SCHIZOPHRENIA  A psychotic disorder characterized by bizarre and disorganized behavior  One of the most serious and debilitating of all psychological disorders

DSM-IV-TR CRITERIA FOR SCHIZOPHRENIA A. 2 or more for at least a 1-month period: 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms – flat affect, alogia,avolition

CRITERIA FOR SCHIZOPHRENIA B. Social/Occupational Dysfunction C. Duration: continuous signs of disturbance for at least 6 months, including at least 1 month of active phase sx and periods of prodromal or residual sx. D. R/O Schizoaffective Disorder, Mood Disorders, the effects of a substance, and general medical conditions.

2 Categories of Symptoms Positive Symptoms - behavioral excesses/ problems; “normal” people do not experience  Better treatment outcomes  Respond to medication Negative Symptoms - behavioral deficits; “normal” people do experience  More resistant to medication

Positive Symptoms  Hallucinations  Delusions  Disorganized Speech  Disorganized Behavior

Hallucinations Sensory experience that is a product of one’s mind; doesn’t exist in the outside world Sensory experience that is a product of one’s mind; doesn’t exist in the outside world Modalities: Auditory, Visual, Tactile, Olfactory, Gustatory, Somatic  Auditory most common  Distressing, give commands, “noise” in their head

Delusions Erroneous beliefs that can’t be influenced or corrected by reason or contradictory evidence Erroneous beliefs that can’t be influenced or corrected by reason or contradictory evidence Themes: Persecutory, Referential, Grandiose, broadcasting

Disorganized Thought & Speech Statements/thoughts aren’t logically connected to each other & content often makes no sense  Tangential - loose associations  Derailment - get off track  Flight of ideas - jump from topic to topic  Neologisms - make up words  Incoherence - “word salad”  Clanging - rhyming

Disorganized Behavior  Disheveled appearance, unusual dress, basic hygiene neglected  Inappropriate affect - doesn’t fit w/ the situation, childlike silliness  Agitation – unpredictable, untriggered  Posturing – inappropriate, bizarre movements  Catatonia – lack of response to environment, stupor (complete unawareness), rigid posturing, negativism (resistant to instructions)

Negative Symptoms  Poverty of speech  Flat affect  Avolition  Social isolation  Motor retardation  Anhedonia

Alogia Poverty of speech  decrease in speech fluency and productivity Poverty of speech  decrease in speech fluency and productivity  Severe reduction in speech – e.g. brief replies  Absence of speech

Flat Affect Severe reduction in or absence of emotional responses to environment. Severe reduction in or absence of emotional responses to environment.Examples:  Face is unresponsive or lacks expression  Poor eye contact  Reduced body language  Diminished range of emotional expression

Avolition  Lack of will/motivation  Inability to initiate or persist at tasks  Little interest in social or work activities

SUBTYPES OF SCHIZOPHRENIA  Paranoid Schizophrenia  Disorganized Schizophrenia  Catatonic Schizophrenia  Undifferentiated Schizophrenia

SCHIZOPHRENIA, PARANOID TYPE  Most common subtype  Presence of prominent delusions (persecutory most common) and hallucinations (usually auditory)  Delusions and hallucinations revolve around a central theme  Lack of catatonic sx, disorganized speech or behavior; no negative symptoms present

SCHIZOPHRENIA, DISORGANIZED TYPE  Disorganized speech  Disorganized behavior  Flat or inappropriate affect  No evidence of catatonia

SCHIZOPHRENIA, CATATONIC TYPE  Rare form of schizophrenia  Catatonic symptoms (motor related) – 2 or more  Echolalia – mimic verbalizations  Echopraxia – mirror motor movements

SCHIZOPHRENIA, UNDIFFERENTIATED TYPE  Don’t fit into any of the other 3 categories  Display a mix of symptoms

Facts & Figures  Prevalence: 1 in 100 people; approx. 4 million in U.S.  Onset: men – mid 20’s (18-25); women – late 20’s (25-35)  Gender: women have a more favorable course  Prognosis: debilitating, long-term disorder; chronic course; complete remission is rare  Living situation: 50% live with or rely on family; many live in residential treatment facilities  High suicide rates: 10-20%

Facts and Figures  Large percentage of the homeless population (10-20%)  High rates of substance abuse: 80-90% use nicotine  More likely to be born in Jan, Feb, March  Strong genetic component: MZ twins 48%; DZ twins 17%

Biological Theories of Schizophrenia  Genetic theories  Structural brain abnormalities  Birth complications  Prenatal viral exposure  Elevated levels of D, NE, 5HT  Lower levels of GABA & Glutamate

Treating Schizophrenia  Psychoeducation for patient and family  Consistent medication management: traditional antipsychotics vs. atypical antipsychotics  Supportive therapy  Intensive psychosocial interventions: intensive case management, outpatient treatment programs, CBT, skills-based training