1. Silvana NissanEmmanuel NelsonSamantha Pedri
Schizophrenia
Silvana NissanEmmanuel NelsonSamantha Pedri

2. 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.

3. 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.

4. 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.

5. 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.)

6. 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

7. 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.

8. Characteristics of Schizophrenia

9. 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)

10. 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).

11. 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

12. 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).

13. Sub-Types

14. 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

15. 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)

16. 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.

17. 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

18. Prevalence of Schizophrenia
Across Socio, Cultural, Race/Ethnicity, Age, Gender, Sexual Orientation, and economic Dimensions

19. 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

20. 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.

21. 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

22. 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.)

23. 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.

24. 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.

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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.

31. Schizophrenia Simulator

32. Historical overview of
Schizophrenia

33. 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.

34. 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)

35. 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.

36. 1st Admission into the DSM
Identified in the DSM 1st edition
Not very detailed
130 Pages
106 Disorders
DSM 5
991 Pages

37. 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

38. Non Therapeutic Treatment
Religious Practices
Prayer
Exorcism
Music
No Formal Treatment
Family Maintained Custody
Hidden
Caged
Abandoned

39. Non Therapeutic Treatment Cont.
Incarcerated to asylums
Jails
Prisons
Inhumane Treatment
Untrained and unqualified Staff
Chained down

40. Therapeutic Treatment
Typical
Chlorpromazine
Fluphenazine
Trifluoperazine
Haloperidol
Loaxpine
Perphenazine
Atypical
Risperidone
Clozapine
Olanzapine
Quetiapine
Ziprasidone
Aripiprazole
Paliperidone

41. Therapeutic Treatment
Insulin Coma Therapy Electroconvulsive Therapy Assertive Community Treatment Cognitive Behavior Therapy

42. 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

43. Empirical research study
"A Randomized Controlled Trial of Cognitive-Behavioral Therapy for Persistent Symptoms in Schizophrenia Resistant to Medication" 

44. 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.

45. 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.

46. 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

47. CBT Intervention Negative Symptoms
Paced Activity Scheduling
Address motivation
Diary Recording
Mastery & Pleasure Rating

48. 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

50. 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.

51. 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.

52. Critical Analysis
Discuss

53. 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

54. 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

55. 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