PSYCHIA CHAPTER 16

• Schizophrenia

  A psychotic disorder characterized by disturbances in thought and sensory perception, thought disorder and by deterioration in psychosocial functioning
• Schizophrenia

  Impaired reality testing, regressive behavior and impairment in interpersonal relationship, ineffective communications
• Schizophrenia

  Diagnosed in late adolescence or early adulthood
• Schizophrenia

  No clinical signs and symptoms are pathognomonic for schizophrenia

  Life expectancy is shortened because of an increase likelihood of suicide
• Schizophrenia in DSM V CRITERIA

  • Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (duration 6 months)
  • Social / occupational dysfunction
  • Schizoaffective and mood disorders are not present and are not responsible for signs and symptoms
  • not caused by substance abuse or a general medical disorder
• Schizophrenia 4 A’s of Schizophrenia according to Eugen Bleuler

  • Affect
  • Autism
  • Ambivalence
  • Associative looseness
• Affect

  ◦flat, blunted, inappropriate for the situation
• Autism

  ◦social withdrawal
• Ambivalence

  ◦ simultaneous opposite feelings, difficulty in making choices
• Associative looseness

  ◦inability to think logically, ideas shift
• BIOLOGIC THEORIES: Neuroanatomic and neurochemical factors

  • People with schizophrenia have relatively less brain tissue and CSF
  • Enlarged ventricles in the brain and cortical atrophy
  • Decreased brain volume and abnormal brain function in the frontal and temporal areas
  • Increased dopamine and Serotonin
• BIOLOGIC THEORIES: Immunovirologic factors

  Cytokines – believed to have a role in the development of psychiatric disorders
• Psychological Theory

  ◦ Poor mother-child relationship, deeply disturbed family interpersonal relationship, rigid concept of reality, impaired sexual identity and body image
• Vitamin Deficiency Theory

  ◦ Vitamin B1, B6, B12 and Vit. C
• Socio-environmental theory

  ◦ Unable to respond selectively to numerous social stimuli, faulty reaction to environment
• Positive or Hard symptoms

  Reflects the presence of overt psychotic or distorted behavior possibly due to an increase in amount of dopamine affecting the cortical areas of the brain

  • Ambivalence
  • Associative looseness
  • Delusions
  • Echopraxia
  • Flight of ideas
  • Hallucinations
  • Ideas of reference
  • Perseveration
• Negative or Soft symptoms

  • Reflect a diminution or loss of normal functions such as affect, motivation or the ability to enjoy activities
  • Alogia
  • Anhedonia
  • Apathy
  • Blunted Affect
  • Catatonia
  • Flat affect
  • Lack of volition
• Alogia - It means you speak less often, use fewer words, take longer to talk or are less likely to talk unless someone talks to you first.
• Anhedonia is the lack of interest, enjoyment or pleasure from life's experiences. You may not want to spend time with others or do activities that previously made you happy.
• Blunted affect is a decreased ability to express emotion through your facial expressions, tone of voice, and physical movements
• Catatonia, a neuropsychiatric syndrome characterized by abnormal movements, behaviors, and withdrawal
• flat affect is the observable absence of emotional reactivity in an individual. This observation includes a lack of emotion in facial expression and a monotone voice, a lack of eye contact, and a lack of body language, which expresses any emotion.
• "Avolition” is a term used to describe the lack of motivation or ability to do tasks or activities that have an end goal, such as paying bills or attending a school function. 
• Schizophrenia: assessment

  • History
  • General Appearance, Motor Behavior and Speech ◦Catatonia ◦Echopraxia ◦Psychomotor retardation ◦Waxy flexibility ◦Word salad
• General Appearance, Motor Behavior and Speech

  • Clang associations
  • Neologisms
  • Verbigeration
  • Echolalia
  • Stilted language
  • Perseveration
• Schizophrenia: assessment

  Mood and Affect Flat affect - no facial expression

  Blunted affect – few observable facial expression

  Anhedonia – feeling of depressed and having no pleasure or joy in life
• Schizophrenia: assessment

  Thought Process and content

  • Thought blocking
  • Thought broadcasting
  • Thought withdrawal
  • Thought insertion
  • Tangential thinking
  • Circumstantiality
  • Delusions
• Schizophrenia: assessment

  • Persecutory/paranoid delusions
  • Grandiose delusions
  • Religious delusions
  • Somatic delusions
  • Referential delusions (ideas of reference)
• Schizophrenia: hallucinations (types)

  • Gustatory
  • kinesthetic
  • Visual
  • Olfactory
  • Cenesthetic
  • Tactile
  • Auditory *command
• Judgment and Insight

  ◦Impaired in patients with schizophrenia
• Schizophrenia: assessment

  Self-Concept

  ◦Loss of ego boundaries

  ◦Lack of a clear sense of where his or her own body, mind, and influence end and where those aspects of other animate and inanimate objects again.

  ◦Evidenced by depersonalization derealization, and ideas of reference
• Schizophrenia: assessment

  Roles and Relationships

  Social isolation

  Physiologic and self-care
• Types of Schizophrenia

  • Schizophrenia, Paranoid Type
  • Schizophrenia, Catatonic Type
  • Schizophrenia, Disorganized Type
  • Schizophrenia, Residual Type
  • Schizophrenia, Undifferentiated Type
• Schizophrenia, paranoid type

  • Characterized by persecutory or grandiose delusions, hallucinations, and occasionally, excessive religiosity or hostile and aggressive behavior
  • May appear hostile or angry
  • None of the following are present: flat or inappropriate affect, disorganized speech or behavior, or catatonic behavior.
• Schizophrenia, disorganized type

  Characterized by grossly inappropriate or flat affect, incoherence, loose associations, and extremely disorganized behavior
• Schizophrenia, catatonic type

  • Characterized by marked psychomotor disturbance, either motionless or excessive motor activity.
  • Motor immobility may be manifested by catalepsy or stupor
  • Excessive motor activity is apparently purposeless and is not influenced by external stimuli.
• Schizophrenia, undifferentiated type

  • Characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect and behavior.
  • Functional level severely impaired
• Schizophrenia, residual type

  • Absence of prominent delusions and hallucinations.
  • Functioning level moderate, but a person can seldom keep a job.
  • There is continuing evidence of disturbances such as presence of negative symptoms
• RELATED DISORDERS:

  • Schizophreniform disorder
  • Schizoaffective disorder
  • Delusional disorder
  • Brief Psychotic disorder
  • Shared psychotic disorder (folie a deux)
• Schizophreniform disorder

  ◦ The client exhibits the symptoms of schizophrenia but for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia

  ◦ Social or occupational functioning may or may not be impaired