Unit 4 Learning Objectives Schizophrenia and Related Psychotic Disorders Criteria DSM IV TR o At least 2 for greater than 1 month Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms o Social occupational dysfunction o Duration continuous signs of the disturbance for at least 6 months o Schizoaffective and mood disorders have been rued out o Disturbance is not due to the direct physiological effects of a substance or general medication o If there is a history of autism or another pervasive developmental disorder the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least 1 month 1 What are the positive and negative symptoms of Schizophrenia Positive symptoms symptoms are salient added experiences unusual perceptions thoughts or o Delusions hallucinations disorganized thought and speech disorganized catatonic Negative symptoms absence of behaviors feelings experiences etc losses or deficits in certain o Affective flattening severe reduction or absence of emotional responses to the environment alogia inability to speak avolition lack of drive motivation o Less obvious weird and not exactly bizarre but associated with more impairment and less responsive to medication 2 Describe the characteristics of delusions hallucinations and catatonic behavior Delusions ideas that an individual believes are true but are highly unlikely or simply impossible o Bizarre delusion DSM IV TF adj involved a phenomenon that the person s culture would behaviors behavior domains regard as totally implausible o Types Persecutory being persecuted watched conspired against Ex belief that CIA FBI and local police are conspiring to catch you in a sting operation Reference random events are directed at oneself Ex belief that a newscaster is reporting on your movements Grandiose great power knowledge talent or is a famous powerful person Ex belief that you are Martin Luther King Jr reincarnated Guilt or sin committed a terrible act or responsible for a terrible event Ex belief that you have killed someone Somatic appearance or part of body is diseased altered Ex belief that your intestines have been replaced by snakes Being controlled thoughts feelings behaviors are being imposed controlled by an Ex belief that an alien has taken over your body and is controlling your external force behavior Types o Thought broadcasting belief that ones thoughts are being broadcast from one s mind for others to hear o Thought insertion belief that another person or object is inserting o Thought withdrawal belief that another person or object is inserting thoughts into one s head thoughts into one s head o Delusions are different from thoughts we tell ourselves by bizarreness preoccupation o Usually multiple types of delusions are woven together in a complex belief system o Specific content of delusions differs across cultures and cohorts o Cultural relativism is important to consider when diagnosing delusions Hallucinations unreal perceptual experiences bizarre and are extremely distressing and impairing resistance o Types Auditory most common women men voices talk to each other Disorganized thought and speech o Formal thought disorder loosening of associations or derailment word salad neologisms Disorganized or Catatonic Behavior o Disorganized unpredictable and untriggered o This can explain Disheveled appearances inappropriate hygiene clothing Shouting swearing pacing o Catatonia group of disorganized behaviors that reflect extreme lack of responsiveness o Catatonic excitement wild agitation that is difficult to subdue 3 What are the cognitive deficits in Schizophrenia Deficits in working memory cognition and attention may cause o Difficulty suppressing unwanted irrelevant information o Difficulty paying attention to relevant information o Overall difficulties is reasoning communication and problem solving Other features associated with schizophrenia o Inappropriate affect laughing at sad things crying at happy things o Anhedonia lack of interest in anything o Impaired social skills not necessarily a symptom of the disorder in the same way rather a result of symptoms 4 What are prodromal and residual symptoms Prodomal phase symptoms present before full criteria is met Acute active psychosis Residual phase symptoms present after acute phase 5 What are the subtypes of Schizophrenia and in what ways might these subtypes be problematic Type PARANOID DISORGANIZED CATATONIC UNDIFFERENTIATED RESIDUAL Paranoid Major features Delusions and hallucinations persecution and grandiosity Incoherence in cognition speech and behavior Flat or inappropriate affect Almost total unresponsiveness to environment Motor and verbal abnormalities Schizophrenic symptoms but doesn t meet criteria for paranoid disorganized or catatonic subtypes History of at least 1 episode of acute positive symptoms Currently no prominent positive symptoms o Most researched type o Prominent delusions and hallucinations highly resistant to any arguments against their delusions become angry if someone tries to argue with them o Involves themes of persecution and grandiosity act arrogantly superior or remain aloof and suspicious o Often do not have disorganized speech or behavior o Better prognosis than the other subtypes o More likely to be able to live independently and hold down a job and show better cognitive and social functioning o Onset later in life o Psychosis triggered by stress o Considered a milder less insidious form of schizophrenia Disorganized o Do not have well formed delusions or hallucinations o Very disorganized speak in word salads and be completely incoherent to others may not bathe dress or eat if left on their own o Odd stereotyped behaviors ex frequent grimacing or mannerisms such as flapping their hands o Emotional experiences and expressions are disturbed may not show any emotional reactions inappropriate emotional reactions may display emotions apparently unrelated to what they are saying or what is going on around them o Early onset continuous course o Often unresponsive to treatment o Most disabled by disorder Catatonic o Motor behaviors and ways of speaking that suggest unresponsiveness to environment o Clinical picture dominated by at least 2 of the following Motoric immobility Excessive purposeless motor activity Extreme negativism or mutism Odd voluntary movement Echolalia repetition of words or echopraxia imitation of an
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