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SCHIZOPHRENIA

SCHIZOPHRENIA. A psychotic disorder characterized by bizarre and disorganized behavior One of the most serious and debilitating of all psychological disorders. DSM-IV-TR CRITERIA FOR SCHIZOPHRENIA. 2 or more for at least a 1-month period: 1. Delusions 2. Hallucinations

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SCHIZOPHRENIA

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

  2. 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

  3. 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/OSchizoaffective Disorder, Mood Disorders, the effects of a substance, and general medical conditions.

  4. 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 2 Categories of Symptoms

  5. Positive Symptoms • Hallucinations • Delusions • Disorganized Speech • Disorganized Behavior

  6. Hallucinations Sensory experience that is a product of one’s mind; doesn’t exist in the outside world Modalities:Auditory, Visual, Tactile, Olfactory, Gustatory, Somatic • Auditory most common • Distressing, give commands, “noise” in their head

  7. Delusions Erroneous beliefs that can’t be influenced or corrected by reason or contradictory evidence Themes:Persecutory, Referential, Grandiose, broadcasting

  8. Disorganized Thought & Speech Statements/thoughts aren’t 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

  9. Disorganized Behavior • Disheveled appearance, unusual dress, basic hygiene neglected • Inappropriate affect - doesn’t 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)

  10. Negative Symptoms • Poverty of speech • Flat affect • Avolition • Social isolation • Motor retardation • Anhedonia

  11. Alogia Poverty of speech decrease in speech fluency and productivity • Severe reduction in speech – e.g. brief replies • Absence of speech

  12. 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

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

  14. SUBTYPES OF SCHIZOPHRENIA • Paranoid Schizophrenia • Disorganized Schizophrenia • Catatonic Schizophrenia • Undifferentiated Schizophrenia

  15. 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

  16. SCHIZOPHRENIA, DISORGANIZED TYPE • Disorganized speech • Disorganized behavior • Flat or inappropriate affect • No evidence of catatonia

  17. SCHIZOPHRENIA, CATATONIC TYPE • Rare form of schizophrenia • Catatonic symptoms (motor related) – 2 or more • Echolalia – mimic verbalizations • Echopraxia – mirror motor movements

  18. SCHIZOPHRENIA, UNDIFFERENTIATED TYPE • Don’t fit into any of the other 3 categories • Display a mix of symptoms

  19. Facts & Figures • Prevalence: 1 in 100 people; approx. 4 million in U.S. • Onset: men – mid 20’s (18-25); women – late 20’s (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%

  20. 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%

  21. 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

  22. 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

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