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Human Growth and Development Group Presentation Summer Session Two August 2008 Presented By: Erin Allen Laura Bielanowski ...
Group Topic <ul><li>Gender  </li></ul><ul><ul><li>Male </li></ul></ul><ul><li>Developmental transitional period </li></ul>...
Schizophrenia <ul><li>Schizo-split </li></ul><ul><li>Phrenia-mind </li></ul>
Challenge
What Is  Schizophrenia?
Schizophrenia <ul><li>A chronic severe debilitating psychotic disorder </li></ul><ul><li>Characterized by: </li></ul><ul><...
CHAOS
 
 
Thought <ul><li>Irrational </li></ul><ul><li>Delusional </li></ul><ul><li>Confused </li></ul><ul><li>Distorted </li></ul>
Behavior <ul><li>Unpredictable </li></ul><ul><li>Erratic </li></ul><ul><li>Irrational </li></ul><ul><li>Dramatic </li></ul>
Mood <ul><li>Depressed </li></ul><ul><li>Disturbed </li></ul><ul><li>Exaggerated </li></ul><ul><li>Volatile </li></ul>
Perception <ul><li>Distorted </li></ul><ul><li>Bizarre </li></ul><ul><li>Unrealistic </li></ul><ul><li>Auditory & Visual <...
Symptoms
Positive Symptoms
Positive Symptoms  (Criteria A1-A4)   Excess or Distortion of Normal Functioning <ul><li>A1-delusions </li></ul><ul><li>A2...
Delusions <ul><li>False ideas believed by the patient but not by other people in the culture. </li></ul><ul><li>Sensory ex...
Hallucinations <ul><li>Gross distortions of visual or auditory stimuli  </li></ul><ul><li>Brain may entirely make up stimu...
Disorganized Speech <ul><li>Answers to questions may be unrelated </li></ul><ul><li>May jump topics in same sentence </li>...
Grossly Disorganized or Catatonic Behavior <ul><li>Disorganized-range from childlike silliness to unpredictable agitation ...
Negative Symptoms
Negative Symptoms  (Criteria A-5) A Loss of Normal Functioning <ul><li>All part of A-5 </li></ul><ul><li>Affective flatten...
Affective Flattening <ul><li>Persons face appears immobile & not responsive </li></ul><ul><li>Range of emotion is diminish...
Alogia <ul><li>Lack of speech </li></ul><ul><li>Brief or minimalist speech </li></ul><ul><li>Inability to communicate </li...
Avolition <ul><li>No will power </li></ul><ul><li>Little or no social activity </li></ul><ul><li>No interest in work </li>...
What  is  at  Stake?
Consider! <ul><li>A person with Schizophrenia has  </li></ul><ul><li>poor  </li></ul><ul><li>occupational ,  </li></ul><ul...
Distressing Facts! <ul><li>2.2 million Americans suffer from Schizophrenia  </li></ul><ul><li>Nearly half are not receivin...
Medical Care <ul><li>26-53% untreated medical problems </li></ul><ul><li>No coherent account of symptoms </li></ul><ul><li...
<ul><li>20-30% capable of PT work </li></ul><ul><li>10-15% capable of FT work </li></ul><ul><li>Few return to competitive ...
Homelessness <ul><li>200,000 homeless 1/3 of homeless population </li></ul><ul><li>Many eat from garbage cans and are regu...
<ul><li>16% of all inmates </li></ul><ul><li>40% in jail  </li></ul><ul><li>32% discharged from psychiatric hospitals go t...
Privation…no Money Food Housing Employment Friends  Family Medical care
<ul><li>Suicide #1 cause of premature death  </li></ul><ul><li>10-13% </li></ul><ul><li>Most  intended </li></ul><ul><li>S...
<ul><li>Hope is needed-help is available! </li></ul>
Treatment
Schizophrenia Is  Treatable!
<ul><li>Informed practitioners </li></ul><ul><li>Physiological & neurological testing </li></ul><ul><li>Basic lab work </l...
<ul><li>usually required initially, only 1of 3 </li></ul><ul><li>treated in psychiatric hospitals </li></ul>Hospitalization
Alternatives To Hospitalization <ul><li>Drugs by injection in ER or medical clinics </li></ul><ul><li>Partial hospitalizat...
Therapy Spectrum <ul><li>Medication </li></ul><ul><li>Supportive counseling and psychotherapy </li></ul><ul><li>Rehabilita...
