SCHIZOPHRENIA

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Coverage:

What is schizophrenia Symptoms of schizophrenia Types of schizophrenia Some of the more common treatments for schizophrenia

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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.
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Emil Kraepelin

Dementia precox (cognitive process) + ( early onset)

Long term mental deterioration Common clinical symptoms of hallucinations and delusions

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Eugene Bleuler

Schizophrenia Need not have a deteriorating course Schisms between:

thought, emotion and behavior

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Four As

Association Affect Autism Ambivalence Secondary symptoms:

Hallucinations Delusions

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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.

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Misdiagnosis

This is a common problem since schizophrenia shares a significant number of symptoms with other disorders.

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Disorders that may appear like Schizophrenia

Schizoid personality Schizophreniform disorder Schizotypal personality Bipolar Disorder Aspergers syndrome

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Symptoms of Schizophrenia

Profound disruption in cognition and emotion, affecting the most fundamental human attributes:

Language Thought Perception Affect Sense of self

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Positive Symptoms

Those that appear to reflect an excess or distortion of normal functions.

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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.

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Hallucinations = perceptual experiences that occur in absence of actual sensory stimuli; involves the 5 senses.

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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.

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Delusion = fixed beliefs that usually involve a misinterpretation of experience. Client believes someone is reading his thoughts Several types: grandiose, persecutory, somatic

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Illusions = person misperceives or exaggerates stimuli that actually exist in the external environment.

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Positive Symptoms

Disorganized thinking/speech. AKA loose associations; speech is tangential, loosely associated or incoherent enough to impair communication.

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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.

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Positive Symptom

Catatonic behavior. Marked decrease in reaction to immediate environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.

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Summary of Positive Symptoms

Hallucinations Delusions Disorganized thinking/ speech Disorganized behavior/ Inappropriate responses Catatonic behavior
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FYI: Positive Symptoms

Positive symptoms are those that have a positive reaction from some treatment. In other words, positive symptoms respond to treatment.

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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.

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Negative Symptoms

Affective flattening. Reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language.

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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.

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Negative Symptom

Avolition The reduction, difficulty or inability to initiate and persist in goal-directed behavior. Often mistaken for apparent disinterest.

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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

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Disorganized Symptoms

This one is somewhat new and may not be considered valid. It is thought disorder, confusion, disorientation and memory problems.

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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
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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
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Types of Schizophrenia

Paranoid Disorganized Catatonic Residual Undifferentiated

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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.

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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.
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Catatonic Schizophrenia

Person is extremely withdrawn, negative and isolated. May have marked psychomotor disturbances.

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Residual Schizophrenia

Lacks motivation and interest in day-today living. Person is not usually having delusions, hallucinations or disorganized speech.

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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.

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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.
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Medications

In general it may take up to 6 months for medications to show consistent effects. The newest medication is:

Paliperidone (Invega) Abilify, Geodon, Clozapine, Risperidone, Seroquel, Zyprexa. [Remember: a giraffe can really see a zebra]
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Atypical antipsychotics:

These medications may have such intolerable side effects that the patient will stop the drugs. More commonly seen in treatment with typical antipsychotics

Chlorpromazine Levomepromazine Haloperidol

Thioridazine Fluphenazine Trifluoperazine

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Treatments

Psychotherapy - an adjunct to meds and is very useful to keep the patient on the meds. Group therapy Family therapy Community support groups

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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.

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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.
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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?
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