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SCHIZOPHRENIA� Comes from Greek words
meaning “split” and “mind”
� People with schizophrenia
do NOT have split
personalities
� ‘split’ refers to loss of
touch with reality
� “split mind” refers to the
fact that people with
schizophrenia are split off
from reality and can’t
distinguish what is real
from what is not real
� Early writings indicating its
presence go back to the 12
century B.C.
� Not a single disorder
� A syndrome with multiple
variations and multiple
etiologies
� The label given to a group
of psychoses in which
deterioration of functioning
is marked by severe
distortion of thought,
perception and mood; by
bizarre behavior; and by
social withdrawal
� Equally frequency, males
have earlier onset
� 18 to 25 for men
� 26 to 45 for women
DESCRIPTIONA group of mental disorders characterized by;
� Psychotic features (hallucinations and delusions)
� Disordered thought process
� Disrupted interpersonal relationships
� Disturbances in affect, mood, behavior, and thought processes occur
DSM IV Criteria
� Schizophrenia
� Schizophreniform
� Schizoaffective
� Delusional Disorder
� Brief Psychotic Disorder
� Shared Psychotic Disorder
� Schizophrenia induced by: Medical conditions; Medications/ drugs /other substance
DSM IV Criteria� Schizophrenia : psychosis that are persistently
disturbing for at least 6 months, with 1 month of active-phase symptoms; age onset of late adolescence or early adulthood
� Schizophreniform : Symptoms of Schizophrenia with the duration of at least 1 month but less than 6 months and social / occupational function may not be impaired.
� Schizoaffective : Symptoms of both Schizophrenia and a mood disorder lasting for 1 month
DSM IV Criteria� Delusional Disorder : presence of one or more
nonbizaare delusions that persist for 1 month or more
� Brief Psychotic Disorder : at least one of the symptoms (hallucinations, delusions, disorganized speech or behavior disturbance) that last at least 1 day but less than 1 month; then a return to the premorbid level of functioning
DSM IV Criteria
� Shared Psychotic Disorder : a delusional disorder developed when the person is involved in a close relationship with an individual who has delusional psychotic disorder.
� Psychotic Disorder due to medical condition or induced by substance abuse : physiologic effect of medical condition; occurrences during intoxication or withdrawal stages but can last for weeks
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EtiologyEtiologyEtiologyEtiology ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia EtiologyEtiologyEtiologyEtiology ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia EtiologyEtiologyEtiologyEtiology ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia EtiologyEtiologyEtiologyEtiology ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia
� The etiology and pathogenesis of schizophrenia is not known
� It is accepted, that the etiology is multifactorial:
� Biological theories
� Biochemical
� Genetic
� Perinatal Risks
� Neurostructural
� Psychological theories
� Social theories
THEORIES� BIOLOGICAL
� BIOCHEMICAL� DOPAMINE HYPOTHESIS� Serotonin and glutamate
� NEUROSTRUCTURAL� INCREASED VBR, BRAIN ATROPHY, DECREASED
CREBRAL BLOOD FLOW
� GENETIC� IDENTICAL TWINS, 1ST DEGREE RELATIVES
� PERINATAL RISK FACTORS� EXPOSURE TO VIRUS, MINOR MALFORMATIONS,
COMPLICATIONS DURING LABOR AND PREGANCY, POVERTY
GeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGenetics
� Idea that it is genetic
goes back at least as
far as the 18th century
� By the 19th century,
genetic hypothesis
was endorsed by
Kraepelin, Bleuler, and
many other experts on
schizophrenia.
RiskRiskRiskRisk FactorFactorFactorFactor RiskRiskRiskRisk FactorFactorFactorFactor RiskRiskRiskRisk FactorFactorFactorFactor RiskRiskRiskRisk FactorFactorFactorFactor
PerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisks
� There are also evidences that perinatalconditions may be an indicator of the risk of having schizophrenia.
