Practical Nursing
Mental Health
Chapter 31 Schizophrenia and Other Psychoses-
I. SCHIZOPHRENIA
-Psychoses are a class of disorders in which reality contact is radically impaired
*Psychoses are most severe of all psychological disorders
*Schizophrenia describes group of psychoses
1. THE PREVALENCE OF SCHIZOPHRENIA
*About 1-2% had or will have schizophrenic episode
-Rates are similar in other countries
*Patients occupy half of hospital beds or are released to smaller facilities or into community
*Health care cost of schizophrenia is approximately $19 billion
2. THE HISTORY OF THE DIAGNOSTIC CATEGORY
-In 1896, Emil Kraepelin proposed type of psychosis dementia praecox
-Begins in adolescence
-Leads to irreversible mental breakdown
-Term means premature mental deterioration
*Eugene Bleuler argued dementia praecox was poor description
-Disorder not necessarily premature
-Most patients did not have complete mental deterioration
-Proposed term schizophrenia
-schizophrenia refers to split among different psychic functions within single personality
-Does not refer to dissociative identity disorder
3. THE SYMPTOMS OF SCHIZOPHRENIA
A. DSM-IV and DSM-IV-TR list five characteristic symptoms
-Two or more symptoms must be shown for at least two months and disturbed behavior exhibited for at least six months
-Episodes that last less than a month, diagnosis of brief psychotic disorder is used
*Episodes that last at least a month but less than six months, diagnosis of schizophreniform disorder
B. Disorders of Thought and Language
a) Delusions
Delusions are firmly held beliefs that have no basis in reality
-Delusions affect at least three-quarters of schizophrenic patients
-Most schizophrenics do not realize the implausibility of their firmly held beliefs and will not abandon them
-Patterns include delusions of persecution, delusions of control, delusions of reference, delusions of grandeur, delusions of sin and guilt, hypochondriacally delusions, and nihilistic delusions
-Thought delusions include thought broadcasting, thought insertion, and thought withdrawal
-Delusions may represent way schizophrenics explain to themselves their mental chaos
b) Loosening of Associations
*Loosening of associations refers to characteristics of speech whereby ideas jump from one track to another
-Problem may lie in mind's way of dealing with associations whereby process of editing breaks down
-Patients with schizophrenia have particular problems with subtle secondary associations
-Research suggests that patients do not understand context well enough to process the last word of a sentence
c) Poverty of Content
⋆Poverty of content characterizes the lack of meaning conveyed
-Speech may include many words with correct grammar
d) Neologisms
-Some suggest schizophrenics have difficulty in finding the right words with which to say something
*Neologisms are new words that result from combining parts of two or more regular words or using words in a new way
e) Clanging (Clang Association)
⋆Clanging is the pairing of words that have no relation to one another beyond fact that they rhyme or sound alike
-Clanging speech often sounds like nonsense
f) Word Salad
-Language may show complete breakdown on associational process
-Becomes impossible to determine any links between successive words and phrase
Word salad refers to speech in which words and phrases are combined into completely disorganized fashion
*Neologism--words are combined to make a "new word" that is usually undefinable by the schizophrenic patient and the person it is directed to
C. Disorders of Perception
a) Breakdown of Selective Attention
-Schizophrenics seem unable to focus and concentrate on important stimuli in environment
-Researchers believe that breakdown of selective attention may underlie most of the other symptoms
b) Hallucinations
Hallucinations are perceptions in the absence of any appropriate external stimulus
-Auditory hallucinations are the most common, notably hearing two or more voices