Classifications Of Mental Disorders PDF

CLASSIFICATIONS OF MENTAL DISORDERS  INTRODUCTION The classification of mental disorders is also known as psychiatric nosology or psychiatric taxonomy. It represents a key aspect of psychiatric and other mental health professions and is an important issue for people who...

CLASSIFICATIONS OF MENTAL DISORDERS  INTRODUCTION The classification of mental disorders is also known as psychiatric nosology or psychiatric taxonomy. It represents a key aspect of psychiatric and other mental health professions and is an important issue for people who may be diagnosed. There are currently two widely established systems for classifying mental disorders: Chapter V of the tenth International Classification of Diseases (ICD-10) produced by the World Health Organization (WHO); The Diagnostic and Statistical Manual of Mental Disorders (DSM- 5) produced by the American Psychiatric Association (APA). DSM –IV CLASSIFICATION The DSM-IV was originally published in 1994 and listed more than 250 mental disorders. It was produced by the American Psychiatric Association and it characterizes mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual,...is associated with present distress...or disability...or with a significant increased risk of suffering" but that "...no definition adequately specifies precise boundaries for the concept of 'mental disorder'...different situations call for different definitions" (APA, 1994 and 2000).  The DSM also states that "there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorders." The DSM-IV consisted of five axes (domains) on which disorder could be assessed. The five axes were: Axis I: Clinical Disorders (all mental disorders except Personality Disorders and Mental Retardation) Axis II: Personality Disorders and Mental Retardation Axis III: General Medical Conditions (must be connected to a Mental Disorder) Axis IV: Psychosocial and Environmental Problems (for example limited social support network) Axis V: Global Assessment of Functioning (Psychological, social and job- related functions are evaluated on a continuum between mental health and extreme mental disorder)  DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY,CHILDHOOD OR ADOLESCENCE INTRODUCTION Various disorders in which the symptoms usually first become evident during infancy, childhood, or adolescence will be examined. That is not to say that some of the disorders do not appear later in life or that symptoms associated with other disorders, such as major depression or schizophrenia, do not appear in childhood or adolescence. All nurses working with children or adolescents should be knowledgeable about ‘normal stages’ of growth and development. At best, the development process is one that is fraught with frustrations and difficulties. Behavioural responses are individual and idiosyncratic. They are indeed human responses.  Whether or not a child a child's behavior indicates emotional problems is often difficult to determine. The DSM-IV-TR includes the following criteria among its diagnostic categories. An emotional problem exists if the behavioral manifestations: 1. Are not age appropriate 2. Deviate from cultural norms 3. Create deficits or impairments in adaptive functioning Basically, we will be focusing on the nursing process in care of clients with mental retardation, autistic disorder, attention- deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, Tourette’s disorder and separation anxiety. MENTAL RETARDATION It is defined by the deficits in general intellectual functioning and adaptive functioning (APA,2000). General intellectual functioning is measured by an individuals performance on intelligent quotient (IQ) tests. Adaptive functioning refers to the persons ability to adapt to requirements of daily living and the expectations of his or her age and cultural group.  The DIAGNOSTIC CRITERIA FOR MENTAL RETARDATION A. Significant sub average general intellectual functioning: an IQ of approximately 70 or below on an individually administered IQ test ( for infant, a clinical judgment of significantly sub average intellectual functioning) B. Concurrent deficit or impairments in adaptive functioning ( i.e the persons effectiveness in meeting the standards expected for his or her age by his or cultural group) in at least two or the following areas: communication ,self care, home living, social/interpersonal skills, use of community resources, self direction, functional academic skills, work, leisure, health and safety PREDISPOSING FACTORS INCLUDE Heredity Early alterations in embryonic development Pregnancy and perinatal factors General medication conditions acquired in infancy or childhood Environmental influences and other mental disorder Class Assignment List the common symptoms of mental retardation. Common nursing diagnosis A. Risk for injury B. Self care deficit C. Impaired verbal communication D. Impaired social interaction Autistic Disorder It is characterized by a withdrawal of the child into self and into a fantasy world of his or her own creation. The child has markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests (APA, 2000). Activities