� 2nd trimester (4-6 months) – brain development
� Conditions that could result in brain injury are:� Maternal starvation; poor nutrition – anemia
� Obstetric complications� Fetal hypoxia
� Maternal alcohol or drug abuse
� Toxin exposure or viral infection – influenza virus
� Incidence of birth trauma and injury
BiochemicalBiochemicalBiochemicalBiochemical::::BiochemicalBiochemicalBiochemicalBiochemical::::
DopamineDopamineDopamineDopamine HypothesisHypothesisHypothesisHypothesis DopamineDopamineDopamineDopamine HypothesisHypothesisHypothesisHypothesis
BiochemicalBiochemicalBiochemicalBiochemical::::BiochemicalBiochemicalBiochemicalBiochemical::::
DopamineDopamineDopamineDopamine HypothesisHypothesisHypothesisHypothesis DopamineDopamineDopamineDopamine HypothesisHypothesisHypothesisHypothesis
� Overactivity of dopamine neurons in the mesolimbic pathway may cause positive symptoms.
� Underactivity of dopamine neurons in the mesocortical pathway in the prefrontal cortex may cause negative symptoms
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BiochemicalBiochemicalBiochemicalBiochemical::::BiochemicalBiochemicalBiochemicalBiochemical::::
SerotoninSerotoninSerotoninSerotonin HypothesisHypothesisHypothesisHypothesis SerotoninSerotoninSerotoninSerotonin HypothesisHypothesisHypothesisHypothesis
BiochemicalBiochemicalBiochemicalBiochemical::::BiochemicalBiochemicalBiochemicalBiochemical::::
SerotoninSerotoninSerotoninSerotonin HypothesisHypothesisHypothesisHypothesis SerotoninSerotoninSerotoninSerotonin HypothesisHypothesisHypothesisHypothesis
� Serotonin (5HT)
mediates dopamine
levels
� LSD and psilocybin are
potent 5HT receptor
agonists and cause
positive symptoms of
Shiz. (in people who do
not have schiz.)
� Atypical antipsychotics
are potent 5HT receptor
antagonists
BiochemicalBiochemicalBiochemicalBiochemical::::BiochemicalBiochemicalBiochemicalBiochemical::::
GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis
BiochemicalBiochemicalBiochemicalBiochemical::::BiochemicalBiochemicalBiochemicalBiochemical::::
GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis
� Glutamate functions in the:
� Relay of sensory information and in the regulation of various motor and spinal reflexes
� Regulation of N-methyl-D-aspartate (NDMA)
Decreased levels of
Glutamate
Decreased regulation of
NMDA
Impaired cognitive
processesPsychotic symptoms
BiochemicalBiochemicalBiochemicalBiochemical::::BiochemicalBiochemicalBiochemicalBiochemical::::
GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis
BiochemicalBiochemicalBiochemicalBiochemical::::BiochemicalBiochemicalBiochemicalBiochemical::::
GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis Clinical Observation
� PCP (“angel dust”) and ketamine (an anesthetic) mimic the positive and negative symptoms of schizophrenia (Javitt & Cole, 2004)
� These drugs block the action of a form of glutamate receptor (NMDA receptor)
� NMDA receptor blockade may produce the dopamine dysfunction seen in schizophrenia, as if too little dopamine were present in the prefrontal cortex (negative symptoms) and too much dopamine in the mesolimbic area (positive symptoms)
NeurostructuralNeurostructuralNeurostructuralNeurostructural::::NeurostructuralNeurostructuralNeurostructuralNeurostructural::::
VentricularVentricularVentricularVentricular BrainBrainBrainBrain RatioRatioRatioRatio VentricularVentricularVentricularVentricular BrainBrainBrainBrain RatioRatioRatioRatio
NeurostructuralNeurostructuralNeurostructuralNeurostructural::::NeurostructuralNeurostructuralNeurostructuralNeurostructural::::
VentricularVentricularVentricularVentricular BrainBrainBrainBrain RatioRatioRatioRatio VentricularVentricularVentricularVentricular BrainBrainBrainBrain RatioRatioRatioRatio
