Schizophrenia David Soskin, M.D. Medical Director, MCBH Chief of Psychiatry, NMC.

Slides:



Advertisements
Similar presentations
Schizophrenia and Other Psychotic Disorders Anita S. Kablinger MD Associate Professor Departments of Psychiatry of Pharmacology LSUHSC-Shreveport.
Advertisements

Progress in Understanding the Neurobiology of Schizophrenia Daphne Holt, MD, PhD Director of Research, Schizophrenia Clinical and Research Program Department.
Bipolar and Related Disorders. Bipolar & Related Disorders – Bipolar I disorder – Bipolar II disorder – Cyclothymic disorder – Substance induced bipolar.
SHAKESPEARE FESTIVAL Hear ye! Hear Ye! Come one, Come all! To the Best Shakespeare Festival!
Assessment and Differential Diagnosis of Abnormal Experience
Diagnosis and Management of Schizophrenia
Schizophrenia. Schizophrenia is a chronic, severe, disabling brain disease that interferes with a person’s ability to think clearly, to distinguish reality.
IzBen C. Williams, MD, MPH Instructor. Lecture 10 SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS.
Chapter 14: Psychological Disorders
IzBen C. Williams, MD, MPH Instructor. Lecture - 11 MOOD DISORDERS.
University Hospital “Sisters of Charity” Psychiatric Clinic Vinogradska c. 29, 1000 Zagreb, Croatia Davor Moravek Addiction and psychotic.
Bipolar Disorder- Assessment B. Anthony Lindsey, MD Professor and Vice Chair UNC Department of Psychiatry.
Mental Health from a Public Health Perspective Professor Carol S. Aneshensel Department of Community Health Sciences 10/12/09.
TWO TOPICS DEFINITION OF MENTAL ILLNESS NATURE OF SCHIZOPHRENIA.
Chapter 15 Psychological Disorders. Substance Abuse and Addictions Mental illness.
Psychotic Disorders. Archetype Schizophrenia Phenomenology The mental status exam The mental status exam Appearance Appearance Mood Mood Thought Thought.
Chapter 13 Schizophrenia and Other Psychotic Disorders
Introduction to neuropsychiatric disorders
Cognitive Disorders Madiha Anas Institute of Psychology Beaconhouse National University.
Other psychotic disorders Dr C Kotzé. Classification Schizophrenia Schizophreniform disorder (1 – 6 months) Brief psychotic disorder (1 day – 1 month)
Managing The Behavioral Health Patient in LSU-HCSD
Schizophrenia. Basics Schizophrenia is a severe and disabling brain disorder that has effected people throughout history People with this disorder may:
David Rosenhan: Pseudo-Patient Experiment Investigated reliability of psychiatric diagnoses Eight healthy people entered psychiatric hospitals complaining.
Bipolar Disorder Research by: Lisette Rodriguez & Selena Nuon.
CHAPTER THIRTEEN Schizophrenic Disorders. OVERVIEW  Psychosis - profoundly out of touch with reality  Most common symptoms: changes in the way a person.
What is psychosis? D B Double
Cognitive Impairment Disorders. Assessing Brain Damage  Mental status examination  Information about current behavior and thought including orientation.
Dementia Reed Radford. What is dementia?  Dementia is a serious loss of global cognitive ability, beyond what might be expected from normal aging. 
IzBen C. Williams, MD, MPH Instructor. Lecture - 8 MOOD DISORDERS.
Introduction to neuropsychiatric disorders
$200 $300 $400 $500 $100 $200 $300 $400 $500 $100 $200 $300 $400 $500 $100 $200 $300 $400 $500 $100 $200 $300 $400 $500 $100 Fathers & Sons Thy kingdom.
Mental and Behavioral Disorders 1. Mental, Behavioral and Neurodevelopment Disorders (F01- F99)  Codes in this chapter include disorders of psychosocial.
FACTITIOUS DISORDER. Intentionally produce signs and symptoms of medical and mental disorder Misrepresent their histories and symptoms Objective: assume.
Task: It is the year, 1597, and you are the theater-manager of The Globe in Southwark, England. William Shakespeare, the man himself, has asked you to.
Half a Century with QUARKS! Vladimir A. Petrov, Institute for High Energy Physics, Protvino Vladimir A. Petrov, Institute for High Energy Physics, Protvino.
Alan Breier, M.D. Leader, Zyprexa Product Team Lilly Research Fellow Professor of Psychiatry, Indiana University School of Medicine Adjunct Associate of.
Chapter 5 Schizophrenia. Description of the Disorder Characterized by broad daily impairments – Social functioning – Difficulties caring for oneself Burdensome.
Schizophrenia Overview. Schizophrenia is the most severe and debilitating mental illness in psychiatry and is a brain disorder.
ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 13 Schizophrenia and Other Psychotic Disorders © 2014, 2013,
Schizophrenia Chapter 14. Louis Wain cat This cat, like many painted during that period, is shown with abstract patterns behind it. Psychologists have.
Cognitive Disorders. Recent Memory Impairment Disorientation Poor Judgment Confusion General loss of intellectual functioning May have: Hallucinations,
1Dx & Classification 462Psych Prof. Alsughayir. 2 Lecture Title : Diagnosis & Classification in Psychiatry Level : 4 th year Medical Students Lecturer.
Psychosis Unit M: Psychosis Updated 9/9/2013 – RAK
The term schizophrenia comes from two Greek words that mean splitting apart of mental functions. “Split mind“ U-Ajwbok&sns=em.
Chapter 8 Schizophrenia & Related Psychotic Disorders.
Shakespeare By. Richard Allen Weston Dalton Hernandez.
Epidemiology of Alzheimer’s Disease
Introduction Suicide is a complex human behavior. There is no one reason why an individual chooses to end his or her life. Suicide has been defined as.
ADHD 9 th dec Dr. Sami Adil. ADHD is a neuropsychiatric condition starting since childhood characterized by diminished sustained attention, and.
Modernism – a movement in art and literature that occurred around the time immediately before and during the First and Second World Wars. Among the factors.
Brief psychotic disorder. period of psychosis whose duration is generally shorter, non re-occurring, and not better accounted for by another condition.psychosis.
Cognitive Disorders Chapter 13 Nature of Cognitive Disorders: An Overview Perspectives on Cognitive Disorders Cognitive processes such as learning, memory,
Polonius’ Top 10 Ways to Behave While Away at College Act 1, Scene 3 could be seen as an advice column. Polonius and Laertes both give advice/rules to.
Schizophrenia & Psychosis. Psychosis The word "psychosis" is used to describe conditions that affect the mind, in which there has been some loss of contact.
Used to be called Dementia Neurocognitive Disorders.
Cognitive Disorders (part 1) Amnesia and Delirium Sami Adil 15 th Nov
Psychosis Madeline Goodman D.O. April 28, Common in both the medical and psychiatric settings Common in both the medical and psychiatric settings.
Cognitive disorders Group of psychiatric disorders characterized by the primary P symptom common to all the disorders, which is an impairment in cognition.
Schizophrenia A. Schizophrenia is a group of severe disorders characterized by the breakdown of personality functioning, withdrawal from reality, distorted.
PSYCHOTIC DISORDER Mental Health First Aid By Mental Health Commission of Canada, 2010.
The Malfunctioning Mind: Degenerative Diseases of the Brain
Bipolar Disorder- Assessment B
Schizophrenia: an inside view
Schizophrenia Emmanuel Okenyi.
Schizophrenia Paranoid by The Jonas Brothers
Public Service Heroism Peter Latchford
Yard. Doç.Dr. N. Berfu AKBAŞ
Advice in Hamlet *MFB* common core adapted*revised 2016
Mood Disorders II Dr.Noor Alibrahim.
Topic Discussion By Alexandria Brown
Presentation transcript:

