CHAPTER ONE

INTRODUCTION

Background of the study

Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and
behaves. It is characterized by episodes of psychosis, which may include hallucinations, delusions,
disorganized thinking, and impaired functioning. Schizophrenia affects approximately 1% of the global
population, with similar prevalence rates across cultures and sexes. It typically emerges in late
adolescence to early adulthood, although it can occur at any age. Men tend to develop symptoms earlier
than women. Schizophrenia may result in a mix of hallucinations, delusions, and disorganized thinking
and behavior. Hallucinations involve seeing things or hearing voices that aren't observed by others.
Delusions involve firm beliefs about things that are not true. People with schizophrenia can seem to lose
touch with reality, which can make daily living very hard. People with schizophrenia need lifelong
treatment. This includes medicine, talk therapy and help in learning how to manage daily life activities.
Because many people with schizophrenia don't know they have a mental health condition and may not
believe they need treatment, many research studies have examined the results of untreated psychosis.
People who have psychosis that is not treated often have more-severe symptoms, more stays in a
hospital, poorer thinking and processing skills and social outcomes, injuries, and even death. On the
other hand, early treatment often helps control symptoms before serious complications arise, making
the long-term outlook better.(Mayo clinic, 2024)

The historical context of schizophrenia is crucial for understanding the current stigma and
misconceptions surrounding the disorder. In ancient times, mental illnesses like schizophrenia were not
well understood. The historical context of schizophrenia is crucial for understanding the current stigma
and misconceptions surrounding the disorder. In ancient times, mental illnesses like schizophrenia were
not well understood. As humanity entered the Renaissance and Enlightenment periods, there was a
gradual shift towards naturalistic explanations for mental disorders. This era marked the beginning of
attempts to understand mental illnesses, including schizophrenia-like symptoms, through a scientific
lens rather than as manifestations of spiritual or demonic influences. This transition laid the foundation
for modern psychiatry and the eventual scientific study of mental health disorders.(Erin, 2024)

The first, formal description of schizophrenia as a mental illness was made in 1887 by Dr. Emile
Kraepelin. He used the term “dementia praecox” to describe the symptoms now known as
schizophrenia. Dementia praecox means “early dementia”. By calling his syndrome ‘early dementia’, he
meant to differentiate it from dementias that occur later in life such as Alzheimer’s disease (senility).
Correctly, Kraepelin believed that dementia praecox was primarily a disease of the brain. However, he
was mistaken in believing that this disorder was a form of dementia. It is now known that schizophrenia
and dementia (mental deterioration) are distinct disorders.(Erin, 2024)
The term “schizophrenia” was first used in 1911 by a Swiss psychiatrist, Eugen Bleuler. It comes from the
Greek roots schizo (split) and phrene (mind). Bleuler used this name to emphasize the mental confusion
and fragmented thinking characteristic of people with the illness. His term was not meant to convey the
idea of an actual split personality or multiple personality. This confusion has, however, become a
common and rather entrenched myth regarding schizophrenia that continues to this [Link]
Bleuler was the first to describe symptoms as “positive” or “negative”, both Kraepelin and Bleuler
recognized that schizophrenia symptoms tended to cluster into distinct categories. They created a
typology of schizophrenic subtypes that continues to be used today. Modern schizophrenic categories
recognized by the DSM (Diagnostic and Statistical Manual of Mental Disorders; the repository of mental
health diagnoses, currently in its fourth, text-revised edition) include paranoid, disorganized, catatonic,
residual, and undifferentiated subtypes, each based on a particular distinct symptom cluster. (Erin,
2024)