� EnlargedEnlargedEnlargedEnlarged ventriclesventriclesventriclesventricles
� IncreasedIncreasedIncreasedIncreased widthwidthwidthwidth ofofofof 3333 rdrdrdrd ventricleventricleventricleventricle
PsychologicalPsychologicalPsychologicalPsychological TheoriesTheoriesTheoriesTheories PsychologicalPsychologicalPsychologicalPsychological TheoriesTheoriesTheoriesTheories PsychologicalPsychologicalPsychologicalPsychological TheoriesTheoriesTheoriesTheories PsychologicalPsychologicalPsychologicalPsychological TheoriesTheoriesTheoriesTheories
Psychological
Theories
Psychoanalytical Psychodynamic
PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::
DysfunctionalDysfunctionalDysfunctionalDysfunctional MotherMotherMotherMother DysfunctionalDysfunctionalDysfunctionalDysfunctional MotherMotherMotherMother --------ChildChildChildChild RelationshipRelationshipRelationshipRelationship ChildChildChildChild RelationshipRelationshipRelationshipRelationship
PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::
DysfunctionalDysfunctionalDysfunctionalDysfunctional MotherMotherMotherMother DysfunctionalDysfunctionalDysfunctionalDysfunctional MotherMotherMotherMother --------ChildChildChildChild RelationshipRelationshipRelationshipRelationship ChildChildChildChild RelationshipRelationshipRelationshipRelationship
SchizophrenogenicSchizophrenogenicSchizophrenogenicSchizophrenogenic mothermothermothermother
�EmotionallyEmotionallyEmotionallyEmotionally withholdingwithholdingwithholdingwithholding
�DomineeringDomineeringDomineeringDomineering
�RejectingRejectingRejectingRejecting attitudesattitudesattitudesattitudes
�OverOverOverOver----protectionprotectionprotectionprotection
ChildChildChildChild growsgrowsgrowsgrows feelingfeelingfeelingfeeling inininin conflictconflictconflictconflict withwithwithwith distrustfuldistrustfuldistrustfuldistrustful ofofofof andandandand , , , , , , , ,
angryangryangryangry towardstowardstowardstowards othersothersothersothers
FaultyFaultyFaultyFaulty egoegoegoego developmentdevelopmentdevelopmentdevelopment
EgoEgoEgoEgo disintegrationdisintegrationdisintegrationdisintegration
IntrapsychicIntrapsychicIntrapsychicIntrapsychic conflictconflictconflictconflict
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PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::
DysfunctionalDysfunctionalDysfunctionalDysfunctional ParentalParentalParentalParental InteractionInteractionInteractionInteraction DysfunctionalDysfunctionalDysfunctionalDysfunctional ParentalParentalParentalParental InteractionInteractionInteractionInteraction
PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::
DysfunctionalDysfunctionalDysfunctionalDysfunctional ParentalParentalParentalParental InteractionInteractionInteractionInteraction DysfunctionalDysfunctionalDysfunctionalDysfunctional ParentalParentalParentalParental InteractionInteractionInteractionInteraction
DysfunctionalDysfunctionalDysfunctionalDysfunctional parentalparentalparentalparental
interactioninteractioninteractioninteraction
SchismaticSchismaticSchismaticSchismatic
marriagemarriagemarriagemarriage
SkewedSkewedSkewedSkewed marriagemarriagemarriagemarriage
InterferenceInterferenceInterferenceInterference withwithwithwith personalitypersonalitypersonalitypersonality
maturationmaturationmaturationmaturation inininin thethethethe offspringoffspringoffspringoffspring
PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::
DoubleDoubleDoubleDoubleDoubleDoubleDoubleDouble--------bindbindbindbind TypeTypeTypeType ofofofof CommunicationCommunicationCommunicationCommunication bindbindbindbind TypeTypeTypeType ofofofof CommunicationCommunicationCommunicationCommunication
PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::PsychoanalyticPsychoanalyticPsychoanalyticPsychoanalytic::::
DoubleDoubleDoubleDoubleDoubleDoubleDoubleDouble--------bindbindbindbind TypeTypeTypeType ofofofof CommunicationCommunicationCommunicationCommunication bindbindbindbind TypeTypeTypeType ofofofof CommunicationCommunicationCommunicationCommunication
DoubleDoubleDoubleDouble----bindbindbindbind typetypetypetype ofofofof
communicationcommunicationcommunicationcommunication
DoubleDoubleDoubleDouble----bindbindbindbind messagemessagemessagemessage
ConflictingConflictingConflictingConflicting messagesmessagesmessagesmessages maymaymaymay bebebebe givengivengivengiven
simultaneouslysimultaneouslysimultaneouslysimultaneously
DefaultsDefaultsDefaultsDefaults inininin interpretinginterpretinginterpretinginterpreting meaningmeaningmeaningmeaning
DisorderDisorderDisorderDisorder ofofofof cognitioncognitioncognitioncognition andandandand
metacommunicationmetacommunicationmetacommunicationmetacommunication
SocialSocialSocialSocial stressorsstressorsstressorsstressors andandandand lifelifelifelife eventseventseventsevents SocialSocialSocialSocial stressorsstressorsstressorsstressors andandandand lifelifelifelife eventseventseventsevents
CopingCopingCopingCoping MechanismsMechanismsMechanismsMechanisms UsedUsedUsedUsed CopingCopingCopingCoping MechanismsMechanismsMechanismsMechanisms UsedUsedUsedUsed
SocialSocialSocialSocial stressorsstressorsstressorsstressors andandandand lifelifelifelife eventseventseventsevents SocialSocialSocialSocial stressorsstressorsstressorsstressors andandandand lifelifelifelife eventseventseventsevents
CopingCopingCopingCoping MechanismsMechanismsMechanismsMechanisms UsedUsedUsedUsed CopingCopingCopingCoping MechanismsMechanismsMechanismsMechanisms UsedUsedUsedUsed
� Denial and Suppression
� Denial – Failure to acknowledge an unbearable
condition; failure to admit the reality of a
situation or how one enables the problem to
continue
� Suppression – Conscious acceptable behavior to
make up for or negative unacceptable thoughts
and feelings from conscious awareness
SocialSocialSocialSocial stressorsstressorsstressorsstressors andandandand lifelifelifelife eventseventseventsevents SocialSocialSocialSocial stressorsstressorsstressorsstressors andandandand lifelifelifelife eventseventseventsevents
StressStressStressStressStressStressStressStress--------VulnerabilityVulnerabilityVulnerabilityVulnerability ModelModelModelModel VulnerabilityVulnerabilityVulnerabilityVulnerability ModelModelModelModel
SocialSocialSocialSocial stressorsstressorsstressorsstressors andandandand lifelifelifelife eventseventseventsevents SocialSocialSocialSocial stressorsstressorsstressorsstressors andandandand lifelifelifelife eventseventseventsevents
StressStressStressStressStressStressStressStress--------VulnerabilityVulnerabilityVulnerabilityVulnerability ModelModelModelModel VulnerabilityVulnerabilityVulnerabilityVulnerability ModelModelModelModel
PersonalPersonalPersonalPersonal
VulnerabilityVulnerabilityVulnerabilityVulnerability
PersonalPersonalPersonalPersonal ProtectorsProtectorsProtectorsProtectors
CopingCopingCopingCoping MedicationsMedicationsMedicationsMedications
StressorsStressorsStressorsStressors
EnvironmentalEnvironmentalEnvironmentalEnvironmental StimulationStimulationStimulationStimulation
FamilyFamilyFamilyFamily ConflictConflictConflictConflict
LifeLifeLifeLife EventsEventsEventsEvents
SymptomsSymptomsSymptomsSymptoms
DecreasedDecreasedDecreasedDecreased
socialsocialsocialsocial andandandand
OccupationalOccupationalOccupationalOccupational
functioningfunctioningfunctioningfunctioning
EnvironmentalEnvironmentalEnvironmentalEnvironmental ProtectorsProtectorsProtectorsProtectors
