SCHIZOPHRENIA

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SCHIZOPHRENIA

• A psychotic disorder characterized by bizarre and
  disorganized behavior
• One of the most serious and debilitating of all
  psychological disorders

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DSM-IV-TR CRITERIA FOR SCHIZOPHRENIA

• 2 or more for at least a 1-month period
• 1. Delusions
• 2. Hallucinations
• 3. Disorganized speech
• 4. Grossly disorganized or catatonic behavior
• 5. Negative symptoms flat affect,
  alogia,avolition

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CRITERIA FOR SCHIZOPHRENIA

• B. Social/Occupational Dysfunction
• C. Duration continuous signs of disturbance for
  at least 6 months, including at least 1 month of
  active phase sx and periods of prodromal or
  residual sx.
• D. R/O Schizoaffective Disorder, Mood Disorders,
  the effects of a substance, and general medical
  conditions.

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2 Categories of Symptoms

• Positive Symptoms -behavioral excesses/ problems
  normal people do not experience
• Better treatment outcomes
• Respond to medication

• Negative Symptoms - behavioral deficits normal
  people do experience
• More resistant to medication

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Positive Symptoms

• Hallucinations
• Delusions
• Disorganized Speech
• Disorganized Behavior

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Hallucinations

• Sensory experience that is a product of ones
  mind doesnt exist in the outside world
• Modalities Auditory, Visual, Tactile,
• Olfactory, Gustatory, Somatic
• Auditory most common
• Distressing, give commands, noise in their head

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Delusions

• Erroneous beliefs that cant be influenced or
  corrected by reason or contradictory evidence
• Themes Persecutory, Referential,
• Grandiose, broadcasting

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Disorganized Thought Speech

• Statements/thoughts arent logically connected to
  each other content often makes no sense
• Tangential - loose associations
• Derailment - get off track
• Flight of ideas - jump from topic to topic
• Neologisms - make up words
• Incoherence - word salad
• Clanging - rhyming

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Disorganized Behavior

• Disheveled appearance, unusual dress, basic
  hygiene neglected
• Inappropriate affect - doesnt fit w/ the
  situation, childlike silliness
• Agitation unpredictable, untriggered
• Posturing inappropriate, bizarre movements
• Catatonia lack of response to environment,
  stupor (complete unawareness), rigid posturing,
  negativism (resistant to instructions)

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Negative Symptoms

• Poverty of speech
• Flat affect
• Avolition
• Social isolation
• Motor retardation
• Anhedonia

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Alogia

• Poverty of speech ? decrease in speech fluency
  and productivity
• Severe reduction in speech e.g. brief replies
• Absence of speech

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Flat Affect

• Severe reduction in or absence of emotional
  responses to environment.
• Examples
• Face is unresponsive or lacks expression
• Poor eye contact
• Reduced body language
• Diminished range of emotional expression

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Avolition

• Lack of will/motivation
• Inability to initiate or persist at tasks
• Little interest in social or work activities

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SUBTYPES OF SCHIZOPHRENIA

• Paranoid Schizophrenia
• Disorganized Schizophrenia
• Catatonic Schizophrenia
• Undifferentiated Schizophrenia

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SCHIZOPHRENIA, PARANOID TYPE

• Most common subtype
• Presence of prominent delusions (persecutory most
  common) and hallucinations (usually auditory)
• Delusions and hallucinations revolve around a
  central theme
• Lack of catatonic sx, disorganized speech or
  behavior no negative symptoms present

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SCHIZOPHRENIA, DISORGANIZED TYPE

• Disorganized speech
• Disorganized behavior
• Flat or inappropriate affect
• No evidence of catatonia

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SCHIZOPHRENIA, CATATONIC TYPE

• Rare form of schizophrenia
• Catatonic symptoms (motor related) 2 or more
• Echolalia mimic verbalizations
• Echopraxia mirror motor movements

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SCHIZOPHRENIA, UNDIFFERENTIATED TYPE

• Dont fit into any of the other 3 categories
• Display a mix of symptoms

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Facts Figures

• Prevalence 1 in 100 people approx. 4 million in
  U.S.
• Onset men mid 20s (18-25) women late 20s
  (25-35)
• Gender women have a more favorable course
• Prognosis debilitating, long-term disorder
  chronic course complete remission is rare
• Living situation 50 live with or rely on
  family many live in residential treatment
  facilities
• High suicide rates 10-20

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Facts and Figures

• Large percentage of the homeless population
  (10-20)
• High rates of substance abuse 80-90 use
  nicotine
• More likely to be born in Jan, Feb, March
• Strong genetic component MZ twins 48 DZ twins
  17

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Biological Theories of Schizophrenia

• Genetic theories
• Structural brain abnormalities
• Birth complications
• Prenatal viral exposure
• Elevated levels of D, NE, 5HT
• Lower levels of GABA Glutamate

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Treating Schizophrenia

• Psychoeducation for patient and family
• Consistent medication management traditional
  antipsychotics vs. atypical antipsychotics
• Supportive therapy
• Intensive psychosocial interventions intensive
  case management, outpatient treatment programs,
  CBT, skills-based training