1. Mental Health Nursing-NUR 417 Schizophrenia
Lecture 5
Mental Health Nursing-NUR 417
Schizophrenia
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2. Introduction
The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind).
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3. Introduction (cont.)
More than any other mental illness, schizophrenia probably causes more
Lengthy hospitalizations
Chaos in family life
Exorbitant costs to people and governments
Fears
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4. Nature of the Disorder Schizophrenia:
A serious mental disorder characterized by:
Disorganized and delusional thinking (Thought processes)
Disturbed perceptions/hallucinations
Inappropriate emotions and actions (affect)
With schizophrenia, there is a severe deterioration of social and occupational functioning
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5. Etiological Implications
Schizophrenia is probably caused by a
combination of factors, including
Biological and Heritability predisposition
Biochemical Causes
Physiological factors
Psychosocial stress
Environmental factors
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6. Etiological Implications
Biological and Heritability predisposition
Genetics plays an important role in the development of schizophrenia.
Biochemical Causes
Dopamine Hypothesis: schizophrenia is caused by excessive dopamine activity.
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7. Predisposing Factors (cont.)
Physiological influences
Examples of Various physical conditions
Epilepsy
Birth trauma
Head injury
Alcohol abuse
Cerebral tumor
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8. Predisposing Factors (cont.)
Psychosocial influences
Deeply disrupted family.
Stressful life events.
Environmental influences
Viral epidemics: associated with viral diseases
Low-socioeconomic
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9. Diagnosis
Schizophrenia is diagnosed based on talking with the patient, and looking at his or her behaviour and experiences.

10. Diagnosis – Examples of Important Tests
MRI (Magnetic resonance imaging)
Identifies brain changes
PET (Positron emission tomography) (is a nuclear medicine imaging)
Determines brain activity
EEG )Electroencephalography(
An electrophysiological monitoring method to record electrical activity of the brain
Neurologic examination
Neuropsychologic tests
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11. Types of Schizophrenia
Catatonic schizophrenia
Characterized by marked psychomotor disturbance
Catatonic stupor: characterized by extreme psychomotor retardation; patient usually mute
Catatonic excitement: Extreme psychomotor agitation; purposeless movements that must be curtailed to prevent injury to client or others
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12. Types of Schizophrenia
Disorganized schizophrenia
Inappropriate affect
Extremely disorganized behavior
Social interaction impaired
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13. Types of Schizophrenia
Paranoid schizophrenia
Characterized by hallucinations, delusions, and persecutory (feeling victimized) or grandeur
Client may be argumentative, and aggressive
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14. Types of Schizophrenia
Residual schizophrenia
Used to diagnose a person who has a history of at least one episode of schizophrenia with prominent psychotic symptoms
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15. Types of Schizophrenia
Schizoaffective disorder
Schizophrenic symptoms accompanied by a strong element of symptomatology associated with mood disorders, either manic or depressive
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16. Types of Schizophrenia
Brief psychotic disorder
Sudden onset of psychotic symptoms following a severe psychosocial stressor
Symptoms persist less than 1 month
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17. Types of Schizophrenia
Schizophreniform disorder
Same symptoms as schizophrenia.
The duration of the disorder has been at least 1 month but fewer than 6 months
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18. Types of Schizophrenia
Undifferentiated schizophrenia
Characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior
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19. Nursing Process: Assessment
Content of thought
Delusions: False personal beliefs
Religiosity: Excessive demonstration of obsession with religious ideas and behavior
Paranoia: Extreme suspiciousness
of others

20. Nursing Process: Assessment (cont.)
Content of thought (cont.)
Word salad: Group of words put together
in a random fashion
Magical thinking: Idea that if one thinks something, it must be true
Mutism: Inability or refusal to speak

21. Nursing Process: Assessment (cont.)
Form of thought
Associative looseness: Shift of ideas from one unrelated topic to another
Neologisms: Made-up words that have meaning only to the person who invents them
Perseveration: Persistent repetition of the same word or idea in response to different questions

22. Nursing Process: Assessment (cont.)
Perception
Hallucinations: False sensory perceptions not associated with real external stimuli
Illusions: Misperceptions of real external stimuli

23. Nursing Process: Assessment (cont.)
Affect: Emotional tone
Inappropriate affect: Emotions are incongruent with circumstances
Apathy: Lack of interest in environment
Emotional ambivalence: Coexistence of opposite emotions toward same object