and interests are restricted and may be considered somewhat bizarre. Predisposing factors Biological factor - Neurological implication - Genetics - Perinatal influence  DIAGNOSTIC CRITERIA FOR AUTISTIC DISORDER A. a total of six ( or more) items from (1), (2) and (3), with at least two from (1) and one each from (2) and (3) 1. qualitative impairment in the use of multiple in social interaction as manifested by at least two of the following a. marked impairment in the use of multiple non verbal behaviours, such as eye to eye gaze, facial expression, body postures and gestures to regulate social interaction b. failure to develop peer relationship appropriate to developmental level c. lack of social or emotional reciprocity  2. qualitative impairments in communication as manifested by at least one of the following : a. delay in, or total lack of, the development of spoken language b. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others c. stereotyped and repetitive use of language or idiosyncratic language d. lack of varied, spontaneous make-believe play or social initiative play appropriate to developmental level 3. Restricted repetitive and stereotype patterns of behaviour, interests and activities as manifested by at least one of the following: a. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus b. apparently inflexible adherence to specific , non functional routines or rituals  c. stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting or complex whole body movement) d. persistent preoccupation with parts of objects B. Delays or abnormal functioning in atleast one of the following areas, with onset prior to age 3: (1) social interaction (2) language as used in social communication (3) symbolic or imaginative play Nursing Diagnosis Risk for self- mutilation Impaired social interaction Impaired verbal communication Disturbed personal identity ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD) The essential features of ADHD is persistent patterns of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development (APA,2000). These children are highly distractible and unable to contain stimuli. Motor activity is excessive and movements are random and impulsive. Onset of the disorder is difficult to diagnose in children younger than the age of 4years because their characteristics behaviour is much more variable than that of older children.  Frequently the disorder is not recognized until the child enters school. It is four to nine times more common in boys than in girls and may occur in as many as 3-7% of school age children (APA, 2000). In about 60-70% of the cases, ADHD persist in young adulthood, and about 25% will subsequently meet criteria for antisocial personality disorder as adults IT IS CATORISED INTO SUBTYPES ACCORDING TO DSM-IV 1. Attention-deficit/ hyperactivity disorder, combined type 2. attention defict/hypersentivity disorder, predominantly inattentive type 3. attention –deficit/hyperactivity disorder, predominantly hyperactive-Impulsive type (Impulsiveness: the trait of acting without reflection and without thoughts to the consequence of the behaviour. An abrupt inclination to act(and the inability to resist acting) on certain behavioural urges) PREDISPOSING FACTORS Biological Environmental Psychosocial influences DIAGNOSISFOR ATTENTION CRITERIA FOR ADHD ( ASSIGNMENT) A. EITHER 1 0R 2 1. NEUROSES INTRODUCTION TO NEUROSIS Neurosis is a mental illness belonging to a class of functional mental disorders involving distress but neither delusion nor hallucinations whereby behavior is not outside socially accepted norms, it is also known as psycho-nëurosis or neurotic disorders and thus those suffering from it are said to be neurotic. Individuals is said to exhibit neurotic behavior if he frequently misevaluates adjustive demands, because anxious in situations that most people would not regard as threatening and tends to develop behavior patterns aimed at avoiding rather than coping with his problems. Curio the individual may realize his behavior is irrational and maladaptive as in the case of a severe phobia for germs but seems unable to alter it. Although neurotic behavior is maladaptive, it does not involve gross distortion of reality of gross personality disorganization, nor is likely to result hospitalization but nevertheless are in need of therapy Predisposing factors include: unpleasant past experience conflict between two psychic maladaptive lifestyle Anxiety Emotional stress Physical stress Depression Irrational fear Sign and Symptoms of Neurosis include Mental unrest Low sense of self-worth Sadness Depression Irritability Decrease in libido Repetition of through and obsession Anger Lethargy Negatively and cynicism Perfectionism Aggressiveness Type of neurotic disorders According to ICD-10 classification, neurosis could be classified as: Anxiety state Hysterical state Obsessive compulsive state Neurotic depression (Reactive depression) Phobic state Malingering Post traumatic stress disorder (PTSD) Neurasthenia Hypochondriasis Unspecified neurotic disorders ANXIETY NEUROSIS Anxiety is a normal response to stress or danger. At times it is helpful because