SCHIZOPHRENIA

REPORTED BY: Francis Von Saulo Ronaly Capunitan Jan Michael Armogenia

OUTLINE:
‡ Schizophrenia

‡ Types of Schizophrenia ‡ Psychotic Disorders in the DSM-IV ‡ Symptoms, Diagnosis and Prognosis - Positive Symptoms - Negative Symptoms - Other features of Schizophrenia ‡ Extraordinary people: JOHN NASH, ´A Beautiful mindµ

‡ Biological Theories - Genetic Contributors to Schizophrenia - Structural Brain Abnormalities - Neurotransmitter ‡ Psychosocial Perspectives - Family Interactions and Schizophrenia ‡ Treatments Stress and Schizophrenia - Biological Treatments: Drug Therapy - Psychological and Sociocultural Treatments

CHAPTER OVERVIEW TAKING PSYCHOLOGY PERSONALLY ‡ Helping families cope with schizophrenia EXTRAORDINARY PEOPLE ‡ John Nash. A Beautiful Mind BIOLOGICAL THEORIES ‡ There is strong evidence that schizophrenia is transmitted genetically. People with schizophrenia show abnormalities in the prefrontal cortex and ventricles of the brain. A number of prenatal difficulties and obstetrical problems at birth are implicated in the .

including prenatal hypoxia and exposure to the influenza virus during the second trimester of gestation. Imbalances in the neurotransmitter dopamine. More recent theories have focused on aspects of family life that . glutamate. and GABA are also implicated in schizophrenia.development of schizophrenia. serotonin. PSYCHOSOCIAL PERSPECTIVE ‡ Early psychodynamic theorists suggested that schizophrenia results from overwhelmingly negative experiences in early childhood between a child and his or her primary caregivers.

Cognitive theories accept that there is a biological vulnerability to schizophrenia but see many symptoms as attempts to understand and cope with basic perceptual and attentional problems. A variety of stressors may worsen the course of schizophrenia . . Behavioral theories suggest that the symptoms of schizophrenia can develop through operant conditioning.and relapse in schizophrenia .

.TREATMENTS ‡ Drugs called neuroleptics have proven useful in the treatment of schizophrenia. New drugs known as atypical antipsychotics appear to be effective without inducing as many side effects as previous drugs. Psychosocial therapies focus on teaching communication and living skills and reducing isolation in people with schizophrenia. They have significant neurological side effects.

emotions.  the most common of the psychotic disorders (or a group of disorders) marked by severely impaired thinking. includes several subtypes. and behaviors.SCHIZOPHRENIA  disorder consisting of unreal or disorganized thoughts. . each having a distinctive set of symptoms. cognitive and behavioral deficits. described in Axis I of the DSM-IV-TR. and perceptions as well as verbal.

In the third or maintenance phase. . In the second or stabilization phase. Even in the maintenance phase. relapses are not unusual and patients do not always return to full functioning. the patient has an overt loss of contact with reality (psychotic episode) that requires intervention and treatment. however. In the acute phase. the patient is relatively stable and can be kept indefinitely on antipsychotic medications.Description of Schizophrenia The course of schizophrenia in adults can be divided into three phases or stages. the initial psychotic symptoms have been brought under control but the patient is at risk for relapse if treatment is interrupted.

They have predominantly "negative" symptoms. by a Swiss doctor named Eugen Bleuler. such as delusions and hallucinations. such as . some psychotherapists have begun to use a classification of schizophrenia based on two main types. or positive schizophrenia.The term schizophrenia comes from two Greek words that mean "split mind. People with Type II. are usually described as poorly adjusted before their schizophrenia slowly overtakes them." It was observed around 1908. Recently. People with Type I. They also tend to suffer more from the "positive" symptoms. or negative schizophrenia. to describe the splitting apart of mental functions that he regarded as the central characteristic of schizophrenia. have a rapid (acute) onset of symptoms and tend to respond well to drugs.

complete motionlessness for long periods.g..g. complete incoherence.g. beliefs that you are being persecuted or that you are the Messiah) Unreal perceptual or sensory experiences ( e. and/or shows a complete lack of responsiveness to the outside world (e.. untriggered outburst) . and feeling things that are not there) Grossly disorganized pattern of speech ( e. sudden..g. hearing. thoughts. linking together of words based on sounds instead of meaning) Behavior that is highly unpredictable.The positive symptoms of schizophrenia represent the presence of unusual perceptions.. seeing. or behaviors. is bizarre. SYMPTOMS DEFINITION AND EXAMPLE Delusions Hallucinations Disorganized thought and speech Disorganized or catatonic behavior POSITIVE SYMPTOMS OF SCHIZOPHRENIA Beliefs with little grounding in reality( e.