Medication <ul><li>Primary focus is on  </li></ul><ul><li>Antipsychotics </li></ul><ul><li>Older medications available sin...
Older Antipsychotic Medications <ul><li>Chlorpromazine (Thorazine) </li></ul><ul><li>Haloperiodol (Haldol) </li></ul><ul><...
Atypical Antipsychotics 1990’s <ul><li>All are effective without  </li></ul><ul><li>causing extrapyramidal </li></ul><ul><...
New Atypical   Antipsychotics  <ul><li>Risperidone (Risperdal) </li></ul><ul><li>Olanzapine  (Zypreza) </li></ul><ul><li>Q...
Length of Drug Treatment <ul><li>Schizophrenia is a  </li></ul><ul><li>chronic disorder,  </li></ul><ul><li>because every ...
Supportive Counseling <ul><li>Treatments designed to  </li></ul><ul><li>assist  patients who are </li></ul><ul><li>stabili...
Rehabilitation & Support  <ul><li>Money management </li></ul><ul><li>Family education </li></ul><ul><li>Job training </li>...
Cognitive Behavioral Therapy <ul><li>Goals  </li></ul><ul><li>Relieve symptoms for improved functioning </li></ul><ul><li>...
Cognitive Behavioral Therapy “ Reactions” Emotions Behaviors Physiological A Situation Automatic   Thoughts Core Beliefs I...
Electroconvuslive Therapy <ul><li>ECT: used during acute onset when confusion  </li></ul><ul><li>and mood disturbances are...
Current Experimental Therapies <ul><ul><li>TMS (Transcranial  </li></ul></ul><ul><ul><li>Magnetic Stimulation) </li></ul><...
History
History <ul><li>Emil Kraepelin   </li></ul><ul><li>1856–1926  German </li></ul><ul><li>Psychiatrist developed </li></ul><u...
History <ul><li>Paul Eugen Bleuler   </li></ul><ul><li>1857 –1939 </li></ul><ul><li>Swiss psychiatrist  </li></ul><ul><li>...
History <ul><li>Similar signs and symptoms are traced from ancient </li></ul><ul><li>documents by the Egyptians as far bac...
History of Diagnosis <ul><li>“ Associative splitting: separation among basic functions of human personality (cognition, em...
Four A’s:  Fundamental symptoms <ul><li>Autism: unresponsive to the world </li></ul><ul><li>Ambivalence: presence of contr...
Diagonsis
Nosology of Schizophrenia
DSM-IV <ul><li>Schizophrenia is a group of psychotic  </li></ul><ul><li>disorders characterized by disturbances in  </li><...
Coding   Schizophrenia   <ul><ul><li>Schizophrenia  </li></ul></ul><ul><ul><ul><li>295.20 Catatonic type  </li></ul></ul><...
Making A Diagnosis (Criterion A-F) <ul><li>Characteristic (active phase) Symptoms  </li></ul><ul><li>2 or more (less if tr...
Making A Diagnosis (Criterion A-F) <ul><li>Duration   </li></ul><ul><li>6 months continuous </li></ul><ul><li>includes at ...
Making A Diagnosis (Criterion A-F) <ul><li>Substance & General Medical Condition Exclusion </li></ul><ul><li>Rule out medi...
295.40 Schizophreniform Disorder <ul><li>Identical to Criterion-A with 2 differences: </li></ul><ul><ul><li>Total Duration...
295.70 Schizoaffective Disorder  <ul><li>Uninterrupted illness characterized by one of the following concurrent with Crite...
295.20 Catatonic Type  <ul><li>“ The essential feature of catatonic type of  </li></ul><ul><li>Schizophrenia is a marked p...
295.10 Disorganized Type  <ul><li>“ The essential feature of the disorganized  </li></ul><ul><li>type of Schizophrenia are...
295.30 Paranoid Type  <ul><li>“ The presence of prominent delusions or  </li></ul><ul><li>auditory hallucinations in the c...
295.60 Residual Type  <ul><li>“ The residual type of Schizophrenia should  </li></ul><ul><li>be used when there has been a...
295.90 Undifferentiated Type  <ul><li>“ The essential feature of undifferentiated  </li></ul><ul><li>type of Schizophrenia...
Associated Features <ul><li>Poor insight into acknowledgement of the disease. </li></ul><ul><li>Poor insight is a symptom ...
Etiology
Etiology <ul><li>Schizophrenia is one  </li></ul><ul><li>of the most serious,  </li></ul><ul><li>and most mysterious </li>...
