SCHIZOPHRENIA
Brittany Ward
EARN
DEFINITION
 Psychiatric disorder characterized by thought disturbance, altered affect,
withdrawal from reality, regressive behavior, difficulty with communication, and
impaired interpersonal relationships.
 Five types




1) Catatonic- stupor, rigidity, posturing, and excitement
2) Disorganized- incoherence, flat or inappropriate affect
3) Paranoid-delusions, hallucinations related to a single theme or both
4) Residual- socially withdrawn, eccentric or peculiar behavior, no current psychotic
behavior
 5)Undifferentiated- prominent delusions and hallucinations, failure to meet any of the
criteria for the other types
PATHOPHYSIOLOGY
 The cause has not been determined but several theories have been proposed.
 Genetic component
 Imbalance in neurotransmitters in certain brain areas
 Overactive dopamine receptors in the basal nuclei.
 The area of the brain that controls motor activity
PSYCHOSES
 Signs and symptoms are often associated with other mental health problems
including substance abuse, depression , and dementia.
 Approximately 3 million Americans have schizophrenia (Adams & Holland 2014).
 Patients with psychosis often develop symptoms between the age of 13 and the
early 20s.
 As much 50% of homeless people in America have schizophrenia (Adams &
Holland 2014).
NURSING ASSESSMENT
 Asses for disturbance in thought process.
 Interpret content of internal and external stimuli.
 Delusions- fixed false beliefs that may be persecutory, grandiose, religious, or somatic
 Ideas of reference- belief that conversations or actions of others have reference to the client
 Assess for disturbance in perception
 Assess for disturbance in affect and behavior
 Assess for disturbance in interpersonal relationships
MANIFESTATIONS
 Looseness of associations
 Echolalia- constantly repeating what is heard
 Neologism- creating new words
 Word salad- speaking a jumbled mixture of real and made-up words
 Hallucinations- false sensory perception usually auditory or visual in nature
 Illusions- misinterpretation of external environment
 Depersonalization- perceives self as alienated or detached from real body
 Delusions- false fixed beliefs that cannot be changed by reason
DIAGNOSIS
 DSM-IV-TR, diagnostic manual prepared by the American Psychiatric Association
that provides diagnostic criteria for all disorders
NURSE INTERVENTIONS
 Establish trust
 Sit with mute clients
 Provide safe and secure environment
 Use matter- of- fact, no judgmental approach
 Use simple, clear, concrete terms when talking with client
 Use clarification
 Avoid arguing and avoid agreeing with inaccurate communications
 Encourage client to identify positive characteristics related to self
PHARMACOLOGY
TREATMENT- DRUGS
 Conventional Antipsychotics




Chlorpromazine
Fluphenazine
Perphenazine
Compazine
 Atypical antipsychotics




Haldol
Abilify
Seroquel
Geodon
DRUG SIDE EFFECTS
 Headache
 Dizziness
 GI symptoms- nausea and constipation
 Thrombocytopenia
 Photosensitivity
 Serotonin Syndrome
 Anti-Cholinergic effects
 Severe Extrapyramidal effects
EXTRAPYRAMIDAL EFFECTS
 Parkinsonism-Rigidity, shuffling gait, pill rolling hand movements and mask like
face
 Akathisia- restlessness, agitation, and pacing. Sudden difficulty sitting down.
 Dystonia- limb ad neck spasms, uncoordinated, jerky movements, difficulty
speaking and swallowing, rigidity and muscle spasms.
 Tardive dyskinesia (permanent side effect)- Involuntary tongue and lip
movements, blinking, tonic movements of limbs and trunk
 Treatment of EPS- anticholinergic drugs (Cogentin, Artane, Benadryl, Ativan, and
Klonopin)
EVIDENCE-BASED TREATMENT
 Milieu therapy
 Behavior Modification
 Family therapy
 Crisis intervention
 Cognitive therapy
 Electroconvulsive Therapy
 Group Intervention
 Drugs
YOUTUBE
 http://youtu.be/WjqRYgICgdU
 http://youtu.be/bWaFqw8XnpA
REFERENCES
 Adams, M.P., & Holland, L.N. (2014). Pharmacology for nurses: A pathophysiology
approach (4th Edition).
 Elsevier.( 2011). HESI Comprehensive review for the NCLEX-RN Examination. (3rd
Edition).