it can help prepare the body for action and it can improve performance in a range of situations. Anxiety becomes a problem when it is experienced intensely and it persistently interferes with a person's daily life. Depression and anxiety commonly occur together. Not everybody who is anxious is depressed but most depressed patients have some symptoms of anxiety. CAUSES OF ANXIETY NEUROSIS Heredity: People have different degrees of background Or trait anxiety. High trait anxiety may stem from inherited behavior or early relationships in childhood. It is also related to personality. Constitutional make-up: In addition to this inherent background anxiety, people react differently to everyday situations. Some people become anxious very easily, others never seem to get anxious. The anxiety that people get because of specific experiences is called 'state' anxiety. An individual with high trait anxiety is particularly venerable to experiencing high state anxiety in stressful situations Psycho-social factors: These include the presence of factors which leads to anxiety in an individual environment e.g. poverty, lack of employment, war e.t.c. TYPES OF ANXIETY DISORDERS There are number of types of anxiety disorders, it is not uncommon for people to have features of several of the disorders. Generalized Anxiety Disorder (GAD) It is characterized by anxiety symptoms that are present for much of the time and are not restricted to specific situations it accompanies phobias and is extremely common in people who are depressed. It can be caused by physical illness such as overactive thyroid gland or from the emotional response to a serious illness such as heart attack  Panic Disorder In panic disorder, repeated. panic attacks occur unpredictably and often without obvious cases. The attacks consist of severe anxiety with physical and psychological symptoms. Physical symptom can include any of the general symptoms of anxiety and psychological symptoms typIcally include dread Phobic Disorders A phobic is a fear that is out of proportion to the situation that causes it and cannot be explained away. The person typically accords the feared situation since this helps to reduce the anxiety. Symptoms of Anxiety Neurosis Feelings of alternating hope and despair Feelings of suspense Feelings of impending doom Helplessness Panic Fear of the future Feelings of threat Tightness in throat Phobic avoidance Low sense of self-worth  Shortness of breath Chest pain or discomfort Racing heart Mental Impulsive and compulsive acts Negativity and cynicism Tension Pupil dilation Sweating Nausea Dizziness, lightheadedness Mental confusion  Numbness, tingling sensations Dry mouth Diarrhea Loss of appetite Insomnia Lethargy Increased blood pressure Anger Repetition of thoughts and obsession Decrease in libido Irritability Unpleasant or disturbing thoughts Sadness or depression  PHOBIA A phobia is a persistent fear of some object or situation that present no actual danger to the person or in which the danger is magnified out of the proportion to its actual seriousness. The principle symptom of the phobia reaction is anxiety. However, diffuse may attach itself to any external, interpersonal or physical issue; whereas in the phobias, the patient fixes his anxiety on a given object or situation which he then can amid. The anxiety of the phobia patient is more properly called "fear" because in its clinic form it present as such. Causes of phobia The main cause of phobia includes: Direct Experience: This is when a person develops a phobia after a particularly bad experience e.g. A child that is bitten by a dog may develop a phobia for a dogs or an individual that was trapped in an elevator for hours may develop a phobia for that. A False Alarm: this occurs when a person has an unexpected feeling or panic of panic attack during a certain situation. The individual then associates this alarm response with the particular situation. For example, many people with a phobia of driving haven't been in a car accident but have experienced a panic attack while driving.  Observing others: in some cases, it is simply enough to watch or even hear some else's awful experience. A phobia may develop when children observe the behavior of a phobia parent. Being Told: sometimes just being warned repeatedly about a certain danger can cause a phobia. A child who has fearful parent who continually warns of the danger of snakes may develop a phobia of snakes despite never having seen one in real life. Symptom of Phobias Phobia symptom can occur through exposure to the fear object or situation or sometime simple thinking about the feared object can lead to a response. Common symptoms associated with phobia include: Palpitations, pounding heart or accelerated heartrate Sweating Trembling of shaking Sensations of shortness of breath or smothering Feeling of choking Chest pain or discomfort Nausea or abdominal distress Feeling dizzy, unsteady, lightheaded or faint  Detribalization (feeling of unreality) or depersonalization (begin detached from oneset) Fear of dying Paresthesis (numbness or tingling sensations) Chills or hot flashes Dizziness Breathlessness