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SCHIZOPHRENIA

What is Schizophrenia?
Schizophrenia is a chronic mental illness with symptomatic manifestations of hallucinations, delusions, and social withdrawal. It usually begins before age 25 and it persists throughout life and affects persons of all social classes.

HISTORY

Benedict Morel (1809-1873)


He

had used the term demence precoce for deteriorated patients whose illness began in adolescence.

Emil Kraepelin (1856-1926)

He

translated Morels demence precoce into Dementia Praecox, a term that emphasized the distinct cognitive process (dementia) and early onset (praecox) of the disorder.

Patients with dementia praecox were described as having a long-term deteriorating course and the common clinical symptoms of hallucinations and delusions.

Eugen Bleuler (1857-1939)

He coined the term schizophrenia which replaced the term dementia praecox in literature.
He stressed that schizophrenia need not have a deteriorating course. His term schizophrenia has become the internationally accepted label for the disorder.

Bleulers Four As

Associations, Loose Affect, Blunted Autism Ambivalent

Meyer
The

founder of Psychobiology. He saw Schizophrenia as reaction to life stresses and called the syndrome a schizophrenic reaction.

Sullivan

Emphasized social isolation as a cause and a symptom of schizophrenia.

Langfeldt

Classified patients with major psychotic symptoms into two groups: 1. Those with true Schizophrenia
2. Those with a Schiozophrenia-like psychosis

Gender and Age

Schizophrenia is equally prevalent in men and women. It usually begins before age 25, and persists throughout life and affects persons of all social classes.

Fallacy
Schizophrenia is Split Personality
In

reality, split personality is Dissociative Identity Disorder according to DSM IV TR It differs completely from Schizophrenia.

Schizophrenic Thought Content

Subtypes of Schizophrenia

Paranoid Schizophrenia
It is characterized by preoccupation with one or more delusions or frequent auditory hallucinations Characterized by the presence of delusions of persecution and grandeur They are typically tense, suspicious, guarded, sometimes hostile or aggressive Their intelligence remains intact.

A Schizophrenic Paranoid Patient

Nursing Responsibilities

Do not whisper Provide sealed meal rations Establish rapport Provide a calm environment Medicate on time Encourage to sleep on time Provide reading materials

Disorganized Schizophrenia
Is characterized by a marked regression to primitive, disinhibited, and unorganized behavior. The onset is generally early before age 25 Thought disorder is pronounced and contact with reality is poor. Behavior is silly, fatuous and collective. Appearance is dilapidated and behavior is inappropriate.

Disorganized Schizophrenic Client

Nursing Responsibilities

Supervise hygiene Monitor patient belongings Provide calm environment Medicate on time Encourage sleeping on time Administer restraints as ordered

Catatonic Schizophrenia

They have marked disturbance in motor function. This disturbance may involve stupor, rigidity, excitement, and positioning. Associated features are stereotypies, mannerisms, and waxy flexibility. Mutism is particularly common. Patients need careful supervision during catatonic stupor or excitement.

Nursing Responsibilities

Provide nutrition Provide safety Provide restraints as ordered Provide calm environment Medicate on time Encourage to sleep on time

Residual Schizophrenia

Characterized by a continuing evidence of schizophrenic disturbance in the absence of a complete set of active symptoms. Emotional blunting, social withdrawal, eccentric behavior, illogical thinking and mild loosening of associations commonly appear with this type.

Nursing Responsibilities
Medicate on time Encourage to sleep on time Encourage client to join art and occupational therapy in order to find ones aesthetic skills Encourage client to verbalize feelings. Provide calm environment

Schizophrenia Undifferentiated

These patients are clearly schizophrenic but cannot be easily fitted into one or another type.

Nursing Responsibilities

Medicate on time Encourage to sleep on time Encourage verbalization of feelings

Anti- Psychotic Medications


Lower end: Chlorpromazine (thorazine/Laractyl) Haloperidol Levomepromazine

Anti-psychotic Medications
Higher end Olanzapine Risperidone (Risperdal) Amisulpride (Solian) Clozapine (Leponex)

Depot Medications

Fluphenazine (Shrizine) Haloperidol (HALDOL) Decanoas Risperidone Consta

Tranquilizers

Haloperidol 5mg/ml - For restraining the client chemically

Anti-EPS: Biperiden (Akineton) - Available in tablet and in vial