Schizo-DID

• Schizophrenia


  A mental disorder characterized by abnormal social behavior and failure to understand what is real
• Paul Eugene Bleuler


  Coined the name schizophrenia
• Phren


  Soul, spirit, mind
• Schizophrenia


  • Dementia praecox: old name
  • Major psychotic disorder
  • Disorganized thinking: no contact with reality (weak ego)
  • Bizarre behavior
  • Cannot be defined as a single illness
  • Split mind & changing personality
• Diagnosed


  Late adolescence or early adulthood
• Peak incidence of onset

  15 to 25 years of age for men
• Peak incidence of onset

  25 to 35 years of age for women
• Primary symptoms (4 A's)

  • Autism
  • Ambivalence
  • Associative Looseness
  • Affective Disturbance
• Autism


  Difficulties in social interaction, verbal & nonverbal communication and repetitive behaviors
• Ambivalence


  Contradictory attitudes or feelings toward an object, person, action
• Associative Looseness


  Association of ideas & thought patterns that are unrelated and lacks logical sequence
• Affective Disturbance


  Emotional regulation difficulties and related affective disturbances
• Etiology


  • Biological theories
  • Psychosocial theory
  • Psychoanalytic / psychodynamic theory
• Genetic theory


  Schizophrenia is genetically transmitted/inherited
• Biochemical theory


  Lie in the chemical formula of the psychotomimetic drugs, mescaline-like products induce psychosis
• Neurostructural theory


  Excessive amount of dopamine
• Psychosocial theory


  Environmental stressors (e.g. Parental divorce, childhood abuse)
• Psychoanalytic / psychodynamic theory


  Ego's job is to keep in control of id's impulses & the moral restrictions of superego. If and when abnormal upbringing (a cold and rejecting mother) can result in weak and fragile ego (disintegration of the ego)
• Subtypes of schizophrenia


  • Paranoid type
  • Disorganized type
  • Catatonic type
  • Residual type
  • Undifferentiated
• Paranoid type


  Characterized by persecutory (feeling victimized) or grandiose delusions, hallucinations, and occasionally, excessive religiosity(delusional religious focus)or hostile or aggressive behavior
• Care of suspicious clients

  • Promote trust
  • Be consistent and honest
  • Be a matter-of-fact
  • Avoid laughing or whispering
  • Avoid touching client w/o warning
  • Avoid competitive activities
  • Let patient open first the tray of food since they have fear of poisoning
• Disorganized type


  Characterized by grossly inappropriate or flat affect, incoherence, loose association, and extremely disorganized behavior
• Catatonic type


  Characterized by marked psychomotor disturbance, either motionless or excessive motor activity. Motor immobility may be manifested by catalepsy (waxy flexibility) or stupor
• Care of catatonic clients


  • Spend time with the patient
  • Provide range of motion exercises
  • Promote bowel and bladder elimination
  • Fluid intake & Adequate nutrition
• Residual type


  Previous diagnoses of schizophrenia, but no longer having any symptoms of hallucinations, delusions and disorganized speech. However, some symptoms may be present
• Undifferentiated


  Characterized by mixed schizophrenic symptoms (of other types) along with the disturbances of thought, affect, and behavior
• Positive symptoms


  • Hallucinations
  • Illusions
  • Delusions
  • Idea of Reference
  • Paranoia
  • Echolalia
  • Echopraxia
  • Flight of Ideas
• Negative symptoms


  • Flat affect- severe reduction in emotional expressiveness
  • Anergia – Lack of physical activity
  • Avolition – person loses the will to perform the purposeful act
  • Anhedonia – loss of capacity to experience pleasure
  • Alogia – poverty of speech
  • Apathy – lack of feelings or emotions
• Types of delusions


  • Delusion of Persecution
  • Delusion Of Grandeur
  • Religious Delusions
  • Somatic Delusions
• Delusion of Persecution


  Client's belief that others are planning to harm or spying her/him
• Delusion Of Grandeur


  Client's claim to association with famous people or celebrities
• Religious Delusions


  Often center around the second coming of Christ or another significant religious figure or prophet
• Somatic Delusions


  Vague and unrealistic beliefs about the client's health or body function
• Nursing interventions for delusions

  • Never confront, argue, debate
  • Present reality in matter-of-fact
  • Talk about facts, real people, things & events
  • Avoid distraction
• Nursing interventions for hallucinations

  • Validate observations
  • Reality-based activities
  • Talk to reinforce reality
  • Note for command hallucinations
  • Let client hum / open mouth wide
  • Don't discuss, argue, or reinforce hallucinations
• Cues for hallucinations


  • Stop talking in the middle of conversation
  • Assumes listening pose
  • Mouthing words

  
• Nonmodifiable factors


  • Genetics
  • Neurostructural problems (increased dopamine)
• Modifiable factors


  • Environment (social & psychological factors)
• Neurochemical changes


  • Excessive neurotransmitters (dopamine & serotonin)
• Neurodevelopmental abnormalities