Examples No facial expressions in response to emotionally charged stimuli. eat breakfast in morning.NEGATIVE SYMPTOMS OF SCHIZOPHRENIA The negative symptoms of schizophrenia represent the absence of usual emotional and behavioral response. no emotional expression in voice. Inability to get dressed. Severe reduction or complete absence of speech. Symptoms Affective flattening (blunted affect) Description Severe reduction or complete absence of affective( emotional) responses to the environment. Alogia Avolition . Complete mutism for weeks. brush teeth. goal oriented tasks. Inability to persist at common.

Sample Illustrations/Photos of Schizophrenics .

Sample Illustrations/Photos of Schizophrenics .

so that unhappy stimuli trigger sadness. ‡ Whatever the cause. affect. the person will switch from one extreme emotional expression to another for no apparent reason. inappropriate affect is one of the most striking symptoms in schizophrenia.OTHER FEATURES OF SCHIZOPHRENIA INAPPROPRIATE AFFECT ‡ Instead of showing flattened. . or blunted. This may happen because he or she is thinking about the responding to something other than what is going on in the environment. the person with schizophrenia may show inappropriate affect. laughing at sad things and crying at happy things. ‡ Inappropriate displays of affect may also occur because the brain processes that match stimuli with the proper emotions and emotional responses to those stimuli are not working properly. Often.

and no matter what happens. IMPAIRED SOCIAL SKILLS ‡ Not surprisingly. however. affect are actually experiencing emotions. they do not feel happy or sad.ANHEDONIA ‡ Recall that many people who display flattened. experience severe anhedonia. People with schizophrenia show a wide range of impaired social skills. similar to the anhedonia that characterizes depression. the symptoms of schizophrenia make it difficult to have normal interactions with other people. This emotional void itself can be very aversive. Some people with schizophrenia. They lose the ability to experience emotion. although they are not showing them. or blunted. including difficulty in holding conversations in maintaining .

Pictures of other features of Schizophrenia .

Social/ occupational functioning: significant impairment in work. academic performance. interpersonal .) Negative symptoms B.DIAGNOSTIC CRITERIA FOR SCHIZOPHRENIA The DSM-IV criteria for schizophrenia require the presence of severe symptoms for at least one month and the presence of some symptoms for at least six months.) Delusions 2.) Disorganized speech 4. A. Core symptoms: two or more of the following present for at least a one-month period: 1.) Grossly disorganized or catatonic behavior 5.) Hallucinations 3.

Prodromal symptoms are present before people go into the acute phase of schizophrenia.C. He viewed the disorder as progressive. irreversible. because he believed that the disorder results from premature deterioration of the brain. . and chronic. and residual symptoms are present after they come out the acute phase. Kraepelin¶s definition of this disorder was a narrow one. at least one month of this period must include symptoms that meet Criterion A above. which resulted in only a small percentage of people receiving this diagnosis. Duration: continuous signs of the disturbance for at least six months. In 1883. Kraepelin labeled the disorder dementia praecox (precocious dementia).

A. there have been delusions or hallucinations for at least two weeks in the absence of prominent mood symptoms. a manic episode. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness. C. During the same period of illness. .DIAGNOSTIC CRITERIA FOR SCHIZOAFFECTIVE DISORDER The major distinction between schizoaffective disorder and schizophrenia is the presence of severe mood symptoms in schizoaffective disorder. or a mixed episode concurrent with symptoms that meet criterion A for schizophrenia. An uninterrupted period of illness during which. B. at same time. there is either a major depressive episode.

Undifferentiated schizophrenia Residual schizophrenia . catatonic schizophrenia. disorganized. and behavior and flat or inappropriate affect. History of at least one episode of acute positive symptoms but currently no prominent positive symptoms. Incoherence in cognition. Diagnosed when a person experiences schizophrenic symptoms but does not meet the criteria for paranoid. Nearly total unresponsiveness to the environment. as well as motor and verbal abnormalities. TYPE Paranoid schizophrenia Disorganized schizophrenia Catatonic schizophrenia MAJOR FEATURES Delusions and Hallucinations with themes of persecution and gradiosity. speech.TYPES OF SCHIZOPHRENIA The DSM-IV recognizes five subtypes of schizophrenia.

S. . ‡ P. do not show disorganized speech or behavior unlike in other types of schiz.Paranoid Schizophrenia ‡ It is the best known and most researched type of Schizophrenia. Schizophrenics (P. highly resistant to any arguments against their delusions. ‡ P. are lucid and articulate. ‡ P.S.) have prominent delusions & hallucinations that involve themes of persecution and grandiosity.S. act arrogantly as if they were superior to others or may remain aloof and suspicious.

± better than the other types. show better cognitive and social functioning. ‡ Likely to live independently. ‡ P. ‡ Onset of P. and episodes of psychosis are often triggered by stress.Paranoid Schizophrenia ‡ Prognosis for P. . hold down a job.S. Schizophrenia is considered a milder less insidious form of Schiz. Schizophrenia tend to occur later in life than does the onset of other types of Schiz..

