10-30-07 Schizophrenia



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Schizophrenia

Psychosis

• Psychosis – a significant impairment in reality testing, as evidenced by:

o Hallucinations – false sensory perception in absence of stimulus (any of 5 senses)

o Delusions – false belief based on incorrect inference despite obvious evidence to contrary, and not part of one’s culture

o Thought Disorganization – loose associations, racing thoughts

o Grossly Disorganized Behavior – meaningless/chaotic speech, bizarre behavior, catatonic

Delusion Types

• Persecutory – belief that one is being malevolently treated in some way

• Referential – neutral occurrences are seen as directed toward oneself… “TV talking to me!”

• Religious – delusional beliefs of a spiritual or religious nature

• Control – thoughts, feelings, or body will feel controlled or manipulated

• Grandiose – inflated sense of worth, power, accomplishment, etc.

• Somatic – belief that one’s body is defective/altered/diseased

• Jealous – belief that one’s sexual partner is unfaithful

• Erotomanic – belief that another (often famous) person is in love with one

Schizophrenia

• QUIZ: Schizophrenia – defined as an active psychosis accompanied by a functional deterioration

• Diagnostic Criteria – psychotic symptoms causing social/occupation dysfunction lasting > 6 months:

o Psychotic symptoms – at least 2 (hallucinations, delusions, disorganized thought/behavior)

o Social/occupational dysfunction – symptoms are impairing life & relationships

o Six month duration – symptoms last for at least 6 months

o Exclusion criteria met – not schizoaffective, not mood disorder, not substance abuse/medical condition, not pervasive developmental disorder (e.g. autism)

Schizophrenia Subtypes

• Paranoid – preoccupied with delusions/hallucinations all the time, but no prominent disorganized speech/behavior, not catatonic, no flat affect; main symptom is active psychosis, but often able to maintain some level of function

o Paranoia? Does not actually need to have paranoia to be paranoid schizophrenic

• Disorganized – prominent disorganized speech/behavior and flat/inappropriate affect; main problem is functional deterioration

• Catatonic – characteristic movements/speech:

o Immobility – motoric immobility, catalepsy (waxy flexibility), or stupor, or…

o Excessive mobility – purposeless motor activity

o Negativism – motiveless resistance to instructions, or mutism

o Peculiarities of movement/posture – stereotyped movements, prominent mannerism, grimacing

o Echolalia/Echopraxia – mimicking words/gestures

• Undifferentiated – no one element predominates (some disorganization/catatonia/delusions)

• Residual – nothing immediately apparent about patients; no delusion/hallucination/disorganization, but…

o Evidence of disturbance – still there, can show flat affect, impaired function, attenuated psychosis, odd beliefs, unusual perceptions

Schizophrenia Descriptions

• Positive Symptoms – presence of delusions, hallucinations, thought disorganization

• Negative Symptoms – characterized by absences:

o Blunted affect – decreased expression, vocal inflection, eye contact, gestures

o Alogia – reduced speech/ideas, thought blocking

o Avolition/apathy – poor grooming/hygiene, low energy

o Anhedonia/Asociality – loss of recreational interests, low sexual activity, absence of intimacy

o Inattention – socially uninvolved, “spacey”

• Cognitive Impairment – poor memory, language, attention, and poor executive function (doing tasks); IQ ................
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