The next major contribution to the progress of understanding schizophrenia came when Kurt Schneider
listed his ‘first rank’ features of the disease in 1959. This important work effectively differentiated
schizophrenia from other psychoses and served as the inspiration for the two diagnostic manuals widely
used to define modern schizophrenia, the International Classification of Diseases (ICD, currently in its
10th edition) and the DSM. The definition and diagnostic criteria for schizophrenia codified in these
manuals continue to evolve today, based primarily on new scientific research and findings that further
illuminate the illness. As the classification of schizophrenia became more refined, so too did the theories
of how it was caused. Gregory Bateson and colleagues offered the “double bind” theory in the middle
1950’s. This theory proposed that schizophrenia was caused by particular forms of bad parenting,
specifically where parents explicitly said one thing and then contradicted that thing with implicit
unconscious messages of opposite content. For example, parents might praise their child, but treat him
poorly. This theory has been largely discredited and discarded for lack of convincing scientific evidence.
However, the idea that stressful life events (such as having crazy parents) can play a role in causing
schizophrenia continues to be important in modern psychiatric research and “diathesis-stress” models
of schizophrenia.(Erin, 2024).

A diathesis is a vulnerability. Diathesis-stress models of schizophrenia basically propose that people have
predispositions and vulnerabilities for schizophrenia (diatheses). Some people have more of these
susceptibilities than others, for varying reasons having to do with genetics, biology and experience.
However, propensity towards schizophrenia alone is not enough to trigger the disorder. Instead,
people’s vulnerabilities must interact with life stresses to trigger the onset of psychotic symptoms and
the illness. The greater a person’s inherent propensity for developing schizophrenia, the less stress is
necessary to trigger a psychotic episode and get the disorder started. Conversely, where there is a
smaller susceptibility for developing schizophrenia, a greater stress is required to produce the disorder.
Until this critical amount of stress is reached (however much or little of it is necessary) people cannot be
said to have schizophrenia, and their vulnerabilities might be said to be “latent” (hidden). Various
sources of stress may combine to produce the releasing effect, including stressors which are
psychological, social, and biological (including trauma, depression, viruses, birth complications, and
similar illnesses). The use of certain ‘recreational’ drugs such as marijuana or psychedelics like LSD may
also be capable of releasing a hidden diathesis towards developing schizophrenia.(Erin,2024).

Modern science has made significant strides in genetic research and neuroimaging studies related to
schizophrenia. Genetic research is unraveling the intricate ways in which genes may contribute to the
risk of developing schizophrenia, providing a clearer picture of its hereditary aspects. Concurrently,
advancements in neuroimaging techniques like MRI and PET scans are offering unprecedented insights
into how schizophrenia affects brain structure and activity. These contributions are crucial in enhancing
our understanding of the biological foundations of schizophrenia and are instrumental in paving the way
for more personalized and effective treatments. The role of patient advocacy and the incorporation of
lived experiences in the treatment and policy-making processes are gaining increasing recognition.
Acknowledging the value of firsthand experiences, healthcare professionals and policymakers are
engaging more actively with individuals who have schizophrenia. This approach is fostering a more
holistic understanding of the condition, leading to treatment models and policies that are more
responsive to the actual needs of those affected by schizophrenia. (Erin,2024).

Statement of Problem

Despite the increasing prevalence of schizophrenia and its significant impact on individuals and society,
there remains a lack of comprehensive understanding and effective education about the disorder among
nursing students. This study aims to investigate the perceptions of student nurses at the College of
Nursing Science, Mental Health/Psychiatric Nursing in FNPH Enugu, towards schizophrenia, as their
attitudes and knowledge can directly influence their future clinical practice, interactions with patients,
and the stigma surrounding mental health. Understanding these perceptions is crucial for developing
educational programs that enhance the readiness of nursing students to manage and support patients
with schizophrenia effectively.

Broad Objective

The general purpose of the study is to explore the perceptions of student nurses at the College of
Nursing Science, Mental health/Psychiatric Nursing in FNPH Enugu, towards schizophrenia, including
their understanding of the condition, attitudes towards individuals diagnosed with schizophrenia, and
the influence of these perceptions on their future professional practice and patient care.

Specific Objective of the study

The specific objectives of the study are to:

1. To acess the level of knowledge students nurses at college of nursing science,mental

health/psychiatric nursing in FNPH, Enugu, have about schizophrenia.

