Chapter: Psychiatric Mental Health Nursing : Schizophrenia


SCHIZOPHRENIA CAUSES DISTORTED and bizarre thoughts, percep-tions, emotions, movements, and behavior.


SCHIZOPHRENIA CAUSES DISTORTED and bizarre thoughts, percep-tions, emotions, movements, and behavior. It cannot be defined as a single illness; rather, schizophrenia is thought of as a syndrome or as disease process with many different variet-ies and symptoms, much like the varieties of cancer. For de-cades, the public vastly misunderstood schizophrenia, fearing it as dangerous and uncontrollable and causing wild distur-bances and violent outbursts. Many people believed that those with schizophrenia needed to be locked away from society and institutionalized. Only recently has the mental health in-dustry come to learn and educate the community at large that schizophrenia has many different symptoms and presenta-tions and is an illness that medication can control. Thanks to the increased effectiveness of newer atypical antipsychotic drugs and advances in community-based treatment, many cli-ents with schizophrenia live successfully in the community. Clients whose illness is medically supervised and whose treat-ment is maintained often continue to live and sometimes work in the community with family and outside support.


Schizophrenia usually is diagnosed in late adolescence or early adulthood. Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women (American Psy-chiatric Association [APA], 2000). The prevalence of schizophrenia is estimated at about 1% of the total popula-tion. In the United States, this translates to nearly 3 mil-lion people who are, have been, or will be affected by the disease. The incidence and the lifetime prevalence are roughly the same throughout the world (Buchanan & Carpenter, 2005).


The symptoms of schizophrenia are divided into two major categories: positive or hard symptoms/signs, which include delusions, hallucinations, and grossly disorganized thinking, speech, and behavior; and negative or soft symptoms/signs, which include flat affect, lack of volition, and social withdrawal or discomfort. For Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR; APA, 2000) diagnostic criteria for schizophre-nia, please refer to the DSM-IV-TR Diagnostic Criteria. Medication can control the positive symptoms, but fre-quently the negative symptoms persist after positive symp-toms have abated. The persistence of these negative symp-toms over time presents a major barrier to recovery and improved functioning in the client’s daily life.


The following are the types of schizophrenia according to the DSM-IV-TR (APA, 2000). The diagnosis is made according to the client’s predominant symptoms:


·    Schizophrenia, paranoid type: characterized by persecu-tory (feeling victimized or spied on) or grandiose delu-sions, hallucinations, and, occasionally, excessive religiosity (delusional religious focus) or hostile and aggressive behavior


·    Schizophrenia, disorganized type: characterized by grossly inappropriate or flat affect, incoherence, loose associations, and extremely disorganized behavior


Schizophrenia, catatonic type: characterized by marked psychomotor disturbance, either motionless or exces-sive motor activity. Motor immobility may be manifested by catalepsy (waxy flexibility) or stupor. Excessive motor activity is apparently purposeless and is not influenced by external stimuli. Other features include extreme negativism, mutism, peculiarities of voluntary movement, echolalia, and echopraxia.

·    Schizophrenia, undifferentiated type: characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior


·    Schizophrenia, residual type: characterized by at least one previous, though not a current, episode; social withdrawal; flat affect; and looseness of associations


Schizoaffective disorder is diagnosed when the client has the psychotic symptoms of schizophrenia and meets the criteria for a major affective or mood disorder. The mood disorder can be mania, depression, or mixed moods. There is disagreement among psychiatrists about the validity of this diagnosis, with many believing that a diagnosis of psy-chotic mood disorder is more appropriate (Lake & Hurwitz, 2007). Other clinicians believe it would be more beneficial to diagnose the client with schizophrenia and a mood disorder, such as bipolar disorder (Mahli, Green, Fagiolini, Peselow, & Kumari, 2008), rather than try to combine the two diagnoses.


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