Nausea A sense of unreality Headache Back pain Stomach upsets  Categories of Phobia Phobia could be classified into three categories a) Fear of object e g. spider, dog, cat etc b) Fear of specific situation such as restaurant, hall, school etc c) Fear of specific illness or death Types of Phobia 1. Acrophobia. Fear of Height 2. Anglophobia. Fear of Pain 3. Androphobia. Fear of Men 4. Authropobia. Fear of People 5. Aguaphobia. Fear of Water 6. Astraphobia. Fear of Lighting 7. Ariophobia. Fear of Flying 8. Belomnophobia. Fear of Needles Reading Assignment provide the meaning of the below as appropriate  Bronotophia 10. Claustrophobia 11. Dementophobia 12. Decidophobia 13. Erotophobia 14. Gephobia 15. Coitophobia 16. Gerascophobia 17. Giossophobia  18. Gynorphobia 19. Hearnophobia 20. Lidophobia 21. Mysophobia 22. Nomophobia 23. Nyctophobia/ 24. Thanatophobia 25. Phasmophobia Malingering Malingering is fabricating or exaggerating the systems of mental or physical disorder for a verify of "Secondary gain motives which may include financial compensation(often tied or fraud); avoiding school, work or military service: obtaining drug.getting lighter criminal sentence simply to attract attention or sympathy. Malingering is different from summarization disorder and factious. Causes Lying for personal benefit has existed since the beginning of time, personal gain is the goal of the  HYSTERIA INTRODUCTION Hysteria or more correctly Hysteria neurosis, is perhaps the oldest name for a disease that has been used in man. There are records of people suffering from this disorder as far back as two milennia. Through its perspective has change drastically since the time thethe tem was cined, the essence that it is a mental disorder remains the same  Hysteria is an extreme psychological condition in which a person reacts out of proportion to the stimuli. The reaction could be expressed in the form of extreme anger, hatred, fear, frustration, depression or similar emotion. Since there are so many different forms hysteric can take and so many different levels to which its symptoms can be manifested there cannot be a concrete definition for the disorder. Any reaction that does not warrant the particular change in the surroundings can be included in the broad heading of hysteria, in order to classified between the various types of undefined hysteria: experts have come up with terms such as functional disorder, non-organic disorder, psychogenic disorder and even medically unexplained disorder. The last term mentioned above is of particular interest. People who suffer from hysteria complain about systems in their body which have no medical proof. Most patient of hysteria would become obsessed about a particular organ of their body and keep complain about problems with it. For example, a person may complain about kidney failure, or heart pains, though there may be no clinic explanation of the same.  Risk factors of Hysteria Gender: Since time immemorial, hysteria has been associated with the female. It has been widely considered even today that hysteria attack are seen only in the women. Especially young women are more prone to hysteria. The first attacks of hysteria may occur when the women is going through her first few menstrual period, the women may not be able to cope up with the fantastic changes taking place with her body and that could manifest itself as an attack of hysteria. However, it is wrong to say that hysteria attacks also. Yet, the disorder is predisposed to women than men.  POST- TRAUMATIC STREE DISORDER (PTSD) Post-traumatic stress disorder (PTSD)) 1s a severe anxiety disorder that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own to someone else's physical Sexual or psychological integrity, overwhelming the individual's ability to cope. As an effect of psychological trauma, PTSD is less frequent and more enduring that the more commonly seen post-traumatic stress also know as acute stress response. The cause of PTSD is unknown. Psychological genetic, physical and social factors are involved. PTSD change the body's response to stress. It affects the stress hormones and chemical that carry information between the nerves (neurotransmitters). It is not know why traumatic events cause PTSD in some people but not others, Having a history of truma may increase your risk for getting PTSD after a recent traumatic event.  Classification Post-traumatic stress disorder is classified as an anxiety disorder, characterized by aversive and physiological traumatic events. Sometimes month after. It features persist for longer than 30 day which distinguished it from the briefer acute stress disorder and disruptive to all aspects of life. It has 3 sub-form: Acute Chronic Delayed onset  Causes Psychological Trauma PTSD IS believed to be caused by experiencing any of wide range of events which produces intense negative feelings of such feelings may include (But are not limited to) i Experiencing or witnessing. Childhood or adult physical i. Experiencing or witnessing physical assault, adult experiencing of usual assault., accidents, drug addition. illness, medical complication, employment in occupation exposed