schizophrenic disorder ppt ok

8/19/2019 Schizophrenic Disorder PPT OK

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Schizophrenic Disorders

By Sawiji, S.Kep.Ns., MSc.*

E-mail: [email protected]

Mobile Phone: !1 "#! #!"""

$EP%&'MEN' () N&S+N B%S+ S+ENE

M%MM%$+/% (MB(N E%0' S+ENE +NS'+''E

mailto:[email protected]:[email protected]


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Topics of discussion

1. Sympoms o2 Schi3oph4enia

#. $iagnosic consi5e4aions

". (nse an5 o64se7. Special 'opic: 6l64e an5 schi3oph4enia

8. Eiological 2aco4s

9. 6lne4abiliy ma4;e4s


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What is schizophrenia?

Schi3oph4enia is 6s6ally ho6gh o be :

a mental disorder or illness

which disturbs how a person

thinks, feels and behaves. Andalso how it affects the person

changes over time.


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Etiology of schizophrenia

'his is an a4ea o2 g4ea 5ebae. Many

heo4ies ha>e been p6 2o4wa45 in he

pas which ha>e no been s6ppo4e5 bylae4 scieni2ic 4esea4ch.

It is probable that there are a

number of different causes.


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1. Mo5e4n echni?6es ha>e 5emons4ae5 ha

some affected people have changes in

the structure of their brains.#. 'he4e is also e>i5ence ha some of these

individuals may have been affected by

infections before they were born.

". (ccasionally the disorder appears to run

in families affecting many members.


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7. +nc4easingly, i has been shown ha some of thechemical messengers in the brain(particularly two called serotonin anddopamine) are not working correctly.

8. 'he in5i>i56als b4ea;5own may occ64 as a resultof drug or alcohol misuse, emotionalstress or difficulties in life experiences.

'he4e is no scieni2ic e>i5ence o s6ppo4 he i5ea

ha how pa4ens b4ing 6p hei4 chil5 can ca6seschi3oph4enia.


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Schizophrenic Symptoms

There are three :

a. positive symptoms

b. negative symptoms

c. disorganized symptoms


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%n eAcess o4 5iso4ion o2 no4mal

26ncions.

Posii>e sympoms 5o no 4e2e4 ogoo5C sympoms, b6 o 26ncions

ha a4e p4esen ha sho6l5 no be.

'hese a4e sympoms 6s6ally e?6ae5wih c4a3inessC

a. Positive (psychotic)

symptoms :


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a.1. Hallucinations

-heighene5 senso4y Dpe4cep6aleApe4iences ha a4e no 56e o eAe4nal

sim6li -Possible o eApe4ience hall6cinaions h4o6gh

any o2 he 8 senso4y mo5es

-Mos common hall6cinaion is auditoryEAample: ea4ing wo >oices ca44ying on a 46nningcon>e4saion abo6 e44ible pe4son yo6 a4e


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a.2. Delusions

-Belie2s 4igi5ly hel5 alho6gh p4epose4o6sin na64e ha 6s6ally in>ol>e a

mis4ep4esenaion o2 pe4cepions an5

eApe4iencesEAample: Belie2 ha yo6 alone can en5 sa4>aion

in he wo4l5

EAample: Belie2 ha s?6i44els a4e aliens sen oea4h on a 4econnaissance mission


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b. Negative symptoms

% loss o4 5e2ici in no4mal 26ncions.

Negai>e sympoms 5o no 4e2e4 o ba5C

sympoms, b6 o 26ncions ha a4e absenha sho6l5 be p4esen.

'hese a4e aspecs o2 behavior and socialrelationships ha sho6l5 be he4e, b6 a4e

no.


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b.1. lunted affect

!affecti"e flattening# -&es4icion o4 2laening o2 non>e4bal5isplay o2 emoion

-+magine i2 people wo4e mas;s all he ime. /o6co6l5 comm6nicae wih hem, b6 yo6 co6l5 no

4ea5 hei4 2acial emoional 4eacions.

EAample: % pe4sons >oice may lac; no4malchanges in pich an5 >ol6me when 5esc4ibing

somehing eAciing ha happene5 o hem.


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b.2. $nhedonia

-%n inabiliy o eApe4ience pleas64e

EAample: losing pleas64e in eaing, o4social 4elaionships ha yo6 wo6l5

ypically 2in5 enjoyable


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b.%. $logia !speechlessness#

-Po>e4y o2 speech ha may loo; li;e b4ie24eplies wih >e4y lile conen Dempy.

EAample

+ne4>iewe4: $o yo6 ha>e any chil54enF

lien: /es.

