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4) Residual schizophrenia (chronic form):- In this type of schizophrenia the severity of schizophrenia

symptom has decreased. Hallucination, delusion and other symptom may still be present. Residual
symptoms may be include:-

 Social isolation
 Impairment in personal hygiene
 Apathy
 Illogical thinking
 Loosening of association
 Blunted or inappropriate affects

5) Undifferentiated schizophrenia:- Undifferentiated schizophrenia is a classification used when a

person exhibits behaviour which fit into two or more of the other types of schizophrenia, including
symptoms such as delusions, hallucinations, disorganized speech or behaviour,catatonic behaviour.

6) Post schizophrenic depression:- Depressive symptoms will be developed in an active schizophrenia

and are associated with suicidal tendencies.

7) Schizoaffective disorder:- Schizoaffective disorder is a mental disorder in which a person experiences

a combination of schizophrenia symptoms such as hallucination or delusion and mood disorder
symptoms such as depression or mania.

Management/treatment of schizophrenia:- The common approach to treatment is as follows:-

A. Pharmacological treatment:-
 Antipsychotic drugs such as haloperidol, Risperidone, Chlorpromazine.
 Antiparkinsonism drugs may be given to reduce the risks of extra pyramidal symptoms(side
effect of antipsychotic drugs- Levodopa).
 Anxiolytic/sedatives:- Lorazepam, Clonazepam, Alprazolam.

B. Physical therapy:- Electro convulsive therapy to control excitement, aggressive behaviour,

violent behaviour in an acute cases. About 10 to 12 ECT(three times in a week).

C. Psychotherapy:- To enhance self esteem and to provide comfort to the client, therapist has to
utilize different psychological therapies:-
 Individual psychotherapy:-
 Insight oriented psychotherapy.
 Supportive therapy that is reality oriented.
 Methods for improving interpersonal communication and emotional expression.
 Group therapy:- Group therapy is to improve skills and to improve interpersonal communication
and relationship.
 Behaviour therapy:- Behaviour modification is a history of qualified success in reducing the
frequency of bizarre, disturbing and deviant behaviour and increasing appropriate behaviour.
 Family therapy:- Family therapy is a well proven therapy that focuses on educating the family
and reducing amount of high expressed emotions in the household. Even when families appear
to cope well, where is notable impact on the mental health status of relatives when a family
member has the illness.
 Milieu therapy:- Milieu therapy provides non-threatening democratic environment to the
client’s they will feel free to express their feelings through talking and relearn certain social
skills, decision making skills, managing skills, and a sense of responsibility are enhanced slowly
declines to learn to adapt to the living situations.

Nursing management of the client with Schizophrenia:-

Nursing diagnosis:-

1. Altered thought process evidence by perceptual disturbance like hallucinations, delusions, loss
of reality, autism and associated problems.

Goals:- The client will be able to improve his thought process, live in reality and enjoys productive life.


 Accept the client as he is.

 Approach the client calmly,gently, focus on front behaviour; established therapeutic relationship
with the client.
 Provide structured guidelines and routines.
 Motivate the client to talk about real events and present situation.
 Explore the feelings of the client related to anxiety or frustration.
 Avoid laughing,arguing, whispering near to the client.
 Discourage long discussion related to irrational thinking.

2. Impaired verbal communication related to disordered thinking process, poor judgement.

Goals:- Gain confidence and communicates effectively with others.


 Never ignore the client, have patience and understanding.

 Develop trust, established rapport, utilize friendly approach, initiate conversation.
 Provide a comfortable, trustworthy, conductive environment when the client is exploring his
 Encourage the client to participate in social activity.
 Maintain a honest and consistent approach; use supporting statement in a non threatening
 Encourage the client to develop efficient coping strategies.
 identify the client interest and encourage it to minimize and develop competence if appropriate.

3. Disturbed personal identify related to disorganized thinking process.

Goals: Mobilize declined to participate in therapeutic milieu.

