Introduction. The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind).Schizophrenia is probably caused by a combination of factors, including:Of all mental illnesses, schizophrenia probably causes moreLengthy hospitalizationsChaos in family li
1. Schizophrenia and Other Psychotic Disorders
2. Introduction The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind).
Schizophrenia is probably caused by a
combination of factors, including:
Of all mental illnesses, schizophrenia probably causes more
Chaos in family life
Exorbitant costs to people and governments
3. Nature of the Disorder Schizophrenia disturbs
Thought processes, Perception and Affect
With schizophrenia, there is a severe deterioration of social and occupational functioning
* In the United States, the lifetime prevalence of schizophrenia is about 1 percent.
4. Premorbid behavior of the patient with schizophrenia can be viewed in four phases.
First Phase: Schizoid Personality
Indifferent, cold, and aloof, these people are loners. They do not enjoy close relationships with others.
Second Phase: Prodromal Phase
These people are socially withdrawn and show evidence of peculiar or eccentric behavior.
Neglect of personal hygiene and grooming
Blunted or inappropriate affect
Disturbances in communication
Lack of initiative
Third Phase: Schizophrenia
In the active phase of the disorder, psychotic symptoms are prominent
Impairment in work, social relations, and self-care
Fourth Phase: Residual Phase
Symptoms similar to those of the prodromal phase
Flat affect and impairment in role functioning are prominent
5. Predisposing Factors Various physical conditions
Head injury in adulthood
Systemic lupus erythematosus
6. Characteristic Symptoms Positive symptoms:
Grossly disorganized or catatonic behavior
7. Types of schizophrenia and other psychotic disorders Paranoid
Schizoaffective disorder Brief psychotic disorder
Shared psychotic disorder
substance-Induced psychotic disorder
8. Content of Thought Delusions Of Persecution
Of control or influence
Form Associative Looseness
9. Perception Hallucination
Affects Inappropriate affect
Bland or flat affect
10. Conventional Antipsychotics Generic
11. Conventional Antipsychotics Advantage
-Effective for positive
- Available in IM
formulation for acute
- Cheap Disadvantage
Minimally effective for
Higher incidence of
side effects (EPS, NMS,
tardive dyskinesia, etc.
12. Atypical Antipsychotics Generic
Risperdal (Consta, M-tab)
Seroquel, Seroquest XR
13. Atypical Antipsychotics Advantage
Effective for positive
of symptoms of
May improve negative
Lower incidence of
side effects compared to conventional antipsychotics
Higher incidence of
Higher incidence of
14. Side Effects Neuroleptic malignant syndrome (NMS)
Potentially life threatening
High fever, unstable BP, myoglobinemia
Extrapyramidal symptoms (EPS)
Involuntary muscle symptoms similar to those of Parkinson’s disease
Akathisia (distressing muscle restlessness)
Acute dystonia (painful muscle spasms)
Treated with benztropine (Cogentin) and trihexyphenidyl (Artane)
Tardive dyskinesia (TD)
Involuntary contractions of oral and facial muscles
Choreoathetosis (wavelike movements of extremities)
Occurs with continuous long-term antipsychotic therapy
15. Nursing Process Nursing Assessment
16. A 29 year old woman is being discharged in 2 days form the hospital after her first psychotic break (paranoid schizophrenia). She is recently divorced and has been working as a legal secretary, although her work had become erratic, and her suspicious behavior was calling attention to herself at work. She will be discharged in her mother’s care until she is able to resume working. Her mother is overwhelmed and asked the nurse how she is going to cope. “She has become so distant and she always takes thing the wrong way. I can hardly say anything to her with her misconstruing everything. She is very mad at me because I called 911 and had her admitted after she told me she was going to get justice back in the world by blowing up evil forces that have been haunting her life and then proceeded to try to run over her ex-husband, thinking he was the devil. She told me there is nothing wrong with her and I am concerned she won’t take her medication once she is discharge.
17. What are some of the priority concern that nurse could address in the hospital setting before she is discharge?
How would you explain to the mother some of the symptoms that she is experience in? What suggestion could you give her to handle some of the immediate concerns?
What issues could you bring up to the staff about her medication compliance? What would be some ways to deal with this issue?
4. What do you think of the prognosis for her? Support your hypothesis with data regarding influences on the course of schizophrenia.