Classification of Schizophrenia Flashcards
what is schizophrenia?
6
a type of psychosis and a severe mental disorder characterised by a profound disruption of cognition and emotion — meaning that thoughts and emotions are so impaired that contact is lost with external reality
this affects a person’s language, thought, perception, emotions and sense of self
people with schizophrenia tend to have delusions (believing things that are not and cannot possibly be true) and hallucinations (hearing voices or seeing visions when there are no sensory stimuli to create them)
schizophrenia affects about 4 in 1000 people at some point in their lives — it is the most common psychotic disorder, affecting about 1% of the population at some point in their lifetime
most often diagnosed between the ages of 15 and 35, with men and women affected equally
there are many symptoms of the disorder, although not every patient displays all the symptoms
diagnosing schizophrenia
5
in order to diagnose schizophrenia, a clinician would use a diagnostic manual such as DSM-V
DSM (The Diagnostic and Statistical Manual of Psychiatric Disorders) is the classification and description of over 200 mental disorders, grouped in terms of their common features
DSM-V is the most recent update
DSM is mostly used in the US, whereas in Europe ICD (International Classification of Diseases) is more commonly used
the most recent update of ICD is ICD-11
characteristics necessary for a diagnosis of schizophrenia using DSM-V
5
CRITERION A — two or more of the following symptoms…
• delusions
• hallucinations
• disorganised speech (frequent derailment or incoherence)
• grossly disorganised or catatonic behaviour
• negative symptoms (affective flattening, alogia or avolition)
only one of these symptoms are required if delusions are bizarre OR hallucinations consist of a voice commenting on the person’s behaviour or two or more voices communicating with each other
CRITERION B — social and occupational dysfunction; one or more major areas of functioning such as work, interpersonal relations or self-care are markedly below the level achieved prior to the onset
CRITERION C — duration; continuous signs of the disturbance persist for at least 6 months, this period must include at least 1 month of symptoms that meet criterion A
during non-active periods, disturbance may be limited to negative symptoms or two or more criterion A symptoms in attenuated form (e.g. odd beliefs or unusual perceptual experiences)
positive symptoms of schizophrenia
3
the symptoms of schizophrenia are typically divided into positive and negative symptoms
positive symptoms = symptoms that appear to reflect an excess or distortion of normal functions
these include.... • hallucinations • delusions • disorganised speech • grossly disorganised or catatonic behaviour
positive symptoms: hallucinations
7
hallucinations are bizarre, unreal perceptions of the environment
they are distortions or exaggerations of perception in any of the senses
hallucinations can be…
• AUDITORY (hearing voices that other people can’t hear)
- VISUAL (seeing lights, objects or faces that other people can’t see)
- OLFACTORY (smelling things that other people cannot smell)
- TACTILE (such as feeling that bugs are crawling on or under the skin or something touching the skin)
hallucinations are usually auditory and many schizophrenics report hearing a voice or several voices, telling them to do something (such as harm themselves or others) or commenting on their behaviour
positive symptoms: delusions
8
delusions are bizarre beliefs that seem real to the person with schizophrenia, but they are not real
they are firmly held incorrect beliefs that are caused by distortions of reasoning or misinterpretations of perceptions and experiences
sometimes these delusions can be PARANOID and persecutory in nature — this often involves the belief that the person is being followed or spied upon by someone
they may belief that their phone is tapped or that there are video cameras hidden in their home
DELUSIONS OF GRANDEUR — delusions may also involve inflated beliefs about the person’s power and importance
for example, the individual may believe they are famous or have special powers or abilities
DELUSIONS OF REFERENCE — a schizophrenic may also experienced delusions of reference in which they believe that events in the environment appear to be directly related to them
for example, special personal messages are being communicated through the TV or radio to them
positive symptoms: disorganised speech
4
disorganised speech is the result of abnormal thought processes
the individual has problems organising their thoughts, which shows in their speech
they may slip from one topic to another, even in mid sentence (known as derailment)
in extreme cases, their speech may be so incoherent like that it sounds like complete gibberish (often referred to as ‘word salad’)
positive symptoms: grossly disorganised or catatonic behaviour
4
the inability or lack of motivation to initiate a task, or to complete it once it has started
this leads to difficulties in daily living and can result in a decreased interest in personal hygiene
the individual may dress or act in ways that appear bizarre to other people, such as wearing heavy clothes on a hot summers day
catatonic behaviours are characterised by a reduced reaction to the immediate environment, rigid postures or aimless motor activity
negative symptoms of schizophrenia
9
negative symptoms = symptoms that appear to reflect a reduction or loss of normal functions
often persist even during periods of low or absent positive symptoms
around 1 in 3 schizophrenia patients suffer from significant negative symptoms
weaken the person’s ability to cope with everyday activities, affecting their quality of life and their ability to manage without significant outside help
schizophrenics are often unaware of the extent of their negative symptoms and are typically less concerned about them than their relatives may
enduring negative symptoms are sometimes referred to as the deficit syndrome, which is characterised by the presence of at least two negative symptoms for 12 months or longer
those with the deficit syndrome have been found to have more pronounced cognitive deficits and poorer outcomes than patients who do not have this syndrome
negative symptoms respond poorly to antipsychotic treatment, although the newer ‘atypical’ antipsychotics are claimed to be superior in this respect than the older ‘typical’ antipsychotics
negative symptoms include... • speech poverty (alogia) • avolition • affective flattening • anhedonia
negative symptoms: speech poverty (alogia)
5
the lessening of speech fluency and productivity, which reflects slowing or blocked thoughts
patients who display speech poverty display a number of characteristic signs….
• they may produce fewer words in a given time on a verbal fluency task (such as naming as many animals as they can in one minute)
this is not because they don’t know as many words as non-schizophrenics, it’s because they have more difficulty with spontaneously producing them
they may also speak in less complex syntax, such as fewer clauses and shorter utterances
this type of speech appears to be associated with long illness and earlier onset of the illness
negative symptoms: avolition
7
the reduction, difficulty or inability to initiate and persist in goal directed behaviour
often mistaken for apparent disinterest
a reduction of interests and desires as well as an inability to initiate and persist in goal directed behaviour
this may involve sitting in the house for hours every day doing nothing
avolition is different to poor social function or simple disinterest, which can be the result of other circumstances
for example, an individual may have no social contact with family or friends because they have none or communication with them is difficult
however, this would not be considered avolition because avolition is specified as a reduction in self initiated involvement in activities that are available to the patient
negative symptoms: affective flattening
3
a reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language
individuals show fewer body and facial movements, smile less and use less co-verbal behaviour such as movement of the hands, head and face that usually accompany speech
they may also show a deficit in prosody (paralinguistic features such as intonation, tempo, loudness and pausing) that provide extra information and cues to the listener as to emotional or attitudinal content and turn taking
negative symptoms: anhedonia
5
a loss of interest or pleasure in all or almost all activities or a lack of reactivity to normally pleasurable stimuli
it may be pervasive and all embracing or may be confined to a certain aspect of experience
physical anhedonia = the inability to experience physical pleasures such as pleasure from food or bodily contact
social anhedonia = the inability to experience pleasure from interpersonal situations such as interacting with others
social anhedonia overlaps with other disorders such as depression whereas physical anhedonia does not so is considered a more reliable symptom of schizophrenia
