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Silvana NissanEmmanuel NelsonSamantha Pedri
Schizophrenia Silvana NissanEmmanuel NelsonSamantha Pedri
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Definition Schizophrenia- The splitting or tearing of the mind and emotional stability of the patient. Schizophrenia is characterized by a broad range of unusual behaviors that cause profound disruption in the lives of people suffering from the condition, as well as in the lives of the people around them. Schizophrenia strikes without regard to gender, race, social class or culture.
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How is Schizophrenia a problem?
Schizophrenia is a brain disorder that affects the way a person behaves, thinks, and sees the world. The illness can have a profound negative impact on the individual’s opportunities for attaining social and occupational success, and the conquences can be devastating for the patient’s life course, as well as for family members.
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How Does Schizophrenia Affect Society?
Schizophrenia is chronic disease associated with a significant and long-lasting health, social, and financial burden, not only for patients but also for the families, other caregivers, and the wider society. Schizophrenia is an important factor in social aid and welfare costs, health care costs, employment inefficiency, impaired learning ability, alcoholism, broken homes and suicide. The average person with schizophrenia will cost one to two million dollars to society, directly and indirectly, in his/her lifetime.
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How Does Schizophrenia Affect Society?
Cost-of-illness are identified in three main categories of costs: a) direct costs, for which payments are made b) indirect costs, for which resources are lost c) intangible costs, which describe the drawbacks of an illness such as pain or depression Coverage: Direct costs- cover hospital, nursing home care, physician, drugs, services. Indirect Costs- are wholly dominated by the value of lost productivity due to morbidity and premature mortality. (Mortality costs are the product of the number of deaths from the disorder and the discounted value of average expected future earnings. Morbidity costs include production losses by patients and their caregivers due to the illness.)
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How Does Schizophrenia Affect Society?
Cost-of-illness of a disorder to society. Total Costs of Schizophrenia: billion (Direct costs of $17.3 billion represented 2.5 percent of total national health care expenditure in 1990) Today biliion Cost of Inpatient services- Inpatient admission is the single largest contributor to the direct costs of treating schizophrenia Cost of Drugs, Mortality Costs, Family Impact Costs, Criminal Justice System Costs
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What factors may contribute to the development of Schizophrenia?
No single factor Patients vary Research indicates: a) Schizophrenia is a brain disease b) its etiology involves the interplay between genetic and environmental factors c) multiple developmental pathways eventually lead to disease onset, and d) brain maturational processes play a role in the etiological process.
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Characteristics of Schizophrenia
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295.90 CRITERION A. Symptoms of schizophrenia
The characteristic symptoms of schizophrenia involve a range of cognitive, behavioral, and emotional dysfunctions, but no single symptom is of the disorder. CRITERION A. 2 or more characteristic symptoms present for 1-month period over a 6-month period: Delusions Hallucinations Disorganized speech Disorganized behavior Negative symptoms ( American Psychiatric Association, 2013)
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Symptoms of schizophrenia
Symptoms are typically divided into positive and negative symptoms because of their impact on diagnosis and treatment. Positive symptoms are those that appear to reflect an excess or distortion of normal functions. Negative symptoms are those that appear to reflect a loss of normal functions. These often persist in the lives of people with schizophrenia during periods of low (or absent) positive symptoms. ( American Psychiatric Association, 2013).
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Continued Criterion B. Level of functioning in one or more areas-work, interpersonal relations, self care, vocation-is markedly below the level of functioning prior to the onset; social/ occupational dysfunction – cant work or relate C. Continuous signs of the disturbance for at least 6 months (at east 1 month with symptoms from category A. Duration is the main factor in differentiating schizophrenia from similar illnesses D. have successfully ruled out schizoaffective disorder and mood disorder (with psychotic symptoms) b/c no evidence of mania or depression E. not due to substance abuse F. not due to Autism spectrum disorder
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Specifiers Specifiers are only to be used after a 1-year duration of the disorder and if they do not in contradiction to the diagnostic course criteria. 1st episode, currently in acute stage 1st episode currently in partial remission 1st episode in full remission multiple episodes, currently in acute episode multiple episodes currently in partial remission multiple episodes currently in full remission continuous with catatonia ( American Psychiatric Association, 2013).
