ETIOLOGY

Predisposing

Factors

Present/

AbsentRationale Justification

Genetic

Theory

Present The consequence of a chromosome

deletion referred to as the 22q1

deletion syndrome has been

identified. The risk of developing

schizophrenia in the presence of this

syndrome appears to be

approximately 25% accorfing to Dr.

Basset of the University of Toronto.

Scientists may also be close to

identifying genetic locations of

schizophrenia, which are believed to

be on human chromosomes 13 and 8.

One of the studies have found that

mothers od schizophrenic clients had

a high incidence of the gene type

H6A-B44.

Shives & Isaacs, Psychiatric-Mental

Health Nursing

Trinucleotide repeat amplification-

mutation in which a certain stretch of

DNA occurs more than once when

genes are copied. This could explain

some of the differential rates of

occurrence of schizophrenia. If one

child in a family carrying a gene for

There are histories of

mental illness on the father

side. His grandmother and

the youngest sibling of his

father, his aunt, are known

to have mental illnesses.

schizophrenia happens to have one

trinucleotide repeat than the others,

the other children could have the

tendency of having mental illness.

Stuart & Laraia, Principles and

Practice of Psychiatric Nursing

Neurobiology

Theory

Probable The two most consistent

neurobiological research findings in

schizophrenia are imaging studies

showing decreased brain volume and

abnormal function, neurochemical

studies showing alterations of

numerous neurotransmitter systems.

Psychotic behaviors may be related to

lesions in the frontal, temporal, and

limbic regions of the brain, and

dysregulation of neurotransmitter

systems connecting these regions.

Stuart & Laraia, Principles and

Practice of Psychiatric Nursing

The patient did not have a

laboratory result of

undergoing any imaging

tests that may prove the

patient has lesions to the

brain, but the patient had a

history of fall and may

have affected or

contributed some lesions to

the regions of his brain that

caused dysregulation of

neurotransmitter systems

connecting to these regions.

Neurodevelop

mental Theory

Probable Several brain structures are abnormal

in patients with schizophrenia as

compared to people who don’t

manifest the symptoms of

schizophrenia. Research suggests that

some disruption of fetal neural

development may change the way the

brain matures. Some research has

found a greater frequency of prenatal

and perinatal complications among

people with schizophrenia, including

The mother stated that she

has not experienced any

complications during her

pregnancy nor has used

alcohol or any maternal

problems but factors such

as poor nutrition, exposure

to stress and cigarette

smoke are inevitable as we

do our daily activities

especially with their

pre eclampsia; trauma; oxygen

deprivation at the time of delivery;

maternal problems such as poor

nutrition, stress, use of tobacco,

alcohol, caffeine, and use of

teratogenic pharmacological agents.

Stuart & Laraia, Principles and

Practice of Psychiatric Nursing

capabilities in terms

financial status. These

factors may also have

contributed to the abnormal

development of the

developing fetus that

caused neurodevelopmental

that may have triggered to

manifest the symptoms of

Schizophrenia

SYMPTOMATOLOGY

Precipitating

FactorsPresent/ Absent Rationale Justification

Biochemical

Influences

(Intake of drugs,

substances or

chemicals which

increase levels of

dopamine.)

Present The biochemical and

neurostructural theory

includes dopamine

hypothesis; excessive

dopamine allows nerve

impulses to bombard the

brain, resulting to

development of symptoms

of schizophrenia. The

cause of the release of high

levels of dopamine has not

yet been found.

Shives & Isaacs,

Psychiatric-Mental Health

Nursing

The dopamine hypothesis

theory suggests that

schizophrenia may be

caused by an excess of

dopamine-dependent

neuronal activity in the

brain. This excess activity

may be related to increased

production or release of

the substance at nerve

terminals, increased

receptor sensitivity, too

The patient’s mother

claims that the patient

has not taken any

illegal drugs. Also, his

laboratory results

shows no presence of

methamphetamine and

marijuana.

Even though the

patient’s chart did not

show any laboratory

results to confirm the

existence of such

anomalies if such are

present in the patient.

But the family of the

patient the patient

strongly claims that he

has the history of

inhaling rugby

much dopamine receptors,

or combination of these

mechanisms. The

manifestations of

schizophrenic symptoms

may be relatred to

increased number of

dopamine receptors.

Sociocultural and

Environmental

Theory

Present Some theorists proposed

that poverty, society, and

cultural disharmony could

cause schizophrenia or that

people chose to become

schizophrenic to cope with

the insanity of the modern

world.

Stuart & Laraia,

Principles and Practice of

Psychiatric Nursing

The patient’s family is

not well off and the

patient works as a

kargardor in the

market place which is

a very low source of

income. They live in a

congested around the

slum area and their

relationship with the

neighbors are not that

good especially

because of the

symptoms he

manifests as

schizophrenic.

