SCHIZOPHERNIA

DEFINITION:

ACCORDING TO S.M. RAJU: IT IS MOST PROMINENT DEBILITATING AND EXPENSIVE ILLNESS IN ANY SCOIETY. ACCORDING TO L.P.SHAH & HEMA IT REFERS TO GROUP OF MENTAL ILLNESS CHARACTERISED BY SPECIFIC PSYCHOLOGICAL SYMPTOMS LEADING TO A DIS ORGANISATION OF THE PERSONALITY OF AN INDIVIDUAL.

INCIDENCE

IT ARISES FROM 25-30 YEARS OF AGE AND BOTH SEXES. 3-4 % IN 1000 POPULATION WERE AFFECTED IN COMMUNITY PER YEAR. ABOUT 1% ARE AT RISK ABOUT 15% OR NEW ADMISSION TO A MENTAL HOSPITAL FOR THIS CONDITION.

HIGHEST RISK IN LOW SOCIO ECONOMIC PEOPLE. 3.5 % IN 10-14 YEARS AND 24.3% 14-19 YEARS. MALE & FEMALE RATIO 3.5 : 1.5 A/C TO WORLD MENTAL HEALTH REPORT 2001: 24 MILLION PEOPLE ARE AFFECTED.

ETIOLOGY

BIOLOGICAL FACTORS BIOCHEMICAL FACTORS PSYCHOLOGICAL FACTORS SOCIO-ECONOMIC FACTORS.

BIOLOGICAL FACTORS:

VIRUS: VIRAL EXNCEPHALITIS. GENETIC FACTORS OR CHOROMOSMAL ABNORMALITIES. NEUROPATHOLOGY: DISREGULATION OF NEUROTRANSMITTER, HEAD INJURY, CVA, BIRTH TRAUMA.

BIOCHEMICAL FACTORS:

DOPAMINE HYPOTHESIS. TRANSMETHYLATION HYPOTHESIS.

INDOLAMINE HYPOTHESIS.

PSYCHOLOGICAL FACTORS:

PERSONS WHO ARE WITHDRAWN AND HAVE VERY FEW SOCIAL CONTACT ARE MORE PRONE TO DEVELOP SCHIZOPHERNIC ILLNESS.

SOCIAL OR CULTURAL :

DIVORCE FAMILIES. CULTURAL BELIEFS. INDUSTRALISATION. POVERTY. INADEQUATE NUTRITION. FEELING OF HOPELESSNESS. HOME ENVIRONMENT.

CLASSIFICATION
TYPICAL ATYPICAL ICD 10. COURSE OF ILLNESS.

CLASSIFICATION:

TYPICAL TYPE: - CATOTONIC SCHIZOPHERNIA. - PARNOID SCHIZOPHERNIA. - HEBEPHERNIC SCHIZOPHERNIA. - SIMPLE SCHIZOPHERNIA. - UNDIFFERENTIAL OR MIXED SCHIZOPHERNIA.

ATYPICAL TYPE: - CHILDHOOD & JUVENILE - LATE SCHIZOPHERNIA : 40 YEARS - SCHIZO AFFECTIVE (MANIA) - PSEUDONEUROTIC SCHIZOPHERNIA. - RESIDUAL AND LATENT SCHIZOPHERNIA

A/C TO ICD-10:

POST-SCHIZOPHERNIA DEPRESSION.(12 MONTHS) PSEUDONEUROTIC SCHIZOPHERNIA (1 YEAR) SCHIZOPHERIFORM (<6 MONTHS) ONEIROID: PERCETION DISTURBANCE VONGOGH SYNDROME (MUTILATION) LATE PARAPHERNIA (WOMEN) NEGATIVE SCHIZOPHERNIA PTROPF SCHIZOPHERNIA (MR).

A/C TO COURSE OF ILLNESS:

SUB CHRONIC: LESS THAN 2YEARS 6 MONTHS. CHRONIC : MORE THAN 2 YEARS. COURSE SCHIZOPHERNIA: EXACERBATION AND RELATIVE REMISSION.

CLINICAL MANIFESTATION:

POSITIVE SYMPTOMS: - HALLUCINATIONS - DELUSIONS - TALKING NONSENSE - PRE-OCCUPATION - VIOLENT OR AGGRESSIVE BEHAVIOUR - PERSERVATION - FLIGHT OF IDEAS.

NEGATIVE SYMPTOMS: - FLATTENED AFFECT - SOCIAL WITHDRAWL - SUICIDAL THOUGHT - LACK OF MOTIVATION - AMBIVALENCE - THOUGHT DISTURBANCE - AUTISM - EMOTIONAL DISTURBANCE

DIAGNOSTIC ASSESMENT:

HISTORY COLLECTION. PHYSICAL EXAMINATION. SKULL X-RAY STUDIES. CT SCAN AND MRI SCAN. POSITRON EMISSION TOMOGRAPHY. EEG. EVOKED POTENTIAL STUDIES INVASIVE PROCEDURES.

MANAGEMENT

MEDICAL MANAGEMENT. ELECTRO-CONVULSIVE THERAPY. PSYCHO THERAPY. BEHAVIOUR MODIFICATION THERAPY. SOCIAL THERAPY. MILIEU THERAPY. FAMILY THERAPY. GROUP THERAPY. INDIVIDUAL THERAPY.

DRUG THERAPY:

CLOZAPINE IT BINDS DOPAMINE RECEPTORS. THIORIDAZINE EXERT THE POST SYNPATIC BLOCKAGE. PROCHLOROPEAZINE INHIBIT THE BLOCKAGE OF RECEPTORS. HALOPERIDOL EXERT OF ANTIPSYCHOTIC EFFECTS.

OTHERS: - NITRAZEPAM - FLURAZEPAM - PHENOTHIAZINE - THIOTHIZONE - CHLOROPRONZINE - DIAZEPAM

DIET THERAPY
VEG

NON-VEG 2300 k.cal. 150 gm. 357 gm. 120 gm.

K. CAL : PROTEINS: CHO: FATS :

1900 k.cal 128 gm 458 gm 110 gm

NURSING MANAGEMENT:

ALTERED THOUGHT PROCESS EVIDENCED BY DELUSION R/T INABILITY TO PROCESS AND SYNTHESIZE INFORMATION. SOCIAL ISOLATION EVIDENCED BY WITHDRAWL. ALTERED CO-OPERATION R/T MENTAL ILLNESS.

ALTERED THOUGHT PROCESS EVIDENCED BY HALLUCINATION, DELUSIONS EXAGGREGATED RESPONSES R/T INABILITY TO EVALUATE REALITY. IMPARIED VERBAL COMMUNICATION EVIDENCED BY FLIGHT OF IDEAS. DISTURBED SELFESTEM R/T REPEATED FAILURE BY WORTHLESSNESS HOPELESSNESS.

THANK Q