SUICIDE It has been estimated that 1 million people die by suicide each year, more than 42,000 in the United States alone. Around 25 million other people throughout the world — 650,000 in the United States—make unsuccessful attempts to kill themselves Parasuicide - A suicide attempt that does not result in death. Suicide is the fourth leading cause of death among 15-19-year-olds.SUICIDESUICIDE Death seeker is a person who clearly intends to end his or her life while attempting suicide. Death initiators also clearly intend to end their lives, but they act out of a belief that the process of death is already under way and that they are simply hastening the process. Death ignorers do not believe that their self- inflicted death will mean the end of their existence. Death darers experience mixed feelings, or ambivalence, about their intent to die, even at the moment of their attempt, and they show this ambivalence in the act itself,SUICIDEHOW IS SUICIDE STUDIED? + Psychological Autopsy - one strategy is retrospective in which clinicians and researchers' piece together data from the suicide victim’ past. Relatives, friends, therapists, or physicians may emember past statements, conversations, and behaviors that shed light on a suicide. Suicide notes Because of these limitations, many researchers also use a second strategy —Studying people who survive their suicide attempts. It is estimated that there are 12 nonfatal suicide attempts for every fatal suicideWHAT TRIGGERS A SUICIDE? NYecocsitl| Events and Situations ; Serious Illness Isolation Abusive or RSS AY Seater nita te Occupational StMODELING: THE CONTAGION OF SUICIDE one suicidal act apparently serves as a model for another.SCHIZOPHRENIA AND HIZOPHRENIA-LIKE DISORDERS these patients have had two or more of these + Schizophrenia. For at least 6 month: h, hallucinations, five types of psychotic symptom: delusions, disorganized spe negative symptoms, and catatonia or other markedly abnormal behavior. Ruled out as causes of the psychotic symptoms are significant mood disorders, substance use, and general medical conditions + Catatonia associated with another mental disorder (catatonia specifier). These patients have two or more of several behavioral characteristics. The specifier can be applied to disorders that include psychosis, mood disorders, autistic spectrum disorder, and other medical conditions + Schizophreniform disorder. This category is for patients who have the basic symptoms of schizophrenia but have been ill for only 1-6 months—less than the time specified for schizophreniaSCHIZOPHRENIA AND SCHIZOPHRENIA-LIKE DISORDERS + Schizoaffective disorder. For at least 1 month, these patients have had basic schizophrenia symptoms; at the same time, they have prominent symptoms of mania or depression + Brief psychotic disorder. These patients will have had at least one of the basic psychotic symptoms for less than 1 month (p. 80). + Delusional disorder. These patients have delusions, but not the other symptoms of schizophreniaSCHIZOPHRENIASYMPTOMS OF PSYCHOSIS * Delusions - A delusion is a false belief that cannot be explained by the patient’s culture or education; the patient cannot be persuaded that the belief is incorrect, despite evidence to the contrary or the weight of opinion of other people.DELUSIONS CAN BE OF MANY TYPES, INCLUDING THESEHALLUCINATIONS - IS A FALSE SENSORY PERCEPTION THAT OCCURS IN THE ABSENCE OF A RELATED SENSORY STIMULUS Visual Auditory Jj Olfactory Grete ayDISORGANIZED SPEECH + A psychotic patient may have disorganized speech in which mental associations are governed not by logic but by rhymes, puns, and other rules not apparent to the observer, or by no evident rule at all. + Loose associations: Rapidly shifting between topics with no connections between topics + Perseveration: Repeating the same things over and over again (word or behavior). + Neologism: Made up words that only have meaning to the speaker. "I'm going to the park to ride the wallywhoop." * Clang Speech: Use of rhyming words without meaning. "Deck the halls with boughs of holly, folly, pally, dolly, hello Dolly, want a lollipop’ + Word Salad. Saying sentences that make no sense to other people. "Give paper floor me school hop bus,” + Echolalia, Repeating exactly what someone else has saidDISORGANIZED BEHAVIOR + Repeating the same activity (word or behavior) over and over again (perseveration). + Repeating exactly what someone else has done (echopraxia). + Dressing oddly, such as wearing many sets of clothing one over the other or wearing hats, gloves, and heavy coats in the summer. + Doing things in public that are usually done only in private.CATATONIC BEHAVIOR eyo er ‘sj ici focus | Oe Sitting or standing in unusual aeesene positions (posturing). nomen em ante Allowing another person to move one's arms and legs into different positions (waxy flexibility). Sitting without moving for long periods of time (stupor). Being very active but with no purpose (catatonic excitement).NEGATIVE SYMPTOMS Negative mental symptoms Negative physical symptoms + a seeming lack of interest in the + an inexpressive or blank face (flat world affect) + not wanting to interact with other + monotone or monosyllabic speech People (socal withdrawal) «+ lack of gesturing when communicating + an inability to feel or express pleasure (anhedonia) + lack of eye contact + decreased sense of purpose + physical inactivity lack of motivation (avolition) + not talking much + difficulty speaki due to disorganized thinking or poverty of speech (alogia)ESSENTIAL FEATURES OF SCHIZOPHRENIA + The classic picture of a patient with schizophrenia is of a young person (late teens or 20s) who has had: (1) delusions (especially persecutory) (2)hallucinations (especially auditory () speech that is incoherent or otherwise disorganized (4) severely abnormal psychomotor behavior (catatonic symptoms), or (8)negative symptoms such as restricted affect or lack of volition (they don't feel motivated to do work, maintain family life). Diagnosis requires at least two of these five types of psychotic symptoms, at least one of which must be delusions, hallucinations, or disorganized speech (criterion A). The patient is likely to have some mood symptoms, but they will be relatively brief. illness usually begins gradually and builds across at least 6 months in a crescendo of misery and chaos.DON’T DISMISS THE D’S + Duration (6+ months, with criterion A symptoms for at least a month) + Distress or disability (social, occupational, or personal impairment) + Differential diagnosis (other psychotic disorders, mood or cognitive disorders, physical and substance-induced psychotic disorders, peculiar ideas—often political or religious— shared by a community)General population | 19 DIATHESIS-STRESS MODEL Spouse rani Il People with a biological predisposition will develop schizophrenia only if certain kinds of events or stressors are also present. Aetationship to Person with SchizophreniaSCHIZOPHRENIA Dopamine hypothesis- the theory that schizophrenia results from excessive activity of the neurotransmitter dopamine, Antipsychotic drugs - drugs that help correct grossly confused or distorted thinking. Phenothiazines - A group of antihistamine drugs that became the first group of effective antipsychotic medications. Antipsychotic drugs produce Parkinsonian symptoms in people with schizophrenia while removing their psychotic symptoms.+ These people look as if they . do have schizophrenia, but SCHIZOPHRENIFORM DISORDER some of them later recover completely with no residual effects.ESSENTIAL FEATURES OF SCHIZOPHRENIFORM DISORDER + The term usually indicates a young person (late teens or 20s) who for 30 days to 6 months has + (1) delusions (especially persecutory) + (2) hallucinations (especially auditory (3) speech that is incoherent or otherwise disorganized + (4) severely abnormal psychomotor behavior (catatonic symptoms) (5) negative symptoms such as restricted affect or tack of volition (they don’t feel motivated to do work or maintain family life). + Diagnosis requires at least two of these five types of psychotic symptoms, at least one of which must be delusions, hallucinations, or disorganized speech. The patient recovers fully within 6 months. + Duration (30 days to 6 months)BRIEF PSYCHOTIC DISORDERESSENTIAL FEATURES OF BRIEF PSYCHOTIC DISORDER + All within the course of a single month, the patient develops, then recovers completely from an episode of psychosis that includes delusions, hallucinations, or disorganized speech (disorganized behavior may also be present). The episode lasts at least 1 day but less than 1 month. + Duration (1 day to 1 month) You can specify: With postpartum onset. Symptoms begin within 4 weeks of giving birthSCHIZOAFFECTIVE DISORDER a cross between a mood disorder and schizophrenia ‘2.weoks (psychosis) 2+ more weeks (mood episode) The mood symptoms are important in that they must be present during half or more of the total duration of illness. The psychosis symptoms are important in that they must be present by themselves for at least 2 weeks.ESSENTIAL FEATURES OF SCHIZOAFPFECTIVE DISORDER + A patient has a period of illness during which a manic episode or a major depressive episode lasts half of more of the total time involved. For at least a fortnight during this same continuous period, the patient fulfills the criterion A requirements for schizophrenia without having a mood episode. If the patient has a major depression, one of the symptoms must be depressed mood; “mere” loss of interest doesn’t cut it. Duration (a total of 1+ months) Differential diagnosis (psychotic mood disorders, substance use, and physical disorders)DELUSIONAL DISORDER Persistent delusions are the chief characteristic of delusional disorder The age of onset is often later in life (mid- to late 30 Delusional disorder is uncommon (by some estimates, schizophrenia is 30 times more frequent). Chronically reduced sensory input (being deaf or blind) may contribute to its development, as may social isolation (such as being an immigrant in a strange country). Delusional disorder may also be associated with family traits that include suspiciousness, Jealousy, and secretiveness. The persecutory type is by far the most common of the subtypes; the jealous type ranks a tant second. s) than that of schizophrenia.SHARED DE LUSIONS One or more persons develop delusions as a sult of close association with anothe delusional person DSM-IV called this condition shared psychotic disorder; as long ago as 150 years it was known as folie & deux, which mi “double insanity.” Shared delusions affect women more often than men, and they usually occur families. Social isolation may play a role in the development of this strange conditionESSENTIAL FEATURES OF DELUSIONAL DISORDER + For at least a month, the patient has had delusions but no other psychotic symptoms, and any mood symptoms are relatively brief. Other than consequences of the delusions, behavior isn’t much affected. + There might be some hallucinations of touch or smell, but only as they relate to the delusions. And they won't be prominent. + Duration (1+ months) + Distress and disability (none, except as related to the delusional content) + Differential diagnosis (physical and substance-induced psychotic disorders, mood or cognitive disorders, schizophrenia, obsessive-compulsive disorder