Symptoms Present/

Not

Present

Rationale Justification

Hallucinations Probabl

e

A hallucination is a perception

experienced without external

stimulation of the sense organs.

Sensory hallucinations can be

auditory, tactile, visual,

gustatory, and olfactory. When

occurrence of increase dopamine

production occurs, dopaminergic

receptors, they were found to be

associated with increased

activity in a widely distributed

network of brain regions,

especially in the visual cortex in

the occipital lobe, but also in

regions of the frontal and

temporal lobes.

It was indicated

on the nurse’s

progress notes

that the patient

classified the

flies and

mosquitoes

along with

stimuli

butterflies but

there were

instances that the

patient is talking

by himself.

Illusions Present Illusions are misinterpretations

of stimuli. Like hallucinations,

illusions also occur as a result of

hyperdopaminergic state in

limbic areas.

It was indicated

on the nurse’s

progress notes

that the patient

classified the flies

and mosquitoes as

butterflies.

Flight of Ideas Present Flight of ideas is characterized

by overproductivity of talk and

verbal skipping from one idea to

another which tangential

Communication

skills of the

patient show

constant

associations occur quickly

frequently (every one to two

sentences or so) resulting from

increased activity in a widely

distributed network of brain

regions.

incoherent

statements,

circumstantiality,

tangentiality and

the like which are

highly indicative

of inadequate and

inappropriate

communication.

Associative

looseness was

observed during

interview.

Associative

looseness

Not

Present

Thinking is characterized by

speech in which ideas shift from

one unrelated subject to another

and the individual is unaware

that the topics are unconnected.

As a neurotransmitter, dopamine

transmits chemical signals from

the dopamine-containing

neurons to target cells that

contain dopamine receptors. In

the brain, dopamine controls

memory thus there will be

manifestations such as speech

disorders.

Loose

associations can

be traced in many

of the statements

made by the

patient in

conversations.

Details which do

not have anything

to do with the

topic are being

mentioned by the

patient.

Ambivalence Absent The coexistence of opposite

emotions toward the same

object, person, or situation.

Overproduction of

This symptom is

not exhibited by

the patient.

neurotransmitters will cause

abnormalities to the networks

medial prefrontal cortex and the

posterior cingulate cortex,

regions that are associated with

self-reflection and

autobiographical memories and

which become connected into a

synchronously active network

when the mind is allowed to

wander

Apathy Present Apathy is another symptom

associated with the affective

alterations brought about by

schizophrenia. It can be defined

as a lack of concern or interest. It

is the inability to generate a

normal response to people,

situations or the environment.

Overproduction of

neurotransmitters will cause

abnormalities to the networks

medial prefrontal cortex and the

posterior cingulate cortex,

regions that are associated with

self-reflection and

autobiographical memories and

which become connected into a

synchronously active network

when the mind is allowed to

wander

As the informant

could remember

the patient used to

play sports like

basketball

together with his

friends. The

patient has

diminished or lost

interest in

communicating

with people and

isolates himself

from the society.

Alogia Not

Present

The absence of spontaneous

speech production for the

purpose of answering questions

or expressing oneself.

The patient did

not exhibit this

symptom

Flat Affect Not

Present

The near absence of emotional

or facial expressions throughout

a conservation or in different

situations

The patient did

not exhibit this

symptom

Anhedonia Present The inability to experience

pleasure which is highly

associated with the detrimental

effects of schizophrenia in the

affect of individuals suffering

from schizophrenia. Dopamine

transmits chemical signals from

the dopamine-containing

neurons to target cells that

contain dopamine receptors.

Dopamine release in the nucleus

accumbens is so consistently tied

with pleasure that neuroscientists

refer to the region as the brain's

pleasure center.pleasure

Autism Present Difficulty in communicating and

forming relationships with other

people and in using language

and abstract concepts. It is

characterized by qualitative

alterations in three behavioral

areas: social reciprocity,

The patient has

troubled

relationship with

other people

including his

family.

communication, and breadth of

interests manifest by repetitive

behaviors or restricted

interests. There is evidence in

autistic children for reduced

brain serotonin synthesis during

periods of peak synaptogenesis

Delusion Probabl

e

A persistent belief contrary to

the educational and cultural

background of the individual.

When occurrence of increase

dopamine production occurs,

dopaminergic receptors, they

were found to be associated with

increased activity in a widely

distributed network of brain

regions, especially in the visual

cortex in the occipital lobe, but

also in regions of the frontal and

temporal lobes.

Delusions of

grandeur are

highly evident in

the patient’s

verbalizations

and actions

described by the

informants.

The patient

believes that his

mother is his

yaya, as

verbalized

“kanang mama-

mamahan nako

akoa man nang

yaya.” He also

believes that

someone took his

money as stated

by the patient

“gikuha akuang

kwarta,” which

was indicated on

the nurses’s

progress notes