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.

Disorders that may appear like Schizophrenia

• Schizoid personality• Schizophreniform disorder• Schizotypal personality• Bipolar Disorder• Asperger’s syndrome

Symptoms of Schizophrenia

• Profound disruption in cognition and emotion, affecting the most fundamental human attributes: – Language– Thought– Perception– Affect– Sense of self

Positive Symptoms

• Positive symptoms are those that have a positive reaction from some treatment.

• In other words, positive symptoms respond to treatment.

• 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.

Hallucinations. Distortions or exaggerations of perception in any of the senses.

Often they hear voices within their own thoughts followed by visual hallucinations

• Disorganized thinking/speech.

• AKA loose associations; speech is tangential, loosely associated or incoherent enough to impair communication.

• Grossly disorganized behavior.

• Difficulty in goal directed behavior (ADLs), unpredictable agitation or silliness, social disinhibition, or bizarre behavior.

• There is a purposelessness to behavior

• Catatonic behavior.• Marked decrease in reaction to immediate

environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.

• Other Positive Symptoms:• Inappropriate response to stimuli• Unusual motor behavior (pacing, rocking)• Depersonalization• Derealization• Somatic preoccupations

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.

• Affective flattening.• Reduction in the range and intensity of

emotional expression, including facial expression, voice tone, eye contact and body language.

• 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.

• 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 SymptomsLack of emotionLow energyLack of interest in lifeAffective flatteningAlogiaInappropriate social skillsInability to make friendsSocial 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

Currently there is no treatment that has a consistent impact on negative symptoms

Types of Schizophrenia

• 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-to-day 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.