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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. 27/02/2010 75