Schizophrenia POFSEEOR DR ELHAM FAYAD At the end

Schizophrenia POFSEEOR DR, ELHAM FAYAD

At the end of this lecture the students will be able to: Explain the meaning of schizophrenia Discuss symptoms of schizophrenia Differentiate and contrast etiological factors Determine schizophrenia subtypes Assess client with schizophrenia Develop a nursing care plan for a client with schizophrenia

Out line § Definition § Etiological factors related to schizophrenia § Symptoms of schizophrenia § Subtypes of schizophrenia § Assess client with schizophrenia § Develop a nursing care plan for a client with schizophrenia

The term schizophrenia, means "split mind, “

1. Autistic thinking Start with fantasy & day dream ending by delusion & hallucination 2. Associative looseness Illogically connected things. 3. Ambivalence holding 2 different emotion to the same person at the same time. 4. Apathy Absent of emotional experience & expression

a. Role of Neurotransmitters: Common impaired neurotransmitters are acetylcholine , dopamine, norepinephrine, serotonin & Gamma Aminobutyric Acid (GABA).

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§ The risk for inheriting schizophrenia is 10 % in those who have one immediate family member with the disease § About 40% if the disease affects both parents and an identical twin. § About 60% of people with schizophrenia have no close relatives with the illness.

a. Infectious The viruses as a cause of schizophrenia such as living in crowded conditions. b. Seasonal factors The risk for schizophrenia worldwide is 5 – 8 % higher for those born during winter and spring, when colds and viruses are more prevalent. Pregnant Mother's Exposure to Viruses.

a- Psychoanalytic and developmental theories : Psychoanalytic theory states that there are distortions in the mother-child relationship, so that the child is unable to progress beyond dependence.

According to learning theory, the irrational ways of handling situations, the distorted thinking, and the deficient communication patterns of persons with schizophrenia are a result of poor parental models in early childhood.

1. Double bind 2. Scapegoat 3. Eschewed family 4. Schismatic family

positive symptoms. a. b. c. d. e. Delusions: Hallucinations Disorganized Thinking Disorganized Behavior Catatonic Behavior

Negative symptoms Withdrawal, Loss of Motivation & Ambivalence Loss of Feeling or an Inability to Experience Pleasure (Anhedonia) Poverty of Speech (A logia) Flat Presentation (Affective Flattening

The disorganized type of schizophrenia is characterized by a severe disintegration of the personality. Word salad Incoherent speech Clang association

Major feature, manifestations of psychomotor disturbance include. Stupor Excitement Mutism Other symptoms include Echopraxia Echolalia stereotypy

Undifferentiated schizophrenia cannot be classified as paranoid, disorganized, or catatonic. It does not clearly meet the criteria necessary for a diagnosis.

An individual has had at least one acute episode of schizophrenia and is now free of prominent positive symptoms, but has some negative symptoms he is diagnosed as suffering from residual schizophrenia. The usual signs of the illness are Illogical thinking, Loosening of associations Emotional blunting Social withdrawal Eccentric (bizarre) behavior

Positive Symptoms 1. Thought process disturbed DELUSIONS: Types: Paranoid delusion Ideas of reference Delusion of grandeur Delusion of jealousy Delusion of persecution Somatic delusion

Thought broadcasting: the belief that one’s thoughts can be heard by others Thought insertion, the belief that thoughts of others are being inserted into one’s mind Thought withdrawal, the belief that thoughts have been removed from one’s mind by an outside agency Delusion of being control

OTHER THOUGHT SYMPTOMS Lose association: the thought process becomes illogical & confused. Neologisms: made up words that have a special meaning to the delusional person. Concrete thinking: an overemphasis on small or specific details & an impaired ability to abstract. Clang associations: the meaningless rhyming of a word in a forceful way.

2. Sensory Perception disturbed Hallucination Types: Mainly auditory, commanding, commenting, or two voices conversing to each other Depersonalization Derealization

Nursing Management Common diagnoses applicable to schizophrenia. 1 - thought processes disturbance. 2 - Sensory perceptual disturbance 4 - Social isolation. 5 - Ineffective individual coping. 6 - Self-care deficit 8 - Risk for violence (directed at others &self)

Thought process disturbed Related to Biologic factors (neurophysiologic, genetic) sensory-perceptual disturbance Psychosocial/environmental stressors Evidenced by Demonstrated neologisms, word salad, thought blocking, thought insertion, thought withdrawal, poverty of speech , or Mutism

Goals Demonstrate reality-based thinking in verbal and nonverbal behavior. Demonstrate absence of psychosis (delusions, incoherent, illogical speech , magical thinking ideas of references, thought blocking thought insertions , thought broadcasting).

Nursing Intervention Refrain from touching a client who is experiencing a delusion especially if it is a persecutory type. Touch may be interpreted as a physical or sexual assault. Avoid challenging the client’s delusional system or clients, since delusion cannot be changed through logic. Distract the client from the delusion by engaging him in a less threatening or more comforting topic or activity at the first sign of anxiety or discomfort. Focus on the meaning, feeling , or intent provoked by the delusion rather than on the delusional content.

2. Sensory Perception disturbed Related to: Psychosocial stressors, loneliness and isolation. Withdrawal from environment. thought processes disturbance. Evidenced by Negligent to surroundings (preoccupied with hallucination) Startles when approached and spoken to others. Talks to self (lips move as if conversing with unseen presence Appears to be listening to voices or sounds when neither are present

Goals Able to hold conversation without hallucinating. Remains in group activities. Attends to the task at hand (e. g. group process, recreational or occupational therapy activity). States that hallucination are under control.

Nursing Interventions Call the client and staff members by their names to reinforce reality. Utilize clear statements. Utilize clear, direct communication Continuously orient patient to actual environmental events or activities , to present reality.

reinforce reality When danger or violence is imminent , protect the client and others by the following facility procedures and policies for seclusion , mechanical restraint to prevent harm or injury to client or others. Teach the client techniques that will help stop the hallucinations.

Nursing intervention goals are: Strengthening differentiation between delusion & reality PROMOTE SOCIALIZATION. IMPROVE ACTIVITY TOLERANCE. PROMOTE COPING. ENSURE SAFTY.

I AM A CLIENT COMPLAINING OF SCHIZOPHRENIA & NOT SCHIZOPHRENIC PATIENT

Elham fayad Thank you