SCHIZOPHRENIASCHIZOPHRENIA

A psychotic disorder characterized A psychotic disorder characterized by bizarre and disorganized by bizarre and disorganized behaviorbehavior

One of the most serious and One of the most serious and debilitating of all psychological debilitating of all psychological disordersdisorders

DSM-IV-TR CRITERIA FOR DSM-IV-TR CRITERIA FOR SCHIZOPHRENIASCHIZOPHRENIA

A.A. 2 or more for at least a 1-month period:2 or more for at least a 1-month period:1. Delusions1. Delusions2. Hallucinations2. Hallucinations3. Disorganized speech3. Disorganized speech4. Grossly disorganized or catatonic 4. Grossly disorganized or catatonic behaviorbehavior5. Negative symptoms – flat affect, 5. Negative symptoms – flat affect, alogia,avolitionalogia,avolition

CRITERIA FOR CRITERIA FOR SCHIZOPHRENIASCHIZOPHRENIA

B. B. Social/Occupational DysfunctionSocial/Occupational DysfunctionC. C. Duration:Duration: continuous signs of continuous signs of

disturbance for at least 6 months, disturbance for at least 6 months, including at least 1 month of active including at least 1 month of active phase sx and periods of prodromal or phase sx and periods of prodromal or residual sx.residual sx.

D. D. R/OR/O Schizoaffective Disorder, Mood Schizoaffective Disorder, Mood Disorders, the effects of a substance, Disorders, the effects of a substance, and general medical conditions.and general medical conditions.

2 Categories of Symptoms2 Categories of Symptoms

Positive SymptomsPositive Symptoms - -behavioral excesses/ behavioral excesses/ problems; “normal” problems; “normal” people do not people do not experienceexperience

Better treatment Better treatment outcomesoutcomes

Respond to Respond to medicationmedication

Negative SymptomsNegative Symptoms - - behavioral deficits; behavioral deficits; “normal” people do “normal” people do experienceexperience

More resistant to More resistant to medicationmedication

Positive SymptomsPositive Symptoms

HallucinationsHallucinations DelusionsDelusions Disorganized SpeechDisorganized Speech Disorganized BehaviorDisorganized Behavior

HallucinationsHallucinations

Sensory experience that is a product of Sensory experience that is a product of one’s mind; doesn’t exist in the outside one’s mind; doesn’t exist in the outside worldworld

Modalities:Modalities: Auditory, Visual, Tactile,Auditory, Visual, Tactile,

Olfactory, Gustatory, SomaticOlfactory, Gustatory, Somatic Auditory most commonAuditory most common Distressing, give commands, “noise” in Distressing, give commands, “noise” in

their headtheir head

DelusionsDelusions

Erroneous beliefs that can’t be influenced Erroneous beliefs that can’t be influenced or corrected by reason or contradictory or corrected by reason or contradictory evidenceevidence

Themes:Themes: Persecutory, Referential,Persecutory, Referential,

Grandiose, broadcastingGrandiose, broadcasting

Disorganized Disorganized Thought & SpeechThought & Speech

Statements/thoughts aren’t logically Statements/thoughts aren’t logically connected to each other & content often connected to each other & content often makes no sensemakes no sense

TangentialTangential - loose associations - loose associations Derailment Derailment - get off track- get off track Flight of ideasFlight of ideas - jump from topic to topic - jump from topic to topic NeologismsNeologisms - make up words - make up words IncoherenceIncoherence - “word salad” - “word salad” ClangingClanging - rhyming - rhyming

Disorganized BehaviorDisorganized Behavior

Disheveled Disheveled appearance, unusual dress, basic appearance, unusual dress, basic hygiene neglectedhygiene neglected

Inappropriate affect Inappropriate affect - doesn’t fit w/ the situation, - doesn’t fit w/ the situation, childlike sillinesschildlike silliness

AgitationAgitation – unpredictable, untriggered – unpredictable, untriggered PosturingPosturing – inappropriate, bizarre movements – inappropriate, bizarre movements CatatoniaCatatonia – lack of response to environment, – lack of response to environment,

stupor (complete unawareness), rigid posturing, stupor (complete unawareness), rigid posturing, negativism (resistant to instructions)negativism (resistant to instructions)

Negative SymptomsNegative Symptoms

Poverty of speechPoverty of speech Flat affectFlat affect AvolitionAvolition Social isolationSocial isolation Motor retardationMotor retardation AnhedoniaAnhedonia

AlogiaAlogia

Poverty of speechPoverty of speech decrease in decrease in speech fluency and productivityspeech fluency and productivity

Severe reduction in speech – e.g. Severe reduction in speech – e.g. brief repliesbrief replies

Absence of speechAbsence of speech

Flat AffectFlat Affect

Severe reduction in or absence of Severe reduction in or absence of emotional responses to environment.emotional responses to environment.