Schizophrenia David Soskin, M.D. Medical Director, MCBH Chief of Psychiatry, NMC

Objectives Schizophrenia: – Defining features – Phenomenology of schizophrenia – Diagnosis

What is Psychosis? Impairment in reality-testing

What is Schizophrenia?

DSM-IV Criteria

Domains of Dysfunction MGH Comprehensive Clinical Psychiatry, 2008

Positive Symptoms MGH Comprehensive Clinical Psychiatry, 2008

Positive Symptoms MGH Comprehensive Clinical Psychiatry, 2008

Disorganization Yet here, Laertes! aboard, aboard, for shame! The wind sits in the shoulder of your sail, And you are stay’d for. There; my blessing with thee! And these few precepts in thy memory. See thou character. Give thy thoughts no tongue, Nor any unproportioned thought his act. Be thou familiar, but by no means vulgar. Those friends thou hast, and their adoption tried, Grapple them to thy soul with hoops of steel; But do not dull thy palm with entertainment. Of each new-hatch’d, unfledged comrade. Beware of entrance to a quarrel, but being in, Bear’t that the opposed may beware of thee. Give every man thy ear, but few thy voice; Take each man’s censure, but reserve thy judgment. Costly thy habit as thy purse can buy, But not express’d in fancy; rich, not gaudy; For the apparel oft proclaims the man, And they in France of the best rank and station, Are of a most select and generous chief in that. Neither a borrower nor a lender be; For loan oft loses both itself and friend, And borrowing dulls the edge of husbandry. This above all: to thine ownself be true, And it must follow, as the night the day, Thou canst not then be false to any man. Farewell: my blessing season this in thee. (Shakesepare, Hamlet) Circumstantial