Etiology <ul><li>Many theories stress unfavorable social and  </li></ul><ul><li>emotional experiences as the probable caus...
Etiology <ul><li>Other researchers see Schizophrenia as a physical disease of the nervous system.  For example, the patien...
Diathesis – Stress Model The diathesis-stress model is a model that combines interaction of  biological and genetic factor...
Diathesis – Stress Model
Diathesis Stress – Model  <ul><li>“ Figure 1 illustrates a contemporary version of the diathesis-stress model that encompa...
Diathesis Stress - Model <ul><li>“ The picture that has emerged from research on Schizophrenia, as well as other psychotic...
Developmental  Issues
Preschizophrenic Children   <ul><li>Premorbid Development   </li></ul><ul><ul><li>Schizophrenia is diagnosed in late adole...
Preschizophrenic Children <ul><li>Social Situations </li></ul><ul><ul><li>Less responsive </li></ul></ul><ul><ul><li>Less ...
Adolescence   <ul><li>Symptoms </li></ul><ul><ul><li>Major adjustment problems </li></ul></ul><ul><ul><li>Depression </li>...
Schizotypal Personality Disorder (SPD)   <ul><li>Sometimes preschizophrenic adolescents have sings of psychotic symptoms, ...
Schizotypal Personality Disorder    Schizophrenia <ul><li>The transition from SPD to Schizophrenia usually happens in you...
SPD and Schizophrenia have some similar functional abnormalities <ul><li>Motor abnormalities </li></ul><ul><li>Cognitive d...
Conclusion
References <ul><li>American Psychiatric Association. (2000).  Diagnostic and statistical. </li></ul><ul><li>manual of ment...
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Schizophrenia

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A group presentation on Schizophrenia by:

Erin Allen
Laura Bielanowski
Joseph Palumbo
Bernd Weishaupt

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Transcript of "Schizophrenia"

  1. 1. Human Growth and Development Group Presentation Summer Session Two August 2008 Presented By: Erin Allen Laura Bielanowski Joseph Palumbo Bernd Weishaupt
  2. 2. Group Topic <ul><li>Gender </li></ul><ul><ul><li>Male </li></ul></ul><ul><li>Developmental transitional period </li></ul><ul><ul><li>Adolescent to adult </li></ul></ul><ul><li>Mental health issue… </li></ul>
  3. 3. Schizophrenia <ul><li>Schizo-split </li></ul><ul><li>Phrenia-mind </li></ul>
  4. 4. Challenge
  5. 5. What Is Schizophrenia?
  6. 6. Schizophrenia <ul><li>A chronic severe debilitating psychotic disorder </li></ul><ul><li>Characterized by: </li></ul><ul><ul><li>Disturbances of thought often with </li></ul></ul><ul><ul><li>Delusions </li></ul></ul><ul><ul><li>Bizarre behavior </li></ul></ul><ul><ul><li>Inappropriate mood and </li></ul></ul><ul><ul><li>Disturbances of perception affecting speech & emotions </li></ul></ul>
  7. 7. CHAOS
  8. 10. Thought <ul><li>Irrational </li></ul><ul><li>Delusional </li></ul><ul><li>Confused </li></ul><ul><li>Distorted </li></ul>
  9. 11. Behavior <ul><li>Unpredictable </li></ul><ul><li>Erratic </li></ul><ul><li>Irrational </li></ul><ul><li>Dramatic </li></ul>
  10. 12. Mood <ul><li>Depressed </li></ul><ul><li>Disturbed </li></ul><ul><li>Exaggerated </li></ul><ul><li>Volatile </li></ul>
  11. 13. Perception <ul><li>Distorted </li></ul><ul><li>Bizarre </li></ul><ul><li>Unrealistic </li></ul><ul><li>Auditory & Visual </li></ul><ul><li>Hallucinations </li></ul>
  12. 14. Symptoms
  13. 15. Positive Symptoms
  14. 16. Positive Symptoms (Criteria A1-A4) Excess or Distortion of Normal Functioning <ul><li>A1-delusions </li></ul><ul><li>A2-hallucinations </li></ul><ul><li>A3-disorganized speech </li></ul><ul><li>A4-grossly disorganized or catatonic behavior </li></ul>
  15. 17. Delusions <ul><li>False ideas believed by the patient but not by other people in the culture. </li></ul><ul><li>Sensory experience that is misinterpreted. </li></ul><ul><li>Person is convinced that random events relate to him </li></ul><ul><li>May be paranoid or grandiose </li></ul><ul><li>CIA, FBI, NSA, aliens, superman, Napoleon, Jesus, etc. </li></ul>I am Jesus Christ
  16. 18. Hallucinations <ul><li>Gross distortions of visual or auditory stimuli </li></ul><ul><li>Brain may entirely make up stimuli </li></ul><ul><li>Auditory are the most common </li></ul><ul><li>Hearing voices, seeing things </li></ul><ul><li>Religious visions & voices not typically included </li></ul>You talkin’ to me?
