Schizophrenia is the most common and disabling of the psychotic disorders. Its etiology came from a physiologic malfunctioning of the brain. It affects all races and is common in men than in women as well as those in the lower socioeconomic status.
It came from the Greek words, schizo meaning split and phrene meaning mind; which was first described and termed by Emil Kraepelin in 1887. On the other hand it was coined by Eugene Bleuler in 1911 and described the negative and positive symptoms of schizophrenia.
Causes of schizophrenia involves different theories like the genetic predisposition theory, where it implicated that there is chromosome deletion; biochemical and neurostructural theory, explaining the dopamine hypothesis – that is an excessive amount of dopamine makes the nerve impulses bombard the mesolimbic pathway (part of the brain involved in arousal and motivation) and thus normal cell communication is disrupted resulting to hallucinations and delusions; organic or pathophysiologic theory, that suggest that it caused by stressors such as viral infection, trauma, toxins and other harmful substances; environmental or cultural theory, that a person with schizophrenia has a faulty environment and being unable to respond effectively to stimuli; perinatal theory, linking schizophrenia to the idea that during conception, there is oxygen deprivation of the fetus and that the mother suffers malnutrition; and lastly, the psychological or experiential theory, genetic, neurologic factors and stressful experiences like no – win experience (double – bind situation) are believed to cause schizophrenia.
There are five phases in the development of schizophrenia: (1) premorbid phase, when there is still no demonstration of symptoms, (2) prodromal phase, when there is a gradual subtle behavioural change which worsens and become recognizable as symptoms, (3) onset phase, when the client manifests cognitive deficits, (4) progressive phase, during which first episode of symptoms occurs and it usually have repeated relapses, and (5) chronic or residual phase, the time when client experiences repeated episodes and relapses for a number of years.
Kraepelin introduced the term dementia praecox, relating to a syndrome manifesting hallucinations and delusions, however, later on Bleuler introduced the 4A’s of schizophrenia: (1) Affective disturbances, (2) Autistic thinking, (3) Ambivalence, and (4) Looseness of association.
Clinical Symptoms of Schizophrenia
|Positive Symptoms||Negative Symptoms||Disorganized Symptoms|
Evidence of two or more of the following:
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
- The symptoms should be presented for a one- month period
- Significant impairment in normal functioning specifically in work and interpersonal relations and on self – care activities
- Demonstration of problems continuously for at least 6 months interval
- Symptoms should be not related to schizoaffective and mood disorder, substance related disorder or any medical condition.
Subtypes of Schizophrenia
- Paranoid – Manifestations of hostility, aggressions, delusional and hallucination preoccupations
- Catatonic – Demonstrates symptoms of waxy flexibility, echolalia, and echopraxia
- Disorganized – Symptoms may present disorganized speech and behavior and flat affect
- Undifferentiated – Meets diagnostic characteristics but not a criteria for other subtypes
- Residual – Having the absence of prominent delusions, hallucinations, disorganized speech and grossly disorganized behavior but with the presence of negative symptoms.
Other disorders linked to Schizophrenia
- Schizoaffective disorder
- Schizophreniform disorder
- Brief psychotic disorder
- Psychotic disorder due to a general medical condition
The participation of family members and other significant others in the treatment process of schizophrenia is greatly necessary especially during assessment of objective clinical symptoms. It is somehow challenging but the importance of nursing interventions put into actions and the immersing of a multidisciplinary approach makes significant impact on its treatment regimen which is the therapeutic milieu. Treatment modalities include the use of psychopharmacology specifically the antipsychotic medications, and interactive and psychosocial therapies. Furthermore, client and family education is an essential tool especially in the continuum of care.