SCHIZOPHRENIA - PowerPoint PPT Presentation

1 / 36
About This Presentation
Title:

SCHIZOPHRENIA

Description:

SCHIZOPHRENIA SUMMARY A very rare but disabling disorder Characterized by loss of contact with reality, including delusions, hallucinations, disorganized speech and ... – PowerPoint PPT presentation

Number of Views:449
Avg rating:3.0/5.0
Slides: 37
Provided by: kellyb73
Category:

less

Transcript and Presenter's Notes

Title: SCHIZOPHRENIA


1
(No Transcript)
2
  • SCHIZOPHRENIA
  • LECTURE OUTLINE
  • Historical perspective
  • Incidence/prevalence
  • Description
  • Diagnostic issues
  • Etiology Dynamic vulnerability model
  • Treatment, rehabilitation, and early intervention

3
  • SCHIZOPHRENIA
  • Historical perspective
  • Ancient and medieval times demonic possession
  • Morel (1852) demence precoce
  • Kraeplin (1893) dementia praecox
  • Bleuler (1911) schizophrenia
  • Today family of problems, core is disordered
    thought
  • Often confused with dissociative identity
    disorder (multiple personality disorder)

4
  • SCHIZOPHRENIA
  • Incidence/prevalence
  • Lifetime prevalence rates range from .5 to 1
  • Low incidence rate also 1 per 10,000 per year,
    but very debilitating disorder
  • Onset from adolescence to age 45
  • Men have earlier onset (18-25) than women (25-35)

5
  • SCHIZOPHRENIA
  • Description
  • Process vs. reactive schizophrenia
  • Usually it is the family who seeks treatment
  • Frequent cause of psychiatric hospitalization
    (50 in psych hospitals)
  • High rates of rehospitalization
  • Severe impairment of social, occupation,
    educational functioning, resulting in poverty,
    poor housing, discrimination

6
  • SCHIZOPHRENIA
  • Description
  • Formerly long-term stays in psych hospital,
    assumption of chronicity
  • Harding et al. (1987) follow-up study of
    patients diagnosed with schizophrenia from
    Vermont State Hospital
  • 20-25 years later, more than half showed
    considerable improvement
  • current vision of recovery

7
  • SCHIZOPHRENIA
  • Description Positive symptoms
  • Delusions false beliefs that have no basis in
    reality persecutory, religious, grandiose,
    reference, somatic
  • Hallucinations - false perceptions in the
    absence of any relevant sensory stimulus
    auditory are most common lack of control over
    hallucinations is key feature

8
  • SCHIZOPHRENIA
  • Description Positive symptoms
  • Disorganized speech thought-content and
    thought-form symptomatology derailment,
    neologisms, word salad, excessive concreteness
  • Grossly disorganized behaviour can be
    manifested in a variety of ways

9
  • SCHIZOPHRENIA
  • Description Positive symptoms
  • Catanonia stuporous, rigidity, negativism,
    posturing, waxy flexibility echopraxia and
    echolalia excitement

10
  • SCHIZOPHRENIA
  • Description Negative symptoms
  • Reflect an erosion or loss of normal functions,
    patterns of experience and conduct
  • Symptoms include impoverishment of emotional
    expression, reactivity, and subjective experience
    (emotional blunting)
  • Other symptoms include thought blocking,
    avolition, anhedonia, asociality, attention
    deficits

11
  • SCHIZOPHRENIA
  • Description Three main types of symptoms
  • Psychomotor poverty
  • Disorganization
  • Reality distortion

12
  • SCHIZOPHRENIA
  • Diagnostic issues
  • DSM IV lists 9 disorders under the category of
    schizophrenia and other psychotic disorders
  • Schizophrenia
  • Schizophreniform disorder
  • Schizoaffective disorder
  • Delusional disorder
  • Brief psychotic disorder
  • Shared psychotic disorder
  • Psychotic disorder due to a general medical
    condition
  • Substance-induced psychotic disorder
  • Psychotic disorder not otherwise specificed

13
  • SCHIZOPHRENIA
  • Diagnostic issues
  • US-UK study (Cooper et al., 1982)
    Schizophrenia more likely to be diagnosed in US,
    mood disorder in UK
  • DSM-IV must have 2 or more of delusions,
    hallucinations, disorganized speech, grossly
    disorganized or catatonic behaviour, negative
    symptoms (only 1 needed if delusions are bizarre
    or voice keeps running commentary on persons
    behaviour or thoughts)

14
  • SCHIZOPHRENIA
  • Diagnostic issues - Subtypes
  • Paranoid 35-40
  • Disorganized 10
  • Catatonic 10
  • Undifferentiated 20
  • Residual 20

15
  • SCHIZOPHRENIA
  • Diagnostic issues 2-factor theory
  • Factor I severity of disorder paranoid type
    is less severe than other types
  • Factor II severity of symptoms frequency and
    prominence of symptoms irrespective of subtype

16
  • SCHIZOPHRENIA
  • Etiology Dynamic vulnerability model
  • Genetic endowment
  • Vulnerability
  • Symptoms of schizophrenia
  • Appraisal and coping
  • Stressors

17
  • SCHIZOPHRENIA
  • Etiology Vulnerabilities
  • Developmental influences studies of high-risk
    children
  • Genetics according to your text 45
    concordance for MZ twins, 10-15 for DZ Torrey
    et al. (1994) review of 8 twin studies 28 for
    MZ, 6 for DZ
  • Biochemical influences Dopamine hypothesis