+ne4>iewe4: ow many chil54en 5o yo6 ha>eF lien: 'wo.

+ne4>iewe4: ow ol5 a4e heyF

lien: 'h4ee an5 se>en.


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b.&. $"olition

-'he lac; o2 >oliion o4 willpowe4 o iniiae

an5 pe4sis in goal-5i4ece5 aci>iies.

EAample: Showing lile ine4es in bahing,

b46shing eeh an5 combing ones hai4 Di.e.,

pe4sonal hygiene

EAample: No waning o go o a "pm class e>en-

ho6gh yo6 ha>e 54esse5 2o4 class


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c. Disorganized symptoms

Sympoms ha 5o no 2i he cha4ace4isics

o2 posii>e o4 negai>e sympoms.

&e2lec bi3a44e beha>io4s an5 5is64bancesin hin;ing.


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c.1. Disorganized speech

-Saying hings ha con>ey lile, i2 any,

meaning. Speech p4es6me5 o 4e2lec

6n5e4lying 5iso4gani3e5 hin;ing.

EAample- le6ce is a 4ans2o4maion o2 a 5ea5 co6ga4(especially US = PUMA ha s622e4e5 a 4elapse on

he lions oe.C

+ne4>iewe4: =hy a4e yo6 in he hospial, Ge22F

Ge22: + 4eally 5on wan o be he4e. +>e go ohe4 hings

o 5o. 'he ime is 4igh, an5 yo6 ;now, when

oppo46niy ;noc;sH


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c.2. izarre beha"iors

-Grossly disorganized behavior orcatatonic behavior , s6ch as 6n6s6albo5y mo>emens o4 inappropriate affect s6ch as emoional eAp4essions ha 5o nomach he si6aion

EAample: Mainaining a s?6aing pos64e ha is

4esisan o any e22o4s a changing he pos64e

EAample: iggling while 4elaying some pe4sonal4age5y


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Schizophrenia Symptoms

Posi1i>esymp1oms

Nega1i>esymp1oms

$iso4gani3e5symp1oms

.all6cina1ions Bl6n1e5

a22ec1

$iso4gani3e5

Speech

$el6sions %nhe5onia $iso4gani3e5Beha>io4

%logia

%>oli1ion


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Sympoms o2 Schi3oph4enia $iagnosic consi5e4aions (nse an5 o64se Special 'opic: 6l64e an5 schi3oph4enia Eiological 2aco4s 6lne4abiliy ma4;e4s '4eamens =ill no co>e4

I Phases o2 Schi3oph4enia

I Ne64opahology


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2. Diagnosing Schizophrenia

M6s show an impai4men in social o4

occupational 26ncioning

duration o2 a leas 9 monhs wih

conin6o6s 5is64bance, whe4e # o4 mo4e

posii>e, negai>e o4 5iso4gani3e5sympoms a4e p4esen 2o4 a leas 1 monh


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'(cluding related disorders

Be2o4e a 5iagnosis o2 schi3oph4enia can

be gi>en, 5iso45e4s wih simila4 sympoms

m6s be 46le5 o6 as a possibiliy


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'(ample of Diagnostic

e(clusion )o4 eAampleJ 564ing monh whe4e

posii>e, negai>e o4 5iso4gani3e5

sympoms a4e aci>e hose sympomsm6s appea4 in absence o2 a majo45ep4essi>e o4 manic episode

+2 5ep4ession an5 mania symptoms a4ep4esen, hei4 duration must be brie! in4elaion o he 564aion o2 aci>e an54esi56al schi3oph4enia sympoms.


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Distinguishing Schizophrenia

from other similar disorders (he4 5iso45e4s ha>e psychoic sympoms

as hei4 co4e sympoms, incl65ing:

Schi3oa22eci>e 5iso45e4

Schi3oph4eni2o4m 5iso45e4

B4ie2 psychoic 5iso45e4

$el6sional 5iso45e4


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Schizoaffecti"e "s.Schizophrenia

)o4 schi3oa22eci>e 5iso45e4

I 5el6sions an5 hall6cinaions m6s be p4esen2o4 a leas # wee;s wiho6 p4ominen moo5

sympoms. I Moo5 sympoms m6s be p4esen 2o4 a

substantial po4ion o2 he psychoic5is64bance

)o4 schi3oph4enia:

I he lengh o2 ime ha moo5 sympoms a4ep4esen is brie! in compa4ison o he 564aion

o2 psychoic 5is64bance


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Schizophreniform and rief

psychotic "s. Schizophrenia

B4ie2 psychoic Schi3oph4eni2o4m Schi3oph4enia

1 5ay 1 monh 9 monhs


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Delusional disorder "s.