2. To ascertain the attitude of students nurses at college of nursing science,mental health/psychiatric

nursing in FNPH, Enugu, towards individuals living with schizophrenia
3. To determine the preparedness of students nurses at college of nursing science,mental
health/psychiatric nursing in FNPH, Enugu, in managing patients with schizophrenia.

Research Questions

1. What is the level of knowledge of student nurses at college of nursing science,mental

health/psychiatric nursing in FNPH, Enugu, about schizophrenia?

2. What are the attitudes of student nurses at college of nursing science,mental health/psychiatric
nursing in FNPH, Enugu, towards individuals living with scschizophrenia?

3. How prepared are student nurses at college of nursing science,mental health/psychiatric nursing in
FNPH, Enugu, in managing patients with schizophrenia?

The significance of the study

The information obtained from this study will improve patient's care by understanding student nurses'
perceptions which can highlight areas needing improvement in their training, ultimately enhancing the
quality of care provided to individuals with schizophrenia. Also the findings can guide curriculum
developers in nursing programs to address gaps in knowledge and attitudes towards mental health,
ensuring future nurses are better equipped to handle psychiatric conditions. By exploring perceptions,
the study can contribute to strategies aimed at reducing stigma associated with schizophrenia,
promoting a more compassionate and informed approach to mental health care among future
healthcare professionals. Understanding student nurses perceptions can help identify the support needs
of nursing students as they prepare to work in mental health settings, facilitating the development of
targeted educational resources and interventions.

Scope of the study

This study is delimited to the perception of student nurses at college of nursing science,mental
health/psychiatric nursing in FNPH, Enugu, towards schizophrenia.

Operational Terms

1. Perception: Refers to the awareness and interpretation of student nurses' knowledge, attitudes, and
preparedness regarding schizophrenia.

2. Knowledge: The level of understanding that student nurses possess about schizophrenia, including its
symptoms, causes, treatment options, and management strategies.
3. Attitude: The feelings and beliefs that student nurses hold towards individuals living with
schizophrenia, reflecting their openness, empathy, stigma, and overall willingness to engage with these
patients.

4. Preparedness: The readiness and confidence of student nurses to effectively manage and care for
patients with schizophrenia.

5. Student Nurses: Individuals enrolled in the nursing program at the College of Nursing Science, Mental
Health/Psychiatric Nursing in FNPH Enugu, with a focus on those specializing in mental
health/psychiatric nursing.

6. Mental Health/Psychiatric Nursing: A specialized field of nursing that focuses on the care and
treatment of patients with mental illnesses, including schizophrenia.

7. FNPH (Federal Neuro-Psychiatric Hospital): The designated institution providing clinical experiences
and educational resources for student nurses in the study area, specifically relevant to psychiatric
nursing.

8. Schizophrenia: A chronic mental disorder characterized by delusions, hallucinations, disorganized

thinking, and negative symptoms, impacting social and occupational functioning. The students’
understanding of this condition will be a focal point of the study.

CHAPTER TWO

LITERATURE REVIEW
This chapter discusses the literature review under the following headlights; conceptual framework,
Theoretical framework, Empirical Review and Summary of literature Review.

Conceptual Review

Concepts of Schizophrenia

Schizophrenia is a chronic and severe mental disorder affecting 20 million people worldwide (Bhandari,
2022).Schizophrenia is characterized by distortions in thinking, perception, emotions, language, sense of
self and behavior. Common experiences include hallucinations (hearing voices or seeing things that are
not there) and delusions (fixed, false beliefs).Worldwide, schizophrenia is associated with considerable
disability and may affect educational and occupational performance (Bhandari, 2022).People with
schizophrenia are 2-3 times more likely to die early than the general population. This is often due to
preventable physical diseases, such as cardiovascular disease, metabolic disease and infections
(Bhandari, 2022). Stigma, discrimination and violation of human rights of people with schizophrenia is
common. Schizophrenia is treatable, treatment with medicines and psychosocial support is effective.
Facilitation of assisted living, supported housing and supported employment are effective management
strategies for people with schizophrenia (Bhandari, 2022).