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Sub-Types
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Diagnostic Features Other symptoms outside the major diagnostic criteria include mood dysphoria, inappropriate affect sleep disturbance depersonalization, derealization somatic concerns, vocational impairments Lack of insight or awareness or even denial about the existence of the illness is also a symptom that commonly occurs. Aggression, sometimes associated with delusions is common in males, although not as a rule Although there are many brain and genetic abnormalities that have been identified, there are no “absolute” biological markers Schizophrenia is often overdiagnosed in the poor There is a high rate of suicide among schizophrenics-6%. With a suicide attempt rate of close to 20% Still thought to be a lifelong illness although the occurrence of "positive symptoms" seem to diminish with age Depression often shows up over time
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Differential Diagnosis
Given the broad range of symptoms that may occur in schizophrenia, it is not surprising that the differential diagnosis is quite large. Major depressive or bipolar with psychotic or catatonic features Schizoaffective disorder Schizophreniform disorder and brief psychotic disorder Delusional disorder Schizotypal personality disorder Obsessive-compulsive disorder and body dysmorphic disorder Posttraumatic stress disorder Autism spectrum disorder or communication disorders Other mental disorders associated with a psychotic episode ( American Psychiatric Association, 2013)
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Changes to the Diagnosis
DSM-5 raises the symptom threshold, requiring that an individual exhibit at least two of the specified symptoms. (In DSM IV-TR, it was one.) The diagnostic criteria no longer identify subtypes. Subtypes had been defined by the predominant symptom at the time of evaluation. But these were not helpful to clinicians because patients’ symptoms often changed from one subtype to another and presented overlapping subtype symptoms, which blurred distinctions among the five subtypes and decreased their validity. Some of the subtypes are now specifiers to help provide further detail in diagnosis. For example, catatonia (marked by motor immobility and stupor) will be used as a specifier for schizophrenia and other psychotic conditions such as schizoaffective disorder. This specifier can also be used in other disorder areas such as bipolar disorders and major depressive disorder.
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HOPE Treatment The Disease can not be cured but treated
The treatment of schizophrenia almost always involves the use of an antipsychotic drug. Patients may also be seen in supportive psychotherapy, either on an individual basis or in a group, and in social skills training groups. With medication, therapy, and a strong support network, many people with schizophrenia are able to control their symptoms, gain greater independence, and lead fulfilling lives. HOPE
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Prevalence of Schizophrenia
Across Socio, Cultural, Race/Ethnicity, Age, Gender, Sexual Orientation, and economic Dimensions
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Schizophrenia Worldwide
Schizophrenia is one of the top ten causes of disability in developed countries worldwide. It affects 1.1% of the worlds population over the age of 18. 51 million people suffer from schizophrenia 6-12 million in China million in India 2.2 million in USA 285,000 in Australia Over 280,000 in Canada Over 250,000 In Britain
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Schizophrenia Worldwide
Every 1 in 4,000 people will be diagnosed as having schizophrenia a year. About 1.5 million people will be diagnosed with schizophrenia this year worldwide. The term 'prevalence' of Schizophrenia usually refers to the estimated population of people who are living with Schizophrenia at any given time. The term 'incidence' of Schizophrenia refers to the annual diagnosis rate, or the number of new cases of Schizophrenia diagnosed each year.
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Schizophrenia in United States
Therefore, the approximate number of people in the United States suffering from: Schizophrenia: Over 2.2 million people Multiple Sclerosis: 400,000 people Insulin-dependent Diabetes: 350,000 people Muscular Dystrophy: 35,000 people
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Where are the People with Schizophrenia?
Approximately: 6% are homeless or live in shelters 6% live in jails or prisons 5% to 6% live in Hospitals 10% live in Nursing homes 25% live with a family member 28% are living independently 20% live in Supervised Housing (group homes, etc.)
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Homelessness and Schizophrenia
About 200,000 individuals with schizophrenia or manic-depressive illness are homeless. 1/3 of 600,000 homeless population There are more people in the US living on the streets with untreated severe psychiatric illnesses than in hospitals getting treatment.
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Schizophrenia and Gender
“Women tend to have better premorbid functioning, a distinct symptom profile and better course of illness, and different structural brain abnormalities and cognitive deficits.” Men tend to develop signs earlier than women They become ill between 16 years and 25 years old. Average onset is 18 years old. Women develop symptoms years later, after age 30. Average onset is 25 years old.
