Schizophrenia - A Psychological Disorder

1
Schizophrenia

• Abnormal Psychology

2
Overview Schizophrenia

• Schizophrenia is one of the most common of the
  serious mental disorders
• Signs and symptoms are variable and include
  changes in perception, emotion, cognition,
  thinking, and behavior. The expression of these
  manifestations varies across patients and over
  time, but the effect of the illness is always
  severe and is usually long lasting.
• The disorder usually begins before age 25 years,
  persists throughout life, and effect persons of
  all social classes. Both patients and their
  families often suffer from poor care and social
  ostracism because of wide spread ignorance about
  the disorder.

3
Overview Schizophrenia

• Clinicians should appreciate that the diagnosis
  of schizophrenia is based entirely on the
  psychiatric history and mental status
  examination. .
• There is no laboratory test for schizophrenia.
  

4
Emil Kraepelin - 18561926

• Kraepelin translated Morels démence précoce into
  dementia precox,.
• term that emphasized the change in cognition
  (dementia) and early onset (precox) of the
  disorder.
• Patients with dementia precox were described as
  having a long-term deteriorating course and the
  clinical symptoms of hallucinations and
  delusions.

5
Emil Kraepelin

• Another separate condition called paranoia was
  characterized by persistent persecutory
  delusions.
• These patients lacked the deteriorating course of
  dementia precox and the intermittent symptoms of
  manic-depressive psychosis.

6
Eugene Bleuler - 18571939

• Bleuler identified specific fundamental (or
  primary) symptoms of schizophrenia to develop his
  theory about the internal mental schisms of
  patients.
• These symptoms included associational
  disturbances of thought, especially looseness,
  affective disturbances, autism, and ambivalence,
  summarized as the four As associations, affect,
  autism, and ambivalence.
• Bleuler also identified accessory (secondary)
  symptoms, which included the symptoms that
  Kraepelin saw as major indicators of dementia
  precox hallucinations and delusions.

7
EPIDEMIOLOGY - prevalence

• In the United States, the lifetime prevalence of
  schizophrenia is about 1 percent, which means
  that about one person in 100 will develop
  schizophrenia during their lifetime.
• The Epidemiologic Catchment Area study sponsored
  by the National Institute of Mental Health
  reported a lifetime prevalence of 0.6 to 1.9
  percent. In the United States.

8
Gender and Age

• The peak ages of onset are 10 to 25 years for
  men and 25 to 35 years for women.
• Approximately 3 to 10 percent of women with
  schizophrenia present with disease onset after
  age 40 years.
• About 90 percent of patients in treatment for
  schizophrenia are between 15 and 55 years
  old.Onset of schizophrenia before age 10 years
  or after age 60 years is extremely rare.

9
Gender and Age

• Some studies have indicated that men are more
  likely to be impaired by negative symptoms
  (described later) than are women and that women
  are more likely to have better social functioning
  than are men before disease onset.
• In general, the outcome for female schizophrenia
  patients is better than that for male
  schizophrenia patients. When onset occurs after
  age 45 years, the disorder is characterized as
  late-onset schizophrenia.

10
Another - EPIDEMIOLOGY Factors

• Reproductive Factors - The number of children
  born to parents with schizophrenia is continually
  increasing. The fertility rate for persons with
  schizophrenia is close to that for the general
  population.
• First-degree biological relatives of persons with
  schizophrenia have a ten times greater risk for
  developing the disease than the general
  population

11
Another - EPIDEMIOLOGY Factors

• Medical Illness - Persons with schizophrenia
  have a higher mortality rate from accidents and
  natural causes than the general population.
• Institution- or treatment-related variables do
  not explain the increased mortality rate, but the
  higher rate may be related to the fact that the
  diagnosis and treatment of medical and surgical
  conditions in schizophrenia patients can be
  clinical challenges.
• Several studies have shown that up to 80 percent
  of all schizophrenia patients have significant
  concurrent medical illnesses and that up to 50
  percent of these conditions may be undiagnosed.

12
CLINICAL FEATURES

• Three Major key issues to find the clinical
  signs and symptoms of schizophrenia.
• A - No clinical sign or symptom is path gnomonic
  for schizophrenia.
• B - Every sign or symptom seen in schizophrenia
  occurs in other psychiatric and neurological
  disorders.
• C- This observation is contrary to the
  often-heard clinical opinion that certain signs
  and symptoms are diagnostic of schizophrenia.
• Example This observation is contrary to the
  often-heard clinical opinion that certain signs
  and symptoms are diagnostic of schizophrenia.

13
CLINICAL FEATURES

• Therefore, a patients history is essential for
  the diagnosis of schizophrenia clinicians cannot
  diagnose schizophrenia simply by results of a
  mental status examination, which may vary.
• Second, a patients symptoms change with time.
• For example, a patient may have intermittent
  hallucinations and a varying ability to perform
  adequately in social situations, or significant
  symptoms of a mood disorder may come and go
  during the course of schizophrenia.
• Third, clinicians must take into account the
  patients educational level, intellectual
  ability, and cultural and sub cultural
  membership.

14
Symptoms of schizophrenia

• The symptoms of schizophrenia can be divided
  into three dimensions positive symptoms,
  negative symptoms, and disorganization.
• Positive Symptoms
• Negative Symptoms
• disorganization
• Delusions
• Hallucinations

15
Delusions, Hallucinations

• What is Delusions Called The Bharm
• There are two forms of psychotic symptoms
• Delusions - persistent false beliefs that are
  held despite evidence that the beliefs are
  incorrect or exaggerate reality. The content of
  delusions can vary across psychological
  disorders.
• Hallucinations - are sensations that are so
  vivid that the perceived objects or events seem
  real, although they are not. Hallucinations can
  occurin any of the five senses, but the most
  common type is auditory hallucinations, in
  particular, hearing voices.