Schizophrenia $el6sional 5iso45e4 is eAacly as i so6n5s.

Non-bi3a44e 5el6sions is he p4ominen

psychoic sympom

(he4 schi3oph4enic sympoms, s6ch as

hall6cinaions, 5iso4gani3e5 an5 negai>e

sympoms a4e absent in 5el6sional5iso45e4


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– Phases of Schizophrenia

– Neuropathology


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3. a. Onset of the disorder

0i2eime p4e>alence 4ae in gene4al

pop6laion is 1

men appea4 o ha>e an ea4lie4 age o2onse Dypically 1!-#8

onse 2o4 women is ypically #8-"8

0i;elihoo5 o2 onse 54ops signi2icanlya2e4 88


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%.b. )ourse

'he co64se 2o4 schi3oph4enia >a4ies.

No e>e4yone wih schi3oph4enia will

5ee4io4ae in 26ncioning o>e4 ime


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)hapter 1%* Schizophrenic

Disorders Sympoms o2 Schi3oph4enia $iagnosic consi5e4aions (nse an5 o64se Special 'opic: 6l64e an5 schi3oph4enia Eiological 2aco4s 6lne4abiliy ma4;e4s '4eamens =ill no co>e4


– Neuropathology


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4. pecial topic!

"s schizophrenia solely

a #estern $isor$er Gane M. M64phy D1Le4e menalillness as 5e2ine5 in wese4n c6l64e was

p4esen in Non-=ese4n c6l64es


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)hoice of +nuit and ,orubas

EAamine5 +n6i 24om %las;a an5 /o46ba

o2 Nige4ia

hose hem beca6se hey we4e h6ne4gahe4e4 c6l64es Di.e., 5isincly 5i22e4en

han he wes an5 ha5 lile conac wih

wese4n c6l64e


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+nuit sample

0i>e5 wih +n6i 24om 1L87-1L88 in a

>illage o2 7LL +n6i

$aa came 24om one o2 he +n6i >illage4s,li2e hiso4ies o2 a 2ew +n6i an5 5aily

obse4>aions


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Yoruba sample

0i>e5 among a /o46ba 4ibe 564ing 1L91

an5 1L9"

$aa was gahe4e5 24om ine4>iews wih "nai>e heale4s an5 a membe4 o2 an

in5igeno6s c6l.


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'(amined - uestions

$o +n6i an5 /o46ba eAhibi beha>io4simila4 o he sympoms we callschi3oph4eniaF

+2 so, wha 5o hese beha>io4s loo; li;eF +s he4e a wo45 6se5 o label hese

beha>io4sF

%4e hese sympoms 5i22e4en 24om hoseeAhibie5 by wich 5oco4s an5 shamenF

+2 so, how a4e hey 5i22e4enF


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eha"iors similar toSchizophrenia/

Boh he +n6i an5 /o46ba ha5 in5i>i56als

wih beha>io4s ha 4esemble5schi3oph4enia.


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What do these behaviors

look like?=ihin he +n6i hese beha>io4s we4e:al;ing o onesel2, sc4eaming a someone who5oes no eAis, belie>ing ha a chil5 o4 h6sban5

was m645e4e5 by wichc4a2 when nobo5y elsebelie>es i,C

Some o2 he /o46ba beha>io4s incl65e5:

hea4ing >oices an5 4ying o ge ohe4 people osee hei4 so64ce ho6gh none can be seen,as;ing onesel2 ?6esions an5 answe4ing hem,pic;ing 6p sic;s an5 lea>es 2o4 no p64poseeAcep o p6 hem in a pile


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0as there a ord used to

describe these beha"iors/ /es.

'he +n6i e4m was "uth#aviha#

$ere was he wo45 6se5 by he /o46bas

'hese beha>io4s we4e so 5isinc o4

5i22e4en 24om no4mal +n6i an5 /o46ba

beha>io4 ha each c6l64e ha5 labele5

hem.


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$re beha"iors different

than those of the Shaman/ No.

