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Schizophrenia Nursing Guide

Schizophrenia is a severe, persistent psychiatric disorder characterized by a variety of neuroanatomical and neurochemical abnormalities. 

Content reviewed by Ann Dietrich, MD, FAAP, FACEP.

Schizophrenia Etiology and Epidemiology 

Schizophrenia is a severe, persistent psychiatric disorder characterized by positive psychotic symptoms including hallucinations, delusions, disorganized speech, and grossly disorganized behavior.  In addition, negative signs and symptoms such as reduced emotional expression, avolition, and cognitive impairment are present. Severity ranges from mild, where individuals can adapt to daily life, to severe, requiring constant supervision. 

Epidemiology: 

  • Lifetime incidence in the U.S. is approximately 0.25 to 0.64%. 
  • Peak onset: 18-25 years in males, 26-45 years in females. 
  • Increased mortality due to unhealthy lifestyles, medication side effects, and limited healthcare access. 
  • 5% lifetime risk of suicide.

Neuroanatomical Abnormalities: 

  • Reduced overall brain volume 
  • Decrease grey matter in frontal lobe, temporal lobe and hippocampus 

Neurochemical Changes: 

  • Overactivity of the dopamine system (D2 receptors) causes "positive" symptoms, which are blocked by antipsychotic drugs. 
  • Diminished dopamine activity in the mesocortical pathway may cause "negative" symptoms. 

Etiological Factors: 

  • Genetic predisposition and intrauterine events are major contributors. 
  • Psychosocial stressors can precipitate or exacerbate the disorder. 
  • Environmental factors such as complications during childbirth, early-life adverse events, and migrant status may interact with genetic predisposition in the development of schizophrenia. 
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Schizophrenia Complications 

  • Depression 
  • Family conflicts 
  • Homelessness 
  • Impaired health 
  • Inability to work or attend school 
  • Poverty 
  • Self-destructive behavior 
  • Substance use 
  • Suicide 

Schizophrenia Risk Factors 

  • Family history of schizophrenia 
  • Intrauterine malnutrition or viral exposure 
  • Older paternal age 
  • Pregnancy or birth complications 
  • Stress 
  • Psychoactive drug use during adolescence 

Schizophrenia Diagnosis 

A diagnosis requires the presence of two or more of the following symptoms for a significant part of a one-month period (unless treated): 

  • Delusions 
  • Hallucinations 
  • Disorganized speech 
  • Grossly disorganized or catatonic behavior 
  • Negative symptoms (e.g., flat affect, social/emotional isolation) 

Additionally, continuous signs of disturbance must persist for at least six months, with significant impairment in social, occupational, or self-care functioning. 

The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia recommends an initial diagnostic evaluation to exclude other etiologies including a CBC, blood chemistry panel, RPR, HIV testing, pregnancy test (as appropriate), EEG (where indicated), neuroimaging as appropriate, genetic testing (as appropriate) and drug toxicology screening.   

Schizophrenia Management 

The goal is to manage schizophrenia through a combination of antipsychotic medications and counseling/behavioral therapies. 

Medications: 

  • Antipsychotics: 
    • Clozapine (Clozaril®) 
    • Risperidone (Risperdal®) 
    • Olanzapine (Zyprexa®) 
    • Quetiapine (Seroquel®) 
    • Ziprasidone (Geodon®) 
  • Anticholinergics: 
    • Diphenhydramine (Benadryl®) 
    • Benztropine (Cogentin®) 
  • Benzodiazepines: 
    • Diazepam (Valium®) 
    • Lorazepam (Ativan®) 

Therapies: 

  • Psychosocial therapy 
  • Family therapy 
  • Vocational counseling 

Schizophrenia Nursing Care Plan 

Assessment 

History: 

  • Aggressiveness, anger control problems, catatonic behavior, delusions, hallucinations, inability to perform daily activities, inappropriate emotional reactions, incoherent speech, lack of personal hygiene, paranoia, social isolation, and unusual behavior. 

Physical Examination: 

  • Decreased emotional expression, impaired concentration, and behaviors such as agitation, combativeness, withdrawal, or catatonia. 

Laboratory Tests: 

  • Urine and/or serum drug/toxin screen 
  • Medical evaluation as appropriate to exclude other conditions 

Nursing Diagnoses/Risk For 

  • Anxiety, disturbed personal identity, disturbed sleep pattern, fear, hopelessness, impaired social interaction, ineffective coping, powerlessness. 
  • Risk for altered nutrition, impaired verbal communication, ineffective role performance, injury, self-care deficit, social isolation, violence. 

Interventions 

  • Administer medications as ordered. 
  • Encourage normal activity with daily exercise. 
  • Encourage self-care and promote good hygiene. 
  • Explain the disorder, diagnosis, and treatment. 
  • Follow safety precautions and maintain a calm environment. 
  • Provide emotional support and reality-based explanations. 
  • Teach and encourage social skills and coping techniques. 
  • Monitor treatment response, adverse reactions, and vital signs. 

Expected Outcomes 

  • Decrease in anxiety, fear, hopelessness, and powerlessness. 
  • Maintenance of normal body weight, personal identity, sleep pattern, social interaction, and verbal communication. 
  • Prevention of injury. 

Individual/Caregiver Education 

  • Discuss the disorder, diagnosis, and treatment. 
  • Explain medications and potential adverse effects. 
  • Teach family members signs of relapse and management strategies. 
  • Encourage compliance with treatment to prevent relapses or symptom worsening. 
  • Advise on avoiding illicit drug use, reducing stress, getting enough sleep, and using antipsychotic medications to manage symptoms. 

ICD-10 Code for Schizophrenia:

  • F20.9 -  Schizophrenia, unspecified

FAQs

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2028

References

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