ProblemProblemProblemProblem SolvingSolvingSolvingSolving SocialSocialSocialSocial SupportSupportSupportSupport
ASSESSMENT
Physical Characteristics
� Unkempt appearance
� Body Image distortions
� Maybe preoccupied with somatic complaints
� May neglect hygiene, eating, sleeping, and elimination
ASSESSMENT
Motor Activity
� Catatonic posturing: Holding bizaare postures for long periods of time
� Catatonic excitement: Moving excitedly, with no environmental stimuli present
� Possible total immobilization
� Inability to respond to commands or responding only to commands
� Waxy flexibility
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ASSESSMENT
Motor Activity� Repetitive or stereotyped movements
� Motor activity that may be increased as evidenced by agitation, pacing, inability to sleep, loss of appetite and weight, and impulsiveness
� Possible inability to initiate activity (anergia)
ASSESSMENT
Emotional Characteristics� Mistrust may be present
� View of the world as threatening and unsafe
� Affect may be blunted, flat, or inappropriate
� May display feelings of ambivalence, helplessness, anxiety, anger, guilt, or depression
ASSESSMENT
Emotional Characteristics� Compulsive rituals: Performed as an attempt to solve
conflicting feelings by constant, repetitive activity
� Overcompliance: Attempt to deny responsibility for any action by doing only what another person instructs exactly
� Affective disturbances (flat, inappropriate, altered thought process)
ALTERED THOUGHT PROCESS�Impaired reality testing�Fragmentation of thoughts�Thought blocking�Loose associations�Echolalia�Distorted perception of the environment�Neologisms�Magical thinking�Inability to conceptualize meaning in words or
thoughts�Inability to organize facts logically�Delusions associated with thought processes or content
TYPES OF DELUSIONS� DELUSION OF PERSECUTION
� DELUSION OF GRANDEUR
� SOMATIC
� Loss of reference in which the client believes that certain events, situations, or interactions are related directly to self
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INTERVENTIONS�Interact based on reality�Encourage the client to express feelings�Do not dispute the client or try to convince the client
that delusions are false�Initially initiate activities on one-on-one basis�Alter hospital routines as necessary, such as using
canned or packaged food or food from home�Recognize accomplishments and provide possible
feedback for successes
PERCEPTUAL DISTORTIONS� Illusions
� Hallucinations
HALLUCINATIONA sense perception (occurs with one of the five senses)
for which no external stimuli exist; can have an organic or functional cause
Types
� Auditory
� Visual
� Gustatory
� Olfactory
� Tactile
INTERVENTIONS� Ask the client directly about the hallucination
� Avoid reacting to the hallucination as if it were real
� Decrease stimuli or move the client to another area
� Do not negate the client’s experience
� Focus on reality based topics
INTERVENTIONS� Attempt to engage the client’s attention through a
concrete activity
� Respond verbally to anything real that the client talks about
� Avoid touching the client
� Monitor for signs of increasing anxiety or agitation, which may indicate that the hallucinations are increasing
For Active Hallucinations
�Monitor for hallucination cues and assess content�SAFETY is the First PRIORITY�Ensure that the client does not have an auditory
command telling him or her to harm self or others�Intervene with one-on-one contact�Avoid touching the client�Encourage to express feelings�Provide easy activities and structured environment
with routine ADL�Administer medications as prescribed
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TYPES OF SCHIZOPHRENIA� PARANOID
� DISORGANIZED