Some o2 hese beha>io4s s6ch as seeing

hings ha ohe4s 5o no see an5 loo;ing inohe 2664e we4e a4ib6e5 o shaman in he

+n6i an5 /o46ba >illage

'he shaman was no 4e2e44e5 o as $ere o4"uth#aviha#

=hyF


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Shaman beha"ior

'he shaman we4e seen as con4olling

when hey wo6l5 eAhibi hese beha>io4s

I EAample: =hen he shaman is healing he iso6 o2 his min5, b6 he is no crazy .C

'he shamans beha>io4s we4e 6se5 2o4 a

speci2ic p64pose wihin hese c6l64es


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olition and multiple

beha"iors 'hose who eAhibi $ere an5 "uth#aviha#

a4e 5i22e4en 24om he Shaman in wo

p4ima4y ways Shaman >ol6na4ily hea4 >oices o4 see

hings. 'he beha>io4s o2 $ere an5"uth#aviha# a4e in>ol6na4y.

'hose wih $ere o4 "uth#aviha# eAhibipae4ns o4 m6liple beha>io4s. 'heshaman 5o no eAhibi m6liple beha>io4s.


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Overall conclusion

M64phy 2o6n5 ha h6ne4 gahe4e4 c6l64es

wih limie5 conac wih wese4n c6l64e

ha5 4ecogni3e5 an5 labele5 se>e4e menalillness.

e4 2in5ings ha boh wese4n an5 non-

wese4n c6l64es eAhibi sympoms o2schi3oph4enia ha>e been s6ppo4e5 by

epi5emiological 5aa, s6ch as hose 24om

he =o4l5 ealh (4gani3aion.


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Pre"alence of Schizophrenia

across 0est and Non30est

0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.%

!i"etimemorbid risk

#in percents$

n&land

'apan

(ussia

)nited *tates

+reland

)rban +ndia

(ural +ndia

,enmark

%ase$ on a narro# $efinition of schizophrenia


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– Neuropathology


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-. 'tiological factors* a. 4enes

)amily an5 win s65ies in5icae a

geneic in2l6ence

pai4wise conco45ance 4aes show: I M conco45ance 7! pe4cen

I $ conco45ance 1< pe4cen

'win conco45ance 4ae also implicaeohe4 2aco4s beyon5 geneics


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'tiology* b. Social 5actors ighes p4e>alence 2o6n5 in he lowe4

socioeconomic sa6s

# hypoheses abo6 why his occ64s

ypohesis 1 is social causation:

low socioeconomic 2aco4s, s6ch as,

s4ess26l li2e e>ens, social isolaion o4

poo4 n64iion lea5s o 5e>eloping

Schi3oph4enia


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'tiology*

Social 5actors con6t ypohesis # is social selection : 56e o cognii>e an5 social impai4mens

associae5 wih people who 5e>elopschi3oph4enia, hey a4e less able o

p4og4ess o highe4 le>els o2 e56caion, o4

;eep high paying jobs, which lea5s hem o54i2 ino a low socioeconomic sa6s


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c. Psychological factors*

'(pressed 'motion !''# EE is a gene4al negai>e o4 in46si>e

ai65e owa45s schi3oph4enic paien

igh EE wo6l5 be c4iical, hosile o4

emoionally o>e4-in>ol>e5


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Relapse rate for EE and

level of contact

0

10

20

30

40

50

0

-i&h %% !o. %%

-i&h contact

#/35 hr.k$!o. contact

#35 hr.k$

&igh EE fa'ilies close contact ris( of relapse

)o# EE fa'ilies close contact ris( of relapse


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7ultiple pathays

to schizophrenia 'he 5e>elopmen o2 schi3oph4enia 6n2ol5s o>e4

ime.

Many 2aco4s play a 4ole in someone 5e>elopingschi3oph4enia, as well as he co64se he 5iso45e4a;es

enes, biological 2aco4s Dn64iion, psychosocial

2aco4s Da5>e4se economic ci4c6msances incombinaion o4 sing6la4ly ells a so4y o2 whysomeone 5e>elope5 schi3oph4enia


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7ultiple pathays to

schizophrenia

combine5

liabiliy

a5olescence yo6ng a56l mi55le age

'ime

chizophrenia

&ints of

psychosis


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– Neuropathology


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. )haracteristics of

ulnerability 7ar8ers Ma4;e4 m6s 5ising6ish hose wihschi3oph4enia 24om ohe4 g4o6ps

Ma4;e4 m6s be a sable cha4ace4isico>e4 ime Ma4;e4 mo4e common among 1s 5eg4ee

4elai>es han gene4al pop6laion Ma4;e4 sho6l5 p4e5ic 2664e episo5es o2

schi3oph4enia among hose who ha>e hema4;e4, b6 ha>e no eApe4ience5 a

psychoic episo5e


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0hy search for "ulnerability

mar8ers +mpo4an o ;now who is a 4is;

D>6lne4able 2o4 5e>eloping psychosis.

