WHAT IS SO CALLED SCHIZOPHRENIA?

WHAT IS SO CALLED SCHIZOPHRENIA? 

https://loonylabs.files.wordpress.com/2014/09/schizophrenia.jpg

Schizophrenia is a chronic and severe mental brain disorder that effect on how the person thinks, feels and action or behave. They maybe look or seem to lose with their own world or thought. When the Schizophrenia trigger the symptom starts to be shown by having delusions, hallucinations, trouble with thinking and concentration, and lack of motivation. However, with treatment, most symptoms of schizophrenia will greatly improve.

To general belief, schizophrenia is not a split or multiple personality. Schizophrenia includes a psychosis, a type of mental illness in which a person can’t tell what’s real from what’s imagined. National Institute of Mental Health have quoted based on psychosis "A person’s thoughts and perceptions are disturbed and the individual may have difficulty understanding what is real and what is not based on what they see".

https://youtu.be/C7Jl9_59tfY

This video have shown how the person really felt during the pre,onset and also the disease they have lived through out daily basis.

https://wifflegif.com/gifs/618567-schizophrenia-depression-gif

Type of Schizophrenia

Type of Schizophrenia

            There are four common type of schizophrenia. There are paranoid type, hebephrenic type, catatonic type and schizoaffective type.

1)  Paranoid type

https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwiKj-nr4K3lAhUWiXAKHeQkDaUQjRx6BAgBEAQ&url=https%3A%2F%2Fwww.belmarrahealth.com%2Fparanoid-schizophrenia-causes-symptoms-complications%2F&psig=AOvVaw3DjM22GEej8A0ti4-38ASm&ust=1571761174147257

• Commonly known as paranoid schizophrenia is the type of schizophrenia that has prejudice against their environment. It is also a reflection shown by the sufferers of their fear. They also can’t distinguish between reality or just fantasy.  

   

2)  Hebephrenic type

https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwi1rP6q363lAhVIPI8KHVzaDuAQjRx6BAgBEAQ&url=https%3A%2F%2Fwww.honestdocs.id%2F9-mitos-dan-fakta-skizofrenia&psig=AOvVaw1CbD3Fykk1E3l9-2Ln95BS&ust=1571760753765940

•      Hebephrenic schizophrenia is a type  of schizophrenia which can be trace by their disorganized speech, disorganized behavior and flat or inappropriate affect

3)  Catatonic type

•       Schizophrenia catatonic type is marked psychomotor disturbance that involve motoric immobility. The common symptom shown by the sufferers is they are able to get into a specific position on a long period of time. For examples they able to keep their hand up for hours.

4)   Schizoaffective disorder

Schizoaffective disorder is a combination of schizophrenia symptoms such as delusional, hallucination and mood disorder like depression, mania, and hypomania.

American Psychiatric Association. (2017). Diagnostic and statistical manual of mental disorders: Dsm-5. Arlington, VA.

SIGNS AND SYMPTOMS

SIGNS AND SYMPTOMS

Schizophrenia has various symptoms which prove the absence of the mental illness. Many people also experience improvements in their symptoms by time to time. And the symptoms include:

https://www.brightquest.com/delusional-disorder/somatic-delusions/

• Confusion - feel confused, may be forgetful. Example; confused on their medical consumption.
• Delusions- untrue of idea, experiences, memories, act of deluding. Example; feel poisoned.
• Hallucinations
• Paranoid thoughts- wrong thought of someone or something which can give harm to them. 
• Hyperactive or manic mood- over excited, energetic, full of ideas. 
• Difficulty in concentrating- disturbance mind.
• Catatonia- an ability to move normally.
• Depression
• Poor  personal hygiene- cannot manage Activities of Daily Living well.
• Insomnia
• Changes in appetite- may be loss of appetite or instead.
• Thoughts of suicide- due to feeling of hopeless, useless. Example, commit suicide by overdosing drugs intake.
• Social isolation- prefer to be alone. Example; when feeling embarrassed so they chose to be isolated.