� CATATONIC
� UNDIFFERENTIATED
� RESIDUAL
PARANOID� Suspiciousness
� Hostility
� Delusions
� Auditory hallucinations
� Anxiety and anger
� Aloofness
� Persecutory themes
� Violence
DISORGANIZED� Extreme social withdrawal
� Disorganized speech or behavior
� Flat or inappropriate affect
� Silliness unrelated to speech
� Stereotyped behaviors
� Grimacing mannerisms
� Inability to perform ADL
CATATONIC� Psychomotor disturbances
� Immobility
� Stupor
� Waxy flexibility
� Excessive purposeless motor activity
� Echolalia
� Automatic obedience
� Stereotyped or repetitive behavior
UNDIFFERENTIATED� Does not meet the criteria for paranoid, disorganized,
or catatonic
� Delusions and hallucinations
� Disorganized speech
� Disorganized or catatonic behavior
� Flat affect
� Social withdrawal
RESIDUAL� Diagnosed as Schizophrenic in the past
� Time limited between attacks but may last for many years
� Exhibits social isolation and withdrawal, and impaired role functioning
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INTERVENTIONS
FOR SCHIZOPHRENIA�Assess the client’s physical needs�Set limits on the client’s behavior�Maintain a safe environment�Spend time with the client �Monitor for altered thought process�Set realistic goals�Monitor for suicide risk�Reorient the client as necessary�Provide short, brief, and frequent contact �Provide simple, concrete activities�Assist the client to use alternative means to express
feelings through music, art or writing
INTERVENTIONS� MEDICATIONS
� TYPICAL AND ATYPICAL ANTIPSYCHOTICS
� NURSE-PATIENT RELATIONSHIP
� FOCUS IS ON INTERPERSONAL
COMMUNICATION, SOCIALIZATION SKILLS, INDEPENDENCE AND SURVIVAL SKILLS FOR POSTHOSPITALIZATION
� FAMILY INVOLVEMENT
� SUPPORT AND EDUCATION
� MILIEU THERAPY
INTERVENTIONS
� MILIEU MANAGEMENT
�Disruptive behavior:� Set limits
� Decrease environmental stimuli
� Observe escalation of aggression
� Remove objects potential weapon
� Once violation of limits occurs, remind the patient of the consequences
� For restraints, assure the safety of client
INTERVENTIONS
� Withdrawn behavior :
� Arrange for a non-threatening activities and
socialization
� Arrange in semicircle group activities
� Provide decision-making activities /
opportunities
� Reinforce appropriate grooming and hygiene
� Provide remotivation and resocialization
� Provide psychosocial rehabilitation
INTERVENTIONS� Impaired communication
� Provide opportunities for decision-making
� Be patient and do not pressure patients to make
sense
� Involve clients to nonthreatening activity
� Provide for purposeful psychomotor activities
(painting, ceramic work, exercise)
� Disordered perception
� Provide distracting activities
� Monitor television selections
� Monitor hallucinations
� Presence and availability of staff for interaction
� Present reality
INTERVENTIONS
� Disorganized
� Provide less stimulating and calm
environment
� Provide safe and simple activities
� Provide and use information boards
� Protect patient from “embarassing” himself
� Assist in grooming and hygiene
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INTERVENTIONS� Altered levels of activity
� Hyperactivity� Provide safe environment and place
� Activities that does not require fine motor skills or intense concentration
� Immobility� Minimize circulatory problems and loss of muscle tone
� Provide adequate diet, exercise and rest
� Maintain bladder and bowel functioning
� Protect client from “victimization”
SummarySummarySummarySummary ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia SummarySummarySummarySummary ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia SummarySummarySummarySummary ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia SummarySummarySummarySummary ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia
