Schizophrenia Explained

person with schizophrenia holds blanket over face

Schizophrenia (shattered mind) it affects the way thinks, feels, perceives reality. It causes disturbances in thought process, perception, and affect. Skizo means split or divided and phren means mind.

In history, people thought individuals with schizophrenia were possessed by the devil due to lack of knowledge and were scared. Today stigma is huge and society is often unwilling to shoulder the costs of housing, treatment, and rehabilitation for people with mental disorders like schizophrenia.

Signs and Symptoms

Symptoms usually occurring late adolescence or early adulthood. Males eighteen to twenty-five and females twenty-six to forty-five. Twenty-five percent of people with schizophrenia experience complete remission after one or several psychotic episodes. People with schizophrenia experience complete remission after one or several psychotic episodes. Early interventions help increase the rate of recovery or decrease the severity of the disorder. Remission means they are not cured but symptoms are under control. It can be seen as anger, anxiety in the early years.

There are positive and negative symptoms of schizophrenia. Positive symptoms are ones that can be controlled by medications such as delusions, hallucinations, and illusions. These positive symptoms are ones that are added to the individual. Negative symptoms are ones that are taken away from the individual and often cannot be fixed with medicine. These include social withdrawal, blunt or flat affect, and lack of avolition (absence of will or drive). Negative symptoms include lack of pleasure in life and the absence of emotional content in-person expression or voice. it also includes the lack of ability to begin and sustain planned activities.

Other symptoms include laughing without reason, crying without a reason, poor memory, speech disorder, aggression, visual or auditory hallucinations, and lack of movement.

These symptoms negatively affect people’s jobs, empathy, relationships, self-care, schooling, and much more.

Delusions are a fixed false belief and are used in everyday language to describe a belief that is false, fanciful, or derived from deception. Delusions usually include pathological misperceptions. Hallucinations are perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception.

Behaviors

individual with schizophrenia looks out the blinds

Grandiose is feeling increased self-importance such as royalty and wealth. Persecutory is bad thoughts (someone is out to get me and when I fall sleep they break into my house and poison the food). Somatic is the feeling that something is wrong with your body. Nihilistic is thoughts that something bad is gonna happen (they are dead or the world is coming to an end). Hypervigilance is always waiting for something frightening or important to happen (watches out blinds all day). This is sustained attention to external stimuli. Preservation is persistent adherence to a thought or idea ( people on the radio can hear what I think) you can’t get them off that topic

Waxy Flexibility is a posture held in an odd or unusual fixed position for an extended period, usually in an awkward position. They will not move or get repositioned even with assistance. This may last from a few hours to a few days. Akathisia is when they rock in place.

Avolition is being so unmotivated that simple activities of daily living don’t get done such as showering. Ambivilou is being unable to make decisions and not really care either way. Anhedonia is not being able to enjoy things.

Speech Impairment and Unusual Patterns

Clang association is relating ideas based on sound and rhyme. Verbigeration is the repetition of words. Neologisms are invented words by the client. Word salad is jumbled words and phrases that are disconnected. Echolalia is imitation or repetition of what someone says.

Diagnosis

There is no lab test to determine Schizophrenia. Symptoms must be present for a significant period of one month, but with continuous signs of disturbances for at least six months, before a diagnosis can be done. Individuals must exhibit at least two of the specified symptoms (delusions, hallucinations, disorganized speech, grossly disorganized behavior, or negative symptoms). People with this disorder will experience a disturbance in their level of functioning.

The cause of schizophrenia is unknown. Some theories include familial patterns, dopamine hypothesis, reduction in brain metabolism, and thalamus.

It is thought that schizophrenia may be related to familial patterns. It may be caused by a genetic reason or a biological predisposition. First degree relatives of people with schizophrenia are ten times more likely to experience schizophrenia than the general population.

Another theory is the dopamine hypothesis. A schizophrenic brain shows that there is a high amount of dopamine in the brain. this level may be too much. Certain medications can block dopamine receptors in the brain.

The thalamus plays a major role in cognitive disturbances. It works as a gate or filter of information.

Risk Factors

Risk factors for schizophrenia include stress and infection during pregnancy that affects the baby. Schizophrenia is not caused by poor parenting, poor bond, or medication is taken during pregnancy.

Co-Morbidities include diabetes mellitus.

Interventions

Early interventions help increase the rate of recovery or decrease the severity of the disorder. Promoting safety is always number one when treating and intervening. It is encouraged that people with schizophrenia should participate in support groups.

Pharmacologic interventions are needed to control the symptoms of schizophrenia. Typical antipsychotic medications will control positive symptoms such as hallucinations, delusions, and illusions. Unfortunately, they do not help negative symptoms and sometimes will worsen them. Newer atypical antipsychotics have fewer neurological side effects and they are more effective at improving negative symptoms.

Side effects from medications range from mild discomfort to permanent movement disorders. Many side effects are frightening and upsetting to clients and they frequently cause non-compliance.

An individual may experience weight gain, sedation, dry mouth, blurred vision, hypotension, constipation, and urinary retention.

Extrapyramidal side effects such as akathisia, dystonia, and Tardive dyskinesia may occur. Akathisia is feet that are in constant motion. This causes restlessness, trouble standing, and pacing. Tardive dyskinesia is involuntary movements of the body and extremities as well as sucking or smacking of the lips. People may do a chewing motion or roll their tongue. Acute dystonia is facial grimacing such as involuntary eye movements and muscle spams which usually cause the trunk to arch forward.

Medication Emergencies

If an individual experiences medication emergencies administer anticholinergics, stop administration of offending meds, monitor vitals, reduce body temperature, and safety protect muscles.

Watch for an anticholinergic crisis. Anticholinergic medication is great for the treatment of extrapyramidal side effects but may cause anticholinergic crisis. This will show as confusion and hallucinations. This also presents as “red as a beet, mad as a hatter, blind as a bat, dry as a bone, and hot as a hare”.Physical signs are dilated pupils, blurred vision, difficulty swallowing, nausea, vomiting, seizures, decreased bowel should, tachycardia, and fever.

Neuroleptic malignant syndrome is another condition to watch out for. It is a life-threatening reaction that can occur in response to neuroleptic or antipsychotic medication. Symptoms include severe muscle rigidity, elevated temperature, changes in the level of consciousness, elevated liver enzymes, elevated creatine phosphokinase, and leukocytosis.

Clinical Course

There are four periods of the acute illness period, the stabilization period, the maintenance and recovery period, and the relapses period.

The acute illness period is bizarre or disruptive thoughts and behaviors that cannot be overlooked. This includes both negative and positive symptoms. The goal of this stage is suicide prevention, normalize sleep, and reduce substance abuse. There are three phases of the Acute illness period. Phase one is prodrome which introduces early symptoms to the client. Phase two is acute symptoms. Lastly, phase three is recovery.

The stabilization period introduces treatment which is fairly intense. Medication regime is established. Family and patient need to adjust to the new diagnosis and lifestyle. Symptoms are less acute but may be present.

Maintenance and recovery period occurs when the condition is stabilized. The goal is to regain the previous level of functioning and quality of life. For this stage to occur, medication compliance and family support are crucial. Education is key, monitor adverse effects.

Relapses may occur anytime during treatment and recovery. This is usually from noncompliance with medication.

This is a lifetime disorder, so it is vital to make sure that there are support systems in place and treatment is available to all. Education is necessary for people to understand schizophrenia so support safe and continued.

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