1. Symptoms of Schizophrenia

2. Symptoms of Schizophrenia
Profound disruption in cognition and emotion, affecting the most fundamental human attributes:
Language
Thought
Perception
Affect
Sense of self

3. Positive Symptoms
Those that appear to reflect an excess or distortion of normal functions.

4. 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.

5. Positive Symptoms
Hallucinations. Distortions or exaggerations of perception in any of the senses.
Often they hear voices within their own thoughts followed by visual hallucinations.

6. Positive Symptoms Disorganized thinking/speech.
AKA loose associations; speech is tangential, loosely associated or incoherent enough to impair communication.

7. Positive Symptom Grossly disorganized behavior.
Difficulty in goal directed behavior (ADLs), unpredictable agitation or silliness, social disinhibition, or bizarre behavior.
There is a purposelessness to behavior.

8. Positive Symptom Catatonic behavior.
Marked decrease in reaction to immediate environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.

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

10. Summary of Positive Symptoms
Delusions
Hallucinations
Disorganized thinking
Disorganized behavior
Catatonic behavior
Inappropriate responses

11. FYI: Positive Symptoms
Positive symptoms are those that have a positive reaction from some treatment.
In other words, positive symptoms respond to treatment.

12. 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.

13. Negative Symptoms Affective flattening.
Reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language.

14. Negative Symptom 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.

15. Negative Symptom Avolition
The reduction, difficulty or inability to initiate and persist in goal-directed behavior. Often mistaken for apparent disinterest.

16. 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

17. Disorganized Symptoms
This one is somewhat new and may not be considered valid.
It is thought disorder, confusion, disorientation and memory problems.

18. Summary of Negative Symptoms
Lack of emotion
Low energy
Lack of interest in life
Affective flattening
Alogia
Inappropriate social skills
Inability to make friends
Social isolation

19. 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

20. FYI: Negative Symptoms
Currently there is no treatment that has a consistent impact on negative symptoms.

21. Types of Schizophrenia
Paranoid
Hebephrenic
Catatonic
Residual
Schizoaffective
Undifferentiated

22. 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.

23. 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.

24. Catatonic Schizophrenia
Person is extremely withdrawn, negative and isolated.
May have marked psychomotor disturbances.

25. Residual Schizophrenia
Lacks motivation and interest in day-to-day living.
Person is not usually having delusions, hallucinations or disorganized speech.

26. Schizoaffective Disorder
There will be symptoms of schizophrenia as well as mood disorder (depression, bipolar, mixed mania).

27. 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.

28. Summary
Before a diagnosis the psychiatrist must make a thorough evaluation including a physical/medical exam, a mental status exam, appropriate labs, and a full history.
History includes changes in thinking, behavior, movement, mood, etc. as seen by the family.

29. Medications
In general it may take up to 6 months for medications to show consistent effects.
The newest medication is Invega.
Meds include atypicals: Abilify, Geodon, Clozapine, Risperidone, Seroquel, Zyprexa.
[Remember: a giraffe can really see a zebra]

30. These medications may have such intolerable side effects that the patient will stop the drugs.
One study showed the average time the meds were taken regularly was 3 months.

31. Treatments
Psychotherapy - an adjunct to meds and is very useful to keep the patient on the meds.
Group therapy
Family therapy
Community support groups

32. Early detection and treatment has the best results/response to treatment.
Per patients, once you have schizophrenia you have it for life. The best you can hope for is control.