SCHIZOPHRENIA

Schizophrenia is functional psychosis characterized by disturbance in thinking, emotion, volition and perception.

Schizophrenia is a chronic mental illness that affects a person’s ability to think, feel, and behave clearly.

Schizophrenia is one of the major mental illnesses characterized by disorder of thinking, perception and mood, deterioration of interpersonal relationship.

Schizophrenia is one of the most severe forms of mental illness. It affects 1% of the general population. The term schizophrenia was coined in 1908 by Swish Psychiatrist Eugen Bleuler. The word was derived from the Greek word Schizo which means split and Phren – mind.

Causes of Schizophrenia

The actual cause of schizophrenia is unknown (idiopathic) but some factors are associated with it.

1. Genetic Predisposition:

• Family history plays a significant role. Relatives of individuals with schizophrenia have a significantly higher risk of developing the disorder compared to the general population.
• Twin studies offer compelling evidence. Monozygotic (identical) twins share 100% of their genes, and the concordance rate for schizophrenia in this group is four times higher than in dizygotic (fraternal) twins who share only 50% of their genes.
• Specific genes associated with schizophrenia are being identified, but the exact mechanisms by which they contribute to the disorder remain under investigation.

2. Biological Factors:

• Neurotransmitter Imbalances: The dopamine hypothesis suggests that schizophrenia may be linked to excessive dopamine activity in certain brain regions. However, other neurotransmitters, such as glutamate and serotonin, are also implicated.
• Brain Structural Abnormalities: Studies have revealed structural differences in the brains of individuals with schizophrenia. Enlarged ventricles (fluid-filled spaces in the brain) are commonly observed, often associated with cognitive impairments.
• Physiological Influences:
  
  • Viral Infections: Prenatal exposure to certain viral infections may increase the risk of schizophrenia.
  • Birth Complications: Hypoxia (oxygen deprivation) during birth can also contribute to the development of the disorder.
  • Other Physiological Factors: Alcohol abuse, head injuries, cerebral vascular accidents (strokes), and other conditions affecting the brain can also trigger or exacerbate symptoms of schizophrenia.

3. Environmental Factors:

• Socioeconomic Status: Individuals from lower socioeconomic classes experience higher rates of schizophrenia. This correlation may be attributed to several factors, including:
  
  • Poor living conditions: Crowded housing, lack of access to adequate nutrition, and limited healthcare resources contribute to increased stress and vulnerability.

Symptoms of Schizophrenia

Positive Symptoms

• Delusions: Primarily characterized by persecutory delusions (belief that one is being harmed or conspired against) or delusions of grandeur (belief of having special powers or importance).
• Hallucinations: Auditory hallucinations (hearing voices) are common, often reflecting the content of delusions.
• Suspiciousness and Hostility: Difficulty trusting others, often viewing the world as threatening.

Catatonic Schizophrenia

This causes a person to experience either excessive movement, called catatonic excitement, or decreased movement, known as a catatonic stupor. (May be unable to talk or repeat other people’s words)

• Symptoms:
  
  • Stupor: A state of unresponsiveness and immobility, with a waxy flexibility (the ability to be moved into a position and hold it).
  • Excitement: Agitation, restlessness, and purposeless movements.
  • Negativism: Resistance to any attempts to move or interact.
  • Echolalia: Repeating words or phrases spoken by others.
  • Echopraxia: Imitating the movements of others.

Undifferentiated Schizophrenia

A mixture of symptoms that do not fit neatly into any of the other subtypes.

Residual Schizophrenia

A person would have had several symptoms of schizophrenia but would not exhibit prominent delusions, hallucinations, disorganization, or catatonic behavior. They might have had mild symptoms, such as odd beliefs or unusual perceptions.

• Key Features: A chronic phase following a more acute episode, characterized by:
  
  • Negative Symptoms: Predominantly negative symptoms, such as social withdrawal, flat affect, and avolition (lack of motivation).

Catatonic Stupor

Catatonic schizophrenia is a mental illness that can cause hallucinations, delusions, and a flattened affect–that includes both symptoms of schizophrenia and catatonia.

Catatonia is a motor disorder that impairs a person’s movement, speech, and response to outside stimuli.

Catatonia is a state characterized by marked abnormalities in motor behavior, ranging from complete immobility to excessive, agitated movements.

Those with catatonic schizophrenia experience catatonic stupors, in which they are awake, but not fully responsive. They may also be unable to control their movement, speech or expressions.

Catatonic Stupor is the lack of critical mental function and a level of consciousness where a patient is almost entirely unresponsive and only responds to base stimuli such as pain. Its occurrence in depression is called Depressive stupor.

Catatonic stupor is one specific manifestation of catatonia. While it’s the most extreme form, it’s not the only way catatonia presents. Other catatonic behaviors include:

• Mutism – Refusal or inability to speak.
• Staring – Fixed gaze, unresponsive to surroundings.
• Grimacing – Sustained odd facial expressions.
• Waxy flexibility – Limbs remain in positions they are placed (like wax).
• Automatic obedience – Following commands without question, even if harmful.
• Negativism – Active resistance to instructions or touch.
• Posturing – Maintaining rigid, bizarre postures for long periods.
• Stereotypy – Repetitive, non-goal-directed movements.
• Mannerism – Exaggerated, stylized movements.
• Echopraxia – Imitating examiner’s movements.
• Echolalia – Repeating examiner’s words.

Clinical Presentation of Catatonic Stupor (Emergency Context)

Note: Catatonic stupor is a psychiatric emergency due to risk of:

• Starvation/dehydration
• Thromboembolism
• Rhabdomyolysis
• Sudden cardiovascular collapse

 

Differential Diagnosis (Must Rule Out)

Immediate Management of Catatonic Stupor (Emergency Protocol)

Lorazepam Response:

• 70–80% of catatonic patients respond within hours
• Diagnostic and therapeutic

 

Nursing Care in Catatonic Stupor

Prognosis

• With prompt treatment: Full recovery possible
• Untreated: High mortality (up to 20%) from complications
• Recurrence: Common if underlying schizophrenia untreated