1. Schizophrenia Cara & MacCrae, Ch 7 OT 460a

2. What you need to know Diagnostic Criteria: Criteria A-C Diagnostic Criteria: Criteria A-C Different types of schizophrenia Different types of schizophrenia Onset, prevalence, and prognosis Onset, prevalence, and prognosis Other Schizophrenic-like disorders, e.g., Schizophreniform Disorder, Schizoaffective Disorder, Delusional Disorder, Brief Psychotic Disorder Other Schizophrenic-like disorders, e.g., Schizophreniform Disorder, Schizoaffective Disorder, Delusional Disorder, Brief Psychotic Disorder Impact on Function Impact on Function Medical Management Medical Management

3. Definition Affects 1/100 people; 2 million people will develop in their lifetime Affects 1/100 people; 2 million people will develop in their lifetime Dx has been treated differently in history in various physical, emotional, and spiritual ways Dx has been treated differently in history in various physical, emotional, and spiritual ways Sx: Psychosis; disorganized thoughts Sx: Psychosis; disorganized thoughts Hallucinations; delusions; bizarre behavior Hallucinations; delusions; bizarre behavior NOT ALL forms have LT cognitive deficits NOT ALL forms have LT cognitive deficits

4. Myths and misconceptions Split personality Split personality Bad parenting Bad parenting Drug experimentation Drug experimentation Lack of motivation Lack of motivation Rising incidence Rising incidence Institutionalization and disability Institutionalization and disability Low intelligence Low intelligence Danger and violence Danger and violence Predictors include male; poor med compliance; excessive substance abuse Predictors include male; poor med compliance; excessive substance abuse

5. Onset and Prevalence Onset typically between early adolescence and mid thirties Onset typically between early adolescence and mid thirties Lifetime prevalence is.6-1.9% of general population Lifetime prevalence is.6-1.9% of general population

6. Prognosis LT outcome is not possible to predict LT outcome is not possible to predict Severity and prognosis may be affected by cultural and environmental influences Severity and prognosis may be affected by cultural and environmental influences Presence or absence of cognitive deficits = strongest indicator of LT functional deficits Presence or absence of cognitive deficits = strongest indicator of LT functional deficits Prognosis is also linked to tx quality Prognosis is also linked to tx quality

7. Prognosis Recovery is now viewed as possible with effective intervention Recovery is now viewed as possible with effective intervention 50% have good outcomes 50% have good outcomes 25% are able to lead satisfying lives with ongoing supports 25% are able to lead satisfying lives with ongoing supports 25% who have repeated exacerbations have poorer prognosis 25% who have repeated exacerbations have poorer prognosis

8. Etiology Structural deficits: Structural deficits: Enlarged ventricles; brain atrophy; abnormalities in limbic structures; cerebellum; corpus collosum Enlarged ventricles; brain atrophy; abnormalities in limbic structures; cerebellum; corpus collosum Evidence of abnormalities in frontal lobe/ basal ganglia Evidence of abnormalities in frontal lobe/ basal ganglia Possibility of a developmental disability that manifests in puberty Possibility of a developmental disability that manifests in puberty Neurochemistry: Neurochemistry: Excess of dopamine or dopamine receptors Excess of dopamine or dopamine receptors Norpinephrine, serotonin, glutamate; neuropeptides Norpinephrine, serotonin, glutamate; neuropeptides Viral theory- prenatal exposure lies latent Viral theory- prenatal exposure lies latent Dietary- used to understand cause and tx Dietary- used to understand cause and tx Fatty acids; fish oil; caffeine; vitamins Fatty acids; fish oil; caffeine; vitamins

9. Positive Sx vs Negative Sx Delusions Delusions Perceptual distortions Perceptual distortions Language disturbance Language disturbance Abnormal affect/ disorganized speech Abnormal affect/ disorganized speech Motor changes- restlessness, lethargy Motor changes- restlessness, lethargy Hallucinations- not necessarily indicative of severity of dx Hallucinations- not necessarily indicative of severity of dx Affective blunting Affective blunting Alogia (poverty of tht) Alogia (poverty of tht) Avolition Avolition Anhedonia Anhedonia Inattention Inattention

10. Diagnostic Criterion Criterion A: Symptoms: two or more of the following present for at least one month: Criterion A: Symptoms: two or more of the following present for at least one month: Delusions; hallucinations; disorganized speech; disorganized or catatonic behavior; negative sx: Alogia; avolition; flat affect Delusions; hallucinations; disorganized speech; disorganized or catatonic behavior; negative sx: Alogia; avolition; flat affect Social occupational dysfunction Social occupational dysfunction Some signs present for at least 6 months Some signs present for at least 6 months