18
  • SCHIZOPHRENIA
  • Etiology Vulnerabilities
  • Evidence supporting dopamine hypothesis
  • Anti-psychotic drugs reduce transmission of
    dopamine
  • High number of dopamine receptors in brains of
    people with schizophrenia
  • Amphetamine psychosis
  • Research suggests that other neurotransmitters
    are likely involved (e.g., NE and glutamate)

19
  • SCHIZOPHRENIA
  • Etiology Vulnerabilities
  • Prenatal and perinatal influences
  • Neuroanatomical basal ganglia and thalamus,
    front lobes, temporal lobes and ventricles
  • Neurodevelopmental factors synaptic density
  • Personality factors

20
  • SCHIZOPHRENIA
  • Etiology Stressors
  • Family dynamics schizophrenogenic mothers,
    double-bind hypothesis, expressed emotion
    (criticism, hostility, overinvolvement)
  • Cultural influences people who experience
    schizophrenia in developing countries appear to
    do better than those in industrialized nations

21
  • SCHIZOPHRENIA
  • Etiology Stressors
  • Social status SES inversely related to rates
    of schizophrenia social selection vs. social
    causation (sociogenic) hypotheses
  • Labelling theory
  • Other stressors child sexual abuse

22
  • SCHIZOPHRENIA
  • Treatments The medical model
  • Some past treatments insulin coma therapy,
    lobotomy
  • Pharmacotherapy anti-psychotic drugs problem
    of side-effects (EPS) and Tardive Dyskenesia
  • ECT
  • Individual therapy, family therapy and
    psychoeducation, group therapy by professionals
    inpatient and outpatient

23
  • SCHIZOPHRENIA
  • Treatments The medical model
  • Mental hospitalization Goffman (1961),
    Asylums, the total institution, disculturation,
    closing the ranks, spoiled identity
  • Efforts to reform the mental hospital
    therapeutic community (Maxwell Jones) and token
    economies (behaviourism)

24
  • SCHIZOPHRENIA
  • Treatments Paul Lentz (1977) study
  • Comparative study therapeutic community
    (milieu), token economy, typical hospitalization
  • 28 participants randomly assigned to the 3
    groups (half men, half women)
  • All with diagnosis of schizophrenia, all
    receiving drug treatment
  • gt 1/3 mute or incontinent
  • Average of 17 years of hospitalization

25
  • SCHIZOPHRENIA
  • Treatments Paul Lentz (1977) study
  • Common elements of milieu and token economy
  • Residents, not patients
  • Residents not sick, expected to be responsible
  • Informal relations
  • Open communication between staff and residents
  • Same staff operated the 2 programs

26
  • SCHIZOPHRENIA
  • Treatments Paul Lentz (1977) study
  • Therapeutic milieu program
  • Expectations
  • Involvement
  • Group cohesion

27
  • SCHIZOPHRENIA
  • Treatments Paul Lentz (1977) study
  • Outcomes
  • Improved behaviour greatest for token economy
    residents
  • Release rates token economy (96), milieu
    (68), hospital (46) at 18-month follow-up after
    release

28
  • SCHIZOPHRENIA
  • Treatments Paul Lentz (1977) study
  • Outcomes
  • Cost-effectiveness token economy was most
    cost-effective
  • only 10 of token economy residents and 18 of
    milieu residents remained on psychotropic
    medications

29
  • SCHIZOPHRENIA
  • Treatments Shift to community
  • What happens after hospitalization? (Goering et
    al., 1981) psychiatric aftercare in Toronto
  • Deinstitutionalization or transinstitutionalizati
    on? From mental hospital to general hospital
    psychiatric wards
  • First person accounts

30
(No Transcript)
31
  • SCHIZOPHRENIA
  • Treatments Shift to community
  • Community mental health approaches
  • Programs of Assertive Community Treatment (PACT,
    Stein Test, 1980) and case management
  • Supportive housing the residential continuum
    (from halfway house to group home to supervised
    apartment to independent living)

32
  • SCHIZOPHRENIA
  • Treatments Shift to community
  • Supported housing, employment, and education
    (Paul Carling, 1995) choose, get, and keep
    philosophy, consumer control and
    self-determination, community integration
  • Self-help and consumer/survivor initiatives a
    home, a job, a friend, self-help groups and
    organizations, consumer-run businesses (A-way
    express, the Raging Spoon)

33
  • SCHIZOPHRENIA
  • Early intervention?
  • Several projects, beginning in Australia, aimed
    at early psychosis intervention
  • Phases of psychotic episode prodrome, actue
    symptoms, recovery
  • Gatekeeper education, quick access to treatment,
    home-based treatment, low-dose drug treatment
    designed to intervene early in first episodes

34
  • SCHIZOPHRENIA
  • SUMMARY
  • A very rare but disabling disorder
  • Characterized by loss of contact with reality,
    including delusions, hallucinations, disorganized
    speech and behaviour, and negative symptoms
  • Several different sub-types
  • Great deal of heterogeneity in how this disorder
    is manifested

35
  • SCHIZOPHRENIA
  • SUMMARY
  • A very mysterious disorder in terms of its
    origins/causes
  • Several different lines of research are being
    pursued to examine vulnerabilities and stressors
  • The medical model (hospitalization and drug
    therapy) has been the dominant way of responding
    to this disorder

36
  • SCHIZOPHRENIA
  • SUMMARY
  • Many problems with this model
  • Newer approaches include a variety of community
    mental health programs and early psychosis
    intervention
Write a Comment
User Comments (0)
About PowerShow.com