Transcript new schizophrenia ppt 09

SCHIZOPHRENIA
A trip into madness
What Schizophrenia Is Not:
It is not split personality (or multiple
personality disorder)

What is split in schizophrenia is not so
much personality as the connections among
thoughts
Schizophrenia is a psychotic disorder…

people are out of touch with reality
Evidence in the Brain
Onset
Onset occurs between the late teens
and mid-30s.

Onset prior to adolescence rare.
The onset could be abrupt/acute(fast)
or insidious(slow)

majority of individuals display some type of
slow and gradual development of a variety
of signs and symptoms
Prevalence and Familial Pattern
Between .5% and 1.5% of adults are believed to
have schizophrenia
Causes
Genetic
Biological
-different brain structure
-high dopamine levels
-amphetamines make it worse
Viral infections during pregnancy
Stress Theory- predisposition and certain
level of stress (college??)
Diagnostic criteria for
Schizophrenia:
Criterion A: Two (or more) of the following,
each present for a significant portion of the
time during a 1-month period (or less if
successfully treated):
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
Delusions
Delusions:
False beliefs or
thoughts that resists
all argument or clear
proof.
Delusions make sense
and sufferers do not
question them even if
the delusions are
scary or threatening
Types of Delusions:
1. Persecution
2. Reference
3. Control
4. Thought insertion
5. Thought withdraw
6. Grandeur
Delusions
Persecution: someone (or everyone) is out to get you
Reference: External people/objects send signs or messages
to you. (Ex. Billboards or commercials speak specifically
to you)
Control: controlled by some outside force (Satan made you
do it)
Thought Insertion: other people are putting thoughts into
your head
Thought Withdraw: people are taking thoughts out of your
head (others can know your thoughts)
Grandeur: belief of greater abilities than you actually
possess (Ex. Think you can fly, believe you are God)
Hallucinations
Hallucinations:
False sensory
experiences that can
come in the form of
auditory or visual.
Most common are
auditory “hearing
voices”
What do the voices say?
Command them to act
(usually against
themselves)
Voices say cruel and
hateful things about the
person
Where do the voices come
from?
Outside
Disorganized Speech
This is what makes
sufferers look
“crazy”!
Some believe this to
be the single most
important feature
“slip off track”
Types:
1.Loose associations
2.Tangentiality
3.Neologisms
4.Preserevation
5.Clanging
6.Blocking
Disorganized Speech
Loose associations: jump from one idea or topic
to the next in the same sentence. ~sometimes
called word salad
Tangentiality: when asked a question, go off on
unrelated topic
Neologisms: create new words or new
meanings for words
Preserevation: repeat same sound or word
Clanging: choose words by sound, not meaning
Blocking: stop mid-sentence
Grossly Disorganized Behavior
May manifest itself in a variety of ways
Problems with goal-directed behavior
Problems performing activities of daily living
Person may appear markedly disheveled or
may dress in an unusual manner
Display clearly inappropriate sexual behavior
Unpredictable and untriggered agitation
Negative Symptoms
Absence of something that should be
there
Types:




Affective flattening: no emotion
Alogia: missing speech (won’t
speak/appropriateness of speech)
Avolition: lack of motivation
Anhedonia: inability to feel pleasure
Note for Criterion A:
Only one Criterion A symptom is
required if delusions are bizarre or
hallucinations consist of a voice keeping
up a running commentary on the
person’s behavior or thought, or two or
more voices conversing with each other
(Bizarre= not possible)
Criterion B: Social/Occupational
Dysfunction
A significant portion of the time since the
onset, one or more major areas of
functioning, such as work, interpersonal
functioning, or self-care are markedly
below the level achieved prior to the onset
(or when the onset is in childhood or
adolescence, failure to achieve expected
level of interpersonal, academic, or
occupational achievement).
Social/Occupational Dysfunction
Examples for adults:
1. Fired from a job
2. Loses friends
3. Mismatched dress,
unkempt
Examples for children:
1. Trouble
making/keeping
friends
2. Trouble in school
3. Trouble with play
or completing
normal “kid” tasks
Criterion C: Duration
Continuous signs of the disturbance persist for at
least SIX months.
This six month period must include at least ONE
month of symptoms (or less if successfully
treated) that meet Criterion A (i.e. active phase
symptoms) and may include periods of
prodromal or residual symptoms.
During these prodromal or residual, the signs of
the disturbance may be manifested by only
negative symptoms or two or more symptoms
listed in Criterion A present in an attenuated
form (e.g. odd beliefs, unusual perceptual
experiences).
Criterion D: Schizoaffective and
Mood disorder exclusion
Schizoaffective disorder and Mood Disorder with
psychotic features have been ruled out
because either
(1) no major depressive, manic or mixed episode
have occurred concurrently with active phase
symptoms; or
(2) if mood episodes have occurred during active
phase symptoms, their total duration has been
brief relative to the duration of the active and
residual periods.
Criterion E: Substance/general
medical condition exclusion
The disturbance is not due to the direct
physiological effects of a substance
(e.g. a drug of abuse, a medication) or
a general medical condition.
Criterion F: Relationship to a
Pervasive Developmental Disorder
If there is a history of Autistic Disorder or
another Pervasive Developmental
Disorder, the additional diagnosis of
Schizophrenia is made only if prominent
delusions or hallucinations are also
present for at least a month (or less if
successfully treated).
Subtypes:
The subtypes of Schizophrenia are
defined by the predominant
symptomatology at the time of
evaluation.
There is an order to follow if two or
more subtype’s symptoms are present.
Which goes like this…
1.
2.
3.
4.
Catatonic Type
Disorganized Type
Paranoid Type
Undifferentiated Type
Subtypes
Catatonic Type:
Marked psychomotor
disturbance
 Immobility
 Excessive motor
activity
 Extreme negativism
 Mutism
 Echolalia- repetitive
sound
 Echopraxia- repetitive
movement
Disorganized Type:
Strangest and sickest of
sufferers
Course type is usually
continuous
“CRAZY” – “true
madness”
Subtypes:
Paranoid Type:
Usually centered around
one delusion
Basic theme
Hard to treat because
they don’t trust anyone –
esp. the therapist
Undifferentiated Type
~The catch-all
category
Treatments
Psychotic medicine
helps to reduce
symptoms, however,
there is NO cure for
Schizophrenia.
Not all people
respond to
medicine.
Seroquel
Abilify
Zyprexa
Risperdal
Geodon
Haldol
Thorazine
Clozaril
Trilafon
Stelazine