SCHIZOPHRENIA

2nd most frequent diagnosis of patients 14-64 y/o

What is schizophrenia?

• A chronic severe brain disorder; often they hear voices, believe media are broadcasting their thoughts to the world or may believe someone is trying to harm them.

• In men it usually develops in teen years and early 20s; in women it usually develops in 20s and 30s.

Diagnosis

• Currently there is no physical or lab test that can absolutely diagnose schizophrenia.

• A psychiatrist usually comes to the diagnosis based on clinical symptoms.

Misdiagnosis

• This is a common problem since schizophrenia shares a significant number of symptoms with other disorders.

• Per the Nat’l Depression & Bipolar Support Alliance there is an average of 10 years from onset to correct diagnosis & tx.

Symptoms of Schizophrenia

• Profound disruption in cognition and emotion, affecting the most fundamental human attributes: – Language– Thought– Perception– Affect– Sense of self

Positive Symptoms

• Those that appear to reflect an excess or distortion of normal functions.

Positive Symptoms

• Delusions. Those where the patient thinks he is being followed or watched are common; also the belief that people on TV, radio are directing special messages to him/her.

Positive Symptoms

• Hallucinations. Distortions or exaggerations of perception in any of the senses.

• Often they hear voices within their own thoughts followed by visual hallucinations.

Positive Symptoms

• Disorganized thinking/speech.

• AKA loose associations; speech is tangential, loosely associated or incoherent enough to impair communication.

Positive Symptom

• Grossly disorganized behavior.

• Difficulty in goal directed behavior unpredictable agitation or silliness, social disinhibition, or bizarre behavior.

• There is a purposelessness to behavior.

Positive Symptom

• Catatonic behavior.

• Marked decrease in reaction to immediate environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.

Other Positive Symptoms

• Inappropriate response to stimuli

• Unusual motor behavior (pacing, rocking)

• Depersonalization

• Derealization

• Somatic preoccupations

Summary of Positive Symptoms

• Delusions

• Hallucinations

• Disorganized thinking

• Disorganized behavior

• Catatonic behavior

• Inappropriate responses

FYI: Positive Symptoms

• Positive symptoms are those that have a positive reaction from some treatment.

• In other words, positive symptoms respond to treatment.

Types of Schizophrenia

• Paranoid

• Hebephrenic

• Catatonic

• Residual

• Schizoaffective

• Undifferentiated

Paranoid Schizophrenia

• Persons are very suspicious of others and often have grand schemes of persecution at the root of their behavior.

• During this phase they may have hallucinations and frequent delusions.

Hebephrenic Schizophrenia

• AKA disorganized schizophrenia; characterized by emotionless, incongruous, or silly behavior, intellectual deterioration, frequently beginning insidiously during adolescence.

• May be verbally incoherent and may have moods and emotions that are not appropriate to the situation.

• Hallucinations not usually present.

Catatonic Schizophrenia

• Person is extremely withdrawn, negative and isolated.

• May have marked psychomotor disturbances.

Residual Schizophrenia

• Lacks motivation and interest in day-to-day living.

• Person is not usually having delusions, hallucinations or disorganized speech.

Schizoaffective Disorder

• There will be symptoms of schizophrenia as well as mood disorder (depression, bipolar, mixed mania).

Undifferentiated Schizophrenia

• Conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the previous types.

• Exhibits more than one of the previous types without a clear dominance of one.

Summary

• Before a diagnosis the psychiatrist must make a thorough evaluation including a physical/medical exam, a mental status exam, appropriate labs, and a full history.

• History includes changes in thinking, behavior, movement, mood, etc. as seen by the family.

• These medications may have such intolerable side effects that the patient will stop the drugs.

• One study showed the average time the meds were taken regularly was 3 months.

Treatments

• Psychotherapy - an adjunct to meds and is very useful to keep the patient on the meds.

• Group therapy

• Family therapy

• Community support groups