Causes of schizophrenia

The exact causes of schizophrenia are unknown. Research suggests a combination of physical, genetic,
psychological and environmental factors can make a person more likely to develop the condition. Some
people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic
episode. However, it's not known why some people develop symptoms while others do not
(Washington, 2023)

Increased risk

Genetics

Schizophrenia tends to run in families, but no single gene is thought to be [Link] is more likely
that different combinations of genes make people more vulnerable to the condition. However, having
these genes does not necessarily mean you will develop schizophrenia. Evidence that the disorder is
partly inherited comes from studies of twins. Identical twins share the same genes.

In identical twins, if a twin develops schizophrenia, the other twin has a 1 in 2 chance of developing it,
too. This is true even if they are raised separately. In non-identical twins, who have different genetic
make-ups, when a twin develops schizophrenia, the other only has a 1 in 8 chance of developing the
condition. While this is higher than in the general population, where the chance is about 1 in 100, it
suggests genes are not the only factor influencing the development of schizophrenia (Washington,
2023).

Brain development
Studies of people with schizophrenia have shown there are subtle differences in the structure of their
brains. These changes are not seen in everyone with schizophrenia and can occur in people who do not
have a mental illness. But they suggest schizophrenia may partly be a disorder of the brain (Washington,
2023)

Neurotransmitterss

Neurotransmitters are chemicals that carry messages between brain cells. There is a connection
between neurotransmitters and schizophrenia because drugs that alter the levels of neurotransmitters
in the brain are known to relieve some of the symptoms of schizophrenia. Research suggests
schizophrenia may be caused by a change in the level of 2 neurotransmitters: dopamine and serotonin.

Some studies indicate an imbalance between the 2 may be the basis of the problem. Others have found
a change in the body's sensitivity to the neurotransmitters is part of the cause of schizophrenia
(Washington, 2023).

Pregnancy and birth complications

Research has shown people who develop schizophrenia are more likely to have experienced
complications before and during their birth, such as:

* a low birthweight

* premature labour

* a lack of oxygen (asphyxia) during birth

It may be that these things have a subtle effect on brain development (Bhandari, 2022)

Triggers

Triggers are things that can cause schizophrenia to develop in people who are at risk. These include:

Stress:

The main psychological triggers of schizophrenia are stressful life events, such as:

* bereavement

* losing your job or home

* divorce
* the end of a relationship

* physical, sexual or emotional abuse.

These kinds of experiences, although stressful, do not cause schizophrenia. However, they can trigger its
development in someone already vulnerable to It (Bhandari, 2022).

Drug abuse

Drugs do not directly cause schizophrenia, but studies have shown drug misuse increases the risk of
developing schizophrenia or a similar illness. Certain drugs, particularly cannabis, cocaine, LSD or
amphetamines, may trigger symptoms of schizophrenia in people who are susceptible.

Using amphetamines or cocaine can lead to psychosis, and can cause a relapse in people recovering
from an earlier episode. Research has shown that teenagers and young adults who use cannabis
regularly are more likely to develop schizophrenia in later adulthood (NHS, 2019).

Early warning signs of schizophrenia

In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly,
with subtle warning signs and a gradual decline in functioning, long before the first severe episode.
Often, friends or family members will know early on that something is wrong, without knowing exactly
what.

In this early phase of schizophrenia, you may seem eccentric, unmotivated, emotionless, and reclusive
to others. You may start to isolate yourself, begin neglecting your appearance, say peculiar things, and
show a general indifference to life. You may abandon hobbies and activities, and your performance at
work or school can deteriorate (NHS, 2019).

The most common early warning signs include:

* Depression, social withdrawal

* Hostility or suspiciousness, extreme reaction to criticism

* Deterioration of personal hygiene

* Flat, expressionless gaze

* Inability to cry or express joy or inappropriate laughter or crying

* Oversleeping or insomnia; forgetful, unable to concentrate

* Odd or irrational statements; strange use of words or way of speaking

While these warning signs can result from a number of problems “not just schizophrenia” they are cause
for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved
one, seek medical advice. If schizophrenia or another mental problem is the cause, getting treatment
early will help (NHS, 2019).

