Schizophrenia Flashcards
Major psychological disorder
Severe Mental Illness (SMI)
“Schiz” means splitBetween thoughts and reality
Between thoughts and reality
␣ NOT between 2 separate minds ␣ NOT Dissociative Identity Disorder
Profound in its consequences
Impaired thought processes
␣ Misperceptions of the environment ␣ General life functioning usually quite impaired ␣ Impaired concentration ␣ Problems with motor activity ␣ Abnormal emotional style
Diagnostic Criteria Schiz
Problems present for at least 6 months
␣ Must be active period with psychotic episode for at least one month
␣ Course may or may not include a prodromal stage
␣ Cannot be due to a substance ␣ Very important differential diagnosis
The Course of Schizophrenia:
ot every patient diagnosed with schizophrenia manifests symptoms for life
ven though diagnostically will always carry diagnosis [schizophrenia, residual type]
Historically, used one-third rule
1/3 deteriorate for life ␣ 1/3 have chronic episodes of schizophrenia ␣ 1/3 show substantial improvement
Research on Relapse and Remission
5-year follow-up research results ␣ Zubin et al., 1989
22% one episode Research on Relapse and Remission
Group 1: One episode only; no impairment and improved
functioning (22%)
78% several episodes and varying degrees of
lasting impairment Group 2:Research on Relapse and Remission
Several episodes with minimal impairment
35%
Group 3:Research on Relapse and Remission
Impairment after single episode and increased impairment later (no return to normality) (8%)
Group 4: Research on Relapse and Remission
Impairment increasing after several episodes (no return to normality) (35%)
Gender Differences
Roughly similar prevalence rates for men and women
␣ Males diagnosed much earlier in life then rates decrease
␣ Women more frequently diagnosed later in life
␣ Age of onset has potential prognostic value
Symptoms of Schizophrenia1/2
No single feature seen invariably or only in schizophrenia
␣ No pathognomonic sign
␣ A constellation of features must exist for a diagnosis of schizophrenia to be made
␣ Talk about as positive and negative symptoms
Symptoms of Schizophrenia 2/2
Two (or more) during a 1-month period ␣ Delusions
␣ Hallucinations ␣ Disorganized speech ␣ Grossly disorganized or catatonic behavior ␣ Negative symptom
Negative Symptoms
correlated with more problems ␣ Higher rates of permanent disability
␣ Affective flattening ␣ Alogia ␣ Avoiltion ␣ Apathy
␣ Anhedonia ␣ Asociality
Thought Disorders
positive symptom
␣ Considered a “hallmark” of schizophrenia
␣ Remember NO pathognomonic signs! ␣ Thought disorders manifest in
␣ Content and/or ␣ What the thought is about
␣ Form ␣ How the production of thought appears
Thought disorders of Content
Major feature is presence of delusions ␣ False, fixed beliefs
␣ Not based in reality ␣ Maintained in the light of overwhelming
evidence to the contrary ␣ Many types of delusions
Delusion of persecution
Perhaps most common ␣ Belief that agency, group, or individual is out to
get person
Delusion of grandiosity
Person is extremely special, capable of special
feats ␣ Not based in reality ␣ Example: God, Christ, etc.
Delusion of reference
Events, objects, or people given unusual
significance ␣ . e.g., Nurse may be the Angel of Death
18
Delusions: Thought broadcasting
person believes can send thoughts to
minds of others
Delusion: Thought insertion
Belief that thoughts are being inserted into
one’s mind from some external source
Thought removal or extraction:
Belief that external agent is removing thoughts from one’s brain or head
Formal thought disorders
How the thought is expressed
Loose associations
Person jumps from topic to topic with no awareness that the topics are not (or are only obliquely) related
e.g., Q: “how are you feeling today?”
Disturbances of Perception
positive symptom ␣ Most common are hallucinations
-Perception of a stimulus where one does not exist
␣ Cf. delusion ␣ Must differentiate from keen sense or
sharpened sense in a trade ␣ E.g. “smelling when fluorescent lights go bad”
Hallucinations1/2
May be ongoing throughout problem and into remission
- Not necessarily every moment
- More sporadic than that
Hallucinations2/2
Different types indicate different problems
Psychological, substance induced, neurological
Auditory Hallucinations
-Most common in schizophrenia
- Hear sounds someone sitting next to person cannot hear because there is no sound
- Experienced externally
-Person with auditory hallucinations may not be
able to concentrate on any other task because “the voices” will not let them focus
-May be sounds or voices
-If voices, may be in form of narration or command -Command hallucinations can be risky
Tactile Hallucinations
Feeling something that is not present
␣ Much less common
␣ Include such things as tingling and burning sensations
␣ Frequently induced by substance
␣ Psychostimulants ␣ Crack cocaine, methamphetamine
Visual Hallucinations
Seeing what isn’t there ␣ Not typically found with patients diagnosed with
schizophrenia ␣ Often more indicative of substance induced
psychosis ␣ Hallucinogens, psychostimulants, MDMA, PCP
␣ May also be sign of organic (neurological) mental disorder
␣ Malignant neoplasm (tumor)
Olfactory Hallucinations
Perception of odors which are not present
␣ So uncommon warrant a complete set of neurological tests
␣ Must rule out possibility of brain tumor or other biological problem
␣ Stroke, preictal phase of seizure
Disturbance of Affect
Negative symptom ␣ Disturbance in emotional experience or expression
Restriction of affect
Reduction in range of emotions
Blunting of affect
Reduction in intensity of affective expression
Flattened affect
Complete absence of affective expression in the face or voice
Inappropriate affect
Responsiveness is inappropriate to the subject being discussed
␣ e.g., laughing when being told others will view and remove thoughts from you
Disturbances of Psychomotor Behavior
Catatonic features ␣ Catatonia refers to problems with movement ␣ Catatonic stupor-No movement, non-respondent ␣ Catatonic excitement
-Agitated, intense, or exaggerated movements
