1. Schizophrenia

2. Sub-types of Schizophrenia
The big 3 are
Disorganised,
Catatonic
Paranoid
(DSM-IV-TR.)

3. Disorganised......
normally diagnosed in adolescents and young adults who demonstrates behaviour that we would commonly associate with ‘madness’. Kraepelin called this hebephrenic. Here a patient will suffer from a shallow or inappropriate mood, have disorganised thought and incoherent speech.

4. Disorganised continued...
They may also suffer with hallucinations and behave in an irresponsible, unpredictable or childish manner. A person may become violent but this is normally associated with a hallucinatory state. A person may also become incontinent and tend to ignore their personal appearance and hygiene.

5. Catatonic schizophrenia-
....a patient may alternate between extremes such as (a) hyperkinesias (hyperactivity) and stupor (a marked reduction of spontaneous movements and activity) or.... (b) automatic obedience ‘command automatism’ and negativism (apparently motiveless resistance to all instructions/ attempts to be moved or doing the opposite of what it is asked).

6. Catatonic schizophrenia continued...
There may be episodes of apparently purposeless motor activity combined with a dreamlike (oneroid) state with vivid scenic hallucinations.
Other characteristics are mutism, posturing (the voluntary assumption of inappropriate and bizarre postures) and waxy flexibility (maintenance of the limbs and body in externally imposed positions).

7. Catatonic schizophrenia continued-
Onset may be sudden more than other types of schizophrenia and the patient is likely to have shown previous apathy and withdrawal from reality.

8. Paranoid Schizophrenia...
is dominated by relatively stable often paranoid delusions (although delusions of grandeur are quite common) these may accompanied by vivid auditory hallucinations. Also common are ideas of reference the patients incorporates unimportant events with a delusional framework and reads personal significance into other people’s trivial actions-

9. Paranoid Schizophrenia continued
for example they might think that overheard fragments of a conversation or something on TV or in a magazine are about them.
Some patients also tend to be agitated, argumentative, angry and sometimes violent while others who are less disturbed (have a better preserved personality)

10. Paranoid Schizophrenia continued...
... are more emotionally responsive, alert, verbal although their language could be filled with reference to delusions it is not disorganised.
It is the most homogeneous type of Schizophrenia as individuals with paranoid schizophrenia are more alike (in their symptoms) than those in other categories.

11. Simple schizophrenia
normally appears during late adolescence and has a slow gradual onset. The main symptoms are gradual social withdrawal and difficulty in making friends, aimlessness and idleness, blunting of affect, loss of volition and drive and decline in academic or occupational performance such people may become drifters or tramps and are often regarded by others as idle and ‘layabouts’.

12. Sub-types of Schizophrenia
There are no major psychotic symptoms as in the other types. Only ICD actually distinguishes this type, which is still used in some countries.

13. Undifferentiated (a typical) schizophrenia...
the label given to patients whose symptoms cannot be easily placed elsewhere i.e. a psychotic condition that meet the general diagnostic criteria but does not conform to any of the subtypes, stated above, due to either insufficient or overlapping symptoms.

14. Sub-types of Schizophrenia
Residual schizophrenia is used to describe a patient who no longer meets the full criteria but still shows some signs of illness.

15. Evaluation of sub- types
With the possible exception of paranoid schizophrenia; psychiatrists find it difficult to tell these ‘sub-types’ apart. Some patients present symptoms of one subgroup at one time than those of another subgroup later (Gelder et al 1999). This dramatically reduces the reliability of diagnosis.

16. Evaluation of sub- types
Catatonic symptoms are much less common now than fifty years ago. This could be due to effective drug therapy on bizarre motor processes. Alternatively, it could be due a diagnosis that is more effective. In the film, ‘awakenings’ many cases of catatonic schizophrenia were in fact encephalitis lethargica (sleeping sickness).

17. Evaluation of sub- types
Assessing someone to a particular sub-type provides very little information that helps in either treatment or predicting the outcome of the illness (Davidson &Neale 2001).

