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

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Presentation on theme: "Schizophrenia Prepared by \ Mofida Al - barrak Under supervision Prof. Dr. Elham Fayad AL-barrak 1430."— Presentation transcript:

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

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

3 Outlines 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 AL-barrak 1430

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

5 What are the different between neurotic & psychotic
Delusion & hallucination Environment insight Lack Insight Can not stop medication Medication Can stop e.g. schizophrenia e.g. anxiety & stress hospitalization Need Clinical AL-barrak 1430

6 Introduction 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 . AL-barrak 1430

7 Definition 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 . AL-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. AL-barrak 1430

9 Three component are integrated in the normal person
Tho ught proc ess Affe ct Beh avio r AL-barrak 1430

10 Three component are disintegrated like Schizophrenia patient (each one Split or separate from other)
Cognition Affect Behavior AL-barrak 1430

11 Eugen Bleuler – Introduced the term “schizophrenia” or “splitting of the mind”; the 4 As:
Associations Apathy Ambivalence Autistic thinking AL-barrak 1430

12 ****Symptoms Blerler 4 as****
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 AL-barrak 1430

13 schizophrenia is characterized by the disruption of:
Normal perceptual & thought process Personality Affect Withdrawal AL-barrak 1430

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

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16 Schizophrenia: Some Facts and Statistics
Figure 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 Etiological Factors of Schizophrenia
1. Biologic Factors 2. Environmental factors 3.Psychological factors 4. Family theory AL-barrak 1430

18 1- Biologic Factors a. Role of Neurotransmitters Neurotransmitters:
Common impaired neurotransmitters are acetylcholine , dopamine, norepinephrine, serotonin & Gamma Aminobutyric Acid (GABA). AL-barrak 1430

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21 1- Biological factors AL-barrak 1430

22 b . Abnormalities in brain
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. AL-barrak 1430

23 Brain structure Dilatation of the left ventricular AL-barrak 1430

24 Causes of Schizophrenia: Neurotransmitter Influences
Figure Some ways drugs affect neurotransmission.

25 Causes of Schizophrenia: Other Neurobiological Influences
Figure 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 C. Genetic Factors 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. AL-barrak 1430

29 Causes of Schizophrenia: Findings From Genetic Research (cont).
Figure Risk for schizophrenia among children of twins.

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35 2. Environmental factors
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 AL-barrak 1430

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38 3.Psychological factors personality development
psychoanalysis theory Erickson Cognitive theory Behaviorism AL-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. AL-barrak 1430

40 b- Learning theory 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 . AL-barrak 1430

41 ******c- Family theory ********
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) AL-barrak 1430

42 Questions review 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 1430

43 Symptoms of schizophrenia
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 1430

44 1.“Positive” Symptom Persecution – “chased by other”
a. Delusions: Persecution – “chased by other” Reference – “talking about me” Influence- “controlled by others or agencies” Grandeur – “important person” AL-barrak 1430

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 1430

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 1430

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 1430

48 Negative symptoms AL-barrak 1430

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 1430

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 1430

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 1430

52 There are five major subtypes of ****schizophrenia.
Paranoid schizophrenia Disorganized schizophrenia Catatonic schizophrenia Undifferentiated schizophrenia schizophrenia Residual AL-barrak 1430

53 1. Paranoid schizophrenia
Delusion of grandeur Delusion of persecution Delusion of jealousy Reference Delusion of influence = control AL-barrak 1430

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

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

56 Speech is disorganized and may include
Word salad Incoherent speech Clanging association AL-barrak 1430

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

58 3.Catatonic schizophrenia
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 AL-barrak 1430

59 Means automatic resistance to all stimuli
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 1430

60 Catalepsy (Posturing)
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 1430

61 Catatonic AL-barrak 1430

62 4- Undifferentiated schizophrenia
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 AL-barrak 1430

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

64 5. Residual schizophrenia
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 AL-barrak 1430

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66 Reviewing questions 1. Schizophrenia is a Disorder of neuroanatomy
Groups of disorders involving a disorder of neurotransmitters Collection of disorders involving brain function Disorder of brain metabolism AL-barrak 1430

67 2. Schizophrenia is primarily marked by Inattention & anger
Violent & impulsive behavior Thought disturbance such as delusion Affective disturbance such as dysphasia AL-barrak 1430

68 3. The three primary negative symptoms of schizophrenia include
Alogia, hallucinations & delusion Alogia, affective blunting, & avolition Affective blunting, delusions & avolition Hallucinations, delusions, & avolition AL-barrak 1430

69 a. Hallucination & delusion .
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 1430

70 5. A client was diagnosed with paranoid schizophrenia twenty years ago
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 1430

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

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

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

74 Assessment the common delusion includes: 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 AL-barrak 1430

75 Other delusion observed
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 AL-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. AL-barrak 1430

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

79 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 1430

80 What are the characteristic of schizophrenia
Commanding & commenting auditory AL-barrak 1430

81 Alteration behavior Bizarre & agitated behavior is associated with schizophrenia and may take a variety of forms. Stereotyped Stupor Waxy flexibility AL-barrak 1430

82 Negative symptoms 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 1430

83 Nursing diagnosis (NANDA)
The following is a listing of some of the more common nursing diagnoses applicable to schizophrenia. Altered thought processes. Sensory perceptual alterations. Impaired verbal communication. Social isolation. Self-care deficit (bathing , hygiene , dressing , grooming , feeding , toileting ). AL-barrak 1430

84 Neurotransmitter increase dopamine Genetic
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 1430

85 Goal Absent of psychotic hallucination & delusion AL-barrak 1430

86 Nursing intervention Maintain eye contact
Assess the client to think logically Thought assessment Listen Do not touch the client specially if have delusion Distraction from delusion No reasoning Voice doubt Introduce new subject for discussion AL-barrak 1430

87 Nursing diagnosis no 2 Disturbance sensory perception related to withdrawal as evidence by hallucination AL-barrak 1430

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 1430

89 Goals Able to hold conversation without hallucinating.
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 1430

90 Nursing intervention 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 1430

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 AL-barrak 1430

92 Reference 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)
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 AL-barrak 1430

94 THANK YOU AL-barrak 1430

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