Introduction

Schizophrenia is an extremely complexmental disorder: in fact it is probably many illnesses masquerading as one. A biochemical imbalance in the brain is believed to cause symptoms. Recent research reveals thatschizophrenia may be a result of faulty neuronal development in the fetal brain, which develops into full-blown illness in late adolescence or early adulthood. Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions, movement, and behavior. It cannot be defined as a single illness rather thought as a syndrome or disease process with many different varieties and symptoms. It is usually diagnosed in late adolescence or early adulthood. Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women. The symptoms of schizophrenia are categorized into two major categories, the positive or hard symptoms which include delusion, hallucinations, and grossly disorganized thinking, speech, and behavior, and negative or soft symptoms as flat affect, lack of volition, and social withdrawal or discomfort. Medication treatment can control the positive symptoms but frequently the negative symptoms persist after positive symptoms have abated. The persistence of these negative symptoms over time presents a major barrier to recovery and improved the functioning of clients daily life. TYPES OF SCHIZOPHRENIA:

Schizophrenia, paranoid type is characterized by persecutory (feeling victimized or spied on) or grandiose delusions, hallucinations, and occasionally, excessively religiosity (delusional focus) or hostile and aggressive behavior. Schizophrenia, disorganized type is characterized by grossly inappropriate or flat affect, incoherence, loose associations, and extremely disorganized behavior. Schizophrenia, catatonic type is characterized by marked psychomotor disturbance, either motionless or excessive motor activity. Motor immobility may be manifested by catalepsy (waxy flexibility) or stupor. Schizophrenia, undifferentiated type is characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect, and behavior. Schizophrenia, residual type is characterized by at least one previous, though not a current, episode, social withdrawal, flat affect and looseness of associations.

ANATOMY AND PHYSIOLOGY: Structure and function of the nervous system I. Structures A. The neurologic system consists of two main divisions, the central nervous system (CNS) and the peripheral nervous system (PNS). The autonomic nervous system (ANS) is composed of both central and peripheral elements. 1. The CNS is composed of the brain and spinal cord. 2. The PNS is composed of the 12 pairs of the cranial nerves and the 31 pairs of the spinal nerves. 3. The ANS is comprised of visceral efferent (motor) and the visceral afferent (sensory) nuclei in the brain and spinal cord. Its peripheral division is made up of visceral efferent and afferent nerve fibers as well as autonomic and sensory ganglia. B. The brain is covered by three membranes. 1. The dura matter is a fibrous, connective tissue structure containing several blood vessels. 2. The arachnoid membrane is a delicate serous membrane. 3. The pia matter is a vascular membrane. C. The spinal cord extends from the medulla oblongata to the lower border of the first lumbar vertebrae. It contains millions of nerve fibers, and it consists of 31 nerves 8 cervical, 12 thoracic, 5 lumbar, and 5 sacral. D. Cerebrospinal fluid (CSF) forms in the lateral ventricles in the choroid plexus of the pia matter. It flows through the foramen of Monro into to the third ventricle, then through the aqueduct of Sylvius to the fourth ventricle. CSF exits the fourth ventricle by the foramen of Magendie and the two foramens of Luska. It then flows into the cistema magna, and finally it circulates to the subarachnoid space of the spinal cord, bathing both the brain and the spinal cord. Fluid is absorbed by the arachnoid membrane. II. Function A. CNS 1. Brain a The cerebrum is the center for consciousness, thought, memory, sensory input, and motor activity; it consists of two hemispheres (left and right) and four lobes, each with specific functions.

