Terminologies related to Schizophrenia
Definition of Schizophrenia
Epidemiology
Causes and psychopathology of
Schizophrenia
Diagnosis
Signs and symptoms
Treatment/Prognosis
Nursing Intervention
Loose Association
Definition - thinking haphazard, illogical, and
confused. Connections in thought are interrupted.
Example: “I can’t go to the zoo, no money, Oh... I
have a hat, these members make no sense, man…
What’s the problem”
Neologism
Definition: Words a person makes up that have
meaning only for that person, it is often part of a
delusional system.
Example: “I am afraid to go to the hospital
because the norks are looking for me
Clang Association
Definition: The meaningless rhyming of words,
often in a forceful manner.
Example: “Rain, pain, bang, clang.”
Echolalia
Definition - mimicking or imitating the speech of
another person.
Example: The nurse says to the patient, “Tell me
your name.” The patient responds, “Tell me your
name, tell me your name.”
Word Salad
Definition: Mixture of words and phrases that
have no meaning.
Example: “I am fine…apple pie…no sale…
furniture store…take it slow…cellar door…”
Concrete Thinking
What brought you here to the
hospital?
The cab
• “People in glass houses shouldn’t
through stones.”
Don’t throw stones or the windows will
break.
• ANSWERS ARE LITERAL
Thought broadcasting
The belief that one’s thoughts can be
heard by others
Thought Insertion
The belief that thoughts from other people are
being inserted into one’s mind
Thought withdrawal
The belief that thoughts have been removed from
one’s mind by an outside agency.
Delusions of being controlled
Belief that one’s body or mind is controlled by an
outside agency
Neurological disease that affects a
person’s perception, thinking,
language, emotion, and social
behavior.
Occupies approximately 50% of all
hospital beds and 35-50% of the
homeless population
Schizophrenia
Lifetime Prevalence: 1% worldwide
Typical Age of Onset: late teens and
early 20s.
Men and women equal
Cause unknown most likely a
result of inherited genetic
factors and non-genetic factors
Theories of Causes (Psychopathology)
Neuroanatomical Studies:
structural brain abnormalities
Cerebral ventricles
Cortical atrophy
Atrophy of frontal lobe
MRI of Brain
PET Scan
Non-genetic Risk Factors
Birth and Pregnancy
Complications
Stress-Related Theories
Prodromal /Early Symptoms
Symptoms one month to one year
before psychotic break
Person feels something strange or
weird is happening to them
Misinterprets things in the environment
Feelings of rejection, lack of self-
respect, loneliness,hopelessness,
isolation, withdrawal, and inability to
trust others.
Must exhibit two or more of the following, each
present for at least a 1-month period:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized
Negative symptoms (flat affect)
Affect
Associative Looseness
Autism
Ambivalence
Symptoms may be classified as:
Positive – “attention getter” symptoms
i.e. hallucinations, delusions, bizarre
behavior, disorganized speech
Negative – “crippling” symptoms i.e.
apathy, lack of motivation, anhedonia
Cognitive - i.e. difficulty with attention,
memory, and problem solving
Disorganized – i.e. disorganized speech,
inappropriate affect
Alterations in Thinking
Delusions
Ideas of Reference
Persecution
Grandiosity
Bodily Functions
Jealousy
Control
Symptoms
Loose
Thought Association
broadcasting Neologisms
Thought
Concrete
insertion Thinking
Thought
Echolalia
withdrawal Clang
Being controlled
Association
Word Salad
Alterations in Perceiving
Hallucinations - auditory, visual, olfactory,
gustatory, and tactile
90% of schizophrenics experience hallucinations -
auditory most common
Difference between Illusions and Hallucinations
Depersonalization and Derealization (loss of ego
boundaries)
Bizarre Behavior- Disorganized, unhygienic,
Negative Symptoms
Develop over time
May not be detected (masked by positive
symptoms
Negative symptoms include:
Poverty of speech content
Thought blocking,
Anergia, anhedonia
Affective blunting
Lack of avolition.
