Nursing Care & Management for Schizophrenia

Schizophrenia is an extremely complex mental disorder. As a matter of fact it is probably many illnesses masquerading as one. A biochemical imbalance in the brain is believed to cause symptoms. Recent research reveals that schizophrenia may be a result of faulty neuronal development in the fetal brain, which develops into full-blown illness in late adolescence or early adulthood.

              Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions, movement, and behavior. It cannot be defined as a single illness; rather thought as a syndrome or disease process with many different varieties and symptoms. It is usually diagnosed in late adolescence or early adulthood. Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women.

The symptoms of schizophrenia are categorized into two major categories:-

  • the positive or hard symptoms which include delusion, hallucinations, and grossly disorganized thinking, speech, and behavior
  • negative or soft symptoms as flat affect, lack of volition, and social withdrawal or discomfort.

Medication treatment can control the positive symptoms but frequently the negative symptoms persist after positive symptoms have abated. The persistence of these negative symptoms over time presents a major barrier to recovery and improved the functioning of client’s daily life.

Types of Schizophrenia

The diagnosis is made according to the client’s predominant symptoms:

  1. Schizophrenia paranoid type – is characterized by persecutory (feeling victimized or spied on) or grandiose delusions, hallucinations, and occasionally, excessively religiosity (delusional focus) or hostile and aggressive behavior.
  2. Schizophrenia disorganized type– is characterized by grossly inappropriate or flat affect, incoherence, loose associations, and extremely disorganized behavior.
  3. Schizophrenia catatonic type– is characterized by marked psychomotor disturbance, either motionless or excessive motor activity. Motor immobility may be manifested by catalepsy (waxy flexibility) or stupor.
  4. Schizophrenia undifferentiated type – is characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior.
  5. Schizophrenia residual type – is characterized by at least one previous, though not a current, episode, social withdrawal, flat affect and looseness of associations.

Treatments and Medications

Currently, there is no method for preventing schizophrenia and there is no cure. Minimizing the impact of disease depends mainly on early diagnosis and, appropriate pharmacological and psycho social treatments. Hospitalization may be required to stabilize ill persons during an acute episode. The need for hospitalization will depend on the severity of the episode. Mild or moderate episodes may be appropriately addressed by intense outpatient treatment. A person with schizophrenia should leave the hospital or outpatient facility with a treatment plan that will minimize symptoms and maximize quality of life.

A comprehensive treatment program can include:

  • Anti-psychotic medication
  • Education & support, for both ill individuals and families
  • Social skills training
  • Rehabilitation to improve activities of daily living
  • Vocational and recreational support
  • Cognitive therapy

Medication is one of the cornerstones of treatment. Once the acute stage of a psychotic episode has passed, most people with schizophrenia will need to take medicine indefinitely. This is because vulnerability to psychosis doesn’t go away, even though some or all of the symptoms do. In North America, atypical or second generation antipsychotic medications are the most widely used. However, there are many first-generation antipsychotic medications available that may still be prescribed. A doctor will prescribe the medication that is the most effective for the ill individual

Another important part of treatment is psychosocial programs and initiatives. Combined with medication, they can help ill individuals effectively manage their disorder. Talking with your treatment team will ensure you are aware of all available programs and medications.

In addition, persons living with schizophrenia may have access to or qualify for income support programs/initiatives, supportive housing, and/or skills development programs, designed to promote integration and recovery.