Schizophrenia

• what percent of our population does schizophrenia effect?

  1%
• Who is Emil Kraepelin?

  A German psychiatrist who invented dementia praecox

  He differentiated between 2 psychotic illnesses (Manic depression and dementia praecox)
• Dementia praecox 


  Praecox - early onset

  Dementia - deteriorating course marked by progressive intellectual deterioration
• Who is Eugene Blueler?


  A Swiss psychiatrist that moved away from early definitions and proposed the new name "schizophrenia" which means split mind
• what is the common core of schizophrenia?

  Disruptions of "associative threads" (between thoughts, language, behaviour, etc.)
• Changes of prevalence rates of schizophrenia due to diagnostic changes

  1930s: 20% of a New York State Psychiatric Institute were diagnosed with schizophrenia

  1952: peaked at 80%
• what year did schizophrenia become part of the DSM?

  1952 (DSM-I)

  1968 (DSM-II)
• New diagnostic practices of schizophrenia

  -Schizophrenia was usually diagnosed whenever there were delusions or hallucinations, meaning that individuals who had mood disorder with delusions or hallucinations may have been wrongly diagnosed (according to DSM-II).

  -Those who today would be diagnosed with personality disorder were diagnosed with schizophrenia (according to DSM-II).

  -Those with acute onset of schizophrenia and rapid recovery were diagnosed with schizophrenia.
• DSM-IV subtypes of schizophrenia

  disorganized schizophrenia

  catatonic schizophrenia

  paranoid schizophrenia
• disorganized schizophrenia

  disorganized thought processes
• catatonic schizophrenia 


  -Disturbances in movement, people may exhibit a drastic reduction in activity (catatonic stupor) or dramatic increases in activity (catatonic excitement).

  -These clients resist instructions and suggestions and often echo (repeat back) the speech of others.
• paranoid schizophrenia 


  These individuals may not appear odd or unusual and may not readily discuss the symptoms of their illness, but it might come up at times.

  • Delusions of persecution
  • Grandiose delusions (an exaggerated sense of their own importance, power, knowledge, or identity).
  • Delusional jealousy (the unsubstantiated belief that their partner is unfaithful).
  • Ideas of reference (incorporate unimportant events within a delusional framework and read personal significance into the trivial activities of others).
• undifferentiated schizophrenia 


  diagnosed when people who meet the diagnostic criteria for schizophrenia but not the criteria for any of the 3 subtypes
• residual schizophrenia 


  diagnosed when the patient no longer meets the full criteria for schizophrenia but still shows some signs of the disorder.
• positive symptoms 


  The presence of too much of a behaviour that is not present in most people ("excesses or distortions").

  • delusions
  • hallucinations
  • disorganized speech
• delusions 


  False beliefs strongly held in spite of invalidating evidence.

  -paranoid delusions: (or delusions of persecution where you believe someone is after you)

  -delusions of reference: (when things in the environment seem to be directly related to you even though they are not).

  -somatic delusions: (false beliefs about your body)

  -delusions of grandeur: (you believe that you are very special or have special powers or abilities).
• Hallucinations

  Sensory experiences in the absence of any stimulation from the environment.

  -visual

  -auditory

  -tactile

  -olfactory

  -gustatory
• disorganized speech

  -Incoherence

  -Loose associations: things in a conversation that may be tied together loosely but still aren't making a lot of sense

  -Word salad: really distorted thoughts and then a production of language ("market dog blue asphalt")
• negative symptoms 


  the absence of a behaviour that should be evident in most people
• the 5 As of negative symptoms of schizophrenia

  avolition

  alogia

  anhedonia

  flat affect

  asociality
• avolition


  a lack of energy and a seeming absence of interest in or an inability to persist in what are usually routine activities.

  often mistaken for apparent mis interest
• alogia

  -Lessening of speech fluency and productivity and it is thought to reflect slowed or blocked thoughts which will often result in short or very empty replies to questions. 

  -A negative thought disorder and it can take many forms.

  -In poverty speech, the sheer amount of speech is greatly reduced and in poverty of content of speech, the amount of discourse is adequate, but it conveys little information and tends to be vague and repetitive.
• anhedonia


  an inability to experience pleasure.

  It is manifested as a lack of interest in recreational activities, failure to develop close relationships with other people, and lack of interest in sex.
• flat affect


  Virtually no stimulus can elicit an emotional response.

  A reduction in range and intensity of emotional expression.
• asociality


  a severe impairment in social relationships
• catatonic immobility 


  clients adopt unusual postures and maintain them for very long periods of time.
• waxy flexibility 


  another person can move the persons' limbs into strange positions that they maintain for extended periods.
• inappropriate affect


  the emotional responses of these individuals are out of context

  ex., laughing when someone passes away
• bizarre behaviour

  -talking to themselves in public

  -hoarding food

  -collecting garbage

  -echolalia: copying what someone is saying

  -echopraxia: copying someone's behaviour
• Differential diagnosis to schizophrenia

  mood disorder

  schizoaffective disorder

  personality disorders

  schizophreniform disorder

  brief psychotic episode

  delusional disorder
• mood disorder 


  delusions and hallucinations might be present with mood disorders but are secondary to mood disorders.
• schizoaffective disorder


  disorder characterized by symptoms that meet criteria for schizophrenia and concurrently major depressive disorder or mixed or bipolar episodes.
• personality disorder


  may have similar delusions but we don’t see the deterioration of functioning that we would see in someone with schizophrenia
• schizophreniform disorder

  meets criteria for schizophrenia but for less than 6 months, but greater than one month
• brief psychotic episode

  see symptoms for at least one day, but for less than one month
• delusional disorder

  an illness characterized by the presence of non-bizarre delusions, but not seeing the deterioration of schizophrenia