Schizophrenia overview

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Transcript Schizophrenia overview

What is Schizophrenia?
 Comes from Greek meaning “split” and “mind”
‘split’ refers to loss of touch with reality
not dissociative state
not ‘split personality’
 Equally common among men and women but men
have earlier onset
18 to 25 for men
26 to 45 for women
Sample videos
Symptoms of Schizophrenia
 Positive symptoms:
Disordered thinking and speech
Heightened or distorted perceptions
Inappropriate affect
 Negative symptoms
absence of normal cognition or affect (e.g., flat
affect, poverty of speech, social withdrawal, loss of
 Psychomotor Symptoms
Awkward movement, grimaces, posturing, gestures
Examples from “Rose Garden”
 Positive symptoms:
in Yr a voice shrieked out of the deep Pit: Innocent!
after a while the smell of people in the heavy ether-andchloroform stench of the Pit made her think that she
should try to see them.
Delusions – the construction of Yr & Midworld, her Yr name
(Januce), her Yr name for Dr. Fried, others?
Examples from “Rose Garden”
Disordered thinking/loose associations
Deborah sat down, while the Censor said in Yri: Listen
Bird-one … The tables have no defense against your
clumsiness. ‘Do you know why you are here?’ the doctor
asked. ‘Clumsiness. Clumsiness is first and then we have
a list: lazy, wayward, headstrong, self-centered, fat, ugly,
mean, tactless, and cruel …
Deborah looked at the Nose. “Obstacle,” she said.
Disordered perceptions
Deborah had looked about and found that she could not
see except in outlines, gray against gray, and with no
depth, but flatly, like a picture.
She could only see in gray now, and she could barely
hear. Her sense of touch was also leaving …
Examples from “Rose Garden”
 Psychomotor Symptoms - Catatonic
 that day and the next she spent on Yr’s plains, simple long
sweeps of land where the eye was soothed by the depth of
 A few days later, Deborah returned to the Midworld looking
down on Earth.
DSM-IV Criteria
 Criteria A – Two or during “significant portion of the
time” during a 1-month period:
Disorganized speech
Disorganized/catatonic behavior
Negative symptoms
 B - Social/occupational dysfunction
 C - Continuous disturbance for at least 6 months
 D - Not Schizoaffective or Mood disorder
 E - Not due to substance use/medical condition
 F - Can have a co-occuring pervasive developmental
disorder if hallucinations/delusions > 1 month
Symptoms of Schizophrenia
Delusions of persecution
‘they’re out to get me’
Delusions of grandeur
Delusions of being controlled
the CIA is controlling my brain with a radio
Symptoms of Schizophrenia
 Hallucinations
hearing or seeing things that aren’t there
contributes to delusions
command hallucinations: voices giving orders
 Disorganized speech
overinclusion - jumping from idea to idea without the
benefit of logical association
paralogic - on the surface, seems logical, but seriously
e.g., Jesus was a man with a beard, I am a man with a
beard, therefore I am Jesus
Symptoms of Schizophrenia
Disorganized behavior and affect
behavior is inappropriate for the situation
e.g., wearing sweaters and overcoats on hot days
Affect(emotion) is inappropriately
flat affect - no emotion at all in face or speech
inappropriate affect - laughing at very serious things,
crying at funny things
catatonic behavior
unresponsiveness to environment, usually marked by
immobility for extended periods
DSM-IV Criteria
 5 subtypes:
Disorganized –confusion, incoherence, and flat or
inappropriate affect
Catatonic –psychomotor disturbance of some sort
Paranoid –an organized system of delusions and
auditory hallucinations
Undifferentiated –symptoms cross subtypes
Residual – symptoms have lessened in strength and
Subtypes of Schizophrenia
 Paranoid type
delusions of persecution
believes others are spying and plotting
delusions of grandeur
believes others are jealous, inferior, subservient
 Catatonic type - unresponsive to
surroundings, purposeless movement, parrotlike speech
 Disorganized type
delusions and hallucinations with little meaning
disorganized speech, behavior, and flat affect
Other Psychotic Disorders
 Schizophreniform Disorder – Criteria A, D, E
from Schizophrenia met
Lasts between 1 and 6 months
 Schizoaffective Disorder
Major Depressive, Manic, or Mixed episode at the
same time Criteria A from Schizophrenia met
At least 2 weeks with hallucinations/delusions
without significant mood symptoms
Other Psychotic Disorders
 Delusional Disorder – “Non Bizarre” Delusions
lasting at least 1 month
Erotomanic, Grandiose, Jealous, Persecutory,
Somatic Types
Schizophrenia criteria A never met
Aside from delusions, functioning not impaired
 Brief Psychotic Disorder - Lasts between 1
day and 1 month
Schizophrenia and Genetics
 Sz risk increases with genetic similarity
Lifetime risk
of developing
for relatives of
a schizophrenic
General Siblings Children Fraternal Children Identical
of two
victims 14
Cultural Differences in
 Prevalence of Sz symptoms is similar no
matter what the culture (1-2%)
 Less industrialized countries have better
rates of recovery than industrialized
families tend to be more accepting and less critical
of the Sz patients (humanistic)
less use of antipsychotic medications, which may
impair full recovery
think of Sz as transient, rather than chronic and
lasting disorder: see it as a temporary
exaggeration of normal feelings