  17. 19. Disorganized Speech <ul><li>Answers to questions may be unrelated </li></ul><ul><li>May jump topics in same sentence </li></ul><ul><li>Speech may be incomprehensible </li></ul><ul><li>Possibly connected with disorganized thinking </li></ul>
  18. 20. Grossly Disorganized or Catatonic Behavior <ul><li>Disorganized-range from childlike silliness to unpredictable agitation </li></ul><ul><li>Catatonic-decrease in reactivity to environment </li></ul>
  19. 21. Negative Symptoms
  20. 22. Negative Symptoms (Criteria A-5) A Loss of Normal Functioning <ul><li>All part of A-5 </li></ul><ul><li>Affective flattening </li></ul><ul><li>Alogia </li></ul><ul><li>Avolition </li></ul>
  21. 23. Affective Flattening <ul><li>Persons face appears immobile & not responsive </li></ul><ul><li>Range of emotion is diminished </li></ul><ul><li>Lack of eye contact </li></ul>
  22. 24. Alogia <ul><li>Lack of speech </li></ul><ul><li>Brief or minimalist speech </li></ul><ul><li>Inability to communicate </li></ul>
  23. 25. Avolition <ul><li>No will power </li></ul><ul><li>Little or no social activity </li></ul><ul><li>No interest in work </li></ul><ul><li>No goals </li></ul>
  24. 26. What is at Stake?
  25. 27. Consider! <ul><li>A person with Schizophrenia has </li></ul><ul><li>poor </li></ul><ul><li>occupational , </li></ul><ul><li>interpersonal </li></ul><ul><li>and </li></ul><ul><li>self-supportive abilities </li></ul>
  26. 28. Distressing Facts! <ul><li>2.2 million Americans suffer from Schizophrenia </li></ul><ul><li>Nearly half are not receiving treatment, resulting in homelessness, incarceration, and violence </li></ul><ul><li>Of those treated, they often receive substandard care at general hospitals and nursing homes that lack special psychiatric care and rehabilitation capabilities </li></ul>
  27. 29. Medical Care <ul><li>26-53% untreated medical problems </li></ul><ul><li>No coherent account of symptoms </li></ul><ul><li>High pain threshold delays diagnosis </li></ul><ul><li>Side effects of antipsychotic medication </li></ul><ul><li>Unlikely to practice oral hygiene </li></ul>
  28. 30. <ul><li>20-30% capable of PT work </li></ul><ul><li>10-15% capable of FT work </li></ul><ul><li>Few return to competitive employment </li></ul>Unemployment
  29. 31. Homelessness <ul><li>200,000 homeless 1/3 of homeless population </li></ul><ul><li>Many eat from garbage cans and are regularly victimized </li></ul>
  30. 32. <ul><li>16% of all inmates </li></ul><ul><li>40% in jail </li></ul><ul><li>32% discharged from psychiatric hospitals go to jail </li></ul><ul><li>Most are misdemeanors </li></ul><ul><li>20% for violence or felonies </li></ul><ul><li>10% physically assaulted another </li></ul>Incarceration
  31. 33. Privation…no Money Food Housing Employment Friends Family Medical care
  32. 34. <ul><li>Suicide #1 cause of premature death </li></ul><ul><li>10-13% </li></ul><ul><li>Most intended </li></ul><ul><li>Some accidental </li></ul><ul><li>3 of 4 are males </li></ul>
  33. 35. <ul><li>Hope is needed-help is available! </li></ul>
  34. 36. Treatment
  35. 37. Schizophrenia Is Treatable!