Associated Symptoms
Depression and Suicide
Water Intoxication
Substance Abuse
Violent Behavior
Paranoid Type
Disorganized Type
Catatonic Type
Paranoid
Any intense and strongly defended
irrational suspicion
Most common symptoms -
hallucination and delusions
Defense Mechanism - Projection
Disorganized Type
Most regressed and socially impaired
Symptoms - loose association,
inappropriate affect, bizarre
mannerism, incoherent speech and
withdrawn
Catatonia
Abnormal motor behavior
Physical Needs are a Priority
Typical (Traditional) Antipsychotics –
target the positive symptoms
Older drugs – Watch for signs of EPS
Atypical (Novel) Antipsychotics – diminish
the positive and negative symptoms
Typical Antipsychotic Medications
Thorazine Haldol
Mellaril (Haloperidol and
Stelazine Haloperidol
Trilafon deconate)
Serentil Loxapine
Prolixin Moban
Navane
Typical Antipsychotics
Medications must
be taken regularly
Standard
(Traditional)
Antipsychotics
EPS
Antiparkinson
Drugs
Atypical Antipsychotics
Advantage over typical: alleviate both positive
and negative symptoms (improvement of quality
of life)
Clozapine (Clozaril) - agranulocytosis and
seizures
LOWER SIDE EFFECTS:
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Common Side Effects
Anti-cholinergic
Sedation
Orthostatic Hypotension
Lowered Seizure Threshold
Extrapyramidal Side Effects (EPS)
Altered nutrition: less than body requirements
Risk for violence directed at self or others
Self-care deficit: feeding, bathing, dressing/
grooming, toileting
Noncompliance with medications
Ineffective individual/ family coping
Self-esteem disturbance
Altered thought processes
Psychotherapeutic Management
Provide supportive care
Strengthen patient’s self-esteem
Treat patients as adults
Prevent failure/ embarrassment
Respect individuality - unique
Reinforce reality
Handle hostility calmly & matter-of-factly
Care of Delusion
Presenting reality, orient pts to time, person
& place
Avoid argument, touch, competitive activities,
Reinforce positive behaviors
Encourage verbalization
Care of Disruptive Behavior
Set limit
Decrease environmental stimuli
Intervention before acting out
Close observation
Safety environment - minimize potential
weapons
Making contract with the client
Using restraints
Care of Withdrawn Patients
Arrange nonthreatening activities
Encourage participation - seating
Provide remotivation and resocialization
group experience
Reinforce appropriate grooming and hygiene
Provide psychosocial rehabilitation - social
skill training
Care of Suspicious Patients
Be matter-of-fact.
Avoid close physical contact - no touch
Be consistent in activities
Offer special food
Avoid whisper
Maintain eye contact
Care of Hyperactivity Patients
Allow pt to stand for a few min in group
Provide a safe environment
Provide activities that do not require fine
motor skills
Milieu Management
lCear & realistic limits; consistency;
Supportive environment – structured, predictable
Reduced stimulation
Early intervention for escalating behavior
Safety for the pt and others
Opportunity for nonthreatening social interaction
Remotivating and resocializing group
Communication skills
Family therapy
Involve the family – use appropriate
community resources
Educate the family – chr. dis, S/S of relapse,
med compliance,
Provide an outlet for the family – discuss
feelings, explore alternative effective coping
skills.
Psychotherapy
Individual Theapy – supportive therapy
Group Therapy – interpersonal skills, family
problems, community support
Family Therapy – expand social network,
problem-solving capacity, lower the emotional
over-involvement of families
Case Management
Limited hospital stay, 3rd party payment
Discharge planning – transitional care
Partial hospitalization, halfway houses, day
treatment programs
Community resources
Nurse’s feelings & Self-assessment
Pt’s anxiety, loneliness, dependence, distrust
-> N’s uncomfort
Feelings of helplessness -> anxiety ->
defensive behaviors ie denial, withdrawal,
avoidance -> burnout
Peer group supervision can be helpful
Periodic reassessment of Tx goals,
Patient and Family Health Teaching
Teaching about the disease –S/S
Medication teaching and side-effect
management
Cognitive & social skills enhancement
Identifying signs of relapse
Attention to deficit in self-care, social and
work functioning
Exploration of community resources
Care of Hallucinations & Delusions
Hallucinations
Content of hallucination – commanding H
-> suicidal or homicidal
N’s attitude – nonjudgmental, nonthreatening
Eye contact, louder voice, call the person by name
Delusion
Be empathic - Clarify the reality of the pt’s intent
Clarify misinterpretations of the environment
No argument