3OverviewThe most common symptoms of schizophrenia include changes in the way a person thinks & feelsNo single symptom or specific set of symptoms.combinations of psychotic symptomsboth the patients and their families.
4OverviewThe onset of schizophrenia typically occurs during adolescence or early adulthood.ages of 15 and 35.three phases of variable and unpredictable duration: prodromal, active, and residual.Prodromal signs and symptoms are similar to those associated with schizotypal personality disorder.The residual phase follows the active phase similar in many respects to those seen during the prodromal phase.
7SymptomsHallucinations are sensory experiences that are not caused by actual external stimuli.those experienced by schizophrenic patients are most often auditory.delusions, or idiosyncratic beliefs that are rigidly held in spite of their preposterous nature.Common delusions include the belief that thoughts are being inserted into the patient’s head, that other people are reading the patient’s thoughts, or that the patient is being controlled by mysterious, external forces.
8Symptoms Many delusions focus on grandiose or paranoid content. In actual clinical practice, delusions are complex and difficult to define.Their content is sometimes bizarre and confusing.
10SymptomsNegative Symptoms (continued)poverty of speech, patients show remarkable reductions in the amount of speech.In another form, referred to as thought blocking, the patient’s train of speech is interrupted before a thought or idea has been completed.
13Symptoms Disorganization (continued) Another kind of bizarre behavior involves affective responses that are obviously inconsistent with the person’s situation.The most remarkable features of inappropriate affect are incongruity and lack of adaptability in emotional expression.
14Diagnosis Brief Historical Perspective Kraepelin’s term dementia praecox was,Bleuler suggested a new name for the disorder—schizophrenia.This term referred to the splitting of mental associations, which Bleuler believed to be the fundamental disturbance in schizophrenia. Bleuler's four A's: (disturbance of) affect, association, ambivalence and autism
15DiagnosisDSM-IV-TRDSM-IV-TR lists several specific criteria for schizophrenia.The first requirement (Criterion A) is that the patient must exhibit two (or more) active symptoms for at least 1 month.The DSM-IV-TR definition also takes into account social and occupational functioning as well as the duration of the disorder (Criteria B and C).
17DiagnosisSubtypesDSM-IV-TR recognizes five subtypes of schizophrenia.The catatonic type is characterized by symptoms of motor immobility (including rigidity and posturing) or excessive and purposeless motor activity.The disorganized type of schizophrenia is characterized by disorganized speech, disorganized behavior, and flat or inappropriate affect.
18DiagnosisSubtypesThe most prominent symptoms in the paranoid type are systematic delusions with persecutory or grandiose content.The undifferentiated type of schizophrenia includes schizophrenic patients who display prominent psychotic symptoms and either meet the criteria for several subtypes or otherwise do not meet the criteria for the catatonic, disorganized, or paranoid types.
19DiagnosisSubtypesThe residual type includes patients who no longer meet the criteria for active phase symptoms but nevertheless demonstrate continued signs of negative symptoms or attenuated forms of delusions, hallucinations, or disorganized speech.They are in “partial remission.”
20Diagnosis Related Psychotic Disorders Schizoaffective disorder is defined by an episode in which the symptoms of schizophrenia partially overlap with a major depressive episode or a manic episode.People with delusional disorder do not meet the full symptomatic criteria for schizophrenia, but they are preoccupied for at least 1 month with delusions that are not bizarre.
22Schizophrenia Spectrum & other psychotic disorders in DSM 5 The DSM-IV subtypes of schizophrenia (i.e., paranoid, disorganized, catatonic, undifferentiated, and residual types) are eliminatedMain change of schizoaffective disorder is the requirement that a major mood episode be present for a majority of the disorder’s total duration after Criterion A has been met
23Schizophrenia Spectrum & other psychotic disorders in DSM 5 Criterion A for delusional disorder no longer has the requirement that the delusions must be nonbizarre.DSM-5 no longer separates delusional disorder from shared delusional disorderCatatonia:The criteria for catatonia is now uniform for all contexts
24FrequencyMost studies in Europe and the United States have reported lifetime morbid risk figures of approximately 1 percent.
25Frequency Gender Differences Most epidemiological studies have reported that across the life span men and women are equally likely to be affected by schizophrenia.males younger by about 4 or 5 years than the average age at which schizophrenic women first experience problems.Male patients are more likely than female patients to exhibit negative symptoms.
26Frequency Cross-Cultural Comparisons Schizophrenia has been observed in virtually every culture that has been subjected to careful scrutiny.
27Causes Biological Factors Research evidence points clearly toward some type of genetic influence in the transmission of schizophrenia.The family history data are consistent with the hypothesis that the transmission of schizophrenia is influenced by genetic factors.
28Causes Biological Factors (continued) Linkage analysis has not been able to identify a specific gene for schizophrenia, but it has implicated regions on a small number of chromosomes that may contribute to the etiology of the disorder.For example, reports of positive linkage on regions of chromosomes 6, 8, 13, and 22 have been verified by more than one laboratory.
29Causes Pregnancy and Birth Complications Viral Infections (winter month's birth)Neuropathologydecrease in total volume of brain tissuestructural changes limbic systemenlarged lateral ventriclesfrontal cortex
30Causes Neurochemistry Scientists have proposed various neurochemical theories to account for the etiology of schizophrenia.The most influential theory, known as the dopamine hypothesis, focuses on the function of specific dopamine pathways in the limbic area of the brain.
31CausesSocial FactorsThe evidence supporting an inverse relationship between social class and schizophrenia is substantial.Adverse social and economic circumstances may increase the probability that persons who are genetically predisposed to the disorder will develop its clinical symptoms.
32Causes Psychological Factors The family environment does have a significant impact on the course (as opposed to the etiology) of schizophrenia.Families is high in expressed emotion.Integration and Multiple Pathways
34Treatment Antipsychotic Medication (continued) Atypical antipsychotics are less likely than the classical antipsychotics to produce unpleasant motor side effects.Atypical antipsychotics also produce side effects, such as weight gain and obesity.All antipsychotic medications—both traditional and atypical forms—act by blocking dopamine receptors in the cortical and limbic areas of the brain.
35Treatment Psychosocial Treatment Family treatment programs attempt to improve the coping skills of family members, recognizing the burdens that people often endure while caring for a family member with a chronic mental disorder.There are several different approaches to this type of family intervention.Most include an educational component that is designed to help family members understand and accept the nature of the disorder.
36TreatmentVarious forms of cognitive therapy have been used to treat schizophrenia.Some patients are chronically disturbed and require long-term institutional treatment.Social learning programs, sometimes called token economies, can be useful for these patients.