SummarySummarySummarySummary ofofofof EtiologicalEtiologicalEtiologicalEtiological FactorsFactorsFactorsFactors SummarySummarySummarySummary ofofofof EtiologicalEtiologicalEtiologicalEtiological FactorsFactorsFactorsFactors SummarySummarySummarySummary ofofofof EtiologicalEtiologicalEtiologicalEtiological FactorsFactorsFactorsFactors SummarySummarySummarySummary ofofofof EtiologicalEtiologicalEtiologicalEtiological FactorsFactorsFactorsFactors
EtiologicalEtiologicalEtiologicalEtiological FactorsFactorsFactorsFactors
BiologicBiologicBiologicBiologic TheoriesTheoriesTheoriesTheories PsychologicalPsychologicalPsychologicalPsychological TheoriesTheoriesTheoriesTheories
PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms
BiochemicalBiochemicalBiochemicalBiochemical
TheoriesTheoriesTheoriesTheories
NeurostructuralNeurostructuralNeurostructuralNeurostructural
TheoriesTheoriesTheoriesTheories
Genetic Theory Perinatal Risks PsychodynamicPsychodynamicPsychodynamicPsychodynamic
TheoriesTheoriesTheoriesTheories
PsychoanalyticalPsychoanalyticalPsychoanalyticalPsychoanalytical
TheoriesTheoriesTheoriesTheories
SocialSocialSocialSocial StressorsStressorsStressorsStressors andandandand
LifeLifeLifeLife EventsEventsEventsEvents
PositivePositivePositivePositive SymptomsSymptomsSymptomsSymptoms NegativeNegativeNegativeNegative SymptomsSymptomsSymptomsSymptoms
PositivePositivePositivePositive PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms PositivePositivePositivePositive PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms PositivePositivePositivePositive PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms PositivePositivePositivePositive PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms
PositivePositivePositivePositive SymptomsSymptomsSymptomsSymptoms
CognitiveCognitiveCognitiveCognitive DisturbancesDisturbancesDisturbancesDisturbances
AlterationsAlterationsAlterationsAlterations inininin ThoughtThoughtThoughtThought andandandand LanguageLanguageLanguageLanguage(((( ))))
DelusionsDelusionsDelusionsDelusions
ReligiousReligiousReligiousReligious
DelusionsDelusionsDelusionsDelusions
GrandioseGrandioseGrandioseGrandiose
DelusionsDelusionsDelusionsDelusions
NihilisticNihilisticNihilisticNihilistic
DelusionsDelusionsDelusionsDelusions
PersecutoryPersecutoryPersecutoryPersecutory
DelusionsDelusionsDelusionsDelusions
PerceptualPerceptualPerceptualPerceptual DisturbancesDisturbancesDisturbancesDisturbances
AlterationAlterationAlterationAlteration inininin ThoughtThoughtThoughtThought
ContentContentContentContentAlterationAlterationAlterationAlteration inininin FormFormFormForm ofofofof
ThoughtThoughtThoughtThought
LooseLooseLooseLoose AssociationsAssociationsAssociationsAssociations PovertyPovertyPovertyPoverty ofofofof
ContentContentContentContent
FlightFlightFlightFlight ofofofof
IdeasIdeasIdeasIdeas
HallucinationsHallucinationsHallucinationsHallucinations
SomaticSomaticSomaticSomatic
DelusionsDelusionsDelusionsDelusions
ImpairedImpairedImpairedImpaired SensorySensorySensorySensory
FilteringFilteringFilteringFiltering
AuditoryAuditoryAuditoryAuditory
BizaareBizaareBizaareBizaare BehaviorsBehaviorsBehaviorsBehaviors
AgitatedAgitatedAgitatedAgitated
UnpredictableUnpredictableUnpredictableUnpredictable
BehaviorBehaviorBehaviorBehavior
RepetitiveRepetitiveRepetitiveRepetitive orororor
StereotypedStereotypedStereotypedStereotyped
BehaviorBehaviorBehaviorBehavior
IdeasIdeasIdeasIdeas ofofofof
ReferenceReferenceReferenceReference
NegativeNegativeNegativeNegative PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms NegativeNegativeNegativeNegative PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms NegativeNegativeNegativeNegative PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms NegativeNegativeNegativeNegative PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms
