Download Catatonic schizophrenia

SCHIZOPHRENIA
 1887: Emil Krapelin (discrete mental illness)
used the word “dementia praecox”.
 1911: Eugen Bleuler renamed it as
Schizophrenia.
 The word derived from Greek word .
‘Schizo’ means ‘split’ and ‘Phren’ means ‘mind’
• 1993: Lancy Feldt ( psychiatrist)
distinguished the of schizophrenia from
psychosis.
• Kurt Schneider: He emphasized the role of
psychotic symptoms, as hallucinations,
delusions and gave them the privilege of “the
first rank symptoms” even in the concept of
the diagnosis of schizophrenia.
WHAT IS SCHIZOPHRENIA???
• Schizophrenia actually refers to a group of
disorders. There is not one essential symptom
that must be present for a diagnosis. Instead,
patients experience different combinations of
the main symptoms of schizophrenia.
EPIDEMIOLOGY
DEFINITION
• Schizophrenia is most likely not a single
disease of brain but a heterogenous disorder
with some common features , including
thought disturbances and pre -occupation
with frightening inner experiences , affect
disturbances and behaviour or social
disturbances.
( Kaplan and Sadock, 1996)
Schizophrenia is a mental disorder
characterized by a disintegration of thought
processes and of emotional responsiveness
CAUSES
BIOLOGIAL THEORIES
 GENETIC
 Monozygotic twins – 4 times higher chances.(
46%)
 Dizygotic twins : 14%
 First degree relatives: 8-10 %
 Children of schizophrenia parents:
Single: 10-12%
Both: 40%
2. Biochemical factors
 Hyper activity of dopamine system.
Increased nor epinephrine activity.
Decreased GABA activity.
 Abnormal metabolism of serotonin.
3. Psychological theories
 Family factors
 Dysfunctional parenting
 Parent blaming
 Schizophrenogenic mothers
 Double blind communication
 Over protection
 Broken homes
b) Neuropsychological factors
o Organic brain dysfunction
eg: frontal lobe atrophy
o Brain infections
o Poisons
o Metabolic disorders
o Trauma
Poverty
Society and cultural disharmony
Community disorganization
Social isolation
Strained interpersonal relationship
 ENVIRONMENTAL
- Stressful Environment
- Traumatic experiences

Interpersonal theories
Vitamin deficiency theory
VITAMIN B1, B2,B12,AND
VITAMIN C .
CLASSIFICATION
F20 SCHIZOPHRENIA.
 F20.0 Paranoid schizophrenia
 F20.1 Hebephrenic
 F20.2 Catatonic
 F20.3 Undifferentiated
F20.4 Post schizophrenic depression
F20.5 Residual schizophrenia
F20.6 Simple schizophrenia
F20.8 Other schizophrenia
F20.9 Schizophrenia unspecified
CLINICAL MANIFESTATIONS
• According to Eugen Bleuler:
• Primary symptoms
a) Association disturbances/ looseness.
b) Autism
c) Affective disturbances.
d) Ambivalence
• Secondary symptoms
A. Disorders of perception
a) Hallucination
b) Illusion
B) Disorders of thought
a) delusions

delusions of persecution.