Symptoms of schizophrenia

Positive Symptoms of Schizophrenia: Things That Might Start Happening

Positive symptoms are highly exaggerated ideas, perceptions, or actions that show the person cannot
tell what is real from what is not. Here the word "positive" means the presence (rather than absence) of
symptoms. They can include:

Hallucinations: People with schizophrenia might hear, see, smell, or feel things no one else does. The
types of hallucinations in schizophrenia include:

Auditory hallucination: The person most often hears voices in their head. They might be angry or urgent
and demand that they do things. It can sound like one voice or many. They might whisper, murmur, or
be angry and demanding.

Visual hallucination: Someone might see lights, objects, people, or patterns. Often it is loved ones or
friends who are no longer alive. They may also have trouble with depth perception and distance.

Olfactory and gustatory hallucination: This can include good and bad smells and tastes. Someone might
believe they are being poisoned and refuse to eat.

Tactile hallucination: This creates a feeling of things moving on your body, like hands or insects (NHS,
2019).

Delusions: A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it is
not true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who
have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies (NHS, 2019).

These are beliefs that seem strange to most people and are easy to prove wrong. The person affected
might think someone is trying to control their brain through TVs or that the FBI is out to get them. They
might believe they are someone else, like a famous actor or the president, or that they have
superpowers. Types of delusions include:

Persecutory delusions: The feeling someone is after you or that you are being stalked, hunted, framed,
or tricked.

Referential delusions: When a person believes that public forms of communication, like song lyrics or a
gesture from a TV host, are a special message just for them.
Somatic delusions: These center on the body. The person thinks they have a terrible illness or bizarre
health problem like worms under the skin or damage from cosmic rays.

Erotomanic delusions: A person might be convinced a celebrity is in love with them or that their partner
is cheating. Or they might think people they are not attracted to are pursuing them.

Religious delusions: Someone might think they have a special [Link] with a deity or that they are
possessed by a demon.

Grandiose delusions: They consider themselves a major figure on the world stage, like an entertainer or
a politician (NHS, 2019).

Disorganized speech

Schizophrenia can cause you to have trouble concentrating and maintaining your train of thought, which
may manifest itself in the way that you speak. You may respond to queries with an unrelated answer,
start sentences with one topic and end somewhere completely different, speak incoherently, or say
illogical things (Bhandari, 2022).

Common signs of disorganized speech include:

Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and
the next.

Neologisms – Made-up words or phrases that only have meaning to a schizophrenic patient.

Perseveration – Repetition of words and statements; saying the same thing over and over.

Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the
head”) (Bhandari, 2022).

Disorganized behavior - Schizophrenia disrupts goal-directed activity, impairing your ability to take care
of yourself, your work, and interact with others. Disorganized behavior appears as:

* A decline in overall daily functioning

* Unpredictable or inappropriate emotional responses

* Behaviors that appear bizarre and have no purpose

* Lack of inhibition and impulse control

Confused thoughts and disorganized speech: People with schizophrenia can have a hard time
organizing their thoughts. They might not be able to follow along when you talk to them. Instead, it
might seem like they are zoning out or distracted. When they talk, their words can come out jumbled
and not make sense (Bhandari, 2022).

Trouble concentrating: For example, someone might lose track of what is going on in a TV show as they
are watching.

Movement disorders: Some people with schizophrenia can seem jumpy. Sometimes they will make the
same movements over and over again. But sometimes they might be perfectly still for hours at a stretch,
which experts call being catatonic. Contrary to popular belief, people with the disease usually are not
violent (Bhandari, 2022).

Negative Symptoms of Schizophrenia: Things That Might Stop Happening

Negative symptoms refer to an absence or lack of normal mental function involving thinking, behavior,
and perception. You might notice:

Lack of pleasure: The person may not seem to enjoy anything anymore (Anhedonia).

Trouble with speech: They might not talk much or show any feelings. Doctors call this alogia.

