This document provides an overview of the history and current understanding of schizophrenia. It discusses: 1) Kraepelin first described dementia praecox in the 19th century and Bleuler coined the term schizophrenia in the 20th century; 2) genetic and neurological factors contribute to schizophrenia, which typically develops in early adulthood; and 3) treatment has evolved from psychoanalysis to modern antipsychotic medications, though side effects continue to challenge patient care.

1. Schizophrenia History
19th Century
Kraepelin- Dementia Praecox
20th Century
Bleuler
autism-apathy-ambivalence-anhedonia
Arieti
associative looseness, auditory
hallucinations

2. Current theories
Genetic
↓ 1% of population
10 % of 1st degree relatives
35-55% concordance rate in monozygotic
twins (genetically identical)
15-17% concordance rate in dizygotic
twins (share half their genes)

3.  Slightly more men than women
 Early 20s age of first psychotic break
 75% of people have permanent disability
 Cultural component on relapse

4. Neurotransmitter imbalance
Dopamine system hyperactivity
Norepinepherine elevation
Serotonin elevation
Diminished levels of GABA
Decreased co-enzyme for conversion of PKU to
tyrosine

5. Central Nervous System Anomaly
Type 2 enlarged ventricles
negative symptoms resistant to
medication
Type 1 positive symptoms respond to
medication

6. Positive Symptoms
Delusions
Hallucinations
Disorganized speech
Bizarre or disorganized behavior

7. Negative Symptoms
Flat Affect
Avolition
Alogia
Anhedonia
Attention Impairment

8. History of Therapy
Psychoanalytic
Sullivan/Peplau
Interpersonal Communication
Somatic
Insulin Coma
Electroconvulsive Therapy
Psychosurgery

9. Psychopharmacology
1950s phenothiazines
1990s D1-D2 receptor medications
Community Mental Health
Milieu
Therapeutic Community
De-institutionalization

10. Typology of Thought Disorder
Paranoid
Catatonic
Disorganized
Undifferentiated
Residual

11. Paranoid
Delusions- especially persecutory
Auditory Hallucinations
No loose associations
No marked affective problem
Paranoid

12. Catatonic
Stupor or mutism
Negativism
Rigidity
Excitement
Posturing (waxy flexibility)

13. Disorganized
Marked looseness of associations
Grossly inappropriate affect
Disorganized

14. Undifferentiated
Prominent delusions
Hallucinations or grossly disorganized behavior
Residual

15. Diagnosis
Presence of 1,2, or 3 for more than 1 week
1. Two of the following:
delusions, prominent
hallucinations, marked
associative looseness
catatonic behavior
flat or silly affect

16. 2. Bizarre delusions
3. Prominent hallucinations
Continuous signs of disturbance ↑ 6 months
18 years if age or more
Downward course

17. Nursing Process- Assessment
1.Perceptual changes:
illusions, hallucinations
2. Thought disorder:
loose associations, clanging, delusions
3. Communication changes:
thought disorganization,
blocking, tangential, circumstantial

18. 4. Motor Changes:
catatonia-excited, posturing, waxy
flexibility
5. Family:
enmeshed, family burden

19. Nursing Diagnosis
Impaired communication
poverty of speech
blunt emotions
Self-care deficits
Activity intolerance
Social isolation
Decisional conflict

20. Sensory alterations
Body image distortion
Altered thought processes
delusions, magical thinking
thought insertions, withdrawal
thought broadcasting

21. Altered emotional response
blunted or flat affect
anhedonia
Altered family function

22. Nursing Planning & Intervention
Adequate communication Medication usage
Grooming & hygiene Organize behavior
Social skills Reality based perceptions
Intervene with delusions Congruent emotional
Family understanding responses
Community contacts

23. Nursing Planning & Intervention
Adequate communication Medication usage
Grooming & hygiene Organize behavior
Social skills Reality based perceptions
Intervene with delusions Congruent emotional
Family understanding responses
Community contacts

24. Nursing Implications with Neuroleptic
Medications
1. Phenothiazines
Thorazine(Chlorpromazine)
Mellaril (Thiorizidine)
Stelazine (Trifluoperazine)
Prolixin (Fluphenazine)
Prolixin Decanoate

25. 2. Butyrophenes
Haldol (Haloperidol)
Haldol LA
3. Low potency D1-D2 medications
Clozaril (Clozapine)
Risperdol (Resperidone) & Risperdol E
Zyprexa (Olanzapine)

26.  Abilify (Ariprazole)
 Geodon (Ziprasidone)

27. Side Effects
Nervous system Extra Pyramidal Symptoms
Akathisia--restelessness
Dystonia– muscle contractions
Opisthotonis—tongue sticking out
Occulogryic Crisis- eye rolling
Akinesia– muscle heaviness
Pseudo parkinsonism- mask like fascies and other symptoms
Tardive dyskinesia—tongue movements
Tardive Dyskinesia

28. Other Side Effects
Photophobia
Leukocytosis
Orthostatic hypotension
Anti-cholinergic effects

29. D1 and D2 effects
 Weight gain
 Impotence
 Risk for development of Diabetes Mellitus (Geodon)
 Gallactarhea

30. Neuroleptic malignant syndrome
 Possibly fatal side effect of neuroleptics
 Non-dose related
 Fever
 Confusion
 Convulsions
 Death
 Rx-stop neuroleptic- emergency care

31. Side Effect Treatment
Anti-parkinson medications:
Cogentin (Benztropine)
Artane (Trihexyphenidyl)
Symmetrel (Amantadine)

32. Atropine Psychosis
Mad as a hatter confused
Red as a beet fever
Dry as a bone anticholinergia
Blind as a bat diplopia