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Schizophrenia Prepared by \ Mofida Al - barrak Under supervision Prof. Dr. Elham Fayad Prepared by \ Mofida Al - barrak Under supervision Prof. Dr. Elham.

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Presentation on theme: "Schizophrenia Prepared by \ Mofida Al - barrak Under supervision Prof. Dr. Elham Fayad Prepared by \ Mofida Al - barrak Under supervision Prof. Dr. Elham."— Presentation transcript:

1 Schizophrenia Prepared by \ Mofida Al - barrak Under supervision Prof. Dr. Elham Fayad Prepared by \ Mofida Al - barrak Under supervision Prof. Dr. Elham Fayad 1AL-barrak 1430

2 At the end of this lecture the students will be able to: 1. Explain the meaning of schizophrenia 2. Discuss symptoms of schizophrenia 3. Differentiate and contrast between etiological factors related to schizophrenia 4. Determine schizophrenia subtypes 5. Assess client with schizophrenia 6. Develop a nursing care plan for a client with schizophrenia 2AL-barrak 1430

3  Definition  Etiological factors related to schizophrenia  Symptoms of schizophrenia  Subtypes of schizophrenia  Assess client with schizophrenia  Develop a nursing care plan for a client with schizophrenia 3AL-barrak 1430

4  Neurotic Environment  Psychotic Delusion & hallucination  Personality disorder Raring  Cognitive implement (dementia & delirium)  Substance related disorder 4AL-barrak 1430

5 PsychoticNeurotic Delusion & hallucinationEnvironment insight LackInsight Can not stop medicationMedication Can stop e.g. schizophreniae.g. anxiety & stress hospitalization NeedClinical 5AL-barrak 1430

6  Schizophrenia is a condition that exists in all cultures and in all socioeconomic group.  It is estimated that 1% of the general population suffer from schizophrenia.  people with schizophrenia occupy approximately 50% of the hospital beds for the mentally ill. 6AL-barrak 1430

7  Schizophrenia is a major psychotic disorder marked by a profound withdrawal from interpersonal relationship and cognitive and perceptual disturbances that make dealing with reality difficult.  It is characterized by splitting of normal links between perception, mood, thinking,behavior and contact with reality. 7AL-barrak 1430

8 Schizophrenia is a group of psychotic disorders that interfere with thinking and responsiveness. It is a disease of the brain. The term schizophrenia, which means "split mind," was first used in 1911 by Swiss psychiatrist Eugen Bleuler to categorize patients whose thought processes and emotional responses seemed disconnected. 8AL-barrak 1430

9 Thought process Affect Behavior Three component are integrated in the normal person 9AL-barrak 1430

10 CognitionAffectBehavior 10AL-barrak 1430

11 4 As Associations Apathy Ambivalence Autistic thinking 11AL-barrak 1430

12 1. Autistic thinking Start with fantasy & day dream ending by delusion & hallucination 2. Associative looseness Illogically connected things. 3. Ambivalence holding 2 different emotion to the same person at the same time. 4. Apathy Absent of emotional experience & expression 12AL-barrak 1430

13  Normal perceptual & thought process  Personality  Affect  Withdrawal 13AL-barrak 1430

14 1.Unipolar major depression 2.Bipolar disorder 3.Schizophrenia 4.Epilepsy 5.Alcoholism 6.Dementia 1.Unipolar major depression 2.Bipolar disorder 3.Schizophrenia 4.Epilepsy 5.Alcoholism 6.Dementia 7. Parkinson’s disease 8.Multiple sclerosis 9.Drug use 10.PTSD 11.OCD 12.Panic disorder 7. Parkinson’s disease 8.Multiple sclerosis 9.Drug use 10.PTSD 11.OCD 12.Panic disorder 3 rd highest for years of life with a disability (YLD) among neuropsychiatric disability (YLD) among neuropsychiatric conditions conditions 3 rd highest for years of life with a disability (YLD) among neuropsychiatric disability (YLD) among neuropsychiatric conditions conditions 14AL-barrak 1430

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16 Figure 13.2 The natural history of schizophrenia: a 5-year follow-up. Copyright 1989 by Cambridge University Press. Reprinted with the permission of Cambridge University Press.

