Learning Objectives What are the main symptoms associated with schizophrenia? What is meant by the term ‘subtypes’ when we are talking about schizophrenia? What are the diagnostic criteria for schizophrenia?

Schizophrenia: Background The Greek meaning for sz means ‘split mind’. It implies the person is split between reality and delusions it is NOT the same as MPD It is a psychotic disorder – lose touch with the world Onset = late adolescence to early adulthood Incidence is every 1 in 100 (1%) Sz patients suffer the greatest stigma – seen as ‘mad’

The 1500’s Disturbances mainly in thoughts In the 15th & 16th Centuries Europe – women with Sz were thought to be possessed by the devil and tortured and burned to the stake to exorcise the devil

The 1800’s Inmates were chained to the floor, and treated quite unkindly. "In the 18th century people used to go there to see the lunatics. For a penny one could peer into their cells, view the freaks and laugh at their antics, generally of a sexual nature or violent fights. Entry was free on the first Tuesday of the month. Visitors were permitted to bring long sticks with which to poke and enrage the inmates

Today Although in the 50’s and 60’s most people diagnosed spent their lives in a psychiatric ward – today patients can live independently at home – usually under some supervision also undertaking a combination of drug therapies and psychotherapy

Connect - Symptoms Schizophrenia is made up of both ‘positive’ and ‘negative’ symptoms Positive = those which individuals do not usually experience but are present in people with schizophrenia Negative = these symptoms represent a deficit in normal behaviour patterns Go to the side of the room which you think represents your card!

Introduction Wing (1992) has argued for a distinction between primary and secondary ‘impairments’ In the context of patients with schizophrenia, what might this mean?

Secondary Impairments Alcohol/Drug addiction; Depression/anxiety; An inability to cope with everyday tasks. An inability to hold down a job Social isolation or withdrawal.

Subtypes Type I and Type II DSM-IVR TOP TIP: The term ‘subtypes’ can be interpreted in various ways with respect to schizophrenia you can talk about the Type I, Type II distinction AND / OR the DSM types (e.g. paranoid / catatonic etc)

Type I vs Type II Type I = positive symptoms + responsive to drug treatment + involves limbic system abnormalities The limbic system is a set of brain structures including the hippocampus, amygdala, and the limbic cortex which support a variety of functions including emotion, behavior, long term memory, and olfaction

Type II = negative symptoms + less responsive to drugs + involves abnormalities in the frontal lobes and enlarged ventricles. The ventricles are cavities in the brain which contain (and parts of which are responsible for producing) cerebrospinal fluid

Evaluation of Type I / Type II – A02

Evaluation of Type I / Type II The positive and negative distinction is not universal, third category ‘disorganised schizophrenia’ – chaotic speech / behaviour The positive and negative distinction is not a dichotomy but a continuum with positive and negative at opposite ends There may be overlap with other disorders e.g. ‘schizoaffective disorder’, ‘delusional disorder’…

DSM-IVR – Diagnosing Schizophrenia The Diagnostic and Statistical Manual, 4th Edition, Revised Health professionals use the diagnostic criteria set out in the DSM-IVR (see your worksheet) Symptoms (A), Social / Occupational Dysfunction (B) and Duration (C)

Classification Psychotic Disorder Main Symptoms Duration Schizophrenia Core symptoms 6 months or more Schizoaffective Disorder Core symptoms AND a major mood disorder (e.g. depression) Delusional Disorder Delusions which are not bizarre and are not associated with schizophrenia (usually grandeur, jealousy and persecution) 1 month or more Brief Psychotic Disorder Some of the core symptoms of schizophrenia 1 month or less

TASK Use page 100/101 to make notes and illustrations on the different sub-types of schizophrenia which appear in the DSM Paranoid Catatonic Disorganised Undifferentiated Residual

What do the symptoms mean – the following will help you with your task Disorganised speech e.g. What time is it? Fish. Disorganised thoughts e.g. moving rapidly from one unrelated topic to another Disorganised behaviour e.g. dressing inappropriately Catatonic behaviour – this can mean extreme loss of motor skills or constant hyperactive motor activity Waxy flexibility – if one were to move the arm of someone with waxy flexibility, they would keep their arm where one moved it until it was moved again, as if it were made from wax. Stereotyped movements – a repetitive movement e.g. crossing and uncrossing legs or body rocking

DSM-IVR – Problems with diagnosis Possible issues: symptoms often overlap between sub-types; overlap with different disorders eg manic depression and schizoaffective disorder

Plenary Exam questions A3 summary sheet