Week 5 Schizophrenia 9 27 12
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Transcript Week 5 Schizophrenia 9 27 12
Schizophrenia
Cara & MacCrae, Ch 7
OT 460a
What you need to know
Diagnostic Criteria: Criteria A-C
Different types of schizophrenia
Onset, prevalence, and prognosis
Other Schizophrenic-like disorders, e.g.,
Schizophreniform Disorder, Schizoaffective
Disorder, Delusional Disorder, Brief
Psychotic Disorder
Impact on Function
Medical Management
Definition
Affects 1/100 people; 2 million people will
develop in their lifetime
Dx has been treated differently in history
in various physical, emotional, and
spiritual ways
Sx: Psychosis; disorganized thoughts
Hallucinations;
delusions; bizarre behavior
NOT ALL forms have LT cognitive deficits
Myths and misconceptions
Split personality
Bad parenting
Drug experimentation
Lack of motivation
Rising incidence
Institutionalization and disability
Low intelligence
Danger and violence
Predictors include male; poor med compliance;
excessive substance abuse
Onset and Prevalence
Onset typically between early adolescence
and mid thirties
Lifetime prevalence is .6-1.9% of general
population
Prognosis
LT outcome is not possible to predict
Severity and prognosis may be affected by
cultural and environmental influences
Presence or absence of cognitive deficits
= strongest indicator of LT functional
deficits
Prognosis is also linked to tx quality
Prognosis
Recovery is now viewed as possible with
effective intervention
50%
have good outcomes
25% are able to lead satisfying lives with
ongoing supports
25% who have repeated exacerbations have
poorer prognosis
Etiology
Structural deficits:
Enlarged ventricles; brain atrophy; abnormalities in
limbic structures; cerebellum; corpus collosum
Evidence of abnormalities in frontal lobe/ basal
ganglia
Possibility of a developmental disability that manifests
in puberty
Neurochemistry:
Excess of dopamine or dopamine receptors
Norpinephrine, serotonin, glutamate; neuropeptides
Viral theory- prenatal exposure lies latent
Dietary- used to understand cause and tx
Fatty acids; fish oil; caffeine; vitamins
Positive Sx vs Negative Sx
Delusions
Perceptual distortions
Language disturbance
Abnormal affect/
disorganized speech
Motor changesrestlessness, lethargy
Hallucinations- not
necessarily indicative
of severity of dx
Affective blunting
Alogia (poverty of tht)
Avolition
Anhedonia
Inattention
Diagnostic Criterion
Criterion A: Symptoms: two or more of the
following present for at least one month:
Delusions;
hallucinations; disorganized
speech; disorganized or catatonic behavior;
negative sx: Alogia; avolition; flat affect
Social occupational dysfunction
Some signs present for at least 6 months
Diagnostic Criteria
Criterion A: Presence of 2 or more of the
following symptoms:
Delusions
Hallucinations
Disorganized
Speech
Grossly disorganized or catatonic behavior
(positive symptoms)
Positive symptoms are excesses or distoriions
of normal function as found in criterion A
Diagnostic Criteria
Criterion B: disturbance in one or more
areas of function, such as work,
interpersonal relations, or self-care
Criterion C: Continuous signs of illness for
at least 6 months, including at least one
month of symptoms that meet Criterion A
Diagnostic Criterion
Negative Symptoms represent a loss or
absence of function:
Restricted
emotion
Decreased thought and speech
Lack of motivation and initiative
Inability to relate to others
Subtypes of Schizophrenia
Paranoid type
Preoccupation
with one or more delusions of
persecution or grandeur
Frequent presence of auditory hallucinations
Exhibition of fewer negative symptoms
Disorganized type
Marked
regression: demonstrates primitive,
disihibited, and disorganized behavior
Subtypes of Schizophrenia
Catatonic Type: Severe disturbances in
motor behavior involving stupor,
negativism, rigidity, excitement or
posturing
Undifferentiated type: Used when client
doesn’t fit into one of the other categories
Residual type: Used when there is
continued evidence of schizophrenic
behavior in absence of a complete set of
diagnostic criteria
Other Psychotic Disorders
Schizophreniform Disorder
Individual
meets criteria for schizophrenia,
but episode lasts > one month but < 6
months
Schizoaffective Disorder:
Individual
has an uninterrupted period of
illness during which, at some time, there is a
major depressive, manic, or mixed episode
concurrent with symptoms in Criterion A
Other Psychotic Disorders
Delusional Disorder: Individual’s
predominant symptoms are non-bizarre
delusions with absence of other criterion A
symptoms
Brief psychotic disorder
Individual
experiences at least one day but
less than one month with one or more
Criterion A symptoms of schizophrenia which
result from severe psychosocial stress
Interdisciplinary Tx
Goal Setting
Client centered; include family and others
Managed care may dictate goals
May be impaired by client’s delusions or lack of
insight
Medications: Stabilizes psychosis
Act as antagonist to dopamine
High incidence of non-compliance
Non-compliance can be minimized by providing
education and interventions
Impact on Function
Many individuals exhibit cognitiveperceptual and social interaction skills that
affect all areas of occupations, including
ADLS, IADLs, Leisure, Social Participation,
Education, and Work
Many demonstrate sensory processing
disorders
Many exhibit difficulties with boundaries
which lead to socially inappropriate
behaviors
OT Intervention
Evaluation
ACL
KELS
AMPS
Adult sensory profile
COPM
Intervention (see Table 7-1)
Groups good for social skills
ADL training
Activities with personal meaning / purpose