Flattening: The person with schizophrenia might seem like they have a terrible case of the blahs. When
they talk, their voice can sound flat, like they have no emotions. They may not smile normally or show
usual facial emotions in response to conversations or things happening around them. It is referred to as
affective flattening.

Withdrawal (Apathy): This might include no longer making plans with friends or becoming a hermit.
Talking to the person can feel like pulling teeth: If you want an answer, you have to really work to pry it
out of them.

Struggling with the basics of daily life. They may stop bathing or taking care of themselves.
Avolition (No follow-through): People with schizophrenia have trouble staying on schedule or finishing
what they start. Sometimes they cannot get started at all (Bhandari, 2022).

Cognitive Symptoms & Thinking Problems

These symptoms reflect how well the person’s brain learns, stores, and uses information.

Someone with schizophrenia might have a hard time with their working memory. For example, they may
not be able to keep track of different kinds of facts at the same time, like a phone number plus
instructions. Along with having trouble paying attention, it can be hard for them to organize their
thoughts and make decisions (Bhandari, 2022).

Treatment Options for schizophrenia

Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with
medications and psychosocial therapy can help manage the condition. In some cases, hospitalization
may be needed. A psychiatrist experienced in treating schizophrenia usually guides treatment. The
treatment team also may include a psychologist, social worker, psychiatric nurse and possibly a case
manager to coordinate care. The full-team approach may be available in clinics with expertise in
schizophrenia treatment (Washington, 2023).

Treatment basics

The most effective treatment strategy for schizophrenia involves a combination of medication, therapy,
lifestyle changes, and social support (Washington, 2023).

Schizophrenia requires long-term treatment, most people with schizophrenia need to continue
treatment even when they’re feeling better, in order to prevent new episodes and stay symptom-free.
Treatment can change over time, though. As your symptoms improve, your doctor may be able to lower
the dosage or change your medication.

Medication for schizophrenia works by reducing psychotic symptoms such as hallucinations, delusions,
paranoia, and disordered thinking. But it is not a cure for schizophrenia. It is also much less helpful for
treating symptoms such as social withdrawal, lack of motivation, and lack of emotional expressiveness.
Finding the right drug and dosage is also a trial and error process. While medication should not be used
at the expense of your quality of life, be patient with the process and discuss any concerns with your
doctor (Washington, 2023).

Therapy can help you improve coping and life skills, manage stress, address relationship issues, and
improve communication. Group therapy can also connect you to others who are in a similar situation
and are able to offer valuable insight into how they have overcome challenges. Some therapies like;
Cognitive behavioral therapy (CBT)

CBT aims to help you understand links between your thoughts, feeling and actions. CBT will look at your
symptoms and how they affect your life, and also at your perceptions and beliefs. CBT improves
awareness of your episodes and gives you ways of coping with stress and other symptoms (Washington,
2023).

Arts therapies

Art therapy can help you learn new ways of relating to other people, show how you are feeling, accept
your feelings, and understand your feelings. If your psychosis reoccurs, art therapy should be
considered.

Arts therapy may be more useful if you have depressive symptoms such as withdrawing from family and
friends, as it usually takes place with a group to help combine communication with creativity
(Washington, 2023).

Self-help

Medication and therapy can take time to take full effect but there are still ways you can manage
symptoms, improve the way you feel, and increase your self-esteem. The more you do to help yourself,
the less hopeless and helpless you’ll feel, and the more likely your doctor will be able to reduce your
medication.

The keys to self-help include:

Seek social support: Friends and family vital to helping you get the right treatment and keeping your
symptoms under control. Regularly connecting with others face-to-face is also the most effective way to
calm your nervous system and relieve stress. Stay involved with others by continuing your work or
education. If that’s not possible, consider volunteering, joining a schizophrenia support group, or taking
a class or joining a club to spend time with people who have common interests. As well as keeping you
socially connected, it can help you feel good about yourself.

Manage stress: High levels of stress are believed to trigger schizophrenic episodes by increasing the
body’s production of the hormone cortisol. As well as staying socially connected, there are plenty of
steps you can take to reduce your stress levels. Try adopting a regular relaxation practice such as yoga,
deep breathing, or meditation.