CAUSES OF SCHIZOPHRENIA

CAUSES OF SCHIZOPHRENIA

https://pixabay.com/illustrations/dna-white-male-3d-model-isolated-1889086/

1. Genetic Inheritance

• Schizophrenia tends to run in families, but no single gene is thought to be responsible. But, if someone is having genes that make he or she more vulnerable to the condition, that does not mean he or she will develop schizophrenia. If there is no history of schizophrenia in a family, the chances of developing it are less than 1 percent. However, that risk rises to 10 percent if one of the parents was diagnosed. 

https://pixabay.com/illustrations/artificial-intelligence-brain-think-3683776/

    2. Brain development

• People with schizophrenia shown that there are slight differences in their brain structures. The changes are not seen in all people with schizophrenia only but also can occur in people who do not have  any mental illness. 

https://nootriment.com/serotonin-dopamine/

    3. Neurotransmitter

• Neurotransmitters are chemicals that carry messages between brain cells. Schizophrenia may be caused by a change in the level of these two neurotransmitters, dopamine and serotonin. 

https://pixabay.com/photos/son-pregnant-woman-shoe-bebe-1910304/

    4. Pregnancy and birth complications

• People who experienced complications before and during their birth are more likely to develop schizophrenia. For example, low birth weight, premature labor, and lack of oxygen during birth. 

https://pixabay.com/photos/stress-anxiety-depression-unhappy-2902537/

    5. Stress

• It does not cause schizophrenia but can trigger its development. For example, someone who is having stressful life events such as losing job, divorce, the end of a relationship, physical, sexual and emotional abuse may be triggered to develop schizophrenia. 

https://www.indiatoday.in/mail-today/story/juvenile-crime-drug-abuse-delhi-335571-2016-08-17

    6. Drug abuse

• Drugs also do not directly cause schizophrenia, but if someone is misusing the drugs, it may increasing the risk of developing schizophrenia. Using certain drugs such as cannabis, cocaine and amphetamines may trigger symptoms of schizophrenia. Usage of cocaine and amphetamines may lead to psychosis. 

EFFECT OF SCHIZOPHRENIA

Effect of Schizophrenia 

There are also have side effects of schizophrenia. Usually, people with this condition will experience stress and self-destruction after being told by a doctor that they have schizophrenia. 

If the disease is not treated within a short period of time, it can cause severe physical, emotional, and behavioural problems that can affect every aspect of one's life. Diagnosis of the disease should be done as soon as possible by the doctor for immediate treatment. A detailed treatment plan must be followed because it is very important for the patient to lead a normal and happy life.

Among the complications and side effects if the disease is not treated are :-

• Depression 
• Inability to work or to go to school
• Anxiety :- They will feel panic, fear and uneasiness when they need to face with others 
• Poor personal hygiene :- Inability to do Activities of Daily Living (ADL) such as do not want to take bath, brush teeth and always wear same cloth
• Anti-social :- They prefer to be alone 
• Being the victim of aggressive behaviours by others 
• Abuse of substances such as drugs, alcohol, and prescription medication 
• Self-injury 
• Suicide
• Death 

https://acheronmag.wixsite.com/acheron/single-post/2016/1/30/Christian-Sampsons-brilliantly-creepy-take-on-mental-illness

TREATMENT

TREATMENT 

1.  Psychological treatment / counseling                   

• Individual therapy 

https://sovapsychologist.com/en/individual-%D1%82herapy/

• it is also known as psychotherapy.       
• he therapist and the client have to built a good rapport in order to work together to solve the issues. 
• The therapy must be held in a conducive and calm environment, so that the patient will have clearer mind to think and share their story. 
• It will be easier for the therapist to explore patients' feeling, emotional and the changing of behavior.
• Patient will not be embarrassed to share their story because they know and trust the doctor that they will keep it confidential. 