delusion of reference

delusion of control

somatic delusion
C) DISORDERS OF MOTOR ACTIVITY
-Negativism: motiveless resistance.
-Automatism
- Stereotypic speech
1. Echolalia
2. Verbigeration
3. Echopraxia
4. Mannerism
5. impulsiveness
Disturbance in form of
thought and speech
Neologism
Incoherence
Loosening of association
Thought blocking
 Disturbance in attention
Schneider's first
rank symptoms
Thought alienation
 Thought withdrawal
 Thought insertion
 Thought broad casting
 Delusion of perception
HALLUCINATIONS
• Audible thoughts
• Voices heard arguing
• Voices commenting on one’s action
Passivity phenomenon
Twin studies
Why does one twin become
schizophrenic and the other does
not?
Lower birth weight
More physiological distress
More submissive, tearful,
sensitive
Impaired motor coordination
Positive and Negative Symptoms
Negative
Alogia
Affective flattening
Avolition-apathy
Anhedonia-asociality
Positive
Hallucinations
Delusions
Bizarre behaviour
Positive formal
thought disorder
Attentional impairment
Andreasen N.C., Roy M.-A., Flaum M.: Positive and negative symptoms. In: Schizophrenia, Hirsch S.R. and
Weinberger D.R., eds., Blackwell Science, pp. 28-45, 1995
Clinical Types
Paranoid type
Disorganized type
Catatonic type
Undifferentiated type
Residual type
Paranoid schizophrenia
• Where delusions and hallucinations are
present but thought disorder, disorganized
behavior, and affective flattening are absent.
Disorganized/ hebephrenic
schizophrenia
• Where thought disorder and flat affect are
present together.
• Prominent symptoms are disorganized speech
and behavior, as well as flat or inappropriate
affect.
Catatonic schizophrenia
• The person with this type of schizophrenia
primarily has at least two of the following
symptoms: difficulty moving, resistance to
moving, excessive movement, abnormal
movements, and/or repeating what others say
or do.
• The subject may be almost immobile or
exhibit agitated, purposeless movement.
Symptoms can include catatonic stupor
and waxy flexibility
Undifferentiated schizophrenia
• Psychotic symptoms are present but the
criteria for paranoid, disorganized, or
catatonic types have not been met.
Post-schizophrenic depression
• A depressive episode arising in the aftermath
of a schizophrenic illness where some low-
level schizophrenic symptoms may still be
present.
Simple schizophrenia
• Insidious and progressive development of
prominent negative symptoms with no history
of psychotic episodes
Prominent negative symptoms.
Psychomotor slowing
Underactivity
Blunting of affect
Lack of initiative
Poverty of content of speech
Poor non verbal communication by facial
expression, eye contact, voice modulation and
posture.
 Poor self care.
 Poor social performance.
2.Evidence in the past of at least one clear cut
psychotic episode meeting the criteria for
schizophrenia.
3. A period of at least one year during which
the intensity and frequency of florid symptoms
such as delusions ,hallucinations have been
minimal or substantially reduced and the
‘negative’ schizophrenic syndrome has been
present
MANAGEMENT
PHARMACOLOGICAL
MANAGEMENT
TYPICAL
ANTIPSYCHOTICS
 Chlorpromazine 300-1000mg
Thioridazine 300-600mg
Haloperidol 5-30mg
Flupenthixol 3-18mg
Atypical Antipsychotics
 Risperidone 2-16mg
Olanzapine 5-20 mg
Amisulpride 400-1200 mg
 aripiprazole 15-30mg
Treatment of Schizophrenia
conventional
antipsychotics
(classical
neuroleptics)
chlorpromazine, chlorprotixene,
clopenthixole, levopromazine,
periciazine, thioridazine
droperidole, flupentixol, fluphenazine,
fluspirilene, haloperidol, melperone,
oxyprothepine, penfluridol,
perphenazine, pimozide,
prochlorperazine, trifluoperazine
atypical
antipsychotics
amisulpiride, clozapine, olanzapine,
quetiapine, risperidone, sertindole,
sulpiride
a. Fluphenazine decanoate 25-50mg
b. Haloperidol decanoate 200-400 mg
( every 2-3 weeks)
ELECTRO CONVULSIVE
THERAPY
PSYCHO SOCIAL
TREATMENT
 Psycho education
Group psychotherapy
Cognitive retraining
 Psycho social rehabilitation
Assertive community treatment
Family therapy
NURSING
MANAGEMENT
Nursing diagnosis
• Imbalanced nutrition less than body
requirements related to anorexia as evidenced
by fatigue and aversion to take food.
• Self care deficit related to withdrawal into self
as evidenced by refusal to take bath and poor
grooming.
GOAL
• Client will attain normal thought process as
evidenced by good attention and
concentration .
• Client will voluntarily spend time with other
clients and staff members.
• Client will recognize the disorganized thinking
and improves communication.
• Client demonstrates effective coping skills .
• Client maintains normal nutritional status.
• Client attains the ability to do self care
activities.
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