 Explain the routines, procedures to the client.
 Remove the client from the group, when he is having bizarre behaviour.
 Protect the client from harming either to himself or to others.
 Avoid increased stimuli in the environment.
 Accept the client as he is.
 Provide safe, non stimulating environment to the client.
 Develop one to one interaction.
 Never give support for misperceptions.
 Assist the client in desirable activities.
 Avoid to keep sharp instruments nearer to the client,to prevent self harm by the client, provide
safety measures.

4. Self care deficit related to withdrawal and cognitive impairment and perceptual disturbances.

Goals:- Able to perform self care,daily living activities independently.


 Client will develop independent living skills, daily care living activities.
 Meet the total needs of the client.
 Structured schedule and creative approaches can be adopted meeting his daily needs like
elimination,rest, sleep and nutritional needs. for example regular sleeping, bowel and bladder
 Avoiding frequent naps in the noon time.
 Provide a clean environment and serve the food in neat ,attractive and appealing manner.
 Switch off main lights at 10:00 p.m. keeping dim light,soft music, serving a glass of warm milk
before going to bed.

5. Need for discharge advice, ready to go home and adjust to family environment.

Goals:- Gain family support and able to adjust with family and its environment.


 Help the client adjust to the family surroundings.

 Encourage the client to develop positive attitude and acheiving self confidence.
 Family and situational and support will help them to become normal and it reduce stress,adapts
to the family situation.
 Arrange for discussions with client, and their family members and health care team members.
 Educate the need of continuity and follow up services.

Nursing management of the client with mania:-

Nursing diagnosis:-
1. Prone for violence resulting causing harm to himself or to others related to manic excitement
and perceptual disturbance.
Goals:- Guard to the client from injury or causing harm to others.


 Establish calm and quite,non- provocative or non stimulating environment.

 Keep sharp instruments away from the client.
 Provide supporting environment.
 Encourage the client to perform deep breathing exercise,meditations and interested activities in
a desirable manner.
 Do not provoke or argue with the client or others in the client’s unit.
 Never heart inner feelings of the client,to not do any unhealthy comparisons.
 Restrict or limit the clients negative feelings or activities.
 Encourage the client to participate in group activities and in small discussions.

2. Alteration in thought process related to flight of ideas and delusions.

Goal:- Recovers from perceptual and thought distributions.


 Be with the client, reorient him to the present situation.

 Reduce the environmental stimuli in the client’s environment.
 Warm approach is required in handling the client.
 Teach the problem solving techniques, suggest alternative methods.
 Engage the clients mind in pleasurable thoughts, encourage to participate in useful activities.
 Make the client to live in reality.

3. Activity deficit, sleep disturbance, perceptual problem due to flight of ideas.

Goals:- Able to perform the activities without any difficulties related to perception.


 Never force the client to participate in challenging games.

 Provide calm and quiet environment; comfort measures can be followed. For example.
Minimize volume, dim light, warm milk.
 Advise the client to have minimum 6 to 8 hours of sleep, which is necessary for maintaining
good health.
 Involve the client to do the activities in simple, short term projects.
 Plan and implement the activities with in the scope of clients achievement.

4. Impaired communication, social isolation related to low coping skills and unsatisfactory

Goals:- Maintain good interpersonal relationship through adequate interaction.


 Maintain good theraputic interpersonal relationship.

 Teach social skills and communication skills training.
 Spend some time with the client; initiate brief conversation, directly speak to the client.
 Explain and orient the client for ward routines, procedures and policies.
 Provide scheduled activities.
 Never argue and discourage with the client, when he is in a distrubed mood.
 Give positive reinforcement for non manipulative behaviour.
 Insist the client to verbalize his feelings whether positive or negative.
 Demonstrate specific behaviour modification techniques to ensure security feelings.

5. Knowledge deficit related to follow up care and continuity of care and treatment.

Goals:- Leads qualitative life.


 Assess the self care abilities, interaction pattern, family support, situational guidance,etc.
 If permitted, send the client for trial visit to family environment, observe his adaptation to the
 Arrange for family gathering and spiritual meeting.
 Educate the client and his family members regarding follow up visits; continuation medications,
care at home.
 Create conductive and joyfull environment.
 Never laugh at the client.
 Structure the schedules of activities to be implemented.