S.Disorganized ‡ Disorganized Schizophrenics (D. Schizophrenia . may not show any emotional reactions to anything. dress. or eat if left on their own. prone to odd stereotyped behaviors (frequent grimacing or mannerisms such as flapping of hands). ‡ Emotional experiences and expressions are disturbed. they do not bathe. unusual or inappropriate emotional reactions to events.) do not have well-formed delusions or hallucinations but their thoughts and behaviors are severely disorganized.

Schizophrenia ‡ D. Schizophrenia tends to have an early onset and a continuous course. Disorganized . D. w/c is often unresponsive to treatment.S. are among the most disabled by the disorder.

Catatonic Schizophrenia ‡ Distinct features of Catatonic Schizophrenia. ‡ Clinically significant case of C. jejejejeje :] ) 6. Odd mannerisms (grimacing and hand flapping) 5. Maintenance of rigid postures or being completely mute for long periods of time 4. Catatonic excitement (excessive and purposeless motor activity) 3. the variety of motor behaviors and ways of speaking that suggest almost complete unresponsiveness to their environment. Catatonic stupor (motionless for long periods of time) 2. Echopraxia (repetitive imitation of the movements of another person) . Echolalia (senseless repetition of words just spoken by others-Maina bird is a sample of this. Schizophrenia requires two (2) of the following: 1.

) have symptoms that meet the criteria for schizophrenia (delusions. or catatonic Schiz. disorganized. . ‡ Tend to have an onset relatively early in life and to be chronic and difficult to treat. disorganized behavior.Undifferentiated Schizophrenia ‡ Undifferentiated Schizophrenics (U. disorganized speech. negative symptoms) but do not meet the criteria for paranoid. hallucinations.S.

however.S.‡ Have had at least one acute episode of acute positive symptoms of Schiz. ‡ R.) continue to have signs of the disorder. Residual Schizophrenia .S. including the negative symptoms and mild versions of the positive symptoms. ‡ Residual Schizophrenics (R. But do not currently have prominent positive symptoms of Schiz. may have these residual symptoms chronically for several years.

Schizophrenia ‡ Schizophrenia ³S´ . ‡ As many as 10% of schizophrenics commit suicide. Life expectancy of schizophrenics is 10 years shorter than that without ³S´. ‡ Schizophrenics suffer from infectious and circulatory diseases at a higher rate.is more chronic and debilitating that most other mental disorders.Prognosis . .

Age and Gender Factors ‡ The ³S´ most stabilize w/in 5-10 years of its first episode. Example: John Nash ‡ Women with ³S´ have a more favorable course of the disorder than do men. Women are hospitalized less often and for brief periods of time. . and the number of rehospitalization decline as the person grows older. They show milder negative symptoms and they have better social adjustment when they are not psychotic.

.Socio-cultural Factors ‡ ³S´ tends to have a more benign course in developing countries than in developed countries. ‡ Social factors likely contribute to the gender differences in the course of schizophrenia. The social environments of schizophrenics in developing countries may facilitate adaptation.

serotonin. Exposure to viruses during prenatal period might damage the brain. Delivery complications. Imbalances in levels of or receptors for dopamine cause symptoms. particularly those causing loss of oxygen. or at least a vulnerability to ³S´. Reduced volume and neuron density in the frontal cortex and the temporal and limbic areas causes widespread cognitive and emotional deficits. Birth complications Prenatal viral exposure Neurotransmitter theories . might damage the brain. Enlarged ventricles may indicate deterioration of a number of brain areas.Biological Theories of ´Sµ Theory Description Genetic theories Structural brain abnormalities Disordered genes cause ³S´. and glutamate may also play roles. GABA. leading to cognitive and emotional deficits.

people born into poor urban setting are at increased risk for the prenatal diseases and injuries that may contribute to schizophrenia.. also. Stress and relapse Behavioral theories Cognitive theories The symptoms of ³S´ arise from an individual¶s responses to strange perceptual experiences. Oddities in communication by a caregiver to a child at risk for schizophrenia impair the development of the child¶s ability to communicate with others and increase stress. Schizophrenia impairs functioning.Psychosocial Perspective Perspective Psychodynamic theory Communication patterns Expressed emotion Social drift and urban birth Description Overwhelming rejection by an infant¶s caregiver causes the child to lose ability to distinguish reality from unreality. Families that are over-involved with and hostile toward their member w/ schizophrenia increase stress. w/c leads to relapse. . A variety of stressful events increase risk of relapse. leading an individual to lose social status. Schizophrenics attend to irrelevant stimuli in the environment and do not know socially acceptable responses to others.

Treatments Biological treatments: ‡ Drug Therapy (Antipsychotic drugs) ‡ Insulin coma therapy ‡ Electroconvulsive therapy (ECT) Psychological and Social treatments: ‡ Behavioral. Cognitive. and Social Interventions ‡ Family Therapy .

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