DSM CRITERIA FOR SCHIZOPHRENIA
A. Characteristic symptoms: Two (or more) of the following, each
present for a significant portion of time during a 1-month period
(or less if successfully treated):
1. delusions
2. hallucinations
3. disorganized speech (e.g., frequent derailment or incoh
B. Social/occupational dysfunction:
For a significant portion of the
time since the onset of the disturbance, one or more major
areas of functioning such as work, interpersonal relations, or
self-care are markedly below the level achieved prior to the
onset (or when the onset is in childhoo
C. Duration:
Continuous signs of the disturbance persist for at least
6 months. This 6-month period must include at least 1 month
of symptoms (or less if successfully treated) that may meet Criterion
A (i.e., active-phase symptoms) and may include periods
of prodromal
D. Schizoaffective and Mood Disorder exclusion:
Schizoaffective
Disorder and Mood Disorder with psychotic features have been
ruled out because either (1) no Major Depressive, Manic, or
Mixed Episodes have occurred concurrently with the activephase
symptoms; or (2) if mood episodes have occurred during
E. Substance/general medical condition exclusion:
The disturbance
is not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or a general medical
condition.
F. Relationship to a Pervasive Developmental Disorder:
If there is a
history of Autistic Disorder or another Pervasive Developmental
Disorder, the additional diagnosis of Schizophrenia is made
only if prominent delusions or hallucinations are also present
for at least a month (or less is successfully treated)
Another important criterion
for recognizing schizophrenia is detecting an impaired ability to perform and complete social and work obligations. It is diagnostic of schizophrenia when the person has difficulty performing in one or more areas of life including work, school, social rel
--Several additional psychotic disorders are specified in the DSM-IV-TR:
? Shared psychotic disorder
? Psychotic disorder due to a general medical condition
? Substance-induced psychotic disorder
? Psychotic disorder not otherwise specified (NOS)
Schizophrenia
a devastating psychotic disorder that may involve characteristic disturbances in thinking (delusions), perception (hallucinations), speech, emotions, and behavior
Catatonia
A disorder of movement involving immobility or excited agitation
Hebephrenia
A silly and immature emotionality, a characteristic of some types of schizophrenia
Paranoia
People's irrational beliefs that they are especially important (delusions of grandeur) or that other people are seeking to do them harm
Dementia praecox
The Latin term meaning premature loss of mind; an early label for what is now schizophrenia, emphasizing the disorder's frequent appearance during adolescence
Associative splitting
A separation among basic functions of human personality (for example, cognition, emotion, and perception) seen by some as the defining characteristic of schizophrenia
Psychotic behavior
A severe psychological disorder category characterized by hallucinations and loss of contact with reality
Positive symptoms
A more overt symptom, such as a delusion or hallucination, displayed by some people with schizophrenia
Delusion
A psychotic symptom involving disorder of thought content and presence of strong beliefs that are misrepresentations of reality
Delusions are mistaken or false beliefs about the self or the environment that are firmly held even in the face of disconfirmin
Types of Delusions
1. Delusions of persecution -Belief that others are hostile or trying to harm the individual
EXAMPLE: A woman notices a man looking at her and believes
that he is trying to follow her.
2. Delusions of reference- False belief that public events or people a
Disordered Speech and Behavior
Other positive symptoms represent excesses of language or behavior. Disorganized speech is the outward sign of disordered thoughts and may range from less severe forms (the person moves rapidly from one topic to another), to severe forms (the person's spe
Hallucination
A psychotic symptom of perceptual disturbance in which something is seen, heard, or otherwise sensed although it is not actually present
Negative symptom
A less outgoing symptom, such as flat affect or poverty of speech, displayed by some people with schizophrenia
Negative symptoms of schizophrenia are less dramatic but just as debilitating as positive symptoms
Negative symptoms include the "four As" of sc
Avolition
An inability to initiate or persist in important activities. Also known as apathy
A symptom that is frequently misunderstood by families and
members of the larger community is avolition, an inability to
pursue and persist in goal-directed activities. You
Alogia
A deficiency in the amount or content of speech, a disturbance often seen in people with schizophrenia
Brief, empty verbal responses are known as alogia. Rather
than saying a few sentences in response to a question, clients
with alogia reply with a single
Anhedonia
An inability to experience pleasure, associated with some mood and schizophrenic disorders
Anhedonia, the inability to experience pleasure, is an important symptom that challenges many nurses
Flat affect
An apparently emotionless demeanor (including toneless speech and vacant gaze) when a reaction would be expected
People with schizophrenia often appear to have unemotional or very restricted emotional responses to their experiences.
