Tutorial on Schizophrenia for Nurses

1. Introduction

• Definition:
  Schizophrenia is a chronic, severe mental disorder affecting a person's thinking, feeling, and behavior. It can cause hallucinations, delusions, disorganized speech, and impaired functioning.

• Prevalence:
  Affects about 1% of the global population, usually appearing in late adolescence or early adulthood.

2. Etiology and Risk Factors

• Biological Factors:

  • Genetic predisposition

  • Neurochemical imbalances (dopamine hypothesis)

  • Brain structural abnormalities

• Environmental Factors:

  • Prenatal infections or malnutrition

  • Psychosocial stressors

  • Substance abuse (e.g., cannabis, amphetamines)

3. Signs and Symptoms

• Positive Symptoms (Presence of abnormal behaviors):

  • Hallucinations (mostly auditory)

  • Delusions (paranoid, grandiose)

  • Disorganized thinking and speech

  • Agitation and bizarre behaviors

• Negative Symptoms (Absence or reduction of normal functions):

  • Affective flattening (reduced emotional expression)

  • Alogia (poverty of speech)

  • Avolition (lack of motivation)

  • Anhedonia (inability to experience pleasure)

• Cognitive Symptoms:

  • Impaired attention and memory

  • Poor executive function

4. Diagnosis

• Based on clinical assessment using criteria such as DSM-5 or ICD-10.

• Key points: Symptoms must last for at least 6 months with active symptoms for 1 month.

• Rule out other causes such as substance use or medical illnesses.

5. Nursing Assessment

• Mental status examination (MSE): appearance, behavior, speech, mood, thought processes, perception, insight, and judgment.

• Assess risk of harm to self or others.

• Evaluate medication adherence and side effects.

• Assess social support and coping mechanisms.

• Monitor for co-morbid conditions, including substance abuse.

6. Nursing Diagnoses

• Disturbed thought processes related to schizophrenia symptoms.

• Risk for violence (self-directed or other-directed).

• Social isolation related to negative symptoms.

• Ineffective coping related to chronic mental illness.

• Impaired verbal communication.

7. Nursing Interventions

• Build Therapeutic Relationship:

  • Be calm, patient, and nonjudgmental.

  • Use clear, simple language.

  • Establish trust and safety.

• Manage Symptoms:

  • Administer antipsychotic medications as prescribed.

  • Monitor side effects (extrapyramidal symptoms, tardive dyskinesia, metabolic syndrome).

  • Encourage medication adherence.

• Safety Measures:

  • Observe for signs of aggression or self-harm.

  • Maintain a safe environment.

• Psychoeducation:

  • Educate patient and family about illness and medication.

  • Teach coping strategies and stress management.

• Promote Socialization:

  • Encourage participation in group therapy or social activities.

  • Facilitate family involvement.

• Support Activities of Daily Living:

  • Assist with personal hygiene, nutrition, and sleep routines.

8. Common Medications

• Typical antipsychotics: Haloperidol, Chlorpromazine

• Atypical antipsychotics: Risperidone, Olanzapine, Clozapine

• Monitor for side effects and therapeutic effects.

9. Complications

• Poor medication adherence leading to relapse

• Substance abuse

• Suicide risk (about 5-10% attempt or complete suicide)

• Social and occupational dysfunction

10. Evaluation

• Assess symptom improvement.

• Evaluate patient’s ability to perform ADLs.

• Monitor medication compliance.

• Check for improved social interaction and coping.

11. Summary

Schizophrenia is a complex mental disorder requiring comprehensive nursing care that includes symptom management, medication adherence, safety, and psychosocial support. Nurses play a vital role in early recognition, patient education, and ongoing support to improve quality of life.