Undifferentiated schizophrenia Is a mental disorder which is part of the family of disorders broadly known as schizophrenia.

There are a number of subcategories of schizophrenia including paranoid schizophrenia, catatonic schizophrenia, disorganized schizophrenia, residual schizophrenia, and schizoaffective disorder; undifferentiated schizophrenia is often defined as a form in which enough symptoms for a diagnosis are present, but the patient does not fall into the catatonic, disorganized, or paranoid subcategories. Schizophrenia is characterized by a lack of grounding in reality, known as psychosis. People in a state of psychosis can experience hallucinations, delusions, and other events in which they break from reality. Individuals with schizophrenia experience psychosis and can also develop symptoms such as disorganized speech, lack of interest in social interactions, a flat affect, inappropriate emotional responses to situations, confusion, and disorganized thinking. Patients with undifferentiated schizophrenia do not experience the paranoia associated with paranoid schizophrenia, the catatonic state seen in patients with catatonic schizophrenia, or the disorganized thought and expression observed in patients with disorganized schizophrenia. However, they do experience psychosis and a variety of other symptoms associated with schizophrenia, including behavioral changes which may be noticeable to family and friend. Psychopathology Causes One of the reasons for the ongoing difficulty in classifying schizophrenic disorders is incomplete understanding of their causes. It is thought that these disorders are the end result of a combination of genetic,

neurobiological, and environmental causes. A leading neurobiological hypothesis looks at the connection between the disease and excessive levels of dopamine, a chemical The that transmits factor in signals in the has brain been (neurotransmitter). genetic schizophrenia

underscored by recent findings that first-degree biological relatives of schizophrenics are ten times as likely to develop the disorder as are members of the general population. Prior to recent findings of abnormalities in the brain structure of schizophrenic patients, several generations of psychotherapists advanced a number of psychoanalytic and sociological theories about the origins of schizophrenia. These theories ranged from hypotheses about the patient's problems with anxiety or aggression to theories about stress reactions or interactions with disturbed parents. Psychosocial factors are now thought to influence the expression or severity of schizophrenia rather than cause it directly. As of 2004, migration is a social factor that is known to influence people's susceptibility to psychosis. Psychiatrists in Europe have noted the increasing rate of schizophrenia and other psychotic disorders among immigrants to almost all Western European countries. Black immigrants from Africa or the Caribbean appear to be especially vulnerable. The stresses involved in migration include family breakup, the need to adjust to living in large urban areas, and social inequalities in the new country. Another hypothesis suggests that schizophrenia may be caused by a virus that attacks the hippocampus, a part of the brain that processes sense perceptions. Damage to the hippocampus would account for schizophrenic patients' vulnerability to sensory overload. As of 2004, researchers are focusing on the possible role of the herpes simplex virus (HSV) in schizophrenia, as well as human endogenous retroviruses (HERVs). The possibility that HERVs may be associated with schizophrenia has to do with

the fact that antibodies to these retroviruses are found more frequently in the blood serum of patients with schizophrenia than in serum from control subjects.

Symptoms

Patients with a possible diagnosis of schizophrenia are evaluated on the basis of a set or constellation of symptoms; there is no single symptom that is unique to schizophrenia. In 1959, the German psychiatrist Kurt Schneider proposed a list of so-called first-rank symptoms, which he regarded as diagnostic of the disorder. These symptoms include:

delusions somatic hallucinations hearing voices commenting on the patient's behavior thought insertion or thought withdrawal

Somatic hallucinations refer to sensations or perceptions concerning body organs that have no known medical cause or reason, such as the notion that one's brain is radioactive. Thought insertion and/or withdrawal refer to delusions that an outside force (for example, the FBI, the CIA, Martians, etc.) has the power to put thoughts into one's mind or remove them. Tests and diagnosis When doctors suspect someone has schizophrenia, they typically ask for medical and psychiatric histories, conduct a physical exam, and run medical

and psychological tests and exams. These tests and exams generally include:

Laboratory tests. These may include a complete blood count (CBC), other blood tests that may help to rule out other conditions with similar symptoms, screening for alcohol and drugs, and imaging studies, such as an MRI or CT scan.

