Schizophrenia

Question 1

What is Schizophrenia, and what are its symptoms?

Answer 1

It is a chronic brain disorder with no cure, but can be treated.

When active, symptoms include Delusions, Hallucination, Trouble with Thinking and Concentrating, and Lack of Motivation.

Question 2

When do psychotic features of Schizophrenia develop?

Answer 2

The features typically emerge between late teens and to the mid-30s.

Question 3

What is the DSM-5 Diagnostic Criteria for Schizophrenia?

Answer 3

1. Two or more of the following, each present for for a significant portion of time during a 1-month period: Delusions, Hallucinations, Disorganised Speech, Grossly Disorganised Speech, Grossly Disorganised or Catatonic Behaviour , Negative Symptoms.
2. Continuous signs of Disturbance persisting for at least 6 months.
3. The disturbances are not attributed to the physiological effects of a Substance (e.g. Drug abuse, Medication) or another Medical Condition.

Question 4

What are the Positive Symptoms of Schizophrenia?

Answer 4

1. Delusions:
   - Persecutory Delusions (Belief that one is going to be harmed, harassed by an individual, organisation or other group)
   - Referential Delusions (Belief that certain gestures, comments, environmental cues are directed at oneself)
   - Grandiose Delusions (When an individual believes that he / she has exceptional abilities, wealth or fame)
   - Erotomanic Delusions (When an individual falselt believes that another person is in love with them)
   - Nihilistic Delusions (Involves the conviction that a major catastrophe will occur)
   - Somatic Delusions (Fixed false beliefs that one’s bodily function or appearance is grossly abnormal)
   - Bizarre Delusions (If delusions are clearly implausible snd not understandable to same-culture peers and do not derive from ordinary life experiences)
2. Hallucinations: False sensory perception, Vivid and Clear, Most occur in the context of a Clear Sensorium (Auditory, Visual, Tactile, Olfactory, Gustatory)
3. Disorganised Thinking (Speech): Symptoms must be severe enough to substantially impair effective communication
4. Grossly Disorganised or Abnormal Motor Behaviour: May manifest itself in a variety of ways, ranging from child-like silliness to unpredictable agitation
   - Catatonic behaviour is a marked decrease in reactivity to the environment (Negativism, Mutism and Stupor, Catatonic Excitement)

Question 5

What are the Negative Symptoms of Schizophrenia? (5As)

Answer 5

1. Affect Flattened - Reductions in the expression of emotions
2. Avolition - Decrease in motivated self; Initiated purposeful activities
3. Alogia - Diminished speech output
4. Anhedonia - Decreased ability to experience pleasure or a degradation in the recollection of pleasure previously experienced
5. Asociality - Apparent lack of interest in social interactions

Question 6

What are the Predisposing Factors of Schizophrenia?

Answer 6

1. Biological: Genetics, Pregnancy and Birth Complications with Hypoxia and Greater Paternal Age, Other prenatal and perinatal adversities (Including stress, infection, malnutrition, maternal diabetes, etc.)
2. Psychological and Social: Season of birth has been linked to the incidence of Schizophrenia, Incidence of Schizophrenia is higher for children growing up in am urban environment and for some minority ethnic groups

Question 7

Factors associated with the Risk of Suicide?

Answer 7

• Previous suicidal attempts and social aspects
• Lack of social support and stable relationships
• Social drift after hospitalisation
• Social Impairment
• Psychotic Symptoms: Suspiciousness, Paranoid Delusions, Mental Disintegration, Agitation, Negative Symptoms, Depression and Hopelessness
• Substance Abuse

Question 8

Treatment of Schizophrenia

Answer 8

1. Reduce symptoms
2. Antipsychotics
3. Psychotherapy
4. Somatic Therapy
5. Therapeutic Milieu

Question 9

Assessment - Nursing Diagnosis of Schizophrenia

Answer 9

• Problem (P): Impaired verbal communication
• Etiology (E): Formal thought disorder
• Symptoms (S): Loose assistance or clang association or tangential speech

Question 10

Nursing Management of Schizophrenia

Answer 10

• Coordination of treatment modalities
• Therapeutic Nurse Patient Relationship (TNPR): Establish trusting and open communication with the client
• Ensure Therapeutic Milieu: Modifying the environment and Encouraging activity
• Drug Administration
• Monitoring side effects of drugs
• Medication education
• Provide psychoeducation for client and family members: To increase knowledge of and insight into illness and treatment
• Management of Client with Destructive Behaviours: Ensure client safety, Crisis intervention, Psychoeducation, Protection and Safety, Increasing self-esteem, Regulating emotions and behaviours, Mobilising social support

Question 11

Outcomes of Nursing Management of Schizophrenia

Answer 11

• Client will live, learn, and work at maximum possible level of success
• Prevention of relapse and early intervention
• Planning therapeutic interventions depends on goals related to diagnosis and level of wellness