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SCHIZOPHRENIA
Coverage:
• What is schizophrenia• Symptoms of schizophrenia• Types of schizophrenia• Some of the more common treatments for
schizophrenia
What is schizophrenia?
• A chronic severe brain disorder; often they hear voices, believe media are broadcasting their thoughts to the world or may believe someone is trying to harm them.
• In men it usually develops in teen years and early 20s; in women it usually develops in 20s and 30s.
Emil Kraepelin
• Dementia precox• (cognitive process) + ( early onset)
– Long term mental deterioration– Common clinical symptoms of hallucinations
and delusions
Eugene Bleuler
• Schizophrenia• Need not have a deteriorating course• Schisms between:
– thought, emotion and behavior
Four A’s
• Association• Affect• Autism• Ambivalence• Secondary symptoms:
– Hallucinations– Delusions
Diagnosis
• Currently there is no physical or lab test that can absolutely diagnose schizophrenia.
• A psychiatrist usually comes to the diagnosis based on clinical symptoms.
Misdiagnosis
• This is a common problem since schizophrenia shares a significant number of symptoms with other disorders.
Disorders that may appear like Schizophrenia
• Schizoid personality• Schizophreniform disorder• Schizotypal personality• Bipolar Disorder• Asperger’s syndrome
Symptoms of Schizophrenia
• Profound disruption in cognition and emotion, affecting the most fundamental human attributes: – Language– Thought– Perception– Affect– Sense of self
Positive Symptoms
• Those that appear to reflect an excess or distortion of normal functions.
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.
• Hallucinations = perceptual experiences that occur in absence of actual sensory stimuli; involves the 5 senses.
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.
• Delusion = fixed beliefs that usually involve a misinterpretation of experience. “Client believes someone is reading his thoughts”
• Several types: grandiose, persecutory, somatic
• Illusions = person misperceives or exaggerates stimuli that actually exist in the external environment.
Positive Symptoms
• Disorganized thinking/speech.
• AKA loose associations; speech is tangential, loosely associated or incoherent enough to impair communication.
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.
Positive Symptom
• Catatonic behavior.
• Marked decrease in reaction to immediate environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.
Summary of Positive Symptoms
• Hallucinations• Delusions• Disorganized thinking/ speech• Disorganized behavior/ • Inappropriate responses• Catatonic behavior
FYI: Positive Symptoms
• Positive symptoms are those that have a positive reaction from some treatment.
• In other words, positive symptoms respond to treatment.
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.
Negative Symptoms
• Affective flattening.
• Reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language.
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.
Negative Symptom
• Avolition
• The reduction, difficulty or inability to initiate and persist in goal-directed behavior. Often mistaken for apparent disinterest.
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
Disorganized Symptoms
• This one is somewhat new and may not be considered valid.
• It is thought disorder, confusion, disorientation and memory problems.
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
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
Types of Schizophrenia
• Paranoid• Disorganized• Catatonic• Residual• Undifferentiated
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.
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.
Catatonic Schizophrenia
• Person is extremely withdrawn, negative and isolated.
• May have marked psychomotor disturbances.
Residual Schizophrenia
• Lacks motivation and interest in day-to-day living.
• Person is not usually having delusions, hallucinations or disorganized speech.
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.
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.
Medications
• In general it may take up to 6 months for medications to show consistent effects.
• The newest medication is:– Paliperidone (Invega)
• Atypical antipsychotics: – Abilify, Geodon, Clozapine, Risperidone,
Seroquel, Zyprexa. – [Remember: a giraffe can really see a zebra]
• These medications may have such intolerable side effects that the patient will stop the drugs.
• More commonly seen in treatment with typical antipsychotics– Chlorpromazine Thioridazine– Levomepromazine Fluphenazine– Haloperidol Trifluoperazine
Treatments
• Psychotherapy - an adjunct to meds and is very useful to keep the patient on the meds.
• Group therapy
• Family therapy
• Community support groups
• 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.
Communication Technique
• Confrontation = Presenting the patient with a different reality of the situation.
Ex:
Patient: My best friend never calls. She hates me.
Nurse: I was in the room yesterday when she called.
Communication Technique
• Doubt =Expressing or voicing doubt when a patient relates a situation.
Ex:
Patient: My best friend hates me.
Nurse: From what you have told me, that does not sound like her. When did she last call you?
• end