17 1. Biologic Factors2. Environmental factors3.Psychological factors4. Family theory 17AL-barrak 1430

18 a. Role of Neurotransmitters  Neurotransmitters: Common impaired neurotransmitters are acetylcholine, dopamine, norepinephrine, serotonin & Gamma Aminobutyric Acid (GABA). 18AL-barrak 1430

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21 1- Biological factors 21AL-barrak 1430

22 Structure (neuro anatomical studies  Brain scans using magnetic resonance imaging (MRI) have shown a number of abnormalities in the brain's structure associated with schizophrenia. Such problems can cause nerve damage and disconnections in the pathways that carry brain chemicals. Structure (neuro anatomical studies. 22AL-barrak 1430

23  Dilatation of the left ventricular AL-barrak

24 Figure 13.6 Some ways drugs affect neurotransmission.

25 Figure 13.7 Location of the cerebrospinal fluid in the human brain. This extracellular fluid surrounds and cushions the brain and spinal cord. It also fills the four interconnected cavities (cerebral ventricles) within the brain and the central canal of the spinal cord.

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28  The risk for inheriting schizophrenia is 10 % in those who have one immediate family member with the disease  About 40% if the disease affects both parents and an identical twin.  About 60% of people with schizophrenia have no close relatives with the illness. 28AL-barrak 1430

29 Figure 13.4 Risk for schizophrenia among children of twins.

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35 a. Infectious  The viruses as a cause of schizophrenia such as living in crowded conditions. b. Seasonal factors  The risk for schizophrenia worldwide is 5 – 8 % higher for those born during winter and spring, when colds and viruses are more prevalent.  Pregnant Mother's Exposure to Viruses. The mother's exposure to viral infections such as rubella, measles, chicken pox,& toxoplasmosis  35AL-barrak 1430

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38 psychoanalysis theoryEricksonCognitive theoryBehaviorism 38AL-barrak 1430

39 a- Psychoanalytic and developmental theories : Psychoanalytic theory states that there are distortions in the mother-child relationship, so that the child is unable to progress beyond dependence. 39AL-barrak 1430

40  Children learn what they are exposed to on a daily basis.  According to learning theory, the irrational ways of handling situations, the distorted thinking, and the deficient communication patterns of persons with schizophrenia are a result of poor parental models in early childhood. 40AL-barrak 1430

41 1. Double bind e.g. I love my san I leave him (say thighs do opposite) 2. Scapegoat e.g. Put all the problem to one person in my family 3. Eschewed family e.g. Father stay in the house & mother are working (opposite role) 4. Schismatic family e.g. Father & mother all the time have (conflict) 41AL-barrak 1430

42  List the causes of Schizophrenia  Explain Eugen Bleuler – Introduced the term “schizophrenia” or “splitting of the mind”; the 4 As :  Discuss Family theory AL-barrak

43  Schizophrenia affects different people in different ways. Not everybody will experience the same symptoms, nor are they always to the same degree.  Two types of symptoms are distinguished in schizophrenia – they are classified as positive and negative symptoms. AL-barrak

44 a. Delusions:  Persecution – “chased by other”  Reference – “talking about me”  Influence- “controlled by others or agencies”  Grandeur – “important person” AL-barrak

45 b. Hallucinations can occur in any of the five senses but the most common are auditory. For example, the person may hear voices repeating their thoughts, in conflict, commenting on their actions telling them what to do (command hallucinations).  Hallucinations of any form occur in over 70 per cent of people who experience psychotic illnesses.  Auditory hallucinations occur in approximately 50 per cent of people with schizophrenia, while visual hallucinations occur in 15 per cent. AL-barrak

46  Disorganized Thinking This is usually expressed through abnormal spoken language. For example, the person's conversation jumps from one topic to another, new words may be created, the grammatical structure of language breaks down and speech may greatly speed up or slow down.  Disorganised Behaviour Disorganised behaviour can lead to problems in conducting the activities of daily living such as organizing meals and maintaining hygiene. AL-barrak

47  Catatonic Behaviour This refers to states of muscular rigidity and immobility, stupor and negativism, The person may hold fixed or bizarre bodily postures for extended periods of time and resist any effort to be moved. AL-barrak

48 Negative symptoms AL-barrak

49  Withdrawal, Loss of Motivation & Ambivalence (Avolition)  People experiencing avolition may be negligent grooming, personal hygiene, have difficulty making decisions & have difficulty persisting at work, school or family tasks. AL-barrak

50 Loss of Feeling or an Inability to Experience Pleasure (Anhedonia)  Lack of interest in social or recreational activities,failure to develop close relationships. Poverty of Speech (Alogia)  The person's amount of speech is greatly reduced & people showing signs of alogia may be slow in responding to questions or not respond at all. AL-barrak

51 Flat Presentation (Affective Flattening)  This can be indicated by unchanging facial expressions, poor or no eye contact, reduced body language and decreased spontaneous movements. Cognitive Impairments cognitive dysfunction is often present in people with schizophrenia is associated with cognitive impairments including problems with attention, concentration and memory. AL-barrak

