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Schizophrenia

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Facts about Schizophrenia. Course: Onset may be acute or gradual ... Being born in winter or early spring. Family history of Schizophrenia ... – PowerPoint PPT presentation

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Title: Schizophrenia


1
Schizophrenia Other Psychotic Disorders
2
Schizophrenia
  • Two or more of the following, each present for a
    significant portion of the time during a 1-month
    period
  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
  • Negative symptoms
  • Exception to the 2 symptom requirement only
    1 psychotic symptom required if
  • Delusion is bizarre
  • Hallucination consists of

3
Delusions (Positive Symptom)
  • Fixed, false beliefs
  • Types
  • Bizarre
  • Thought insertion
  • Thought withdrawal
  • Thought broadcast
  • Reference

4
Delusions (positive symptom)
  • Types, continued
  • Control
  • Somatic
  • Nihilistic
  • Grandiose
  • Religious
  • Persecutory

5
Hallucinations (Positive Symptom)
  • False sense perception
  • Types
  • Auditory
  • Tactile
  • Visual
  • Olfactory/Gustatory
  • Somatic

6
Disorganized Speech (Positive Symptom)
  • Speech that is hard to understand or follow,
    impairs communication
  • Types
  • Loose associations
  • Incoherence
  • Frequent derailment

7
Disorganized Speech (Positive Symptom)
  • Types
  • Circumlocution
  • Tangential
  • Clang
  • Neologisms

8
Disorganized SpeechGeometric Analogy
Tangential
Normal goal directed and linear
Q
A
A
Q
Incoherence
A
Q
Circumlocution
Loosening of Associations
A
Q
A
Q
9
Grossly Disorganized or Catatonic Behavior
(Positive Symptom)
  • Grossly Disorganized Behavior

10
Grossly Disorganized or Catatonic Behavior
(Positive Symptom)
  • Catatonic Behavior

11
Negative Affect (Negative Symptom)
  • Flat affect
  • No emotional expression in speech
  • Restricted fluency of thought and speech

12
Schizophrenia
  • Exception to the 2 symptom requirement only 1
    psychotic symptom required if
  • 1. Delusion is bizarre
  • OR
  • 2. Hallucination consists of either
  • a. voice keeps up a running commentary on the
    persons thoughts or behavior
  • OR
  • b. two or more voices conversing with each
    other

13
Schizophrenia
  • Impairment in functioning
  • Signs of the disturbance for at least 6 months,
    that includes at least 1 month of symptoms
    described by Criterion A
  • Symptoms are not better accounted for
    Schizoaffective Disorder or Mood Disorder with
    Psychotic Features
  • Not due to a GMC or substance
  • If there is a developmental disorder present,
    there are prominent delusions or hallucinations
    present for at least one month

14
Facts about Schizophrenia
  • Prevalence
  • Gender
  • Age of Onset
  • Course

15
Facts about Schizophrenia
  • Course
  • Onset may be acute or gradual
  • Many sufferers experience three phases
  • Prodromal beginning of deterioration
  • Active meet criteria for Schizophrenia
  • Residual return to prodromal levels

16
Facts about Schizophrenia
  • Course, continued

17
Schizophrenia Course
Group 1 15 have only a single episode of illness
with no subsequent impairment
Group 2 25 have repeated episodes of illness
with no impairment between episodes
Group 3 30 have repeated episodes of illness
with some impairment between episodes
Group 4 30 have repeated episodes of illness
with gradually declining impairment between
episodes
18
Facts about Schizophrenia
  • Outcome
  • Approximately 15
  • Approximately 85
  • Approximately 50
  • 90 or more
  • 75 or more
  • Approximately 10

19
Facts about Schizophrenia
  • Culture
  • Prevalence seems to be higher in lower SES
    communities
  • Downward drift direction of causality?

20
Facts about Schizophrenia
  • Culture, continued
  • Prevalence doesnt vary
  • Prevalence doesnt vary
  • Cross cultural variation

21
Factors associated with better prognosis
  • Good premorbid functioning
  • Acute onset
  • Later age at onset
  • Being female
  • Mood disturbance
  • Family history of Mood Disturbance

22
Factors associated with better prognosis
  • Treatment with antipsychotic medication
  • Compliance with medication
  • Brief duration of symptoms
  • Good interepisode functioning
  • No family history of Schizophrenia
  • Insight

23
Subtypes of Schizophrenia
  • Paranoid
  • Disorganized
  • Catatonic
  • Undifferentiated
  • Residual

24
Paranoid Schizophrenia
  • Preoccupation with one or more delusions or
    auditory hallucinations (usually persecutory,
    grandiose, or both)
  • None of the following is prominent
  • Disorganized speech,
  • Disorganized behavior
  • Catatonic behavior
  • Flat/inappropriate affect

25
Disorganized Schizophrenia
  • All of the following are prominent
  • Disorganized speech
  • Disorganized behavior
  • Flat/Inappropriate affect
  • There is no catatonic behavior

26
Catatonic Schizophrenia
  • A type of Schizophrenia in which the clinical
    picture is dominated by at least 2 or more
    catatonic behaviors
  • Motoric immobility as evidenced by stupor,
    catalepsy, or waxy flexibility
  • Excessive motor activity that is apparently
    purposeless and not influenced by external
    stimuli
  • Extreme negativism or mutism
  • Peculiarities of movement (posturing, stereotyped
    movements, prominent mannerisms, or prominent
    grimacing
  • Repeating whatever is said or done

