Transcript L7_Schizophrenia

Disorders of Thought
and Volition
Schizophrenia?
• A chronic severe brain disorder; often they
hear voices, believe media are
broadcasting their thoughts to the world or
may believe someone is trying to harm
them.
• In men it usually develops in teen years
and early 20s; in women it usually
develops in 20s and 30s.
Diagnosis
• Currently there is no physical or lab test
that can absolutely diagnose
schizophrenia.
• A psychiatrist usually comes to the
diagnosis based on clinical symptoms.
Symptoms of Schizophrenia
• Profound disruption in cognition and
emotion, affecting the most fundamental
human attributes:
– Language
– Thought
– Perception
– Affect
– Sense of self
Positive Symptoms
• Those that appear to reflect an excess or
distortion of normal functions.
Positive Symptoms
• Delusions. Those where the patient thinks
he is being followed or watched are
common; also the belief that people on
TV, radio are directing special messages
to him/her.
Positive Symptoms
• Hallucinations. Distortions or
exaggerations of perception in any of the
senses.
• Often they hear voices within their own
thoughts followed by visual hallucinations.
Positive Symptoms
• Disorganized thinking/speech.
• Speech is tangential, loosely associated or
incoherent
enough
to
impair
communication.
Positive Symptom
• Grossly disorganized behavior.
• Difficulty in goal directed behavior ,
unpredictable agitation or silliness, social
dis-inhibition, or bizarre behavior.
• There is a purposelessness to behavior.
Positive Symptom
• Catatonic behavior.
• Marked decrease in reaction to immediate
environment, sometimes just unaware of
surroundings, rigid or bizarre postures,
aimless motor activity.
Other Positive Symptoms
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Inappropriate response to stimuli
Unusual motor behavior (pacing, rocking)
Depersonalization
Derealization
Somatic preoccupations
Summary of Positive Symptoms
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Delusions
Hallucinations
Disorganized thinking
Disorganized behavior
Catatonic behavior
Inappropriate responses
FYI: Positive Symptoms
• Positive symptoms are those that have a
positive reaction from some treatment.
• In other words, positive symptoms
respond to treatment.
Negative Symptoms
• Those that appear to reflect a diminution
or loss of normal functions.
• May be difficult to evaluate because they
are not as grossly abnormal as positive
symptoms.
Negative Symptoms
• Affective flattening.
• Reduction in the range and intensity of
emotional expression, including facial
expression, voice tone, eye contact and
body language.
Negative Symptom
• Alogia (poverty of speech)
• Lessening of speech fluency and
productivity, thought to reflect slowing or
blocked thoughts; often manifested as
short, empty replies to questions.
Negative Symptom
• Avolition
• The reduction, difficulty or inability to
initiate and persist in goal-directed
behavior. Often mistaken for apparent
disinterest.
Examples of Avolition
• No longer interested in going out with
friends
• No longer interested in activities that the
person used to show enthusiasm
• No longer interested in anything
• Sitting in the house for hours or days
doing nothing
Disorganized Symptoms
• This one is somewhat new and may not be
considered valid.
• It is thought disorder, confusion,
disorientation and memory problems.
Summary of Negative Symptoms
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Lack of emotion
Low energy
Lack of interest in life
Affective flattening
Alogia
Inappropriate social skills
Inability to make friends
Social isolation
Cognitive Symptoms
• Difficulties in concentration and memory:
– Disorganized thinking
– Slow thinking
– Difficulty understanding
– Poor concentration
– Poor memory
– Difficulty expressing thoughts
– Difficulty integrating thoughts, feelings,
behaviors
FYI: Negative Symptoms
• Currently there is no treatment that has a
consistent impact on negative symptoms.
Types of Schizophrenia
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Paranoid
Hebephrenic
Catatonic
Residual
Schizoaffective
Undifferentiated
Paranoid Schizophrenia
• Persons are very suspicious of others and
often have grand schemes of persecution
at the root of their behavior.
• During this phase they may have
hallucinations and frequent delusions.
Hebephrenic Schizophrenia
• AKA disorganized schizophrenia; characterized
by emotionless, incongruous, or silly behavior,
intellectual deterioration, frequently beginning
insidiously during adolescence.
• May be verbally incoherent and may have
moods and emotions that are not appropriate to
the situation.
• Hallucinations not usually present.
Catatonic Schizophrenia
• Person is extremely withdrawn, negative
and isolated.
• May have marked psychomotor
disturbances.
Residual Schizophrenia
• Lacks motivation and interest in day-today living.
• Person is not usually having delusions,
hallucinations or disorganized speech.
Schizoaffective Disorder
• There will be symptoms of schizophrenia
as well as mood disorder (depression,
bipolar, mixed mania).
Undifferentiated Schizophrenia
• Conditions meeting the general diagnostic
criteria for schizophrenia but not
conforming to any of the previous types.
• Exhibits more than one of the previous
types without a clear dominance of one.