Transcript SCHIZOPHRENIA

SCHIZOPHRENIA
2nd most frequent diagnosis of
patients 14-64 y/o
What is 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.
Misdiagnosis
• This is a common problem since
schizophrenia shares a significant number
of symptoms with other disorders.
• Per the Nat’l Depression & Bipolar Support
Alliance there is an average of 10 years
from onset to correct diagnosis & tx.
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.
• AKA loose associations; 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
disinhibition, 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.
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.
Summary
• Before a diagnosis the psychiatrist must
make a thorough evaluation including a
physical/medical exam, a mental status
exam, appropriate labs, and a full history.
• History includes changes in thinking,
behavior, movement, mood, etc. as seen
by the family.
• These medications may have such
intolerable side effects that the patient will
stop the drugs.
• One study showed the average time the
meds were taken regularly was 3 months.
Treatments
• Psychotherapy - an adjunct to meds and is very
useful to keep the patient on the meds.
• Group therapy
• Family therapy
• Community support groups