• Group therapy.     

• 

  https://www.verywellmind.com/addiction-overview-4581803

• This is processed which is a small group of patients meet with the therapist to talk about several issues such as how to release anger using anger management method. 
• Being part of the patients will make they realize that they are not alone and they have a hope to recover with an effective treatment  and also with their own desires.  If they are not fully recovered but as long as they can do their activities daily living by their own is good enough. 

• Family therapy 
• The family must showed loved and support toward the patients so that they will feel that there are someone who care about them although they are sick.  
• It will make their desire to recover became stronger.

2. Medication

• Risperidone 
• Works by affecting the amount of certain chemicals called neurotransmitter that occur naturally in the brain. 
• This drug may improved the imbalance of certain neurotransmitters in the brain. 

• Benzodiazepam 
• This drug will bind at the specific receptors at the Centra Nervous System that will increase inhibitory effect of the neorutranmitters gamma-amino butyric acid (GABA) 
• This drug can cause muscle relaxation that can help patients be more relax and in control behavior.

• Halopridol

• This drug helping by restoring and balancing certain natural substance in the brain. 
• This medication can help patients to think clearer and fell less nervous that they can take part in activities just like others.
• It also can help to prevent suicidal and negative thoughts and can also reduce the aggressive and violence action. 

3.   Electroconvulsive therapy (ECT)

• ECT is used by the doctors to cause a changes in patients' brain chemistry to reverse symptoms of the mental health condition. 
• ect will be done under general anesthesia,  small electric current passed through the brain to intentionally trigger the brain that will cause seizures for a short time only.  
• Patients must be assess before the procedure because not all of the patients suitable for ECT.
• The patients with the severe schizophrenia and if they are not compliance to the medication are more suitable for the patients. 

NURSING MANAGMENT

Nursing management 

1. Psychopharmacology:

Drug class and names.

(Typical / Traditional)

• Acetophenazine (Tindal)
• Chlorpromazine (Thorazine)
• Fluphenazin (Prolixin)
• Haloperidol (Haldol)
• Loxapine (Loxitane)
• Mesoridazine (Trilafon)
• Thioridazine (Mellaril)
• Thiothixene (Navane)
• Trifluoperazine (Stelazine)
• Triflupromazine (Vesprin)

(Atypical / Second Generation)

• Aripiprazole (Abilify)
• Clozapine (Clozaril)
• Olanzapine (Zyprexa)
• Olanzapine / fluoxetine (Symbyax)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Sertindole (Serlect)
• Ziprasidone (Geodon)

(Antiparkinsonism / Anticholinergic) to treat extrapyramidal side effects

• Benztropine (Cogentin)
• Biperiden (Akineton)
• Ethopropazine (Parsidol)
• Procyclidine (Kemadrin)
• Trihexyphenidyl (Artane)

(Dopamine Agonnist)

• Amantadine (Symmetrel)

(Beta Adrenergic Blocker)

• Propranolol (Inderal)

(Benzodiazepines)

• Lorazepam (Activan)

(Antihistamine)

• Diphenhydramine (Benadryl)

Nursing considerations and interventions:

1.  Assess patient's response towards the medication and for any possible drug interaction
2. Monitor patient on antipsychotic medications for extapyramidal side effects (EPS) and other adverse effects
3. Administer the abnormal and involuntary movement scale (AIMS) to assess  the client on psychotic medication for the signs of tardive dyskinesia
4. Assess for signs of neuroleptic malignant syndrome (NMS) and access emergency care for the client if NMS suspected
5. Monitor the patient's vital signs for hypotension, orthostatic hypotension, and tachycardia
6. Monitor the patient's body weight
7. Monitor the blood glucose and lipids
8. Monitor the client for any seizure activity
9. Instruct the patient to prevent getting overheated in the sun  by using sunblock or avoiding taking hot baths
10. Perform weekly WBC count with clozapine because of the risk of agranulocytosis