11. Diagnostic Criteria Criterion A: Presence of 2 or more of the following symptoms: Criterion A: Presence of 2 or more of the following symptoms: Delusions Delusions Hallucinations Hallucinations Disorganized Speech Disorganized Speech Grossly disorganized or catatonic behavior (positive symptoms) Grossly disorganized or catatonic behavior (positive symptoms) Positive symptoms are excesses or distoriions of normal function as found in criterion A Positive symptoms are excesses or distoriions of normal function as found in criterion A

12. Diagnostic Criteria Criterion B: disturbance in one or more areas of function, such as work, interpersonal relations, or self-care Criterion B: disturbance in one or more areas of function, such as work, interpersonal relations, or self-care Criterion C: Continuous signs of illness for at least 6 months, including at least one month of symptoms that meet Criterion A Criterion C: Continuous signs of illness for at least 6 months, including at least one month of symptoms that meet Criterion A

13. Diagnostic Criterion Negative Symptoms represent a loss or absence of function: Negative Symptoms represent a loss or absence of function: Restricted emotion Restricted emotion Decreased thought and speech Decreased thought and speech Lack of motivation and initiative Lack of motivation and initiative Inability to relate to others Inability to relate to others

14. Subtypes of Schizophrenia Paranoid type Paranoid type Preoccupation with one or more delusions of persecution or grandeur Preoccupation with one or more delusions of persecution or grandeur Frequent presence of auditory hallucinations Frequent presence of auditory hallucinations Exhibition of fewer negative symptoms Exhibition of fewer negative symptoms Disorganized type Disorganized type Marked regression: demonstrates primitive, disihibited, and disorganized behavior Marked regression: demonstrates primitive, disihibited, and disorganized behavior

15. Subtypes of Schizophrenia Catatonic Type: Severe disturbances in motor behavior involving stupor, negativism, rigidity, excitement or posturing Catatonic Type: Severe disturbances in motor behavior involving stupor, negativism, rigidity, excitement or posturing Undifferentiated type: Used when client doesn’t fit into one of the other categories Undifferentiated type: Used when client doesn’t fit into one of the other categories Residual type: Used when there is continued evidence of schizophrenic behavior in absence of a complete set of diagnostic criteria Residual type: Used when there is continued evidence of schizophrenic behavior in absence of a complete set of diagnostic criteria

16. Other Psychotic Disorders Schizophreniform Disorder Schizophreniform Disorder Individual meets criteria for schizophrenia, but episode lasts > one month but one month but < 6 months Schizoaffective Disorder: Schizoaffective Disorder: Individual has an uninterrupted period of illness during which, at some time, there is a major depressive, manic, or mixed episode concurrent with symptoms in Criterion A Individual has an uninterrupted period of illness during which, at some time, there is a major depressive, manic, or mixed episode concurrent with symptoms in Criterion A

17. Other Psychotic Disorders Delusional Disorder: Individual’s predominant symptoms are non-bizarre delusions with absence of other criterion A symptoms Delusional Disorder: Individual’s predominant symptoms are non-bizarre delusions with absence of other criterion A symptoms Brief psychotic disorder Brief psychotic disorder Individual experiences at least one day but less than one month with one or more Criterion A symptoms of schizophrenia which result from severe psychosocial stress Individual experiences at least one day but less than one month with one or more Criterion A symptoms of schizophrenia which result from severe psychosocial stress

18. Interdisciplinary Tx Goal Setting Goal Setting Client centered; include family and others Client centered; include family and others Managed care may dictate goals Managed care may dictate goals May be impaired by client’s delusions or lack of insight May be impaired by client’s delusions or lack of insight Medications: Stabilizes psychosis Medications: Stabilizes psychosis Act as antagonist to dopamine Act as antagonist to dopamine High incidence of non-compliance High incidence of non-compliance Non-compliance can be minimized by providing education and interventions Non-compliance can be minimized by providing education and interventions

19. Impact on Function Many individuals exhibit cognitive- perceptual and social interaction skills that affect all areas of occupations, including ADLS, IADLs, Leisure, Social Participation, Education, and Work Many individuals exhibit cognitive- perceptual and social interaction skills that affect all areas of occupations, including ADLS, IADLs, Leisure, Social Participation, Education, and Work Many demonstrate sensory processing disorders Many demonstrate sensory processing disorders Many exhibit difficulties with boundaries which lead to socially inappropriate behaviors Many exhibit difficulties with boundaries which lead to socially inappropriate behaviors

20. OT Intervention Evaluation Evaluation ACL ACL KELS KELS AMPS AMPS Adult sensory profile Adult sensory profile COPM COPM Intervention (see Table 7-1) Intervention (see Table 7-1) Groups good for social skills Groups good for social skills ADL training ADL training Activities with personal meaning / purpose Activities with personal meaning / purpose