SCHIZOPHRENIA

2nd most frequent diagnosis of

patients 14-64 y/o
at CRH in 2008

Target Audience
Nursing Staff to include nurses and
technicians

In this module we will cover

What is schizophrenia
Symptoms of schizophrenia
Types of schizophrenia
Some of the more common treatments for
schizophrenia

Last update 6/25/09 ajj

CRH most frequent

diagnosis in 2008
Under 14 y/o
Attention Deficit
Disorder
Oppositional Defiant
Disorder
PTSD
Bipolar
Adjustment disorder

65 and over
Persistent mental
disorder due to
conditions classified
elsewhere
Alzheimer
Schizoaffective
disorder
Other and alcohol
dependence
Bipolar, Manic episode

CRH most frequent

diagnosis in 2008
14-64 y/o
Other & unspecified alcohol dependence
Schizoaffective disorder
Cocaine dependence
Depressive disorder
Combo of drug dependence excluding opioid
type drugs

What is schizophrenia?
A chronic severe brain disorder; often they
hear voices, believe media are
broadcasting their thoughts to the world or
may believe someone is trying to harm
them.
In men it usually develops in teen years
and early 20s; in women it usually
develops in 20s and 30s.

Diagnosis
Currently there is no physical or lab test
that can absolutely diagnose
schizophrenia.
A psychiatrist usually comes to the
diagnosis based on clinical symptoms.

Misdiagnosis
This is a common problem since
schizophrenia shares a significant number
of symptoms with other disorders.
Per the Natl Depression & Bipolar
Support Alliance there is an average of 10
years from onset to correct diagnosis & tx.

Disorders that may appear like

Schizophrenia

Schizoid personality
Schizophreniform disorder
Schizotypal personality
Bipolar Disorder
Aspergers syndrome

Symptoms of Schizophrenia
Profound disruption in cognition and
emotion, affecting the most fundamental
human attributes:
Language
Thought
Perception
Affect
Sense of self

Positive Symptoms
Those that appear to reflect an excess or
distortion of normal functions.

Positive Symptoms
Delusions. Those where the patient thinks
he is being followed or watched are
common; also the belief that people on
TV, radio are directing special messages
to him/her.

Positive Symptoms
Hallucinations. Distortions or
exaggerations of perception in any of the
senses.
Often they hear voices within their own
thoughts followed by visual hallucinations.

Positive Symptoms
Disorganized thinking/speech.
AKA loose associations; speech is
tangential, loosely associated or
incoherent enough to impair
communication.

Positive Symptom
Grossly disorganized behavior.
Difficulty in goal directed behavior (ADLs),
unpredictable agitation or silliness, social
disinhibition, or bizarre behavior.
There is a purposelessness to behavior.

Positive Symptom
Catatonic behavior.
Marked decrease in reaction to immediate
environment, sometimes just unaware of
surroundings, rigid or bizarre postures,
aimless motor activity.

Other Positive Symptoms

Inappropriate response to stimuli

Unusual motor behavior (pacing, rocking)
Depersonalization
Derealization
Somatic preoccupations

Summary of Positive Symptoms

Delusions
Hallucinations
Disorganized thinking
Disorganized behavior
Catatonic behavior
Inappropriate responses

FYI: Positive Symptoms

Positive symptoms are those that have a
positive reaction from some treatment.
In other words, positive symptoms
respond to treatment.

Negative Symptoms
Those that appear to reflect a diminution
or loss of normal functions.
May be difficult to evaluate because they
are not as grossly abnormal as positive
symptoms.

Negative Symptoms
Affective flattening.
Reduction in the range and intensity of
emotional expression, including facial
expression, voice tone, eye contact and
body language.

Negative Symptom
Alogia (poverty of speech)
Lessening of speech fluency and
productivity, thought to reflect slowing or
blocked thoughts; often manifested as
short, empty replies to questions.

Negative Symptom
Avolition
The reduction, difficulty or inability to
initiate and persist in goal-directed
behavior. Often mistaken for apparent
disinterest.

Examples of Avolition
No longer interested in going out with
friends
No longer interested in activities that the
person used to show enthusiasm
No longer interested in anything
Sitting in the house for hours or days
doing nothing

Disorganized Symptoms
This one is somewhat new and may not
be considered valid.
It is thought disorder, confusion,
disorientation and memory problems.

