Chapter 22Schizophrenia and
Schizophrenic-like Disorders
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The burden of psychiatric conditions has been
heavily underestimated. Disability caused by active
psychosis in schizophrenia produces disability equal
to quadriplegia.
National Institute of Mental Health, 2001
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Learning Objectives
• Compare at least three current theories contributing to
the understanding of the development of schizophrenia
• Articulate the classification of the five phases of
schizophrenia
• Differentiate the positive, negative, and disorganized
symptoms of schizophrenia
• Distinguish the five subtypes of schizophrenia
• Understand why cultural differences should be considered
when assessing clinical symptoms in clients with
suspected psychotic disorders
• Analyze why an antidepressant drug and an atypical
antipsychotic agent may be necessary to stabilize the
clinical symptoms of schizophrenia
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Learning Objectives (cont.)
• Articulate the criteria that indicate the presence of
metabolic syndrome
• Recognize the importance of assessing for the presence
of psychogenic polydipsia
• Explain the terms awareness syndrome or awakening
phenomena
• Discuss why a client with the diagnosis of schizophrenia
may develop treatment-resistant symptoms
• Compare and contrast the rationale for the use of the
following interactive therapies generally effective when
providing care for clients with schizophrenia: group
therapy, cognitive–behavioral therapy, and personal
therapy
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Learning Objectives (cont.)
• Discuss the purpose of including the client and family in
multidisciplinary treatment team meetings
• Comprehend the importance of continuum of care for
clients with schizophrenia
• Construct therapeutic nursing interventions when
planning care for a client with the diagnosis of
schizophrenia, paranoid type
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Schizophrenia
• Schizophrenia is considered the most common and
disabling of the psychotic disorders. Although it is a
psychiatric disorder, it stems from a physiological
malfunctioning of the brain.
• This disorder affects all races and is more prevalent in
men than in women.
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Onset of Schizophrenia
• The onset of schizophrenia may occur late in adolescence
or early in adulthood, usually before the age of 30.
Although the disorder has been diagnosed in children,
approximately 75% of persons diagnosed as having
schizophrenia develop the clinical symptoms between the
ages of 16 and 25.
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Etiology of Schizophrenia
• Genetic predisposition theory
• Biochemical and neurostructural theory
• Organic or psychophysiologic theory
• Environmental or cultural theory
• Developmental theory
• Psychological or experiential theory
• Vitamin deficiency theory
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Dopamine Receptors (The Dopamine
Hypothesis)
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Clinical Symptoms and Diagnostic
Characteristics
• Positive symptoms
–
Overt psychotic or distorted behavior
–
Hallucinations
–
Delusions
–
Suspiciousness
• Negative symptoms
–
Diminution or loss of normal functions
–
Flat or blunted affect
–
Poor motivation
–
Inability to enjoy activities
• Disorganized symptoms
–
Confused thinking
–
Incoherent or disorganized speech
–
Disorganized behavior
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Clinical Symptoms and Diagnostic
Characteristics (cont.)
• Paranoid type
• Catatonic type
• Disorganized type
• Undifferentiated type
• Residual type
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Schizophrenic-Like Disorders
• Schizoaffective disorder
• Schizophreniform disorder
• Brief psychotic disorder
• Psychotic disorder due to a general medical
condition
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The Nursing Process
• Assessment
• Nursing diagnoses
• Outcome identification
• Planning interventions
• Implementation
• Evaluation
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Assessment
• Presence or absence of clinical symptoms
• History and physical examination
• Transcultural considerations
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Nursing Diagnoses
• Disturbed thought processes
• Disturbed sensory perception
• Self-care deficit
• Impaired verbal communication
• Noncompliance
• Disturbed sleep pattern
• Social isolation
• Ineffective coping
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Outcome Identification
Outcomes are influenced by several factors:
• The client’s present coping strategies and level of
cognitive function
• The presence or absence of support systems
• The presence or absence of adequate income
• The clinical setting in which each treatment occurs
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Planning Interventions
Interventions planned may include the following:
• Medical interventions
• Diagnostic studies
• Medication
• Cognitive therapy
• Behavioral techniques
• Other supportive therapies
• Electroconvulsive therapy
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Implementation
• Assistance in meeting basic needs
• Medication management
• Interactive therapies
• Psychosocial therapies
• Client and family education
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Evaluation
• Compare the client’s current mental status with stated
desirable outcomes identified.
• If the outcomes have not been met, consider the reasons
why.
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Key Terms
• Affective disturbance
• Echolalia
• Ambivalence
• Echopraxia
• Autistic thinking
• Looseness of association
• Awakening phenomena
• Negative symptoms
• Awareness syndrome
• Pica
• Dementia praecox
• Positive symptoms
• Disorganized symptoms
• Psychogenic polydipsia
• Dopamine hypothesis
• Schizophrenia
• Double-bind situation
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Reflection
Reread the chapter-opening quote.
• In what manner does active psychosis in
schizophrenia produce disability equal to
quadriplegia? Cite two or three examples to
substantiate your explanation.
• How would these examples of disability affect the
family of a client with schizophrenia? Identify what
support systems the family and the client could use.
?
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins