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SCHIZOPHRENIA A psychotic disorder characterized by bizarre and disorganized behavior One of the most serious and debilitating of all psychological disorders
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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
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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.
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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
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Positive Symptoms Hallucinations Delusions Disorganized Speech Disorganized Behavior
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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
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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
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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
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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)
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Negative Symptoms Poverty of speech Flat affect Avolition Social isolation Motor retardation Anhedonia
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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
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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
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Avolition Lack of will/motivation Inability to initiate or persist at tasks Little interest in social or work activities
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SUBTYPES OF SCHIZOPHRENIA Paranoid Schizophrenia Disorganized Schizophrenia Catatonic Schizophrenia Undifferentiated Schizophrenia
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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
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SCHIZOPHRENIA, DISORGANIZED TYPE Disorganized speech Disorganized behavior Flat or inappropriate affect No evidence of catatonia
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SCHIZOPHRENIA, CATATONIC TYPE Rare form of schizophrenia Catatonic symptoms (motor related) – 2 or more Echolalia – mimic verbalizations Echopraxia – mirror motor movements
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SCHIZOPHRENIA, UNDIFFERENTIATED TYPE Don’t fit into any of the other 3 categories Display a mix of symptoms
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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%
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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%
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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
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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
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