Flat affect "is the ab
Somatic Treatments
Prior to the 1950s�which is referred to as the pre-neuroleptic age�insulin coma, drug or electrically induced shock treatments, and psychosurgery, including prefrontal lobotomies, were used to treat schizophrenia. The impact of these extreme somatic treat
Disorganized speech
A style of talking often seen in people with schizophrenia, involving incoherence and a lack of typical logic patterns
Inappropriate affect
An emotional display that is improper for the situation
Catatonic immobility
A disturbance of motor behavior in which the person remains motionless, sometimes in an awkward posture, for extended periods
Paranoid type of schizophrenia
A type of schizophrenia in which symptoms primarily involve delusions and hallucinations; speech and motor and emotional behavior are relatively intact
Prominent hallucinations and delusions are present in the paranoid type of schizophrenia. Delusions are
Disorganized type of schizophrenia
A type of schizophrenia featuring disrupted speech and behavior, disjointed delusions and hallucinations, and silly or flat affect
The central features present in the disorganized type of schizophrenia are disorganized speech and behavior and flat or inap
Catatonic type of schizophrenia
A type of schizophrenia in which motor disturbances (rigidity, agitation, and odd mannerisms) predominate
Although not seen frequently in the United States, the catatonic type of schizophrenia is a distinctive type characterized by extreme psychomotor dis
Undifferentiated type of schizophrenia
A category for individuals who meet the criteria for schizophrenia but not for one of the defined subtypes
UNDIFFERENTIATED TYPE A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Di
Residual type of schizophrenia
a diagnostic category for people who have experienced at least one episode of schizophrenia and who no longer display its major symptoms but still show some bizarre thoughts or social withdrawal
The residual type of schizophrenia is a subtype diagnosis re
Schizophreniform disorder
A psychotic disorder involving the symptoms of schizophrenia but lasting less than 6 months
Schizophreniform disorder is very similar to schizophrenia except the person has not been ill for very long. The diagnostic criteria are the same as the Criterion
Schizoaffective disorder
A psychotic disorder featuring symptoms of both schizophrenia and major mood disorder
In schizoaffective disorder, two sets of symptoms� psychotic and mood symptoms�are present concurrently in the same period of illness episode: Criterion A symptoms of sc
delusional disorder
a psychotic disorder featuring a persistent belief contrary to reality (delusion) but no other symptoms of schizophrenia
Delusional disorder is diagnosed when the client holds one or more nonbizarre delusions for a period of at least 1 month. The client m
brief psychotic disorder
a psychotic disturbance involving delusions, hallucinations, or disorganized speech or behavior but lasting less than 1 month; often occurs in reaction to a stressor
In a brief psychotic disorder, at least one of the Criterion A symptoms for schizophrenia
shared psychotic disorder (folie a deux)
a psychotic disturbances in which individuals develop a delusion similar to that of a person with whom they share a close relationship. Also known as folie a deux
schizotypal personality disorder
a cluster A (odd or eccentric) personality disorder involving a pervasive pattern of interpersonal deficits featuring acute discomfort with, and reduced capacity for, close relationships, as well as cognitive or perceptual distortions and eccentricities o
schizophrenogenic mother
according to an obsolete, unsupported theory, a cold, dominating, and rejecting parent who was thought to cause schizophrenia in her offspring
double blind communication
according to an obsolete, unsupported theory, the practice of transmitting conflicting messages that was thought to cause schizophrenia
expressed emotion (EE)
hostility, criticism, and over-involvement demonstrated by some families toward a family member with a psychological disorder. This can often contribute to the person's relapse
token economy
a social learning behavior modification system in which individuals earn items they can exchange for desired rewards by displaying appropriate behaviors
Biologic Theories
It is unlikely that schizophrenia is caused by one specific biologic abnormality. Scientists have searched unsuccessfully for a unique biologic marker consistently present in people with schizophrenia but absent in healthy people. At the same time, eviden
Genetic Theories
People with schizophrenia inherit a genetic predisposition to the disease rather than inheriting the disease itself. What supports this theory is the fact that relatives of people with schizophrenia have a greater chance of developing the disease than do
Brain Structure Abnormalities
As a group, people with schizophrenia differ in their brain structure from people who do not have schizophrenia. People with chronic schizophrenia show changes to their frontotemporal cortical gray matter, among other areas. Magnetic resonance imaging (MR
Biochemical Theories
The biochemical basis of schizophrenia is captured in the dopamine hypothesis, which states that schizophrenic symptoms may be related to overactive neuronal activity that is dependent on dopamine (DA). In other words, positive psychotic symptoms are asso
Psychological Theories
Most psychological theories focus on the processing of information as well as attention and arousal states in schizophrenia.
Information Processing
Many clients with schizophrenia have information-processing deficits. Two central types of information processing have been identified:
--1. Automatic processing
--2. Controlled or effortful processing Automatic processing occurs when you take information
Family Theories Numerous
theories implicating family interaction alone as a cause of schizophrenia have been proposed and unsupported. Research has failed to support the theory that dysfunctional family interaction alone causes the illness.
Humanistic-Interactional Theories
schizophrenia is due to the interaction of a genetic predisposition or biologic vulnerability, stress or change in the environment, and the individual's social skills and supports. In an interactional model, the influences are multidimensional. A biologic
Stress-Vulnerability Model
An interactional model for understanding schizophrenia that has received wide acceptance is the stress-vulnerability model, which suggests that people with schizophrenia have a genetically based, biologically mediated vulnerability to personal, family, an
Resources That Moderate Stress
Resources that can moderate stress (and are thought to affect the development of symptoms in schizophrenia) include:
? Skill in symptom recognition and management
? Social support
? Antipsychotic medication
---The capacities to self-monitor the waxing and
Blunted Affect
A marked decrease in the variation or intensity of emotional expression
Developing meaningful treatment and conducting effective interventions incorporate these vital aspects into effective nursing care:
? Personal power and efficacy
? Interpersonal relationships
? Social expectations
? Differences between what one hoped for oneself and what one has now
? Connecting with people
? Personal growth
? Stability ? Coping with relapses ? Expression of spiritual
Relapse Triggers in Schizophrenia
Physiological Stressors- Infection Pain Acute illness Fatigue Chronic illness Side effects of medications Dehydration Appetite changes Insomnia Injury Rape Surgery
Personal Stressors -Exacerbation/relapse of illness Financial difficulties Depression An in
There are a number of services necessary and available in the community to maximize both quality of life and more independent functioning for people with schizophrenia and other psychotic disorders. Examples are:
1. Continuing day treatment programs
2. Independent living centers
3. Day hospitals
4. Community mental health centers
5. Social clubs
6. Wellness centers