Summary of Negative Symptoms

Lack of emotion
Low energy
Lack of interest in life
Affective flattening
Alogia
Inappropriate social skills
Inability to make friends
Social isolation

Cognitive Symptoms
Difficulties in concentration and memory:
Disorganized thinking
Slow thinking
Difficulty understanding
Poor concentration
Poor memory
Difficulty expressing thoughts
Difficulty integrating thoughts, feelings,
behaviors

FYI: Negative Symptoms

Currently there is no treatment that has a
consistent impact on negative symptoms.

Types of Schizophrenia

Paranoid
Hebephrenic
Catatonic
Residual
Schizoaffective
Undifferentiated

Paranoid Schizophrenia
Persons are very suspicious of others and
often have grand schemes of persecution
at the root of their behavior.
During this phase they may have
hallucinations and frequent delusions.

Hebephrenic Schizophrenia
AKA disorganized schizophrenia; characterized
by emotionless, incongruous, or silly behavior,
intellectual deterioration, frequently beginning
insidiously during adolescence.
May be verbally incoherent and may have
moods and emotions that are not appropriate to
the situation.
Hallucinations not usually present.

Catatonic Schizophrenia
Person is extremely withdrawn, negative
and isolated.
May have marked psychomotor
disturbances.

Residual Schizophrenia
Lacks motivation and interest in day-today living.
Person is not usually having delusions,
hallucinations or disorganized speech.

Schizoaffective Disorder
There will be symptoms of schizophrenia
as well as mood disorder (depression,
bipolar, mixed mania).

Undifferentiated Schizophrenia
Conditions meeting the general diagnostic
criteria for schizophrenia but not
conforming to any of the previous types.
Exhibits more than one of the previous
types without a clear dominance of one.

Summary
Before a diagnosis the psychiatrist must
make a thorough evaluation including a
physical/medical exam, a mental status
exam, appropriate labs, and a full history.
History includes changes in thinking,
behavior, movement, mood, etc. as seen
by the family.

Medications
In general it may take up to 6 months for
medications to show consistent effects.
The newest medication is Invega.
Meds include atypicals: Abilify, Geodon,
Clozapine, Risperidone, Seroquel,
Zyprexa.
[Remember: a giraffe can really see a zebra]

 These medications may have such

intolerable side effects that the patient will
stop the drugs.
One study showed the average time the
meds were taken regularly was 3 months.

Treatments
Psychotherapy - an adjunct to meds and is very
useful to keep the patient on the meds.
Group therapy
Family therapy
Community support groups

 Early detection and treatment has the best

results/response to treatment.
Per patients, once you have schizophrenia
you have it for life. The best you can hope
for is control.

FYI: Cancer Study

A study in France in 1993, with 3470
patients with schizophrenia, showed that
breast cancer was the second most
common cause of death.
www.komen.org/schizophreniaassociatedwi
thincreasedcancermortality
. Cancer 2009.

 The next few slides are a review of

general psychiatric definitions, defense
mechanism and communication
techniques.
They may or may not be related to the
current topic.

Psych Definitions
Delusion
= fixed beliefs that usually
involve a misinterpretation of experience.
Client believes someone is reading his
thoughts
Several types: grandiose, nihilistic,
persecutory, somatic

Psych Definitions
Hallucinations = perceptual experiences
that occur in absence of actual sensory
stimuli; involves the 5 senses.

Psych Definitions
Illusions
= person misperceives or
exaggerates stimuli that actually exist in
the external environment.

Defense Mechanism
Affiliation =
Turning to others for help or support; sharing
problems with others without implying that
someone else is responsible.
Ex: An individual has a fight with spouse and
turns to their best friend for emotional support.

Defense Mechanism
Devaluation =
Attributing exaggerated negative qualities to
self or others.
Ex: A boy has been rejected by his long time
girlfriend. He tells his friends that he realizes
that she is stupid and ugly.

Defense Mechanism
Displacement =
Transferring a feeling about, or a response to,
one object onto another (usually less
threatening) substitute object
Ex: A child is mad at her mother for leaving
for the day, but says she is really mad at the
sitter for serving her food she does not like.

Communication Technique
Confrontation =
Presenting the patient with a different reality
of the situation.
Ex: My best friend never calls. She hates me.
Nurse I was in the room yesterday when she
called.

Communication Technique
Doubt =
Expressing or voicing doubt when a patient
relates a situation.
Ex: My best friend hates me. Nurse From
what you have told me, that does not should
like her. When did she last call you?

Resources
Schizophrenia Symptoms, by NARSAD,
The Mental Health Research Association.
Schizophrenia Treatment, by John
Grohol, PsychCentral, 08/07/08
Psychiatric Study Guide by Central
Regional Hospital

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