Schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and disordered thinking and behaviour.
Contrary to some popular belief, schizophrenia is not split personality or multiple personality. The word “schizophrenia” does mean “split mind,” but it refers to a disruption of the usual balance of emotions and thinking (Mayo, 2013).
Schizophrenia is a chronic condition, requiring lifelong treatment.
32. PROGNOSTIC FACTORS
Prognosis indicates the likelihood of recovery from a
disease. Factors which are responsible for a good
prognostic outcome of schizophrenia are:
oAge of the patient – The older the patient, the more
favorable the prognosis.
oThe duration of illness – The shorter the duration
prior to treatment, the better the outcome.
oThe rapidity of development of the symptoms –
Surprisingly, it has been found that the more speedily
the symptoms develop, the faster do they respond to
treatment; a very slow, insidious, and gradual onset of
illness suggests a final poor outcome.
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33. PROGNOSTIC FACTORS – CONT’D
A patient who had close friendships and multiple
relationships prior to illness has a brighter chance
with few or no such relationships.
Life stress prior to onset – An episode brought on by a
major identifiable life stress will respond more
quickly than an episode without any obvious cause.
Marital history – A patient with a stable and helpful
marital partner has a favorable prognosis as
compared to an unmarried patient.
Educational history – The higher the level of
education, the more are the chance of a patient
coming rapidly to terms with the illness and handling
the post-illness sequence.
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34. PROGNOSTIC FACTORS – CONT’D
Occupational history – A patient with a good stable
occupation or business prior to onset of illness will
respond better than a patient who is jobless and
economically unsound.
Family’s attitude towards the returning patient –
Hostile behaviour by family members, or vice versa,
excessive care and attention by them can undermine
the patient’s sense of confidence and hamper
recovery.
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35. PROGNOSTIC FACTORS – CONT’D
Social support systems – A patient with a joint family
and a staunch circle of friends who are ready lend a
helping hand, is much better off than a lone man
afflicted with the illness, whose relatives are in some
far off land, and who has no one to turn to.
Organic brain damage – Presence of concurrent
obvious brain damage (mental retardation, epilepsy,
head injury, etc.) hinders the final adequate recovery
from schizophrenia.
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36. PROGNOSTIC FACTORS – CONT’D
However, factors which may indicate a poor or bad prognosis
include:
-Earlier age of onset
-Being a male
-A higher number of negative symptoms
-A family history of schizophrenia
-A low level of functioning prior to onset
-Poor or no support system
-A history of substance abuse
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37. RISK FACTORS
Certain factors seem to increase the risk of developing or
triggering schizophrenia, including:
Having a family history of schizophrenia
Exposure to viruses, toxins or malnutrition while in the
womb, particularly in the first and second trimesters
Stressful life circumstances
Older paternal age
Taking psychoactive drugs during adolescence and young
adulthood
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41. CLINICAL FEATURES (COGNITIVE
SYMPTOMS) CONT’D
However, Mayo (2013) described third symptom as the
Cognitive symptom. Cognitive symptoms involve problems with
thought processes. These symptoms may be the most disabling in
schizophrenia because they interfere with the ability to perform
routine daily tasks. A person with schizophrenia may be born with
these symptoms. They include:
•
Problems with making sense of information
•
Difficulty paying attention
Memory problems
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43. COMPLICATIONS FOR SCHIZOPHRENIA –
CONT’D
Other complications include:
Aggression
Violence
Violence against others
Increased risk of substance abuse (exacerbating
symptoms in some patients)
Complications of schizophrenia from disease database
include:
Auditory hallucinations
Delusions
Mood alteration
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57. OTHER FORMS OF PSYCHOTIC DISORDERS
– CONT’D
Delusional Disorder
People with this illness have delusions involving
real-life situations that could be true, such as
being followed, being conspired against, or having
a disease. These delusions persist for at least one
month.
Shared Psychotic Disorder
This illness occurs when a person develops
delusions in the context of a relationship with
another person who already has his or her own
delusion(s).
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58. OTHER FORMS OF PSYCHOTIC DISORDERS
– CONT’D
Psychotic Disorder due to a General
Medical Condition
Hallucinations, delusions, or other symptoms may
be the result of another illness that affects brain
function, such as a head injury or brain tumor.
Substance-Induced Psychotic Disorder
This condition is caused by the use of or
withdrawal from some substances, such as
alcohol and crack cocaine, that may cause
hallucinations, delusions, or confused speech.
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59. OTHER FORMS OF PSYCHOTIC DISORDERS
– CONT’D
Paraphrenia
This is a type of schizophrenia that
starts late in life and occurs in the
elderly population.
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63. NURSING INTERVENTIONS FOR
SCHIZOPHRENIA CONT’D
Engage the patient in reality-oriented activities
that involve human contact: inpatient social
skills training groups, outpatient day care, and
sheltered workshops. Provide reality-based
explanations for distorted body images or
hypochondriacal complaints.
Clarify private language, autistic inventions, or
neologisms, explaining to the patient that what
he says is not understood by others. If necessary,
set limits on inappropriate behavior. 63
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70. CLIENTS WHO ARE SUSPICIOUS AND
RUDE
Form professional relationships; can be considered a
threat if too friendly.
Be careful with the touch as it can be regarded as a
threat.
Give as much control and autonomy to client within the
therapeutic limits.
Create a sense of trust through brief interactions that
communicate caring and respect.
Describe any treatment, medication and laboratory tests
before the start.
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71. CLIENTS WHO ARE SUSPICIOUS AND RUDE –
CONT’D
Do not focus or strengthen the suspicion or delusional
ideas.
Identify and respond to the emotional needs of the
underlying suspicion or delusional thoughts
Intervene when the client shows signs of increasing
anxiety and potentially express an unconscious
behavior.
Be careful not to behave in a way that could be
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73. PREVENTION OF SCHIZOPHRENIA
Seek early treatment (to control symptoms before
complications develop and to improve long-term
outlook)
Stick to treatment plan (to prevent relapses or
worsening of schizophrenia symptoms)
Learn about risk factors may lead to earlier diagnosis
and earlier treatment
Avoid illegal drug and alcohol use
Reducing stress
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74. PREVENTION OF SCHIZOPHRENIA –
CONT’D
Getting enough sleep
Avoid social isolation
Plan your pregnancy (have a child when you want one,
and don’t have a child if you don’t want one)
Eat a healthy diet with a lot of vegetables, fish with
omega 3 fatty acids.
Avoid head injuries
Vitamin D supplements
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75. CHALLENGES OF THE MENTALLY ILL AT
HOME
Poverty
Homelessness
Unemployment
Denial of benefits
Excluded from insurance cover
Vulnerable to exploitation
Inability to cope with everyday life issues
Unsympathetic treatment by healthcare givers
Refusal to pay claims by insurance companies
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76. CHALLENGES OF THE MENTALLY ILL AT
HOME – CONT’D
Conflict with law enforcement agencies (due to
petty property crimes)
Self medication
Drug abuse
Barrier to education
Reduced promotion opportunities
Additional cost of medication
Sexually abuse/promiscuity
Lack of family support
Isolation/withdrawn
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