Nursing Measures for Side Effects (Anticholinergic Syndrome)

1. Suggest chewing sugarless gum or hard candy to offset effect of dry mouth
2. Suggest rinsing mouth frequently to decrease side effect of dry mouth
3. Encourage use of stool softeners by increasing water intake and dietary fiber to decrease the side effect of constipation
4. Suggest use of saline nasal spray to decrease side effect of nasal congestion
5. Instruct patient to use caution due temporary side effect of blurred vision. Vision will return to previous condition in a few weeks
6. Instruct patient to acknowledge the nurses if any eye pain happened immediately 
7. Instruct patient on need to use caution in the sun , wear sunscreen, sunglasses, and avoid becoming overheated because of side effects of photophobia and photosensitivity
8. Instruct patient to use caution with sudden changes in body positions due to possible orthostatic hypotension
9. Monitor patient for signs of urinary retention and hesitation

Extrapyramidal Side Effects from Antipsychotic Medications

Akathisia: Motor restlessness , inability to remain still, can also occur as subjective feeling

https://images.app.goo.gl/qT5zGxZQNnEfemK87

Akinesia: Absence of movement or difficulty with movement

https://images.app.goo.gl/aHAsYQgQfHbtgYni6

Dystonias: Muscle spasm, spastic movements of the neck and back, can be painful and frightening for the client

https://images.app.goo.gl/83iu8dsFKJYwF2yM8

Pseudoparkinsonism: Shuffling and slow gait, masklike facial expression, tremors, pill-rolling movements of the hands, stooping posture, rigid

https://images.app.goo.gl/2A4SF9PEPkMJy1jR6

Tardive dyskinesia: Involuntary and abnormal movements of the mouth, tongue, face, and jaw. May progress to the limbs, irreversible condition, may occur in months after using antipsychotic drug

https://images.app.goo.gl/FotiqhsvzCpdmiMt8

Neuroleptic malignant syndrome: A potientially lethal side effect of antipsychotic medicaation that requires emergency treatment, manifested symptoms include hyperthermia, muscle rigid, tremors, altered consciousness,  tachycardia, hypertension, incontinence

2. Individual and group intervention:

https://images.app.goo.gl/AQSMU6opAxiE483z7

Management of delusions and hallucinations

1. Established trusting and therapeutic relationship for the clients by being honest supportive and consistent.

2. Encourages patient express their feelings and thought

3. Avoid arguing with the patient with their client about delusion and hallucination

General nursing considerations and interventions

1. Assess of self-destructive behaviors, provide needed precautions

2. Provide opportunities for the client to promote socialization and prevent or decrease isolation

3. Encourage patient to express feelings by verbalize their thought openly

3. Milieu Therapy: Method psychotherapy by controlling the environment client provide interpersonal contact to enhance trust, assurance and personal autonomy.

https://images.app.goo.gl/Ku7N8xDzsEWfAUzF7

1. Provide for the clients’ safety and the safety of others in the milieu

2. Provide a supportive environment that structured and predictable

3. Assist client with ADL needed and encourage client progresses

4. Family therapy:

https://images.app.goo.gl/Ac5zjXLQQeEMmomS9

1. Educate family about chronic illness of schizophrenia.

- Implications
- Early signs
- Symptoms of relapse
- Disease management
- Medication management
- Community support systems available

2. Provide outlet for family discus patient’s feelings and fear, explore healthy and helpful, effective coping skills

3. Educate family stress within family (expressed emotion) to decrease the patient relapsing.

CONCLUSION

There is no certain technique to avoid schizophrenia but sticking with the treatment plan can support or avoid relapses or worsening of symptoms. In addition, researchers hope that learning more about risk factors for schizophrenia may lead to detecting earlier diagnosis and giving first degree of treatment before this severe mental disorder spreading or becoming worsen among human being .

https://www.facebook.com/700781106650842/photos/rpp.700781106650842/700781503317469/?type=3&theater