P4o>i5es cl6es o he ca6se o2schi3oph4enia


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'ye3Trac8ing Dysfunction

$i22ic6ly wih smooh-p64s6i eyemo>emen

I pa4ic6la4ly when 4ac;ing he moion o2 a

pen56l6m o4 simila4 oscillaing sim6l6s +n5i>i56als wih schi3oph4enia ypically

eAhibi 4api5 eye mo>emen

a4ge non Sc3 s6bjec Sc3 s6bjec

+s ' T 8in D sf n ti n


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+s 'ye3Trac8ing Dysfunction aulnerability 7ar8er for

Schizophrenia/ Ma4;e4 m6s 5ising6ish hose wih

schi3oph4enia 24om ohe4 g4o6ps

I (nly ! o2 gene4al pop6laion show eye-4ac;ing 5ys26ncion compa4e5 o a

s6bsanial po4ion o2 people wO schi3oph4enia

Ma4;e4 m6s be a sable cha4ace4isic

o>e4 ime

I E>i5ence o s6ppo4 eye-4ac;ing 5ys26ncion

as a sable 4ai o2 schi3oph4enia

' 8


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+s 'ye3Trac8ing a

ulnerability 7ar8er !con6t# Ma4;e4 mo4e common among 1s 5eg4ee4elai>es han gene4al pop6laion

I hal2 o2 1s 5eg4ee 4elai>es show simila4 eye-4ac;ing impai4mens

Ma4;e4 sho6l5 p4e5ic 2664e episo5es o2

schi3oph4enia among hose who ha>e he

ma4;e4, b6 ha>e no eApe4ience5 a

psychoic episo5e

I no mar#ers !ound to do this yet


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– Neuropathology


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9. Treatment considerations

%lho6gh 5ec4easing se>e4iy o2 sympoms in

schi3oph4enia is impo4an i is no he only

4eamen consi5e4aion

Being able o ineg4ae ha paien bac; ino

he comm6niy h4o6gh symptom/medicine

management skills, daily living skills, an5

social skills nee5s o also be consi5e4e5 %s s6ggese5 by 4esea4ch on EE, teaching

families how o cope wih schi3oph4enia will

lessen he li;elihoo5 o2 a5>e4se o6comes

T


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Treatment*

1# antipsychotic medication %lso ;nown as neuroleptics beca6se heyin56ce si5e e22ecs ha 4esemble he

moo4 sympoms o2 Pa4;insons $isease

I motor side effects incl65e eA4apy4ami5al

sympoms DEPS s6ch as m6sc6la4 4igi5iy,

4emo4s, an5 pec6lia4 in>ol6na4y pos64es

I tardive dyskinesia (!" is anohe4 si5e e22echa incl65es abno4mal in>ol6na4y mo>emens

o2 he mo6h an5 2ace an5 spasmo5ic

mo>emens o2 limbs an5 46n; o2 bo5y


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Symptom impro"ement

1O7 o2 he paiens who 6se ne64olepics show noimp4o>emen an5 "-7 show limie5

imp4o>emen

0

5

10

15

20

25

30

35

40

no improvement partialimprovement

% .ith smptom

improvement


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:elapse rates

0

10

20

30

40

50

0

0

1r 2nd r

discontinue meds

continue meds

proper med dosa&e

use

65-70- relapse 1st year #ith $iscontin/ation of 'e$s

s. 40- if contin/e to /se 'e$s. t 2yr interal een in

the est case scenario half #ill still relapse

T t t


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Treatment*

2# atypical antipsychotics nli;e ne64olepics, atypical

antipsychotics 5o no p4o56ce he

moo4 sympoms associae5 wih EPS May no be associae5 wih an inc4ease5

4is; o2 5e>eloping he syn54ome '$

lo3apine an5 &espe4i5one a4e wo o2he mos wi5ely 6se5

T


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Treatment:3) Psychosocial

+ne4ese5 in long-e4m s4aegies o imp4o>e

aspecs o2 paiens li2e ohe4 han he 4e56cion

o2 psychoic sympoms Some psychosocial 4eamens aim o imp4o>e

family coping skills an5 reduce relapse.

I 1 Eliminaing 6n4ealisic eApecaions 2o4 he paien

I # +mp4o>ing comm6nicaion an5 p4oblem-sol>ing

s;ills o2 2amily membe4s


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Treatment* Psychosocial

(he4 psychosocial 4eamens s6ch as

social s;ills 4aining an5 asse4i>e

comm6niy 4eamen a554ess social an5

occ6paional 26ncioning

schizophrenic disorder ppt ok

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