16
Hallucination

• However, a hallucinationin and of itselfdoes
  not indicate psychosis or a psychological
  disorder. Rather, this form of psychotic symptom
  must arise in a context that renders it unusual
  and indicates impaired functioning
• specifically, hearing voices Most common type
  experienced by people with schizophrenia.
• The voices have returned with a vengeance,
  bringing hell to my nights and days. With
  scathing criticism and a constant scornful
  commentary on everything I do, they sometimes
  order me to do things I shouldnt. So far, Ive
  stopped myself, but I might not always be able
  to. . . . (Wagner Spiro, 2005, )

17
Disorganized Speech Behavior

• People with schizophrenia can sometimes speak
  incoherently, although they may not necessarily
  be aware that other people cannot understand what
  they are saying,
• One type of disorganized speech is word salad.
  which is a random stream of seemingly unconnected
  words.
• Thats wish-bell. Double vision. Its like
  walking across a persons eye and reflecting
  personality. It works on you, like dying and
  going to the spiritual world, but landing in the
  Vella world.
• (Marengo et al., 1985,)In this case,
  wish-bell is the neologism it doesnt exist,
  nor does it have an obvious meaning or function
  as a metaphor.

18
Abnormai iViotor Behavior (inciuding Catatonia)

• Catatonic behavior is a marked decrease in
  reactivity to the environment. This ranges from
  conflict to instructions negativism) to
  maintaining a rigid, inappropriate or bizarre
  posture to a complete lack of verbal and motor
  responses mutism and stupor)
• It can also include purposeless and excessive
  motor activity without obvious cause catatonic
  excitement).
• Other features are repeated stereotyped
  movements, staring, grimacing, mutism, and the
  echoing of speech. Although catatonia has
  historically been associated with schizophrenia,
  catatonic symptoms are nonspecific and may occur
  in other mental disorder.

19
Abnormai iViotor Behavior (inciuding Catatonia)

• (e.g., bipolar or depressive disorders with
  catatonia) and in medical conditions (catatonic
  disorder due to another medical condition).
  

20
Positive symptoms

• Positive symptoms, also called psychotic
  symptoms, include hallucinations and delusions.
• The term positive symptoms of schizophrenia does
  not involve that these symptoms are beneficial or
  adaptive. Rather, it suggests that they are
  characterized by the presence of unusual
  response (such as hearing a voice that is not
  really there).
• Positive symptoms are those that reflect an
  excess or distortion in a normal repertoire of
  behavior and experience, such as delusions and
  hallucinations.

21
Negative Symptoms DSM - V

• Two negative symptoms are particularly prominent
  in schizophrenia
• A - diminished emotional expression B-
  avolition
• Diminished emotional expression-
• includes reductions in the expression of emotions
  in the face, eye contact, intonation of speech
  (prosody), and movements of the hand, head, and
  face that normally give an emotional emphasis to
  speech (alogia, which means very little speech
  )

22
Negative Symptoms

• Avolition is a decrease in motivated
  self-initiated purposeful activities.
• The individual may sit for long periods of time
  and show little interest in participating in work
  or social activities.
• Other negative symptoms include
• A - alogia,
• B- anhedonia,
• C -asociality.

23
Negative Symptoms

• A alogia - is manifested by reduce speech
  output (which means very little speech )
• Anhedonia is the decreased ability to experience
  pleasure from positivestimuli or a degradation
  in the recollection of pleasure previously
  experienced
• Asociality - refers to the apparent lack of
  interest in social interactions and may be
  associated with avolition, but it can also be a
  manifestation of limited opportunities for social
  interactions.

24
Causes

• Some Factor Involve for causes of Schizophrenia
  
• Biological Factor
• Social Factor
• Psychological Factor
• Research method
• Environmental factor

25
Biological Factor

• In the Biological Factor some included like
• Genetics -
• Family Studies
• Adoption Studies - The first adoption study of
  schizophrenia began by identifying records for a
  group of 49 children who were born between 1915
  and 1945 while their mothers were hospitalized
  for schizophrenia (Heston, 1966). All the
  children were apparently normal at birth and were
  separated from their mothers within three days of
  birth

26
Biological Factor

• Pregnancy and Birth Complications
• Neuropathology
• Structural Brain Imaging
• Functional Brain Imaging -

27
Functional Brain Imaging

• The role of neurological abnormalities in
  schizophrenia has been highlighted by a study of
  identical twins conducted by investigators at the
  National Institute of Mental Health (NIMH).
  Participants included 27 pairs of twins
  discordant for schizophrenia and 13 pairs that
  were concordant for the disorder. Changes in
  brain structure, measured by MRI, and changes in
  brain function, measured by cerebral blood flow,
  were prominent in the twins who had developed
  schizophrenia.

28
Psychological Factors

• Most of the attention devoted to psychological
  factors and schizophrenia has focused on patterns
  of behavior and communication within families.

29
Treatment

• Antipsychotic medication
• Second-Generation Antipsychotics
• Maintenance Medication
• Motor Side Effects of Medication

30
(No Transcript)
31
Psychosocial Treatment

• Family-Oriented Aftercare Social Skills
  Training
• Assertive Community Treatment

32
Reference / Source

• DSM V
• Abnormal Psychology Butcher
• Abnormal Psychology Robert Emery