52 Paranoid schizophreniaDisorganized schizophreniaCatatonic schizophreniaUndifferentiated schizophrenia schizophrenia Residual 52AL-barrak 1430

53 Delusion of grandeur Delusion of persecution Delusion of jealousy Reference Delusion of influence = control 53AL-barrak 1430

54 This subtype of schizophrenia is characterized by Delusions that tend to be persecutory or Grandiose. 54AL-barrak 1430

55 The disorganized type of schizophrenia is characterized by a severe disintegration of the personality. It has an dangerous start. 55AL-barrak 1430 CognitionAffectBehavior

56  Word salad  Incoherent speech  Clanging association AL-barrak

57  Odd  Stereotyped behaviors  uninhibited sexual behaviors such as masturbating in public.  WithdraPoor coordination.  Poor personal grooming  unable to complete activities of daily living (ADLs). 57AL-barrak 1430

58 Major feature, manifestations of psychomotor disturbance include.  Stupor There is complete suppression of motor activity The patient doesn't respond to any stimulus neither external (question or painful stimulus)or internal stimuli (hunger, thirst, distended bladder) 0r  Excitement Sever form of hyperactivities excessive purposeless motor activity & the patient may destruct herself or others 58AL-barrak 1430

59  Negativism Means automatic resistance to all stimuli (Muscular e.g. tell the pt’s keeping the arm extended on trying to flex it )opposite performance Speech (Mutism)  Mutism (Speech total loss) Automatic obedience Other symptoms include  Echopraxia  Echolalia  stereotypy AL-barrak

60  Waxy flexibility Maintenance of imposed postures e.g. raising the head of the patient from the pillow, or the arm up) *absence of fatigue  Catalepsy (Posturing) Is sustained immobility (patient initiates position by herself) AL-barrak

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62 Undifferentiated schizophrenia cannot be classified as paranoid, disorganized, or catatonic.It does not clearly meet the criteria necessary for a diagnosis.  The psychotic manifestations are extreme,including  Fragmented delusions  Vague  Hallucinations 62AL-barrak 1430

63  Bizarre  Disorganized behavior  Disorientation  Incoherence  Affect is usually inappropriate  mixture of positive and negative symptoms.  Dress & grooming are careless  Individual seems uninterested with life. 63AL-barrak 1430

64 If an individual has had at least one acute episode of schizophrenia and is now free of prominent positive symptoms, but has some negative symptoms he is diagnosed as suffering from residual schizophrenia. The usual signs of the illness are  Illogical thinking,  Loosening of associations  Emotional blunting  Social withdrawal  Eccentric (bizarre) behavior  64AL-barrak 1430

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66 1. Schizophrenia is a a. Disorder of neuroanatomy b. Groups of disorders involving a disorder of neurotransmitters c. Collection of disorders involving brain function d. Disorder of brain metabolism AL-barrak

67 2. Schizophrenia is primarily marked by a. Inattention & anger b. Violent & impulsive behavior c. Thought disturbance such as delusion d. Affective disturbance such as dysphasia AL-barrak

68 3. The three primary negative symptoms of schizophrenia include a. Alogia, hallucinations & delusion b. Alogia, affective blunting, & avolition c. Affective blunting, delusions & avolition d. Hallucinations, delusions, & avolition AL-barrak

69 4. When assessing a schizophrenic client for positive symptoms, the nurse should look for a. Hallucination & delusion. b. Inability to express thoughts and feelings. c. Depression. d. Lack of goal-directed behavior. AL-barrak

70 5. A client was diagnosed with paranoid schizophrenia twenty years ago. The client no longer displays persecutory delusions, but lacks social and self-care skills and is unable to work. What subtype of schizophrenia is the client displaying? a. Disorganized b. Paranoid c. Residual d. Undifferentiated AL-barrak

71 Nursing diagnosis Assessment Goal Nursing intervention & evaluation Nursing management 71AL-barrak 1430

72 Nursing management Nursing management Positive symptoms Negative symptoms Cognitive symptoms Aggressive symptoms Affective symptoms 72AL-barrak 1430

73 Cognitive symptoms: attenon memory executive functions (eg, abstraction) Positive symptoms: delusions hallucinations disorganized speech catatonia Symptoms of schizophrenia Occupational Interpersonal Self- care Social Work Negative symptoms: affective flattening alogia avolition anhedonia Mood symptoms: dysphoria suicidality helplessness QOL 2 73AL-barrak 1430