The frontal lobe controls voluntary muscle movements and contains motor areas, including the area for speech; it also contains the centers for personality, behavioral, autonomic and intellectual functions and those for emotional and cardiac responses. The temporal lobe is the center for taste, hearing and smell, and in the brains dominant hemisphere, the center for interpreting spoken language. The parietal lobe coordinates and interprets sensory information from the opposite side of the body. The occipital lobe interprets visual stimuli. The thalamus further organizes cerebral function by transmitting impulses to and from the cerebrum. It also is responsible for primitive emotional responses, such as fear, and for distinguishing between pleasant and unpleasant stimuli. Lying beneath the thalamus, the hypothalamus is an automatic center that regulates blood pressure, temperature, libido, appetite, breathing, sleeping patterns, and peripheral nerve discharges associated with certain behavior and emotional expression. It also helps control pituitary secretion and stress reactions. The cerebellum or hindbrain, controls smooth muscle movements, coordinates sensory impulses with muscle activity, and maintains muscle tone and equilibrium. The brain stem, which includes the mesencephalon, pons, and medulla oblongata, relays nerve impulses between the brain and spinal cord. 2. The spinal cord forms a two-way conductor pathway between the brain stem and the PNS. It is also the reflex center for motor activities that do not involve brain control. B. The PNS connects the CNS to remote body regions and conducts signals to and from these areas and the spinal cord. C. The ANS regulates body functions such as digestion, respiration, and cardiovascular function. Supervised chiefly by the hypothalamus, the ANS contains two divisions. 1. The sympathetic nervous system serves as an emergency preparedness system, the flight-for-fight response. Sympathetic impulses increase greatly when the body is under physical or emotional stress causing bronchiole dilation, dilation of the heart and voluntary muscle blood vessels, stronger and faster heart contractions, peripheral blood vessel constriction, decreased peristalsis, and increased perspiration. Sympathetic stimuli are mediated by norepinephrine. 2. The parasympathetic nervous system is the dominant controller for most visceral effectors for most of the time. Parasympathetic impulses are mediated by acetylcholine. III. Differences in nervous system response. The nervous system is one of the first systems to form in utero, but one of the last systems to develop during childhood. A. Accuracy and completeness of the neurologic assessment is limited by the childs development.

B. The childs brain constantly undergoes organization in function and myelinization. Therefore, the full impact of insult may not be immediately apparent and may take years to manifest. C. The peripheral nerves are not fully myelinated at birth. As myelinization progresses, so does the childs fine motor control and coordination. D. Early signs of increased intracranial pressure (ICP) may not be apparent in infants because open sutures and fontanelles compensate to a limited extent. E. The development of handedness before 1 year of age may signify a neurologic lesion. F. Several primitive reflexes are present at birth, disappearing by 1 year of age. Absence, persistence, or asymmetry of reflexes may indicate pathology. G. The spinal cord ends at 13 in the neonate, instead of L1-L2 where it terminates in the adult. This affects the site of lumbar puncture. H. Children have 65 to 140 ml of CSF compared to 90 to 150 ml in the adult.

Patient profile
Name: Mr.X Age: 42 years old Gender:Male Adress: 5-A Roses st. paete laguna.

History of present illness (Patient was not able to gathered any information for past and present illness)

Name of drugs
Vitamin c brand names Cecon, Ceelin, Cenolate, Enervon, and Redoxon. Vitamin C is classified as a vitamin.

Indication
>patient with iron deficiency

Mechanism of action
Prevention and treatment of scurvy, acidification of urine, dietary supplement, prevention of and reduction in the severity of colds.

Contraindication Adverse effect

o o o o o o

Nursing consideration
Abrupt vitamin C withdrawal may produce rebound deficiency.

o o o o

Abdominal o cramps Nausea Vomiting Diarrhea Increased urination with doses exceeding 1 gram Flushing Headache Dizziness Sleepiness or insomnia

Name of drug

Indicatio n

Mechanism of action

Contraindication
Hypersensitivity; Bone marrow depression; Severe CNS depression/coma; Uncontrolled epilepsy; Granulocytopenia; Lactation : Discontinue drug or bottlefeed..

Adverse effect

Nursing consideration

Clozapine Psychotic patient Brand name:

Clozaril, Fazacio ODT

Clozapine is an anti-psychotic medication that works by blocking receptors in the brain for several neurotransmitters (chemicals that nerves use to communicate with each other) including dopamine type 4 receptors, serotonin type 2 receptors, norepinephrine receptors, acetylcholine receptors, and histamine receptors. Unlike traditional antipsychotic agents, such as chlorpromazine (Thorazine) andhaloperidol (Haldol) as well as the newer antipsychotics, risperidone(Risperdal) and olanzapine (Zyprexa), clozapine only weakly blocks dopamine type 2 receptors.

Orthostatic hypertension Decrease blood pressure Cardiac and respiratory arrest

>Monitor patients mental status >Monitor blood pressure

>Assess weight and BMI initially throughout therapy.

>Monitor for signs of myocarditis

Mental status examination

GABA :Seen examined an adult male wearing a blue NCMH uniform poorly kept with steady grid. I.Patient cooperative polite poorly good eye contact II. Mood affect-Blunted affect III .Speech- Has no specific answer to the question IV. Perceptual disturbance- denies any visual and auditory hallucination denies any suicidal threat . He has no plan after living discharge In this mentalitation VI. Sensorium- conscious has pair memory good concentration VII. Insight- he has a good judgement but he has a good insight he is un aware why he is in mental VIII. Reliability- he has a pair reliability