Examples:Examples: Face is unresponsive or lacks expressionFace is unresponsive or lacks expression Poor eye contactPoor eye contact Reduced body languageReduced body language Diminished range of emotional expressionDiminished range of emotional expression

AvolitionAvolition

Lack of will/motivationLack of will/motivation Inability to initiate or persist at tasksInability to initiate or persist at tasks Little interest in social or work Little interest in social or work

activitiesactivities

SUBTYPES OF SUBTYPES OF SCHIZOPHRENIASCHIZOPHRENIA

Paranoid Schizophrenia Paranoid Schizophrenia Disorganized SchizophreniaDisorganized SchizophreniaCatatonic SchizophreniaCatatonic SchizophreniaUndifferentiated SchizophreniaUndifferentiated Schizophrenia

SCHIZOPHRENIA, PARANOID TYPESCHIZOPHRENIA, PARANOID TYPE

Most common subtypeMost common subtype Presence of prominent delusions Presence of prominent delusions

(persecutory most common) and (persecutory most common) and hallucinations (usually auditory)hallucinations (usually auditory)

Delusions and hallucinations revolve Delusions and hallucinations revolve around a central themearound a central theme

Lack of catatonic sx, disorganized Lack of catatonic sx, disorganized speech or behavior; no negative speech or behavior; no negative symptoms presentsymptoms present

SCHIZOPHRENIA, SCHIZOPHRENIA, DISORGANIZED TYPEDISORGANIZED TYPE

Disorganized speechDisorganized speech Disorganized behaviorDisorganized behavior Flat or inappropriate affectFlat or inappropriate affect No evidence of catatoniaNo evidence of catatonia

SCHIZOPHRENIA, CATATONIC TYPESCHIZOPHRENIA, CATATONIC TYPE

Rare form of schizophreniaRare form of schizophreniaCatatonic symptomsCatatonic symptoms (motor related) – (motor related) – 2 or more2 or moreEcholaliaEcholalia – mimic verbalizations – mimic verbalizationsEchopraxiaEchopraxia – mirror motor movements – mirror motor movements

SCHIZOPHRENIA, SCHIZOPHRENIA, UNDIFFERENTIATED TYPEUNDIFFERENTIATED TYPE

Don’t fit into any of the other 3 Don’t fit into any of the other 3 categoriescategories

Display a mix of symptomsDisplay a mix of symptoms

Facts & FiguresFacts & Figures

Prevalence:Prevalence: 1 in 100 people; approx. 4 million 1 in 100 people; approx. 4 million in U.S.in U.S.

Onset:Onset: men – mid 20’s (18-25); women – late men – mid 20’s (18-25); women – late 20’s (25-35)20’s (25-35)

Gender:Gender: women have a more favorable course women have a more favorable course Prognosis:Prognosis: debilitating, long-term disorder; debilitating, long-term disorder;

chronic course; complete remission is rarechronic course; complete remission is rare Living situation:Living situation: 50% live with or rely on 50% live with or rely on

family; many live in residential treatment family; many live in residential treatment facilitiesfacilities

High suicide rates:High suicide rates: 10-20% 10-20%

Facts and FiguresFacts and Figures

Large percentage of the homeless Large percentage of the homeless population (10-20%)population (10-20%)

High rates of substance abuse: 80-90% High rates of substance abuse: 80-90% use nicotineuse nicotine

More likely to be born in Jan, Feb, MarchMore likely to be born in Jan, Feb, March Strong genetic component: MZ twins 48%; Strong genetic component: MZ twins 48%;

DZ twins 17%DZ twins 17%

Biological Theories of Biological Theories of SchizophreniaSchizophrenia

Genetic theoriesGenetic theories Structural brain abnormalitiesStructural brain abnormalities Birth complicationsBirth complications Prenatal viral exposurePrenatal viral exposure Elevated levels of D, NE, 5HTElevated levels of D, NE, 5HT Lower levels of GABA & GlutamateLower levels of GABA & Glutamate

Treating SchizophreniaTreating Schizophrenia

PsychoeducationPsychoeducation for patient and family for patient and family Consistent medication management:Consistent medication management:

traditional antipsychotics vs. atypical traditional antipsychotics vs. atypical antipsychoticsantipsychotics

Supportive therapySupportive therapy Intensive psychosocial interventions:Intensive psychosocial interventions:

intensive case management, outpatient intensive case management, outpatient treatment programs, CBT, skills-based treatment programs, CBT, skills-based trainingtraining