Schizophrenia

(Hebephrenic/
Disorganized)
MARIAM A. SOMANDAR
4 Myths of
Schizophrenia
1. People with
schizophrenia have
multiple
personalities.
2. Schizophrenia
makes people
dangerous.
3. Schizophrenia
ONLY involves
delusions and
hallucinations.
4. Schizophrenia
cant be treated.
Bleulers 4 As of Schizophrenia

affect: Inappropriate or flattened affect-

emotions in-congruent to
circumstances/situation.
autism: social withdrawal- preferring to live in a
fantasy world rather than interact with social
world appropriately.
ambivalence : holding of conflicting attitudes
and emotions towards others and self; lack of
motivation and depersonalization.
associations : loosening of thought associations
leading to word salad/ flight of ideas/ thought
disorder. (fragmented thinking)
Hebephrenic/ Disorganized
Schizophrenia

Hebephrenic schizophrenia is characterized by

disorganized thinking with blunted and
inappropriate emotions.
It begins mostly in adolescent age
There could appear mannerisms, grimacing,
inappropriate laugh and joking and sudden
impulsive reactions without external stimulation.
Social isolation.
Hypochondriacal complaints
Usually the prognosis is poor because of the
rapid development of "negative" symptoms,
particularly flattening of affect and loss of
volition.
Causes

Genetics it runs in the family

Brain structures
 Etiology of Schizophrenia:
Neurotransmitters
First, too much dopamine causes
schizophrenia is the fact that antipsychotic
medications, which are used to treat
schizophrenia, block dopamine receptors.
The medications are designed to bind to
dopamine receptors in the brain, and their
effects have helped many people cope
with symptoms.

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 Etiology of Schizophrenia:
Neurotransmitters
And second, drugs that increase levels of
dopamine, like amphetamines, often
cause psychotic symptoms and a
schizophrenic-like paranoid state.

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 The Frontal and Parietal Lobe in
Schizophrenia
Underactive frontal lobes and overactive
parietal lobes are thought to cause some
of schizophrenia's associated symptoms.
For example, when frontal lobes are
underactive, planning, organization, and
volition are all impaired. Frontal lobe
abnormalities are probably related to
schizophrenia's negative symptoms.

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 The Frontal and Parietal Lobe in
Schizophrenia
Parietal lobes are involved in sensory
perception, like voice recognition, the
ability to distinguish patterns, and spatial
orientation. Overactive parietal lobes may
cause distortion of these senses, which is
seen in many people with schizophrenia.
Parietal lobe abnormalities are probably
more closely related to positive symptoms.

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 Signs and symptoms of
disorganized schizophrenia
Earlier age than other types of schizophrenia. Its onset is gradual,
rather than abrupt, with the person gradually retreating into his or
her fantasies. The distinguishing characteristics of this subtype are
disorganized speech, disorganized behavior, and blunted or
inappropriate emotions.

The symptoms of disorganized schizophrenia include:

Impaired communication skills
Incomprehensible or illogical speech
Emotional indifference
Signs and symptoms of
disorganized schizophrenia
Inappropriate reactions (e.g. laughing at a funeral)
Infantile behavior (baby talk, giggling)
Peculiar facial expressions and mannerisms

People with disorganized schizophrenia sometimes

suffer from hallucinations and delusions, but unlike the
paranoid subtype, their fantasies arent consistent or
organized.
Signs and symptoms of disorganized
schizophrenia

Disorganized speech (Formal thought

disorder)
Incoherence
Inability to organize ideas
Loose associations (derailment)
Rambles, difficulty sticking to one topic

Disorganized behavior
Odd or peculiar behavior
Silliness, agitation, unusual dress
e.g., wearing several heavy coats in hot weather

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Positive symptoms

Schizophrenia is often described in terms of

positive (or productive) and negative (or deficit)
symptoms.
Positive symptoms include:
delusions,
auditory hallucinations,
and thought disorder, and are typically regarded
as manifestations of psychosis.
Positive Symptoms: Behavioral
excesses
Delusions Hallucinations
Firmly held beliefs Sensory experiences in the
Contrary to reality absence of sensory
stimulation
Resistant to disconfirming
evidence Types of hallucinations
Persecutory delusions Audible thoughts
common Voices commenting
The CIA planted a listening Voices arguing
device in my head
Increased levels of activity
Other common forms : in Brocas area during
Thought insertion hallucinations
Thought broadcasting
Grandiose delusions
Ideas of reference
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Negative Symptoms: Behavioral
deficits
Avolition
Lack of interest; apathy

Alogia
Reduction in speech

Anhedonia
Inability to experience pleasure
Consummatory pleasure
Anticipatory pleasure

Flat Affect
Exhibits little or no affect in face or voice

Asociality
Inability to form close personal relationships

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DSM-IV-TR Criteria

Two or more symptoms lasting for at least 1

month
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Negative symptoms
Social and occupational functioning have
declined since onset
Signs of disturbance for at least 6 months
At least 1 mo. for delusions
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Clinical Description of
Schizophrenia

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Treatment
Some Typical antipsychotics:
Tablets Trade Name
Chlorpromazine Largactil
Haloperidol Haldol
Pimozide Orap
Trifluoperazine Stelazine
Sulpiride Dolmatil
 Treatment

Depot Injections (may be given 2-4 weekly) Trade Name

Haloperidol Haldol
Flupenthixol decanoate Depixol
Fluphenazine decanoate Modecate
Pipothiazine palmitate Piportil
Zuclopenthixol decanoate Clopixol
Treatment
Some Atypical antipsychotics:
Tablets Trade Name
Amisulpiride Solian
Aripiprazole Abilify
Clozapine Clozaril
Olanzapine Zyprexa
Quetiapine Seroquel
Risperidone Risperdal
Sertindole Serdolect
Zotepine Zoleptil

Depot Injections Trade Name

Risperidone Risperdal Consta
Psychological Treatments:

Cognitive Behavioural Therapy (CBT)

Counselling and supportive psychotherapy
Family work
Nursing Interventions

Spend time with the patient even if hes mute and

unresponsive, to promote reassurance and support.
Remember that, despite appearances, the patient is
acutely aware of his environment, assume the patient can
hear speak to him directly and dont talk about him in his
presence.
Emphasize reality during all patient contacts, to reduce
distorted perceptions (for example, say, The leaves on the
trees are turning colors and the air is cooler, Its fall)
Verbalize for the patient the message that his behavior
seems to convey, encourage him to do the same.
Tell the patient directly, specifically, and concisely what
needs to be done; dont give him choice (for example, say,
Its time to go for a walk, lets go.)
Nursing Interventions

Assess for signs and symptoms of physical illness;

keep in mind that if hes mute he wont complain of
pain or physical symptoms.
Encourage to ambulate every 2 hours.
During periods of hyperactivity, try to prevent him
from experiencing physical exhaustion and injury.
As appropriate, meet his needs for adequate food,
fluid, exercise, and elimination; follow orders with
respect to nutrition, urinary catheterization, and
enema use.
Stay alert for violent outbursts; if these occur, get help
promptly to intervene safely for yourself, the patient,
and others.
THANK YOU FOR
LISTENING.