Get regular exercise: As well as all the emotional and physical benefits, exercise may help reduce
symptoms of schizophrenia, improve his focus and energy, and help him feel calmer. Aim for 30 minutes
of activity on most days, or if it is easier, three 10-minute sessions. Try rhythmic exercise that engages
both the arms and legs, such as walking, running, swimming, or dancing.
Get plenty of sleep: when the patient is on medication, he most likely needs even more sleep than the
standard 8 hours. Many people with schizophrenia have trouble with sleep, but getting regular exercise
and avoiding caffeine can help.

Avoid alcohol, drugs, and nicotine: Substance abuse complicates schizophrenia treatment and worsens
symptoms. Even smoking cigarettes can interfere with the effectiveness of some schizophrenia
medications. If you have a substance abuse problem, seek help.

Eat regular, nutritious meals to avoid symptoms exacerbated by changes in blood sugar levels. Omega-3
fatty acids from fatty fish, fish oil, walnuts, and flaxseeds can help improve focus, banish fatigue, and
balance his moods (Washington, 2023).

Medications

Medications are the cornerstone of schizophrenia treatment, and antipsychotic medications are the
most commonly prescribed drugs. They're thought to control symptoms by affecting the brain
neurotransmitter dopamine (Bhandari, 2022).

The goal of treatment with antipsychotic medications is to effectively manage signs and symptoms at
the lowest possible dose. The psychiatrist may try different drugs, different doses or combinations over
time to achieve the desired result. Other medications also may help, such as antidepressants or anti-
anxiety drugs. It can take several weeks to notice an improvement in symptoms (Bhandari, 2022).

Because medications for schizophrenia can cause serious side effects, people with schizophrenia may be
reluctant to take them. Willingness to cooperate with treatment may affect drug choice. For example,
someone who is resistant to taking medication consistently may need to be given injections instead of
taking a pill.

Ask your doctor about the benefits and side effects of any medication that's prescribed (Bhandari,
2022).

Second-generation antipsychotics

These newer, second-generation medications are generally preferred because they pose a lower risk of
serious side effects than do first-generation antipsychotics. Second-generation antipsychotics include:

Aripiprazole (Abilify)

Asenapine (Saphris)

Brexpiprazole (Rexulti)
Cariprazine (Vraylar)

Clozapine (Clozaril, Versacloz)

Iloperidone (Fanapt)

Lurasidone (Latuda)

Olanzapine (Zyprexa)

Paliperidone (Invega)

Quetiapine (Seroquel)

Risperidone (Risperdal)

Ziprasidone (Geodon)

First-generation antipsychotics

These first-generation antipsychotics have frequent and potentially significant neurological side effects,
including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be
reversible. First-generation antipsychotics include:

Chlorpromazine

Fluphenazine

Haloperidol

Perphenazine

These antipsychotics are often cheaper than second-generation antipsychotics, especially the generic
versions, which can be an important consideration when long-term treatment is necessary.

Long-acting injectable antipsychotics

Some antipsychotics may be given as an intramuscular or subcutaneous injection. They are usually given
every two to four weeks, depending on the medication. Ask your doctor about more information on
injectable medications. This may be an option if someone has a preference for fewer pills and may help
with adherence. (Mayoclinic, 2020).
Common medications that are available as an injection include:

Aripiprazole (Abilify Maintena, Aristada)

Fluphenazine decanoate

Haloperidol decanoate

Paliperidone (Invega Sustenna, Invega Trinza)

Risperidone (Risperdal Consta, Perseris)

Newer Antipsychotic Drugs

These are also called second-generation or atypical antipsychotics. They’re newer than the first-
generation drugs. They generally cause fewer side effects, such as repetitive or involuntary movements
like eye blinking, than older antipsychotics.