74 1. Alteration of thought (delusion )  the common delusion includes:  Paranoid delusion  Ideas of reference  Delusion of grandeur  Delusion of jealousy  Delusion of persecution  Somatic delusion Positive Symptoms 74AL-barrak 1430

75  Thought broadcasting: the belief that one’s thoughts can be heard by others  Thought insertion, the belief that thoughts of others are being inserted into one’s mind  Thought withdrawal, the belief that thoughts have been removed from one’s mind by an outside agency  Delusion of being control 75AL-barrak 1430

76  Lose association: the thought process becomes illogical & confused.  Neologisms: made up words that have a special meaning to the delusional person.  Concrete thinking: an overemphasis on small or specific details & an impaired ability to abstract.  Autistic thinking  Clang associations: the meaningless rhyming of a word in a forceful way.  Word salad: a mixture of words that is meaningless to the listener. 76AL-barrak 1430

77 1. Alteration Perception Hallucinations are the major examples of alterations in perception in schizophrenia, especially auditory hallucinations, 77AL-barrak 1430

78 Auditory hallucination in form of voices may seem to come from outside or inside the person’s head. The voice may be familiar or strange, single or multiple. Voices speaking directly to the person or commenting on the person’s behavior are most common in schizophrenia. A person may believe the voices are from. God,the devil, dead relatives, or strangers. AL-barrak

79 1. Commanding hallucinations Must be assessed, because the “Voices” may command the person to hurt himself or others. For examples, a client might state “the voices” are telling him to “ jump out of the window” or “take a knife & kill my child”. 2. Commenting hallucination e.g. why does not clean Sarah AL-barrak

80 What are the characteristic of schizophrenia Commanding & commenting auditory AL-barrak

81 Alteration behavior Bizarre & agitated behavior is associated with schizophrenia and may take a variety of forms.  Stereotyped  Stupor  Waxy flexibility AL-barrak

82  These symptoms are that most interfere with the individual’s adjustment and ability to survive.  A volition  Anhedonia  Flat affect  Withdrawal  He couldn't take decisions  Neglect basic hygiene and need help with everyday activities. AL-barrak

83 The following is a listing of some of the more common nursing diagnoses applicable to schizophrenia. 1. Altered thought processes. 2. Sensory perceptual alterations. 3. Impaired verbal communication. 4. Social isolation. 5. Self-care deficit 6. (bathing, hygiene, dressing, grooming, feeding, toileting ). AL-barrak

84 Disturbance thought process related to delusion & hallucination evidence by or (observed by) inability to distinguish rational idea  Biological factors  Neurotransmitter increase dopamine  Genetic  Disturbance thought process (hallucination & delusion)  Thought broad casting  Thought withdrawal  Neologism AL-barrak

85 Absent of psychotic hallucination & delusion AL-barrak

86  Maintain eye contact  Assess the client to think logically  Thought assessment  Listen  Do not touch the client specially if have delusion  Distraction from delusion 1. No reasoning 2. Voice doubt 3. Introduce new subject for discussion AL-barrak

87  Disturbance sensory perception related to withdrawal as evidence by hallucination AL-barrak

88 Important note  Types of hallucination in schizophrenia patient’s command & commented  All the types of schizophrenia start early except Paranoid state after age 40 years old.  Drugs schizophrenia takes on long live AL-barrak

89  Able to hold conversation without hallucinating.  Remains in group activities.  Attends to the task at hand (e.g. group process, recreational or occupational therapy activity ).  States that hallucinations are under control AL-barrak

90  All the speech (present from reality )  Call the client by their names to reinforce reality.  Use clear statements  Protect client’s  Teach client’s techniques to stooped hallucination AL-barrak

91 Conclusion Schizophrenia is a severe mental disorder characterized by two kinds of symptoms; Positive symptoms ( thought disorder, hallucinations & delusions, ) & Negative symptoms – impairment in emotional range, energy, and enjoyment of activities. For a formal diagnosis, these symptoms must persist for at least one month and usually result in severe impairment in job and/or social functioning 91AL-barrak 1430

92  Morrison, J. (1995). The first interview: Revised for DSM-IV. New York: The Guilford Press.  Kersting, K. (2005). Serious rehabilitation: Psychologist-developed treatments are providing hope for people with serious mental illness. APA Monitor on Psychology, 36 (1), AL-barrak 1430

93  McKinney, R., & Fiedler, S. (2004). Schizophrenia: Some recent advances & implications for behavioral intervention. the Behavior Therapist, 6,  Nichols, O. T. (2005, November). Headlines in psychopharmacology. Symposium presented at the annual meeting of the Kentucky Psychological Association, Louisville, KY 93AL-barrak 1430

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