to war (Such as solders) or disaster (such as emergency service workers getting a diagnosis of a life threatening illness, children or adult may develop PTSD symptom by experiencing building or mobbing) Approximately 20% of children exposed to family violence can experience PTSD  PTSD symptoms may result when a traumatic event caused an over-reactive adrenaline response, which create deep neurological patient in the brain. These patients can persist long after the vent that triggered the fear. making and individual hyper-responsive to future situations During traumatic experience the high levels of stress hormones secreted suppress hypothalamus  Predisposing factors (a)Hispanic ethnicity coming from an unstable family being punished severely during childhood. Childhood a social behavior and depression as pre-maturity factors. (b)War-zone exposure (C)Pre traumatic dissociation depression as military factors (d)Recent stressful life events (e)Post-vietanan trauma and depression as post military HTO factors, Post-traumatic stress disorder can follow a natural disaster such as a flood or fire, or events such as, Assault, Domestic abuse, prison stay. Rape and terrorism  Symptoms Symptoms of PTSD fall into three main category 1 Reliving the events, which disturbs day-to-day act back episodes, where the events seeds to be happening an again, repeated upsetting memories of the event, repeated nightmare of the event, strong uncomfortable reaction to situation that remind you of the event 2. Avoidance Emotional "numbing: or feeling as through you don't care about anything, feeling detached, being unable to remember important aspects of the trauma, having a lack of interest in normal activities, showing less of your moods, avoiding places, people or through that remind you of the event, feeling like you have no future  3.Arousal Difficulty concentrating, startling easily, having an exaggerated response to things that startle you, feeling more aware (hyper vigilance), feeling irritable or having outbursts of anger, having trouble falling or staying asleep, you might feel guilt about the event (including "'survivor guilt) you might also have some of the following symptoms, which are typical of anxiety, stress and tension. Agitation or excitability Dizziness Fainting Feeling your heart in your chest Headache  OTHER NEUROTIC CONDITIONS Neurotic depression A neurotic disorder characterized by dispropartionate depression which has usualy recognizably ensued on distressing experience. it does not include among its features delusion or hallucination and there is often preoccupation with the psychic trauma which preceded the illness, e g loss of a cherished person or possession Neurasthenia Aneurotic disorder characterized by fatigue, irritability, head-ache depression insomnia difficulty in concentration and lack of capacity for enjoyment (anhedonia) it may follow or accompany an infection or exhaustion or arise from continued emotional stress. If neurasthenia is associated with a physical disorder the latter should also be coded Nervous debility. Depersonalization Syndrome Aneurotic disorder with an unpleasant state of disturbed perception in which external objects or parts of one's Own body are experienced as changed in their quality, unreal, remote of automatized. The patient is aware of the subjective nature of the change he experience. Depersonalization may occur as a feature of several mental disorder including depression. Obsessional neurosis, anxiety and Schizophrenia in that case the condition should not be classified here but in the corresponding major category  Hypochondriasis A neurotic disorder in which the conspicuous features are excessive concern with one's health in general or the integrity and functioning of some part of one's body or less frequently one's mind is usually associated with anxiety and depression Unspecified Neurotic Disorder Neurotic disorders not classified elsewhere. eg occupational neurosis. Patient with mixed neuroses should not be classifed in this category but according to the most prominent symptoms they display.  Conclusion The distinction between neurosis and psychosis is dific remains Subject to debate. however it has been retained in considerable insight and has unimpaired realty testing. In that he usually does not confuse his morbid subjective experience and fantasies with eternal reality Behavior may be greatly affected although usually remaining within soccially acceptable limits, but personality is not disorganized. ft can also be said that neurotic disorders have better prognosis in comparison witn psychosis which is a major mental disor.Behavior may be greatly affected although usually remaining within socCially acceptabie imits, but personality is not disorganized. ft can also be said that neurotic disorders have better prognosis in comparison witn psychosis which is a major mental disorder Treatment for psychotic disorder varies by disorders. It might  SCHIZOPHRENIA The Word was derived from the Greek word Schizo means split Phren means mind. According to Bleuler, the function of the mind namely through, feeling, reasoning etc don't work together harmoniously as it is in normal people. It is the most wide spread type of psychotic disorder which is characterized by loss of contact with reality, through disorder, unpredictable behavior and personality. It was formerly know as Dementia Praecox. There are fourA'S of schizophrenia namely. Autism- This means turning inward away from the world, it is common with catatonic schizophrenia especially in the stuporous stage Ambivalence this means inability to decide whether to love or hate the patient is unstable/volatile and unable to stick to one decision Affect incongruence This is When any individual is emotionally un stable, the mood emotion has no bearing with the Situation on ground Apathy:- This is when one fed up with life Association loosening- This Is When an individual is in aberration of what is happening in the envifonment (Metzer, Bobo Hecker & Fatemi 2008)  Incidence and Prevalence The World Health Organization (WHO)estimate incidence rate for schizophrenia of 13.37 per 100,000 men and 12.94 per 100,000 women. The highest rate occurs in the group 20 to 64years age. The overall prevalence rate for men and women is 0 4%. The estimate lifetime prevalence rate is 0.05% to 1% (APA 2000) schizophrenia is the most common disorder with psychotic symptoms and ranks in the top for disease burden The average life span of a patient with schizophrenia is reduced by 1Oyears. (O Kennedy &Balary.2008)  Etiology The view that schizophrenia is a brain disease now prevail, based on evidence from studies of neurotransmitter system. histological, and neuro-imaging studies of brain structure and studies of brain function, (Thornhill V 2008).et noie In Jacob (2008) opinion. she said while no definite cause to Schizophrenia has been identified, there Could be Contributory factors. 1)Biological Factors:- there can be shrinkage of brain and enlarge ventricles, sometimes areas like basal ganglia and frontal lobe are involved. 2)Biochemical Aspects:- Increased level of dopamine. GABA acvity, serotonin, Glutamate or vitamin deficiency theory B B6 B12 deficiency  3)Genetic Factors:-monozygoic twins are more prone to schizophrenia. Children of Schizophrenia parents are prone to inheriting the disease. 4)Reduction in density of neurons 5)Divergent synapse of neurons 6)Stress Model:-f the patient has a stressful environment and shows vulnerability, it may cause symptoms to develop 7)Social Factor:- These include problem in upbringing conflict, between the parents attraction to one parent. Conflict between by care-taker. the child and caretaker and over protection or hostility  Pathophysiology The response of some schizophrenia symptoms antipsychotic drugs suggests that they may have a biochemical basis. A disorder of dopaminergic function is implied by the efficacy of dopamine-blocking antipsychotic drugs, but there is little direct evidence that abnormal dopaminergic transmission is the cause of schizoph they reduce hallucinations and delusions in delirium, dementia, and severe depressive disorder (Gender, Mayou & Geddes, 2006).  Phases of Schizophrenia Phase I: Schizoid personal: this is described as being indifferent to social relationship and having a very limited range of emotional experience and expression, this group of people prefer to be lonely. Phase ll: Prodomal phase: This phase is characterized by social withdrawal, impairment in role functioning, eccentric neglict of personal hygiene and grooming in appropriate emotion or affect/disturbance in communication, bizarre idea, lack of initiative, the phase may last for many years before the individual breakdown Phase llI: Schizophrenia :psychotic symptoms occur during this phase, these symptoms becomes pronounced such as hallucination, delusion disorganized speech. Phase V: Residual phase: schizophrenia is characterized by periods of remission and exercabation. the symptoms during these phase are similar to development of prodomal phase with impairment in role functioning (Townsend etal 2006)  Classification of Schizophrenia Simple Schizophrenia - usually occurs between 15 and 20years and is more prevalent in males. Affect disturbances, social unresponsiveness, thinking disturbances are present. Delusions and hallucnations are rare Hebephrenic Schizophrenia- usually occurs between 20 around 25years. Thinking disturbances are more marked Regression, childish behavior, inappropriate affect somatic delusions unpredictable gigling and hallucination are the symptoms Paranoid Schizophrenia it occurs between 25 and 30years and is more prevalent in males delusion of suspiciousness, persecution and grandeur are its symptoms. Disorganization of speech and thought and hallucinations are additional  DSM IV Classification Catatonic type Disorganized type Paranoid type Residual type Undifferentiated type (Jacob 2008) (READ MORE)  Clinical Manifestations of Schizophrenia Disorder of Thought: There is sudden stoppage of thinking ability of patient. Knights move thinking: The normal association between ideas is distorted Lack of concrete thinking: The patient is unable to think, there is autistic thinking i.e he goes in war feels bored about answering question being