Medications include:

Aripiprazole (Abilify)

Asenapine (Saphris)

Brexpiprazole (Rexulti)

Cariprazine (Vraylar)

Clozapine (Clozaril)

Iloperidone (Fanapt)

Lumateperone tosylate (Caplyta)

Lurasidone (Latuda)

Olanzapine (Zyprexa)

Paliperidone (Invega)

Olanzapine/samidorphan (Lybalvi)

Pimavanserin (Nuplazid)

Quetiapine (Seroquel)

Risperidone (Risperdal)
Ziprasidone (Geodon)

Second-generation antipsychotics work about equally as well as older drugs. The one exception is
clozapine, which is effective against schizophrenia that doesn’t respond to other treatments.

Side effects: Different atypical antipsychotics may cause different side effects. Your doctor will help you
pick a drug that works best for you with the minimum amount of adverse effects. Some common issues
may include:

* Weight gain

* Higher blood sugar and cholesterol levels

* Low blood pressure

* Drowsiness

* Type 2 diabetes

* Constipation

* Blurry vision

* Dry mouth

First-Generation Antipsychotic Drugs

You might hear these drugs called typical or conventional. These medications block a brain chemical
called dopamine and are more likely than second-generation antipsychotics to cause significant
movement disorders like intense muscle stiffness (called dystonia) or a condition that may develop over
long-term exposure called tardive dyskinesia. Drugs in this group include:

Chlorpromazine (Thorazine)

Fluphenazine (Proxlixin)

Haloperidol (Haldol)

Loxapine (Loxitane)

Perphenazine (Trilafon)

Pimozide (Orap)
Thioridazine (Mellaril)

Thiothixene (Navane)

Trifluoperazine (Stelazine)

They said, many of these drugs have adverse effects, including neurological symptoms and weight gain.
Newer medications may have less severe side effects, however, it is essential for a person to continue
with their treatment plan, even if the symptoms improve. If a person stops taking medication, the
symptoms may return (Mayoclinic, 2020).

Theoretical Review

The Health Belief Model (HBM)

The HBM (LaMorte, 2019) was developed in the early 1950s by social scientists at the U.S. Public Health
Service in order to understand the failure of people to adopt disease prevention strategies or screening
tests for the early detection of disease. Later uses of HBM were for patients' responses to symptoms and
compliance with medical treatments. The theory hypothesizes that people are likely to engage in a given
health-related behavior to the extent that they:

1. Perceived susceptibility - This refers to a person's subjective perception of the risk of acquiring an
illness or disease.

2. Perceived severity - This refers to a person's feelings on the seriousness of contracting an illness or
disease (or leaving the illness or disease untreated).

3. Perceived benefits - This refers to a person's perception of the effectiveness of various actions
available to reduce the threat of illness or disease (or to cure illness or disease).

4. Perceived barriers - This refers to a person's feelings on the obstacles to performing a recommended
health action. There is wide variation in a person's feelings of barriers, or impediments, which lead to a
cost/benefit analysis. The person weighs the effectiveness of the actions against the perceptions that it
may be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful), time consuming, or
inconvenient.

5. Cue to action-This is the stimulus needed to trigger the decision-making process to accept a
recommended health action. These cues can be internal (e.g., chest pains, wheezing, etc.) or external
(e.g. advice from others, illness of family member, newspaper article etc.).

6. Self efficacy: This refers to the level of a person’s confidence in his or her ability to successfully
perform a behavior.
Application of the Model

HBM was applied to the study, the model was used to assess the level of knowledge of informal
caregivers on the causes, signs and symptoms and treatment options used in management of
schizophrenia. It is important for them to understand the causes, signs and symptoms as well as the
treatment options used in management of schizophrenia so that they can make rational and appropriate
care seeking behavior concerning [Link] HBM was spelt out in terms of six constructs
representing the perceived threat and net benefits.

Diagrammatic Representation of the Theory

KNOWLEDGE STUDENTS NURSES TOWARDS SCHIZOPHRENIA.

ATTITUDE OF STUDENTS NURSES TOWARDS INDIVIDUALS LIVING WITH SCHIZOPHRENIA

PREPAREDNESS OF STUDENTS NURSES IN MANAGING PATIENTS WITH SCHIZOPHRENIA.