18. Summary of sub-types: Use the mnemonic to help you remember them:
Phds see you as prs

19. Types of Schizophrenia
H (D) C U R S

20. Types of Schizophrenia
Paranoid schizophrenia
Hebephrenic (Disorganised)
Catatonic
Undifferentiated
Post-schizophrenic
Residual
Simple

21. Types of Schizophrenia
Paranoid schizophrenia
Delusions, hallucinations, negative symptoms
Hebephrenic (Disorganised)
Aimless, disorganised behaviour; rambling, incoherent speech
Catatonic
Motor abnormality – unmoving strange posture or flailing limbs
Undifferentiated
So many symptoms cannot be categorised or not enough symptoms
Post-schizophrenic
Schizophrenia in last 12 months but not now – depressed now
Residual
Symptoms present before but not now, however, negative symptoms now
Simple
Social withdrawal, apathy, paucity of speech, decline in performance

22. A True/False activity on the diagnosis and classification of Schizophrenia.
1. Highlight the statements which are true and
2. If you think that a statement is false write an explanation of your reasoning

23. Answer to Test your knowledge so far.
True or false statements; all true statements are highlighted in blue.

24. 1.
Schizophrenia usually appears in late or early adulthood. 2.
Schizophrenia is more likely to affect men than women.
This illness affects both men and women equally. 3.
There is a 1% lifetime probability of an individual developing Schizophrenia. 4.
Schizophrenia means ‘split mind’ because people with this disorder may several different personalities.
DID (Dissociative Identity Disorder) is a mental illness previously known as multiple personality disorder.
NB: trailer has some adult rated themes i.e. sexually explicit in places. 5.
People with Schizophrenia often suffer from visual hallucination i.e. they see things that are not there.
Auditory hallucinations are more common in Schizophrenia while visual hallucinations are rare. 6.
The diagnosis of Schizophrenia depends on what Schneider called ‘first- rank symptoms’ 7.
First-rank symptoms include thought disorders, hallucinations and delusions. 8.
All these characteristics need to be present for a diagnosis is made.
Only one or more of these symptoms is necessary for a diagnosis of Schizophrenia.

25. 9.
Symptoms usually need to be present 6 months before a diagnosis is made.
10.
Someone with Schizophrenia may believe that thoughts are being put into their head by outside forces, such as aliens or the government.
11.
When Schizophrenics hear a voice in their head, this voice is usually telling them to harm others.
The voices usually comment on what the person is doing and when they tell them to do something it is rarely to cause harm to others.
12.
Symptoms can be divided into positive (Type I) and negative (Type II)
13.
Negative symptoms may include the belief that your thoughts are being known to other people, for example being broadcast on the radio.
This is known as a positive symptom.
14.
Negative symptoms need to be present for a diagnosis to be made.
Negative symptoms are not necessary for a diagnosis of Schizophrenia as these symptoms are quite similar to those of depression. Consequently doctors/ psychiatrist/ clinical psychologists will look for a range of positive symptoms are required for an ‘accurate’ diagnosis of Schizophrenia.

26. These are negative symptoms; positive symptoms are the opposite.
15.
Positive symptoms are characteristics that are not present in Schizophrenics, but are not expected in normal people.
These are negative symptoms; positive symptoms are the opposite.
16.
DSM-IV lists five types of Schizophrenia.
17.
Paranoid Schizophrenia usually develops earlier than the other types.
18.
In the prodromal phase, the disorder subsides.
This is the phase when symptoms start to appear; these subside in the residual phase.
19.
Approximately one third of Schizophrenics become able to function normally.
20.
Schizophreniform disorder is a psychotic similar to Schizophrenia but where the symptoms last for less than 6 months.

27. FRIDAY - Essay question
Outline the clinical characteristics of Schizophrenia
(9 marks)
It is up to you to decide to answer this question using your knowledge of the DSM IV-TR or the ICD-10 or both. Remember that your answer will be between words long.

28. Plan Briefly mention DSM/ICD tools
Define positive (Type 1) and negative (Type 2) symptoms
Describe 4 examples – from;
e.g. delusions, control, hallucinations, disordered thinking, alogia, avolition, flattening, paranoia.
1 page A4