Psychological evaluation. A doctor or mental health provider will check mental status by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance abuse, and potential for violence or suicide. Diagnostic criteria for schizophrenia To be diagnosed with schizophrenia, a person must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions. Diagnosis of schizophrenia involves ruling out other mental health disorders and determining that symptoms aren't due to substance abuse, medication or a medical condition. In addition, a person must:

Have at least two of the common symptoms of the disorder delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or presence of negative symptoms for a significant amount of time during one month

Experience significant impairment in the ability to work, attend school or perform normal daily tasks

Have had symptoms for at least six months

There are several subtypes of schizophrenia, but not everyone easily fits into a specific category. The five most common subtypes are:

Paranoid. Characterized by delusions and hallucinations, this type generally involves less functional impairment and offers the best hope for improvement.

Catatonic. People with this subtype don't interact with others, get into bizarre positions, or engage in meaningless gestures or activities.

Disorganized. Characterized by disorganized thoughts and inappropriate expressions of emotion, this type generally involves the most functional impairment and offers the least hope for improvement.

Undifferentiated. This is the largest group of people with schizophrenia, whose dominant symptoms come from more than one subtype.

Residual. This type is characterized by extended periods without prominent positive symptoms, but other symptoms continue

Nursing intervention 1. Assess the patient's ability to carry out the activities of daily living, paying special attention to his nutritional status. Monitor his weight if he isn't eating. If he thinks that his food is poisoned, allow him to fix his own food when possible, or offer him foods in closed containers that he can open. If you give liquid medication in a unit-dose container, allow the patient to open the container. 2. Maintain a safe environment, minimizing stimuli. Administer medication to decrease symptoms and anxiety. Use physical restraints according to your facility's policy to ensure the patient's safety and that of others.

3. Adopt an accepting and consistent approach with the patient. Don't avoid or overwhelm him. Keep in mind that short, repeated contacts are best until trust has been established. 4. Avoid promoting dependence. Meet the patient's needs, but only do for the patient what he can't do for himself. 5. Reward positive behavior to help the patient improve his level of functioning. 6. Engage the patient in reality-oriented activities that involve human contact: inpatient social skills training groups, outpatient day care, and sheltered workshops. Provide reality-based explanations for distorted body images or hypochondriacal complaints. Clarify private language, autistic inventions, or neologisms, explaining to the patient that what he says isn't understood by others. If necessary, set limits on inappropriate behavior. 7. If the patient is hallucinating, explore the content of the hallucinations. If he has auditory hallucinations, determine if they're command hallucinations that place the patient or others at risk. Tell the patient you don't hear the voices but you know they're real to him. Avoid arguing about the hallucinations; if possible, change the subject. 8. Don't tease or joke with the patient. Choose words and phrases that are unambiguous and clearly understood. For instance, a patient who's told, That procedure will be done on the floor, may become frightened, thinking he is being told to lie down on the floor. 9. Don't touch the patient without telling him first exactly what you're going to do. For example, clearly explain to him, I'm going to put this cuff on your arm so I can take your blood pressure. If necessary, postpone procedures that require physical contact with facility personnel until the patient is less suspicious or agitated.

10.

Remember, institutionalization may produce new symptoms and

handicaps in the patient that aren't part of his diagnosed illness, so evaluate symptoms carefully. 11. Mobilize community resources to provide a support system for the patient and reduce his vulnerability to stress. Ongoing support is essential to his mastery of social skills. 12. Encourage compliance with the medication regimen to prevent relapse. Also monitor the patient carefully for adverse effects of drug therapy, including drug-induced parkinsonism, acute dystonia, akathisia, tardive dyskinesia, and malignant neuroleptic syndrome. Make sure you document and report such effects promptly. Drug Study