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Schizophrenia and Age Very rare to find in those under the
age of ten or over the age of 40. Typically Begins in early adulthood Between ages 15-25
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Schizophrenia and Ethnicity
According to a 2007 report in the International Journal of Epidemiology, African Americans in the US are 200 percent more likely to develop schizophrenia than Caucasians. Studies conducted on Asian participants reveals that there is a relationship between symptoms of schizophrenia and culture. The Content of hallucinations and delusions appeared to be culturally specific
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Schizophrenia and Sexual Orientation
“The fact that individuals who have a gay or lesbian social identity make up a percentage of the general population in so-called Western countries such as Australia implies that such individuals will also be diagnosed with schizophrenia at the same rate as the general population.” LGBTQ Difficulties with mental health care services Mental health services should be delivered in a non-discriminatory environment which recognises and respects the right of the individual with schizophrenia to equal access to mental health care and services
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At Risk Groups Although there is no cure for schizophrenia, treatment success rate with medications and therapies can be high There are over 15 medications for treatment There are psycho-social treatments and cognitive therapies Very costly for families and society
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At Risk Groups The overall U.S. cost of schizophrenia was estimated to be $62.7 billion $22.7 billion excess direct health care cost, about: $7.0 billion outpatient $5.0 billion drugs $2.8 billion inpatient $8.0 billion long-term care
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At Risk Groups Managed care can improve outcomes in patients with schizophrenia by Utilizing community treatment teams Case management Disease management programs Schizophrenia treatment algorithms Provider partnerships Specialty mental and behavioral health organizations Community Mental Health Centers.
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Schizophrenia Simulator
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Historical overview of
Schizophrenia
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Origin of Schizophrenia
Does not have an true origin. Hypothesized that Schizophrenia is a recent disease. Rare before the 1800s Benedict Morel referred to such cases as Demence Precoce. France Thomas Clouston coined the term “Adolescent insanity” Scotland Karl Kahlbaum delineated the catatonic syndrome. Germany Ewald Hecker, a student of Kahlbaum expanded on his research and discovered Hebephrenia.
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Continued Emil Kraepelin (1851-1921)
Made a distinction between Manic-Depressive Psychosis and Dementia Praecox. Manic Depressive Psychosis= Bipolar Disorder Integrated the various symptoms of the disorder under Dementia Praecox. Hebephrenia Catatonia Paranoid Dementia (mild and severe form)
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Schizophrenia Eugene Bleuler (1857-1939)
First one to introduce the term Schizophrenia in which replaced Dementia Praecox. The term came from two Greek words: Schizo= tear or split Phren= several meanings in ancient times, it meant the intellect or the mind. Also means lungs or diaphragm, which believed to be the seat of emotions. Schizophrenia= Splitting or tearing of the mind and emotions.
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1st Admission into the DSM
Identified in the DSM 1st edition Not very detailed 130 Pages 106 Disorders DSM 5 991 Pages
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1st Admission into the DSM Cont…
Schizophrenic reaction, simple type Schizophrenic reaction, hebephrenic type Schizophrenic reaction, paranoid type Schizophrenic reaction, acute undifferentiated type Schizophrenic reaction, chronic undifferentiated type Schizophrenic reaction, schizo- affective type Schizophrenic reaction, childhood type Schizophrenic reaction, residual type Schizophrenic reaction, catatonic type
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Non Therapeutic Treatment
Religious Practices Prayer Exorcism Music No Formal Treatment Family Maintained Custody Hidden Caged Abandoned
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Non Therapeutic Treatment Cont.
Incarcerated to asylums Jails Prisons Inhumane Treatment Untrained and unqualified Staff Chained down
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Therapeutic Treatment
Typical Chlorpromazine Fluphenazine Trifluoperazine Haloperidol Loaxpine Perphenazine Atypical Risperidone Clozapine Olanzapine Quetiapine Ziprasidone Aripiprazole Paliperidone
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Therapeutic Treatment
Insulin Coma Therapy Electroconvulsive Therapy Assertive Community Treatment Cognitive Behavior Therapy
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Effectiveness of CBT Co-occurring symptoms such as depression and anxiety symptoms CBT has been effective in treating hallucinations and delusions Focuses on a separating psychotic thinking from normal thinking Medication Compliance Reduction of symptomatology, low dropout rates, and cost-effective
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Empirical research study
"A Randomized Controlled Trial of Cognitive-Behavioral Therapy for Persistent Symptoms in Schizophrenia Resistant to Medication"
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Empirical research study
Purpose of the research as stated in the article a) The aim was to compare individual CBT with a nonspecific befriending (BF) intervention in reducing psychiatric symptoms among people with schizophrenia who had experienced distressing positive symptoms refractory to conventional antipsychotic medication.