27
Undifferentiated Schizophrenia
  • Characterized by symptoms which fit do not fit
    the paranoid, disorganized, or catatonic subtypes
  • Vague, catch-all category

28
Residual Schizophrenia
  • Characterized by symptoms that have lessoned in
    strength and number
  • Person may continue to display blunted or
    inappropriate emotions

29
Schizophrenia Risk Factors
  • Being born in winter or early spring
  • Family history of Schizophrenia
  • Risk of developing Schizophrenia
  • 6 chance
  • 10 chance
  • 13 chance
  • 42 chance
  • 50 chance
  • If one MZ twin has Schizophrenia and the other
    one doesnt, the one who doesnt have it often
    isnt completely asymptomatic (e.g. may have a
    personality disorder)

30
Schizophrenia Biology
  • Dopamine Hypothesis
  • Schizophrenia has been linked to excessive
    dopamine activity
  • Effective antipsychotics are dopamine antagonists
  • Bind to dopamine receptors
  • Decreasing dopamine too far can result in Tardive
    Dyskinesia
  • Problem with the Dopamine hypothesis

31
Other Psychotic Disorders
  • Schizophreniform Disorder
  • Brief Psychotic Disorder
  • Schizoaffective Disorder
  • Delusional Disorder
  • Shared Psychotic Disorder

32
What is a Psychotic Disorder
  • Psychosis
  • A break from reality
  • Often involves difficulties interacting with and
    perceiving the real world
  • Split between thoughts and emotions

33
Schizophreniform Disorder
  • Criteria A, D, and E of Schizophrenia are met
  • An episode of the disorder (including the
    prodromal, active, and residual phases) lasts at
    least 1 month but less than 6 months

34
Schizophreniform Disorder
  • Essentially, exactly like Schizophrenia, but the
    duration is shorter
  • Schizophrenia
  • Schizophreniform
  • Often used as a provisional diagnosis during the
    first months of a psychotic illness
  • Thus, this diagnosis can change to Schizophrenia
    after 6 months have passed without complete
    recovery

35
Facts about Schizophreniform Disorder
  • Prevalence Varies substantially
  • Industrialized areas
  • Non-industrialized areas

36
Facts about Schizophreniform Disorder
  • Gender
  • Age of Onset
  • Course 1/3 -
  • 2/3 -

37
Brief Psychotic Disorder
  • A. Presence of one or more of the following
    symptoms
  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
  • B. Duration of an episode of the disturbance is
    at least 1 day but less than 1 month, with
    eventual full return to premorbid levels of
    functioning
  • C. Disturbance is not better accounted for by
    another mental disorder and is not due to a GMC
    or substance

38
Brief Psychotic Disorder vs. Schizophrenia/Schizop
hreniform
  • Criteria
  • Schizophrenia/Schizophreniform Disorder
  • Brief Psychotic Disorder
  • Duration
  • Schizophrenia
  • Schizophreniform Disorder
  • Brief Psychotic Disorder

39
Facts about Brief Psychotic Disorder
  • Prevalence
  • Gender
  • Age of Onset
  • Course

40
Schizoaffective Disorder
  • An uninterrupted period of illness during which,
    at some time, there is either a Major Depressive
    Episode, a Manic Episode, or a Mixed Episode
    concurrent with symptoms that meet Criterion A
    for Schizophrenia
  • During the same period of illness, there have
    been delusions or hallucinations for at least 2
    weeks in the absence of prominent mood symptoms

41
Schizoaffective Disorder
  • D. Symptoms that meet criteria for a mood episode
    are present for a substantial portion of the
    total duration of the illness
  • E. Not due to a GMC or substance

42
Subtypes of Schizoaffective Disorder
  • Bipolar Type
  • Depressive Type

43
Facts about Schizoaffective Disorder
  • Prevalence
  • Gender

44
Facts about Schizoaffective Disorder
  • Age of Onset
  • Bipolar Subtype
  • Depressive Subtype
  • Course Better prognosis than Worse
    prognosis than
  • Better prognosis

45
Delusional Disorder
  • Nonbizarre delusions lasting for at least 1 month
  • Criterion A for Schizophrenia have never been met
    (However, tactile and olfactory may be present if
    they are related to the delusional theme)
  • Behavioral functioning is not markedly imparied
    and behavior is not obviously odd or bizarre

46
Delusional Disorder
  • D. If mood episodes have occurred concurrently
    with delusions, their total duration has been
    brief relative to the duration of the delusional
    periods
  • E. Not due to the direct effects of a GMC or
    substance

47
Types of Delusional Disorder
  • Erotomanic
  • Grandiose
  • Jealous

48
Types of Delusional Disorder
  • Persecutory
  • Somatic
  • Mixed
  • Unspecified

49
Facts about Delusional Disorder
  • Prevalence 0.03 -
  • 1-2 -
  • Gender
  • Age of Onset
  • Course

50
Shared Psychotic Disorder (Folie á Deux)
  • A delusion develops in an individual in the
    context of a close relationship with another
    person(s), who has an already-established
    delusion
  • The delusion is similar in content to that of the
    person who already has the established delusion
  • The disturbance is not better accounted for by
    another psychotic disorder or is due to a GMC or
    substance

51
Shared Psychotic Disorder
  • The delusions are shared between two people are
    in a close relationship (husband and wife, parent
    and child, siblings, etc.)
  • Typically, the person with the original delusion
    is the more dominant personality in the
    relationship
  • Generally the delusions are only shared by two
    people, but can be shared among large groups of
    people as well

52
Facts about Shared Psychotic Disorder
  • Prevalence
  • Gender
  • Age of Onset
  • Course
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