeks.
*Advise client not to drive a car until vision clears.
*Clear small items from pathway to prevent falls.
3. Constipation
 Order foods high in fiber; encourage increase in physical activity and fluid intake if
not contraindicated
4. Urinary retention
*Instruct client to report any difficulty urinating; monitor intake and output.
5. Nausea
 gastrointestinal (GI) upset (may occur with all classifications)
 Concentrates may be diluted and administered with fruit juice or other liquid; they
should be mixed immediately before administration
6. Skin rash (may occur with all classifications)
*Report appearance of any rash on skin to physician.
*Avoid spilling any of the liquid concentrate on skin; contact dermatitis can occur
with some medications
7. Sedation
*Discuss with physician the possibility of administering the drug at bedtime.
*Discuss with physician a possible decrease in dosage or an order for a less sedating
drug.
*Instruct client not to drive or operate dangerous equipment while experiencing
sedation.
8. Orthostatic hypotension
*Instruct client to rise slowly from a lying or sitting position.
*Monitor blood pressure (lying and standing) each shift; document and report
significant changes
9.Photosensitivity (may occur with all classifications)
*Ensure that the client wears a sunblock lotion, protective clothing, and sunglasses while spending
time outdoors
Hormonal effects (may occur with all classifications, but more common with typical
antipsychotics)
■ Decreased libido, retrograde ejaculation (the discharge of seminal fluid into the
bladder rather than through the urethra), gynecomastia (men)
*Provide explanation of the effects and reassurance of reversibility. If necessary,
discuss with physician possibility of ordering alternate medication.
■Amenorrhea (absence of menstruation) (women)
*Offer reassurance of reversibility; instruct client to continue use of contraception,
because amenorrhea does not indicate cessation of ovulation.
■ Weight gain (may occur with all classifications; has been problematic with the
atypical antipsychotics)
*Weigh client every other day; order calorie controlled diet; provide opportunity for
physical exercise; provide diet and exercise instruction
10.Electrocardiogram (ECG) changes. ECG changes, including prolongation of the QT
interval, are possible with most of the antipsychotics. This is particularly true with
ziprasidone, thioridazine, pimozide, haloperidol, paliperidone, iloperidone, asenapine,
and clozapine.
 Caution is advised in prescribing these medications to individuals with history of
arrhythmias. Conditions that produce hypokalemia and/or hypomagnesemia, such as
diuretic therapy or diarrhea, should be taken into consideration when prescribing.
*Monitor vital signs every shift.
*Observe for symptoms of dizziness, palpitations, syncope, weakness, dyspnea, and peripheral
edema
.
11. Reduction of seizure threshold (more common with the typical than the atypical
antipsychotics, with the exception of clozapine)
*Closely observe clients with history of seizures.
Note: This is particularly important with clients taking clozapine (Clozaril), with which
seizures have been frequently associated. Dose appears to be an important predictor, with a
greater likelihood of seizures occurring at higher doses. Extreme caution is advised in
prescribing clozapine for clients with a history of seizures

12.Agranulocytosis (more common with the typical than the atypical

antipsychotics, with the exception of clozapine)
 Agranulocytosis usually occurs within the first 3 months of treatment.
 Observe for symptoms of sore throat, fever, malaise. A complete blood count
should be monitored if these symptoms appear.
 13.Tardive dyskinesia (bizarre facial and tongue movements, stiff
neck, and difficulty swallowing; may occur with all classifications,
but more common with typical antipsychotics)
All clients receiving long-term (months or years) antipsychotic
therapy are at risk.
 The symptoms are potentially irreversible.
 The drug should be withdrawn at the first sign, which is usually
vermiform movements of the tongue; prompt action may prevent
irreversibility
Atypical Antipsychotic Agents
(Second Generation; Novel)
Aripiprazole (Abilify)
Asenapine (Saphris)
Clozapine (Clozaril)
Iloperidone (Fanapt)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Paliperidone (Invega)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
ACTION
Atypical antipsychotics
 are weaker dopamine receptor antagonists than the

conventional antipsychotics, but are more potent antagonists

of the serotonin (5-hydroxytryptamine) type 2A (5HT2A)
receptors. They also exhibit antagonism for cholinergic,
histaminic, and adrenergic receptors.
Atypical antipsychotics are contraindicated in hypersensitivity, comatose or
severely depressed patients, elderly patients with NCD-related psychosis,
and lactation.
 Ziprasidone, risperidone, paliperidone, asenapine, and iloperidone are
contraindicated in patients with a history of QT prolongation or cardiac
arrhythmias, recent myocardial infarction (MI), uncompensated heart
failure, and concurrent use with other drugs that prolong the QT interval.
 Clozapine is contraindicated in patients with myeloproliferative
disorders, with a history of clozapine-induced agranulocytosis or severe
granulocytopenia, and with uncontrolled epilepsy.
Extrapyramidal symptoms/ ATYPICAL

1.Pseudoparkinsonism (tremor, shuffling gait, drooling, rigidity)