NegativeNegativeNegativeNegative SymptomsSymptomsSymptomsSymptoms
MoodMoodMoodMood DisturbancesDisturbancesDisturbancesDisturbances
ReducedReducedReducedReduced emotionalemotionalemotionalemotional
responsivenessresponsivenessresponsivenessresponsiveness
PoorPoorPoorPoor EyeEyeEyeEye
ContactContactContactContact
AnhedoniaAnhedoniaAnhedoniaAnhedonia BluntedBluntedBluntedBlunted AffectAffectAffectAffect
MotorMotorMotorMotor BehaviorBehaviorBehaviorBehavior
DisturbanceDisturbanceDisturbanceDisturbance
ThoughtThoughtThoughtThought andandandand LanguageLanguageLanguageLanguage
AlterationsAlterationsAlterationsAlterations
PovertyPovertyPovertyPoverty ofofofof
SpeechSpeechSpeechSpeech
SocialSocialSocialSocial WithdrawalWithdrawalWithdrawalWithdrawal
SocialSocialSocialSocial IsolationIsolationIsolationIsolation
PhysicalPhysicalPhysicalPhysical AnergiaAnergiaAnergiaAnergiaIncreasedIncreasedIncreasedIncreased
LatencyLatencyLatencyLatency ofofofof
ResponseResponseResponseResponse
AvolitionAvolitionAvolitionAvolition
Predictors of course and outcome in
schizophreniaFactorFactor Good OutcomeGood Outcome Poor OutcomePoor Outcome
Age at onsetAge at onset About 20About 20--2525 Below 20Below 20
SexSex Possibly femalesPossibly females Possibly malesPossibly males
Socioeconomic statusSocioeconomic status High, middle High, middle lowlow
Occupational recordOccupational record stablestable irregularirregular
Other adverse social Other adverse social factorsfactors
absentabsent presentpresent
Family history of Family history of mental illnessmental illness
affectiveaffective schizophreniaschizophrenia
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Predictors of course and outcome in
schizophrenia
FactorFactor Good OutcomeGood Outcome Poor OutcomePoor Outcome
Precipitating factorsPrecipitating factors presentpresent absentabsent
onsetonset Acute, lateAcute, late insidousinsidous
Rate of progressionRate of progression rapidrapid slowslow
Length of episode prior Length of episode prior to assessmentto assessment
Months or lessMonths or less yearsyears
Initial clinical Initial clinical symptomssymptoms
Catatonia, paranoia, Catatonia, paranoia, depression depression schizoaffective schizoaffective diagnosis, atypical diagnosis, atypical symptoms, confusionssymptoms, confusions
Negative symptoms Negative symptoms ((e.ge.g flat affect, poverty flat affect, poverty of thought, apathy, of thought, apathy, asocialityasociality; obsessive; obsessive--compulsive symptomscompulsive symptoms
Predictors of course and outcome in
schizophreniaFactorFactor Good Good
OutcomeOutcome
Poor Poor
OutcomeOutcome
CT/MRI studiesCT/MRI studies Normal Normal morphologymorphology
Dilated Dilated ventricles, brain ventricles, brain atrophyatrophy
Early treatment Early treatment with with medicationsmedications
presentpresent absentabsent
Response to Response to medications medications initiallyinitially
presentpresent absentabsent
Course of schizophrenia over 10 and 30
years
� over a 10-year period, 25 % of patients recover completely, 25% improve greatly and become relatively independent, 25% improve but require extensive help, 15% remain hospitalized and do not improve, and finally, 10% die mostly by suicide.
Course of schizophrenia over 10 and 30
years�over a 30-year period, 25% of patients
recover fully, 35% improve significantly and reach relative independence, 15% improve but require extensive support, 10% remain hospitalized and unimproved, and finally, 15% die mostly as a result of suicide
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