Disorganization The fall (bababadalgharaghtakamminarronnkonnbronntonner ronntuonnthunntrovarrhounawnskawntoohoohoordenenthur nuk!) of a once wall strait oldparr is retaled early in bed and later on life down through all christian minstrelsy. The great fall of the off wall entailed at such short notice the pftjschute of Finnegan, erse solid man, that the humptyhillhead of humself prumptly sends an unquiring one well to the west in quest of his tumptytumtoes: and their upturnpikepointandplace is at the knock out in the park where oranges have been laid to rust upon the green since dev- lins first loved livvy. (Joyce, Finnegan’s Wake) Loose, tangential, neologisms, alliteration/clanging

Disorganization So, nat by night by naught by naket, in those good old lousy days gone by, the days, shall we say? of Whom shall we say while kinderwardens minded their twinsbed, therenow they stood, the sycomores, all four of them, in their quartan agues, the majorchy, the minorchy, the everso and the fermentarian with their ballyhooric blowreaper, titranicht by tetranoxst, at their pussycorners, and that old time pallyollogass, playing copers fearsome, with Gus Walker, the cuddy, and his poor old dying boosy cough, esker, newcsle, saggard, crumlin, dell me, donk,the way to wumblin. Follow me beeline and you're bumblin,esker, newcsle, saggard, crumlin. And listening. So gladdied up when nicechild Kevin Mary (who was going to be commandeering chief of the choirboys' brigade the moment he grew up under all the auspices) irishsmiled in his milky way of creamdwibble and onage tustard and dessed tabbage, frighted out when badbrat Jerry Godolphing (who was hurrying to be cardinal scullion in a night refuge as bald as he was cured enough unerr all the hospitals) furrinfrowned down his wrinklywaste of methylated spirits, ick, and lemoncholy lees, ick, and pulverised rhubarbarorum, icky waste of methylated. (Joyce, Finnean’s Wake) Word Salad

Subjective vs. Objective Kring, Psychiatry Res, 2005

Cognitive Cognitive deficits include: – Attention – Memory – Language – Executive function – Information processing – Social cognition

Cognitive Endophenotype Stahl’s Essential Psychopharmacology, 2008

Epidemiology Prevalence? – 1% lifetime prevalence Gender differences? – Males 30-40% higher lifetime risk (McGrath, 2004) – Age of onset 3-4 years later for females (Aleman, 2003) Economic Burden? – 50% of all inpatient admissions (Geller, 92) – $62.7 billion in U.S. in 2002 (Wu, 2005) Genetics: – Heritability coefficient APA Textbook of Psychiatry, 2008

Etiology Stahl’s Essential Psychopharmacology, 2008

Etiology Multiple Neurotransmitter Systems? – Serotonin – Acetylcholine – GABA – Glutamate

Stahl’s Essential Psychopharmacology, 2008

MGH Comprehensive Clinical Psychiatry, 2008

Diathesis Model Prenatal infection (rubella and infection) Obstetric complicatons Season of birth (winter) Immigration Head injury Drug use (LSD, cannabis, and amphetamines) MGH Comprehensive Clinical Psychiatry, 2008

Neurodevelopmental Model APA Textbook of Psychiatry, 2008

Natural Course APA Textbook of Psychiatry, 2008

MGH Comprehensive Clinical Psychiatry, 2008

Clinical Integration Are there things that have happened to you recently that you can’t explain? Have you had any problems with your mind playing tricks on you? Have you seen or heard things that other people haven’t? Do you have any concerns that people are bothering you or trying to harm you? What about people on the radio or TV giving you special messages?

Differential Diagnosis Medical: – Delirium, CNS infections, dementia, other degenerative CNS, structural CNS, metabolic, endocrine Substance: – Stimulants, sedatives, cannabis, hallucinogens, steroids, opioids, anticholinergic agents, anesthetics, antiinfectious agents Psychiatric: – Bipolar, MDE with psychotic features, episodic psychosis, SAD, BPD or borderline personality structure, cluster A

“Though this be madness, yet there is method in it.” Suspect malingering psychosis if: – Hallucinations continuous rather than intermittent – Vague or inaudible AH – Hallucinations not associated with delusions – Abrupt onset or termination of delusions – Eagerness to call attention to delusions – Conduct not consistent with delusions – Bizarre content without disordered thinking – Inconsistency on cognitive testing – Symptom inconsistency – Inability to identify alleviating or exacerbating factors Resnick, Psychiatric Clinics of North America, 1999

Diagnostic Studies Laboratory: – CBC, chemistry 10, urine toxicology, liver function tests, UA, TSH, B12, folate, RPR, HIV, ceruloplasmin Imaging: – MRI If clinically indicated: – CXR, EEG, LP, neuropsychiatric testing

Prognostic Questions Acute versus insidious onset? – Acute Childhood versus adult onset? – Adult Predominance of positive versus negative versus cognitive symptoms at onset? – Positive Living in a developing versus industrialized country? – Developing