asked Disorder of Emotion: there is flat, Incongruent or no emotions Disorder of Volition: Loss of will power, patient has no sense and he/she is unable to take decision, he likes staying alone Patient shows negativism to everything and lack interest in activity. Disorder of Perception: There is hallucination i.e false sensory perception, illusion, misinterpretation of external object, delusion i.e false belief held by the patient. Withdrawal of self: patient withdraws from social activities and prefers to be alone. Insomnia: Patient is unable to sleep, this may due to hyperactivity of the patient. Talkativeness: Patient tend to talk more Destructive behavior Hostility or Suspiciousness: The patient becomes patient neglect their hygiene, they neither bath or wash their cloth, they are rough and dirty. Patient is unable to concentrate and forget thing easily Disorder of speech such as incoherent speech neologism, verbal gyration, echolalia.  Medical Management Prevention of schizophrenia according to the causes, During therapy including: Antipsychotics Neuroleptics Anti drugs Vitamin C supplements Psychotherapy Individual psychotherapy Group therapy Behavioural therapy Family therapy Melieu therapy Electroconvuisive therapy Social therapy Rehabilitation  Nursing Management 1)Disturbances in thought process related to inability to trust in the nurse- patient relationship. panic and anxiety. 2)Impaired affect 3)Disturbed sensory perception auditory or visual related to panic, anxiety and extreme withdrawal to self. Impaired verbal communication related to regression withdrawal, panic anxiety and unrealistic things 4)Social isolation related to inability to trust, panic, anxiety delusional thinking and weak ego. 5)Risk of violence to self or violence directed others, related to extreme. Suspiciousness to hallucination panic, anxiety etc 6)Ineffective family coping related to impaired family communication. 7)Disturbed sleeping pattern. 8)Low self-esteem. 9)Self care deficit. 10)Imbalanced nutrition  Nursing Intervention Disturbances in thought process Do not argue with patient Reinforce and focus on reality Encourage the patient to talk about real events and real people. Do not avoid patient Make conversation simple  Impaired affect Use silence as a therapeutic tool Empathize with the patient Keep the patent occupied with activities that will build as disturbed sensory perception The patient must closely monitored for signs of hallucination Avoid touching the acceptance will encourage the sharing content of hallucination Avoid reinforcing hallucination Try to distract the patient from the hallucination Listen patiently and get a clear idea about the patient's problems Present real facts to the patient Provided a single room with minimum furniture Do not get involved with his delusions  Impaired Verbal Communication Have precise and straight-forward communication with the patient Show appropriate non-verbal behavior Be tactful collecting information from him Maintain secrecy of information Answering the patient's questions with extreme truthfulness Facilitate trust and understanding Orient the patient to reality Be an active listener so as to encourage the patient to talk Allow silence for sometime  Social lsolation Convey acceptance by making brief frequent contacts Allow the patient to sit with other patients Place a chair near to t he patient's bedside and talk to him Encourage the patient to get out of bed and talk to him Encourage the patient to get out to bed and talk to other patient Engage the group in some indoor games Allow him to have company of other patient most of the time  Risk for violence Leave the patient in a group, only under constant and strict supervision Anticipate the attack at anytime due to his paranoid nature and take preventive steps. Tactfully stay with the patient during his aggression and afterwards- Remove all dangerous things from his unit Maintain a calm attitude Administer tranquilizers as per doctor's orders Ineffective family coping Arrange to have a relative with the patient all the time preferably one whom the patient likes involve the relative in assisting in his self-care needs, such as bathing, hair-combing. grooming etc Make the relative talk to the patient and engage in same indoor games  Disturbed sleep pattern Assure a safe environmental to prevent disturbed sleep and to prevent fear Give medications as prescribed Low self-esteem Provide the patient opportunities to have company in doing daily activities, e g. clearing the room. playing games watching television, listen to music etc Encourage the patient to do his own decision making Allow him to solve minor problem by himself Self scare deficits Assists do not take over, the patient in bath, dressing and other hygiene needs The help of relatives can be taken Imbalanced nutrition, less than body requirement The patient may have the decision that his food is being poisoned, so mistake the help of the patient in preparing food Taste the food in front of the patient Do not mix any drug with the food If he trusts his relatives ask them to bring food Fruits can be given without peeling (Jacob, 2008).