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Empirical Research Study
Demographics b) Patients were recruited into the study from 5 clinical services: 2 in West London and 3 in the north of England (one each in Newcastle, Cleveland, and Durham). Had a diagnosis of schizophrenia according to both International Classification of Diseases, 10th Revision (ICD-10) research and DSM-IV criteria Age years old Gender- Women, Men Race/ethnicity- Unspecified Had symptoms causing distress and/or dysfunction that had persisted for at least 6 months despite adequate trails of antipsychotic medication An adequate trial was defined as regular use of antipsychotic medication for 6 months or more, with no evidence of poor adherence, at dosages at or above the equivalent of 300 mg daily of chlorpromazine, including a minimum period of at least 2 weeks of treatment with the equivalent of 600 mg daily of chlorpromazine, unless this was precluded by side effects or contraindications. Exclusion criteria were a primary diagnosis of alcohol or drug abuse; current abuse of drugs or alcohol warranting specific clinical intervention, such as attendance at a specialist substance misuse clinic; exclusively negative symptoms; or not complaining of any positive symptoms or of depression.
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CBT Intervention Distinct Stages
Examine antecedents of the emergence of the psychotic disorders Develop a normalizing rationale Treat co-existing disorders such as anxiety and depression Focus on Positive Symptoms First Negative Symptoms
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CBT Intervention Negative Symptoms
Paced Activity Scheduling Address motivation Diary Recording Mastery & Pleasure Rating
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CBT Intervention Postive Symptoms
Auditory Hallucinations Voice Diaries Critical analysis of origins and nature The reattribution of the causes Coping Strategies Delusions Explained through guided discovery and homework task Socratic Questioning Downward Arrow Technique Improve Thought Disorder/Disorganization Explain the jumps between topics
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Results Hypothesis A course of CBT is superior to BF in reducing psychiatric symptoms. Results Patients using CBT and BF showed significant improvements at the end of treatment. No significant differences between the CBT and BF groups. CBT resulted in greater improvements than BF for all 4 outcome measurements at the 9 month follow up.
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Recommendations/Future
What recommendations did the researchers make? The study done here was to actually overcome any limitations that were found in previous studies done to help with schizophrenia by using CBT. Researchers wanted to use this to improve adherence and for psychotic symptoms unresponsive to medication. The out come of the study was to see how the CBT worked for patients with schizophrenia. The researchers recommended that patients with schizophrenia that are still experiencing distress and negative symptoms regardless of medication, try CBT for improvement. There would be improvement on positive and negative symptoms and even depression. What might be future research directions coming out of this study? Future research done because of this study could be pairing CBT with newer medication to see if improvements happen quicker than the nine months used in this study. Also, this could be used for other mental health disorders to see if there is any improvement with positive or negative symptoms.
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Critical Analysis Discuss
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Citations: Health Topics: Schizophrenia. (2014). In World Health Organization. Retrieved from What is Schizophrenia. (2015). In National Institute of Mental Health. Retrieved from Schizophrenia Facts and Statistics. (2010). In Schizophrenia.com. Retrieved from Pharmaceutica, J. (2007). Gender and Schizophrenia [Electronic version]. US National Library of Medicine National Institutes of Health. TNO Staff. (2014, February). Race, Schizophrenia, and Denial. In The New Observer . Retrieved from Schizophrenia. (2-15). In NAMI National Alliance on Mental Illness. Retrieved from Sex and Gender Issues. (2014). In Schizophrenia Fellowship of NSW. Retrieved from
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Citations: Alexander, F., & Selesnick, S. T. (1966). The history of psychiatry: An evaluation of psychiatric thought and practice from prehistoric times to the present. New York: Harper & Row. American Psychiatric Association. (1952). Diagnostic and statistical manual of mental disorders (1st ed.). Washington, DC: American Psychiatric Association. Retrieved from: Butcher, J. N., Mineka, S., & Hooley, J. M. (2007). Abnormal psychology. Boston: Pearson/Allyn and Bacon. Jablensky, A. (2010). The diagnostic concept of schizophrenia: Its history, evolution, and future prospects. Dialogues in Clinical Neuroscience, 12(3), Maddux, J. E., & Winstead, B. A. (Eds.). (2012). Psychopatholgy: Foundations for a contemporary understanding (3rd ed.). New York: Routledge. Porter, Roy (2002). Madness: A Brief History. New York City: Oxford University Press, Siddle, R., O'Carroll, M., Scott, J., Barnes, T. R. E., Sensky, T., Turkington, D.. . Kingdon, D. (2000). A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry, 57(2), doi: /archpsyc
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Citations: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. ( 5th ed.). Washington, DC: American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association
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