 Symptoms may appear 1 to 5 days following initiation of
antipsychotic medication; occurs most often in women, the
elderly, and dehydrated clients.
2. Akinesia (muscular weakness)
 Same as for pseudoparkinsonism.
3.Akathisia (continuous restlessness and fidgeting)
 This occurs most frequently in women; symptoms may occur 50
to 60 days following initiation of therapy.
4.Dystonia (involuntary muscular movements [spasms] of face, arms, legs, and neck)
 This occurs most often in men and in people younger than 25 years of age.
5.Oculogyric crisis (uncontrolled rolling back of the eyes)
 This may appear as part of the syndrome described as dystonia. It may be mistaken
for seizure activity. Dystonia and oculogyric crisis should be treated as an
emergency situation. The physician should be contacted, and intravenous
benztropine mesylate (Cogentin) is commonly administered.
 Stay with the client and offer reassurance and support during this frightening time
Client/Family Education Related to Antipsychotics
The client should:
1.Use caution when driving or operating dangerous machinery.
Drowsiness and dizziness can occur.
2.Not stop taking the drug abruptly after long-term use. To do so
might produce withdrawal symptoms, such as nausea, vomiting,
dizziness, gastritis, headache, tachycardia, insomnia,
tremulousness.
3.Use sunblock lotion and wear protective clothing when
spending time outdoors. Skin is more susceptible to sunburn,
which can occur in as little as 30 minutes.
3.Report weekly (if receiving clozapine therapy) to have blood
levels drawn and to obtain a weekly supply of the drug.

4.Report the occurrence of any of the following symptoms to the

physician immediately: sore throat, fever, malaise, unusual
bleeding, easy bruising, persistent nausea and vomiting, severe
headache, rapid heart rate, difficulty urinating, muscle twitching,
tremors, darkly colored urine, excessive urination, excessive
thirst, excessive hunger, weakness, pale stools, yellow skin or
eyes, muscular incoordination, or skin rash.
.
5.Rise slowly from a sitting or lying position to prevent a
sudden drop in blood pressure

6.Take frequent sips of water, chew sugarless gum, or suck on

hard candy, if dry mouth is a problem. Good oral care
(frequent brushing, flossing) is very important.
7.Consult the physician regarding smoking while on antipsychotic
therapy. Smoking increases the metabolism of antipsychotics,
requiring an adjustment in dosage to achieve a therapeutic effect.

8.Dress warmly in cold weather, and avoid extended exposure to

very high or low temperatures. Body temperature is harder to
maintain with this medication.

9.Avoid drinking alcohol while on antipsychotic therapy. These

drugs potentiate each other’s effects.
10.Avoid taking other medications (including over the-counter
products) without the physician’s approval. Many medications
contain substances that interact with antipsychotics in a way that
may be harmful.

11. Be aware of possible risks of taking antipsychotics during

pregnancy. Safe use during pregnancy has not been established.
Antipsychotics are thought to readily cross the placental barrier; if
so, a fetus could experience adverse effects of the drug. Inform the
physician immediately if pregnancy occurs, is suspected, or is
planned.
12 Be aware of side effects of antipsychotic drugs. Refer to
written materials furnished by health-care providers for safe
self-administration.

13.Continue to take the medication, even if feeling well and as

though it is not needed. Symptoms may return if medication is
discontinued.

14.Carry a card or other identification at all times describing

medications being taken.
● Assigning Nursing Diagnoses to Behaviors Commonly Associated With Psychotic Disorders
Impaired communication (inappropriate Disturbed sensory perception
responses), disordered thought
sequencing, rapid mood swings, poor
concentration, disorientation, stops
talking in midsentence, tilts head to side
as if to be listening.
2. Delusional thinking; inability to -Disturbed thought processes
concentrate; impaired volition; inability to
problem solve, abstract, or
conceptualize; extreme suspiciousness
of others; inaccurate interpretation of the
environment
3. Withdrawal, sad dull affect, need-fear -Social isolation
dilemma, preoccupation with own
thoughts, expression of feelings of
rejection or of aloneness imposed by
others, uncommunicative, seeks to be
alone
4. Risk factors: Aggressive body language -Risk for violence: Self-directed or other-
(e.g., clenching fists and jaw, pacing, directed
threatening stance), verbal aggression,
catatonic excitement, command hallucinations,
rage reactions, history of violence, overt and
aggressive acts, goal-directed destruction of
objects in the environment, self-destructive
behavior, or active aggressive suicidal acts
5. Loose association of ideas, neologisms,
word salad, clang associations, echolalia, -Impaired verbal communication
verbalizations that reflect concrete thinking,
poor eye contact, difficulty expressing thoughts
verbally, inappropriate verbalization
6. Difficulty carrying out tasks associated with -Self-care deficit
hygiene, dressing, grooming, eating, and
toileting
7.Neglectful care of client in regard to basic human -Disabled family coping
needs or illness treatment, extreme denial or
prolonged overconcern regarding client’s illness,
depression, hostility and aggression
8. Inability to take responsibility for meeting basic -Ineffective health maintenance
health practices, history of lack of health-seeking
behavior, lack of expressed interest in improving
health behaviors, demonstrated lack of knowledge
regarding basic health practices
9. Unsafe, unclean, disorderly home environment; -Impaired home maintenance
household members express difficulty in
maintaining their home in a safe and comfortable
condition
IYAMAN!!!
ALTERNATIVE ICONS
ALTERNATIVE RESSOURCEN
Hier ist eine Auswahl an alternativen Ressourcen im gleichen Stil wie diese Vorlage

VEKTOREN
● Set of different mental disorders
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