Lecture 6

• Schizophrenia


  A disorder characterized by a major disturbance in thought, perception, cognition, & psychosocial functioning
• Schizophrenia is one of the most severe mental disorders
• 1% of the population worldwide suffer from Schizophrenia
• Onset of Schizophrenia tends to occur between late teens & early adulthood (18 – 24years)
• Biological theories on the development of Schizophrenia

  • Genetic factors
  • Biochemical theory
  • Neurostructural theory
  • Organic theory
  • Perinatal theory
  • Vitamin deficiency theory
• Genetic/heredity theory

  The risk of inheriting schizophrenia is 10% in those who have one immediate family member with the disease, and 40% if the disease affects both parents or an identical twin
• Biochemical theory

  Chemicals responsible for the transmission of nerve impulses across the synapse, known as neurotransmitters, may be responsible for the development of Schizophrenia. Excessive Dopamine and increased Serotonin may contribute to the development of Schizophrenia
• Neurostructural theory


  People with Schizophrenia have relatively less brain tissue & cerebral spinal fluid, with enlarged ventricles in the brain & cortical atrophy
• Organic theory

  Schizophrenia is a functional deficit in the brain, caused by viral infection, toxins, trauma or abnormal substances, or a metabolic disorder
• Perinatal theory


  The risk of Schizophrenia exists if the developing fetus or newborn is deprived of oxygen, or if the mother suffers from malnutrition or starvation during the first trimester of pregnancy
• Vitamin deficiency theory

  Persons who are deficient in Vitamin B (B1, B6 & B12) as well as Vitamin C may be at risk of developing Schizophrenia
• Stress-diathesis model

  Individuals are exposed to stressful events in the course of their lives & these events may trigger symptoms in some people who have a predisposition to mental illness. This vulnerability may be related to genetics, environmental factors, alterations in brain structure or biochemistry, or a combination of these
• Common symptoms of Schizophrenia


  • Delusions
  • Religiosity
  • Paranoia
  • Magical thinking
  • Associative looseness
  • Neologisms
  • Concrete thinking
  • Clang associations
  • Word salad
  • Circumstantiality
  • Mutism
  • Perseveration
  • Hallucinations
  • Illusions
  • Echolalia
  • Echopraxia
  • Inappropriate affect
  • Blunt/flat affect
  • Apathy
  • Ambivalence
  • Deteriorated appearance
  • Impaired social interaction
  • Social isolation
  • Anergia
  • Waxy flexibility
  • Posturing
  • Pacing & rocking
  • Anhedonia
• Medications used in the treatment of Schizophrenia

  • Antipsychotics
  • Anticonvulsants/mood stabilizer
  • Anticholinergics/antiparkinson's agents
• Antipsychotics

  Commonly used medications: Chlorpromazine (Largactil), Haloperidol (Haldol), Thioridazine (Melleril), Olanzapine (Zyprexa). They block the transmission of dopamine & serotonin to control symptoms and prevent relapse
• Less severe side effects of Antipsychotics

  • Blurred vision
  • Constipation
  • Drowsiness
  • Dry mouth
  • Hypotension
  • Weight gain
  • Parkinsonian effects
• Severe side effects of Antipsychotics

  • Akathisia
  • Neuroleptic malignant syndrome (NMS)
  • Tardive dyskinesia
  • Acute dystonic reaction
• Nursing intervention for Akathisia

  Contact physician, may need to change the antipsychotic, give anticholinergic
• Nursing intervention for Neuroleptic Malignant Syndrome (NMS)

  Stop drug immediately, maintain hydration, monitor & reduce temperature
• Nursing intervention for Tardive Dyskinesia

  Refer to physician to lower dose, for long term patients may have to taper off dose
• Nursing intervention for Acute Dystonic Reaction

  Requires quick action, give IV or IM antiparkinsonian drug (e.g. Benztropine - Cogentin), careful observation after injection, may develop laryngeal spasm requiring tracheostomy & oxygen therapy
• Nursing interventions for delusions

  Assess risk to self & others, take appropriate action (e.g. close observation, give PRN antipsychotics), try to understand content, do not reinforce or argue, provide quiet environment
• Nursing interventions for auditory hallucinations

  Assess extent & content, assess threat to safety, reassure patient hallucinations are part of illness, identify activities that don't stimulate hallucinations, identify ways to cope, use PRN medications
• Nursing interventions for fear/anxiety/paranoia

  Assess level, reassure patient environment is safe, be aware of own behavior, do not touch or whisper, use PRN medications
• Nursing interventions for disordered thinking

  Assess extent & impact, speak using clear language, assess medication effectiveness, provide diversional activities, control environmental stimuli
• Nursing interventions for lack of insight

  Assess patient's understanding, provide information, reinforce need to take medications as prescribed
• Nursing interventions for poor personal hygiene

  Assess ability, assist patient, encourage/remind to meet hygiene needs
• Nursing interventions for inadequate nutritional intake

  Assess hydration & nutritional status, overcome paranoid delusions about food by involving patient in preparation
• Patient education guidelines on antipsychotic medication


  • Take as prescribed
  • Likelihood of long-term use
  • Discuss severe reactions with physician/nurse
  • Avoid driving/operating machinery due to sedation/fatigue
  • Medication needs review if pregnant
  • Avoid alcohol
  • Avoid illicit drugs
  • Do not stop taking medication due to feeling well
  • Do not double up if a dose is missed
• Not taking antipsychotic medications as prescribed creates the risk of relapse
• Medications interact with alcohol
• Medications should not be mixed with illicit drugs
• If a dose is missed, wait until the next dose is due, do not double up
• Stopping medication due to feeling well creates the risk of relapse