24. Nursing Process: Assessment (cont.)
Sense of Self: The uniqueness and individuality a person feels
Echolalia: Repeating words that are heard
Echopraxia: Repeating movements that are observed

25. Nursing Process: Assessment (cont.)
Impaired interpersonal functioning and relationship to the external world
Autism
Deterioration in appearance: Impaired personal grooming and self-care activities

26. Nursing Process: Assessment (cont.)
Psychomotor behavior (cont.)
Anergia: Deficiency of energy
Posturing: Voluntary assumption of
inappropriate or bizarre postures
Pacing and rocking: Pacing back
and forth and rocking the body

27. Nursing Process: Assessment (cont.)
Positive and negative symptoms
Positive symptoms: Excess or distortion of normal functions
Negative symptoms: Deficit or loss of normal functions

29. List of Nanda Nursing Diagnosis for Schizophrenia
Ineffective role performance
Powerlessness
Risk for injury
Risk for other-directed violence
Risk for self-directed violence
Social isolation
Imbalanced nutrition: Less than body requirements
Impaired home maintenance
Impaired social interaction
Impaired verbal communication
Ineffective coping

30. List of Nanda Nursing Diagnosis for Schizophrenia
Disturbed personal identity
Disturbed sensory perception (auditory, visual)
Disturbed sleep pattern
Disturbed thought processes
Dressing or grooming self-care deficit
Fear
Anxiety
Bathing or hygiene self-care deficit
Disabled family coping
Disturbed body image

31. Planning
The client
Demonstrates an ability to relate to others satisfactorily
Recognizes distortions of reality
Has not harmed self or others
Perceives self realistically
Demonstrates ability to perceive the environment correctly
Maintains anxiety at a manageable level
Demonstrates ability to trust others
Uses appropriate verbal communication in interactions with others
Performs self-care activities independently

32. Nursing interventions for the client with schizophrenia are aimed at:
Implementation
Nursing interventions for the client with schizophrenia are aimed at:
Decreasing anxiety and establishing trust
Assisting client to define and test reality
Encouraging interaction with others
Ensuring safety of client and others
Meeting client’s self-care needs
Promoting adaptive family coping

33. Implementation -Client/Family Education
Management of illness
Appropriate medication management
Side effects of medications
Importance of not stopping medications
When to contact healthcare provider
Relaxation techniques
Social skills training
Daily living skills training

34. Treatment Modalities
Schizophrenia requires treatment that is comprehensive and presented in a multidisciplinary effort.
Psychological treatments
Individual psychotherapy: Long-term therapeutic approach difficult because of client’s impairment in interpersonal functioning

35. Treatment Modalities (cont.)
Psychological treatments (cont.)
Group therapy: Some success if participating over long-term course of the illness; less successful in short-term treatment
Behavior therapy
Occupational therapy

36. Treatment Modalities (cont.)
Psychological treatments (cont.)
Social skills training: Use of role play to teach client appropriate eye contact, interpersonal skills, posture, and so on, aimed at improving relationship development
Electroconvulsive therapy

37. Treatment Modalities (cont.)
Social treatment
Milieu therapy: a type of inpatient therapy, involving prescription of particular activities and social interactions according to a patient's emotional and interpersonal needs
Family therapy: Aimed at helping family members cope with long-term effects of illness

38. Treatment Modalities (cont.)
Psychopharmacology
Antipsychotics: Used to decrease agitation and psychotic symptoms
Antiparkinsonian agents
Others: example:
Diazepam (used to treat anxiety disorders, or muscle spasms.)
Propranolol (used to treat tremors, angina (chest pain), hypertension, heart rhythm disorders, and other heart or circulatory conditions.)

39. Treatment Modalities (cont.)
Side effects for Antipsychotics (e. x:)
Nausea; GI upset; weight gain
Sedation
Decreased libido
Gynecomastia; amenorrhea
The client should
Not stop taking the drug abruptly
Not consume other medications (including over-the-counter drugs) without the physician’s knowledge

40. Evaluation Evaluation questions
Has client established trust with at least one staff member?
Is anxiety level maintained at a manageable level?
Is delusional thinking still prevalent?
Is client able to interrupt anxiety with adaptive coping mechanisms?
Is client easily agitated?