Punzal, Camille Mirasol R.

November 6, 2010

4-NRS2 Mr. Armando Delos Santos, RN, MAN

ONSET OF SCHIZOPHRENIA

Schizophrenia is rare in children, affecting only about 1 in 40,000, compared to 1 in 100

in adults. The average age of onset is 18 in men and 25 in women. Ranking among the top 10
causes of disability worldwide, schizophrenia, at any age, exacts a heavy toll on patients and
their families. Children with schizophrenia experience difficulty in managing everyday life. They
share with their adult counterparts psychotic symptoms (hallucinations, delusions), social
withdrawal, flattened emotions, increased risk of suicide and loss of social and personal care
skills. They may also share some symptoms with-and be mistaken for-children who suffer from
autism or other pervasive developmental disabilities, which affect about 1 in 500 children.
Although they tend to be harder to treat and have a worse prognosis than adult-onset
schizophrenia patients, researchers are finding that many children with schizophrenia can be
helped by the new generation of antipsychotic medications.

TREATMENT:

Anti-psychotic agents also called neuroleptics are primarily used in treatment. These medications
are used to treat psychotic episodes and to maintain patients in remission.

Medications

While there are a number of helpful treatments available, medication remains the
cornerstone of treatment for people with schizophrenia. These medications are often referred to
as antipsychotics since they help decrease the intensity of psychotic symptoms. Many health-care
professionals prescribe one of these medications, sometimes in combination of one or more other
psychiatric medications, in order to maximize the benefit for the person with schizophrenia.

o Mood-stabilizer medications like lithium (Lithobid), divalproex (Depakote),

carbamazepine and lamotrigine (Lamictal) can be useful in treating mood swings that
sometimes occur individuals who have a diagnosable mood disorder in addition to
psychotic symptoms (for example, schizoaffective disorder, depression in addition to
schizophrenia). These medications may take a bit longer to work compared to the
antipsychotic medications. Some (for example, lithium, divalproex, and carbamazepine)
require monitoring of medication blood levels, and some can be associated with birth
defects when taken by pregnant women.
 o Antidepressant medications are the primary medical treatment for the depression that
can often accompany schizophrenia. Examples of antidepressants that are commonly
prescribed for that purpose include serotonergic (SSRI) medications that affect serotonin
levels like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram
(Celexa), and escitalopram (Lexapro); combination serotonergic/adrenergic medications
(SNRIs) like venlafaxine (Effexor) and duloxetine (Cymbalta), as well as bupropion
(Wellbutrin), which is a dopaminergic (affecting dopamine levels) antidepressant.

Psychosocial treatment including:

o Family psycho-education: In addition to educating family members about the

symptoms, course, and treatment of schizophrenia, this form of treatment consists of
providing family support, problem-solving skills, and access to care providers during
times of crises. When this intervention is consistently provided for at least several
months, it has been found to decrease the relapse rate for the individual with
schizophrenia and improve the person's social and emotional outcomes. Also, the burden
that family members experience as a result of having a loved one with schizophrenia is
lessened, family members tend to be more knowledgeable about the disorder and feel
more supported by the professionals involved, and family relationships are improved.
o Assertive community treatment (ACT): This intervention consists of members of the
person's treatment team meeting with that individual on a daily basis, in community
settings (for example, home, work, or other places the person with schizophrenia
frequents) rather than in an office or hospital setting. The treatment team is made up of a
variety of professionals. For example, a psychiatrist, nurse, case manager, employment
counselor, and substance-abuse counselor often make up an ACT team. ACT tends to be
successful in reducing how often people with schizophrenia are hospitalized or become
homeless.
o Substance abuse treatment: Providing medical and psychosocial interventions that
address substance abuse should be an integral part of treatment as about 50% of
individuals with schizophrenia suffer from some kind of substance abuse or dependence.
o Social skills training: Also called illness management and recovery programming,
social-skills training involves teaching clients ways to handle social situations
appropriately. It often involves the person scripting (thinking through or role-playing)
situations that occur in social settings in order to prepare for those situations when they
actually occur. This treatment type has been found to help people with schizophrenia
resist using drugs of abuse, as well as improve their relationships with health-care
professionals and with people at work.
o Supported employment: This intervention provides supports like a work coach
(someone who periodically or consistently counsels the client in the
workplace,interviewing for jobs, and education and support for employers to hire
individuals with chronic mental illness. Supported employment has been found to help
schizophrenia sufferers secure employment, earn more money, and increase the number
of hours they are able to work.
 o Cognitive behavioral therapy (CBT): CBT is a reality-based intervention that focuses
on helping a client understand and change patterns that tend to interfere with his or her
ability to interact with others and otherwise function. Except for people who are actively
psychotic, CBT has been found to help individuals with schizophrenia decrease
symptoms and improve their ability to function socially. This intervention can be done
either individually or in group sessions.
o Weight management: Educating people with schizophrenia about weight gain and
related health problems that can be a side effect of some antipsychotic and other
psychiatric medications has been found to be helpful in resulting in a modest weight loss.
That is also true when schizophrenia sufferers are provided with behavioral interventions
to assist with weight loss.

TYPES OF SCHIZOPHRENIA:

Paranoid schizophrenia: The individual is preoccupied with one or more delusions or

many auditory hallucinations but does not have symptoms of disorganized schizophrenia.

Disorganized schizophrenia: Prominent symptoms are disorganized speech and

behavior, as well as flat or inappropriate affect. The person does not have enough symptoms to
be characterized as catatonic schizophrenic.

Catatonic schizophrenia: The person with this type of schizophrenia primarily has at
least two of the following symptoms: difficulty moving, resistance to moving, excessive
movement, abnormal movements, and/or repeating what others say or do.

Residual schizophrenia: While the full-blown characteristic positive symptoms of

schizophrenia (those that involve an excess of normal behavior, such as delusions, paranoia, or
heightened sensitivity) are absent, the sufferer has less severe forms of the disorder or has only
negative symptoms (symptoms characterized by a decrease in function, such as withdrawal,
disinterest, and not speaking).

Undifferentiated schizophrenia: This is characterized by episodes of two or more of the

following symptoms: delusions, hallucinations, disorganized speech or behavior, catatonic
behavior or negative symptoms, but the individual does not qualify for a diagnosis of paranoid,
disorganized, or catatonic type of schizophrenia.