Schizophrenia and Other Psychoses Assessment & Diagnosis SW 593

Introduction Arguably the most serious and debilitating of the mental disorders. Involve distortions in the perceptions of reality; Impairments in the capacity to reason, speak and behave rationally; Impairments in affect and motivation. Directly or indirectly disrupt all aspects of a client’s life.

Schizophrenia Symptoms include severe disruptions in thinking Gross disorganization in thoughts May involve delusions (system of false beliefs that are not open to reason or appeal) There will be perceptual disturbances including hearing voices. (auditory hallucinations)

Schizophrenia Remaining symptoms (negative): Absence of affect Absence of motivation Absence of interaction There will be significant psychosocial impairment and/or distress Symptoms must have begun at least 6 months earlier.

Schizophrenia Subtypes are based by the predominant symptoms: Paranoid type: delusions/hallucinations are elaborate and encompassing Catatonic type: most rare of all subtypes Disorganized type: disorganized speech and negative symptoms, some catatonia present Residual type: negative symptoms alone Undifferentiated type: no particular features are prominent.

Schizophreniform Disorder Same features as schizophrenia but the time frame since the initial display of symptoms is between 1 and 6 months. This diagnosis exists to ensure that the label of schizophrenia is not used too quickly. Clients with this disorder may not evidence marked psychosocial problems.

Brief Psychotic Disorder Sudden onset of positive symptoms that last more than one day but remit within 30 days. Criteria includes a return to the premorbid level of functioning. Should be provisional A specifier is used to indicate whether there is a discernable stressor that has triggered the episode.

Schizoaffective Disorder Includes the same symptoms as schizophrenia but also has symptoms that constitute one of the episodes of a mood disorder. Periods when only the schizophrenic symptoms are evident. Usually diagnosed after examination of the severe symptoms.

Delusional Disorder Differs in both symptoms and impairment from schizophrenia Disorganization and negative symptoms are not present Social and vocational functioning effected but not as severe. Content of delusional material is not considered bizarre.

Delusional Disorder The distinction between bizarre and non-bizarre delusions is focused on whether the delusional situation could occur in real life.

Shared Psychotic Disorder Occurs when a person who is closely associated with someone else with some psychotic disorder “buys into” the delusional system. Fairly rare but it is more likely to occur when the individual with the original delusions exercises power over the other person.

Assessment Assessment with these clients is accomplished through structured interviews commonly known as mental status examinations. Designed to accrue information about the quality of the client’s mental processes.

Mental Status Examination Cognitive functioning: Normal intelligence? Oriented to person, place, and time? Evidence of problem-solving thinking? Preoccupied? Delusional thinking? Bizarre? Thinking coherent and goal directed? Exhibits good judgment? Memory problems? (immediate, recent, remote) Hallucinations? Peculiar speech?

Mental Status Examination Emotional functioning What emotions are described? Congruent to thoughts? Feeling over the past year? Emotional state creating difficulties? Emotionally stable? Blunted or flattened affect? Expansive?

Mental Status Examination Physical functioning: Level of energy? Past year? Unusual motor behaviors? Medical problems? Recent physical exam? Results? Any prescribed meds? What? Any psychological treatment? Presents with any disabilities?

Mental Status Examination Substance use: Alcohol? How much? Other substances? Social, legal, occupational troubles? CAGE Treatment?

Emergency Considerations Dangerous behavior may occur Mostly toward themselves 60 – 80% will experience suicidal ideations 10 – 15% will actually commit suicide 50% will make a suicide attempt with younger clients making more attempts The more positive the symptoms the greater likelihood.

Cultural Considerations A disproportionately high number of cases of schizophrenia are found among disadvantaged ethnic cultures. Greater in groups with high ethnic discrimination; low educational attainment; and low occupational status.

Social Selection Theory Cultures that are oppressed and unable to attain high socioeconomic status have a greater number of individuals with disabilities and poor health. The result of their oppressed status over the centuries and subsequent genetic predisposition rather than their ethnic background per se.

Cultural Factors Play a role in the course of the illness. Prognosis was more favorable in developing countries (Nigeria, India, Columbia) than in nine industrialized countries (the United Kingdom, the United States, the former Soviet Union). Evidence has indicated that high expressed emotion (EE) within a U.S. family can have a negative impact on the person coping with schizophrenia.

Cultural Factors Psychoeducational support for high EE families has been effective in reducing the relapse and rehospitalization of schizophrenic family members. Social skills training is most effective with Caucasian individuals and families. Less effective with Latinos.