Introduction:
Schizophrenia is a psychotic disorder marked by severely impaired thinking, emotions and behavior.
Types of Schizophrenia:
Paranoid: People with this type have delusion. Their thinking, speech and emotions remain normal.
Catatonic: Don't interact with others, engage in meaningless, purposeless behavior or assume bizarre postures.
Disorganized: Characterized by disorganized behavior that decrease their ability to perform an activity. They are confused and inappropriate and sometimes behave like a child.
Undifferentiated: People with this type of Schizophrenia may show symptoms of more than one subtype.
Residual: The severity of the symptoms has decreased, compared to when it was originally diagnosed.
Causes: Family history, brain chemistry: Imbalance of certain neurotransmitters are observed in schizophrenia. They produce too much of dopamine (neurotransmitters) which affects the way the brain reacts to certain stimuli, leading to hallucination and delusion. Brain structure abnormality: In some cases, neuroimaging studies have shown abnormality in brain structure. Environmental factors: Exposure to viruses, toxins or malnutrition during fetal life, stressful life circumstances, older parental age or taking psycho active drugs during adolescence and young adulthood.
Signs and symptoms:
Positive symptoms: Symptoms that are not present in people without schizophrenia such as delusion, hallucination, thought disorder and disorganized behavior.
Negative symptoms: Reflects the absence of certain normal behaviors in people with schizophrenia includes lack of emotions, loss of interest in everyday activities, neglect of personal hygiene, social withdrawal and reduced ability to plan or carry out activities.
Cognitive symptoms: Problems with making sense of information, memory problems, difficulty paying attention.
Diagnosis: Blood test and imaging studies may be done. Psychological evaluation: checking mental status of the patient. A person is considered to have schizophrenia if the person has the characteristics of symptoms that last for at least 6 months.
Management:
Schizophrenia requires lifelong treatment even when the symptoms have subsided. The goal is to reduce the symptoms and to decrease the chances of a relapse.
Medication: Anti-psychotic medications are used to treat schizophrenia. They help to relieve the symptoms. Examples: CPM, Haloperidol and Olanzapine.
Psychological therapy: Social skill training: To improve communication and social interaction. Family therapy: Train families, by enabling them to help their loved ones with schizophrenia. Individual therapy: Helps the patient better understand the disease and learn about coping up and problem-solving skills. Vocational rehabilitation: To enable the patient to live as independently as possible.
Hospitalization: During the times of severe symptoms (crisis period) the patient should be hospitalized to ensure safety, proper nutrition, hygiene and adequate sleep.
Electroconvulsive therapy: Rarely used nowadays in the treatment of schizophrenia.
Nurse's Interventions:
Assess patient's symptoms and physical needs. Maintain a safe environment. Set limits on the patient's behavior when it interferes with others. Monitor for altered thought process. Spend time with the patient, even if the patient is unable to respond. Avoid an overly warm approach: a neutral approach will be the best. Avoid touching the patient. Limit the time of interaction with the patient. Never make promises to the patient that cannot be fulfilled. Establish daily routine and assist the patient to improve grooming. Do not "go along" with the patient's delusion or hallucination. Reorient the patient when necessary. Help the patient understand what is real and unreal.
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