schizophrenia presented by pawan tyagi

1. Presented by
Mr. pawan k. tyagi
M.Sc. [N] previous
PG COLLEGE OF NURSING GWALIOR

2. Introduction
 Schizophrenia is a group of psychotic disorders that
interfere with thinking and mental or emotional
responsiveness.
 Schizophrenia is a greek word that means breakdown
the personality.
schizo- split
phrenic- mind
 The term schizophrenia was first used in 1911 by Swiss
psychiatrist Eugen bleular.

3.  About three to four per 1000 in every community suffer
from schizophrenia.
 Schizophrenia is equally prevalent in men and women.
 The peak ages of onset are 15-25 years for men and 25-
35 years for women.

4. Definition
 According to American psychiatric association “A
group of disorders manifested by characteristic
disturbance of thinking, mood and behavior”.
 A severe mental disorder in which thinking and
emotion are so impaired that the individual is
seriously out of contact with reality.

5. Pre disposing factors
 There is no definite etiology of schizophrenia
probably. An increase in dopaminergic activity in the
brain has been found to be associated with the disease.
Several factors contribute to the development of
illness. Such as:-
1. Biological factors:- genetic factor, personality body
build, physical handicap, physical deprivation( mal
nutrition, sleep deprivation) etc.

6. Cont….
2. Psychosocial factors:- maternal deprivation,
overprotection of children, pathogenic interpersonal
relationship, stress etc.
3. Socio-cultural factors:- war & violence, economic &
employment problem etc.

7. Cont….
4. Other factors:-
- Intelligence
- Social isolation
- Neurotransmitter system disturbances
- Organic factors[infection, poison, trauma
- Physical and psychological stress

8. Psychopathology
Genetic predisposition Environmental, social &
psychological factor
Neurodevelopmental abnormalities & target features
Brain dysfunction, improper balance of chemicals
schizophrenia

9. Clinical manifestations
Positive symptoms:-
-hallucinations
-delusions
-disorganized speech, behavior & movement
-increase in goal directed activity
-illogical thoughts

10. Negative symptoms:-
-blunted affect
-impaired emotional responsiveness
-apathy
-loss of motivation & interest
-social withdrawal

11. Types of schizophrenia
F20.0 Paranoid Schizophrenia
F20.1 Disorganized Schizophrenia
F20.2 Catatonic Schizophrenia
F20.3 Undifferentiated Schizophrenia
F20.4 Post-schizophrenic depression
F20.5 Residual Schizophrenia
F20.6 simple schizophrenia

12. Paranoid Schizophrenia
 This is the most common type of
schizophrenia.
 It usually occur after 30 year of age.
 Delusions, hallucinations, misinterpretation of
facts are marked in them.
 Violent, suicidal behavior - high risk
 Ex: patient images that someone is trying to
harm him.

13. Disorganized Schizophrenia
(hebephrenic schizophrenia)
 It occur around the age of 20-25 year.
 Thinking disturbance is most marked.
 Hallucination & delusion present.
 Behavior of hebephrenic schizophrenic is
indicated as “silly” behavior.
e.g.-the pt urinates and defecats in the bed.
 Incoherent speech/thought
 Masturbates openly, resist wearing clothes.

14. Catatonic Schizophrenia
 Marked disturbance in thinking, behavior and affect.
 It occur around the age of 15-25 year.
• Prognosis is good but recurrences are common.
• ECT is very affective.
Catatonic patient present two main type of clinical
features
1.Catatonic stupor:-
 it follow depression & apathy.
 Mute, stupors and mask like face.

15. Cont….
 Cataplexy or waxy flexibility is present.
 Dribbling of saliva from angular region
 Involuntary passes urine and stool in the bed.
2. Catatonic excitement:-
 The pt may suddenly attack to anybody and
destroy articles, tear clothes and remain nude.
 Flow of speech from mutism to flight of ideas.
 Hallucination and sleeplessness are present.

16. Undifferentiated Schizophrenia
 Does not fit any of the categories
 Decrease in outside interests/relationships
 Absence of mental activity
 Lack of emotion
 Mixture of symptoms

17. Post-schizophrenic depression
 Depressive features develop in the presence
of residual or active features of
schizophrenia and are associated with an
increased risk of suicide.

18. Residual Schizophrenia
 This category should be used when there has been
at least one episode of schizophrenia in the past.
 Symptoms of residual schizophrenia include
emotional blunting, illogical thinking and social
withdrawal.
 No motivation or interest in life.

19. Simple schizophrenia
 Presence of characteristic negative symptoms,
wandering tendency and aimless activity.
 It differs from residual schizophrenia in that there
never has been an episode with all the typical
psychotic symptoms.
 The prognosis is very poor.

20. Treatment/management of
schizophrenia
 The selection and method of treatment will depend on
the type of schizophrenia. The approach to treatment
is as follows:-

21. 1. Electro-convulsive therapy
About 10-12 E.C.T. spread over a period of 4-6 weeks.
Indications:-
i. Catatonic or paranoid schizophrenia
ii. Stupor, excitement or violent behavior of the pt.
iii. Associated symptoms of depression or mania
iv. Suicidal tendencies
v. Pt not responding to other treatment

22. 2. Pharmacological mgt
Antipsychotic drugs( to suppress dopamine activity)
such as clozopine, resperidone, heloperidol,
chlorpromazine.
Antiparkinsonism drugs may be given to reduce the
risk of extra pyramidal symptoms ( the side effect of
antipsychotic drug)
Anxiolytics/sedatives-lorazepam, clonazepam.

23. 3. Psychotherapy
 Supportive or superficial psychotherapy are given to
the schizophrenic pt.
such as individual therapy, occupation therapy, group
therapy, music therapy etc.

24. 4. Family psycho education
 About the disease and its nature

25. 5. Nursing management
Nursing diagnosis-
 Disturbed thought process, related to inability to trust,
anxiety, delusional thinking.
 Difficulty in sleeping.
 Self care deficit related to withdrawal, panic anxiety,
cognitive impairment.

26.  Potential for violence, self directed or at others related
to command hallucinations.
 Social isolation related to inability to trust, panic
anxiety, delusional thinking.
 Impaired verbal communications related to unrealistic
thinking.

27. Nursing interventions
 Observe behavior pattern, posturing, appearance,
hygiene, psychomotor activities.
 Ask the pt about feelings while thought alterations are
evident.
 Assess the speech patterns.
 Assess the theme & content of delusional thinking.
 Assess the ability to perform self care activity.
 Determine any suicidal intent or recent attempts.

28. Assignment
Write down the nursing care plan of a
schizophrenic patient.