  36. 38. <ul><li>Informed practitioners </li></ul><ul><li>Physiological & neurological testing </li></ul><ul><li>Basic lab work </li></ul><ul><li>Mental & psychological testing </li></ul><ul><li>Education </li></ul>Competent Care Team
  37. 39. <ul><li>usually required initially, only 1of 3 </li></ul><ul><li>treated in psychiatric hospitals </li></ul>Hospitalization
  38. 40. Alternatives To Hospitalization <ul><li>Drugs by injection in ER or medical clinics </li></ul><ul><li>Partial hospitalization- day/night hospitals </li></ul><ul><li>Mobile treatment teams that make house calls </li></ul><ul><li>Short term stay in semi-hospitals- IMD’s (institutions for mental diseases) & crisis homes. </li></ul><ul><li>Public health nursing at home </li></ul>
  39. 41. Therapy Spectrum <ul><li>Medication </li></ul><ul><li>Supportive counseling and psychotherapy </li></ul><ul><li>Rehabilitation & support services </li></ul><ul><li>Cognitive Behavioral Therapy </li></ul><ul><li>ECT (Electroconvuslive Therapy) </li></ul><ul><li>Current Experimental Therapies </li></ul><ul><ul><li>TMS (Transcranial Magnetic Stimulation) </li></ul></ul><ul><ul><li>VNS (Vagal Nerve Stimulation) </li></ul></ul>
  40. 42. Medication <ul><li>Primary focus is on </li></ul><ul><li>Antipsychotics </li></ul><ul><li>Older medications available since 1950 </li></ul><ul><li>Effectively alleviate positive symptoms </li></ul><ul><li>Not a cure for Schizophrenia </li></ul><ul><li>Newer atypical antipsychotic drugs developed 1990’s </li></ul>
  41. 43. Older Antipsychotic Medications <ul><li>Chlorpromazine (Thorazine) </li></ul><ul><li>Haloperiodol (Haldol) </li></ul><ul><li>Perpherenazine (Prolixin) </li></ul><ul><li>Cause extrapyramidal </li></ul><ul><li>side effects: </li></ul><ul><li>rigidity </li></ul><ul><li>muscle spasms </li></ul><ul><li>tremors </li></ul><ul><li>restlessness </li></ul>
  42. 44. Atypical Antipsychotics 1990’s <ul><li>All are effective without </li></ul><ul><li>causing extrapyramidal </li></ul><ul><li>symptoms </li></ul><ul><li>Goal was to reduce side </li></ul><ul><li>effects </li></ul><ul><li>Ex: Clozapine was </li></ul><ul><li>proven effective for </li></ul><ul><li>people who did not </li></ul><ul><li>respond to older </li></ul><ul><li>antipsychotics. </li></ul>
  43. 45. New Atypical Antipsychotics <ul><li>Risperidone (Risperdal) </li></ul><ul><li>Olanzapine (Zypreza) </li></ul><ul><li>Quetiapine (Seroquel) </li></ul><ul><li>Sertindole (Serdolect) </li></ul><ul><li>Ziprasidone (Geodon) </li></ul>
  44. 46. Length of Drug Treatment <ul><li>Schizophrenia is a </li></ul><ul><li>chronic disorder, </li></ul><ul><li>because every person </li></ul><ul><li>is different, how long </li></ul><ul><li>a patient takes </li></ul><ul><li>medication varies. </li></ul><ul><li>Some patients may </li></ul><ul><li>take medication </li></ul><ul><li>their entire lives </li></ul>
  45. 47. Supportive Counseling <ul><li>Treatments designed to </li></ul><ul><li>assist patients who are </li></ul><ul><li>stabilized on medications </li></ul><ul><li>May include: </li></ul><ul><li>Individual counseling </li></ul><ul><li>Vocational counseling </li></ul><ul><li>Group counseling </li></ul><ul><li>Problem-solving </li></ul><ul><li>Psychoeducation </li></ul><ul><li>Co-occurring substance abuse treatment </li></ul>
  46. 48. Rehabilitation & Support <ul><li>Money management </li></ul><ul><li>Family education </li></ul><ul><li>Job training </li></ul><ul><li>Social skills training </li></ul><ul><li>Support Groups </li></ul><ul><li>Community resources </li></ul><ul><li>Hygiene </li></ul><ul><li>Transportation help </li></ul>
  47. 49. Cognitive Behavioral Therapy <ul><li>Goals </li></ul><ul><li>Relieve symptoms for improved functioning </li></ul><ul><li>Target delusional thinking and visual & auditory hallucinations </li></ul><ul><li>Learn to differentiate between delusional and rational thinking </li></ul><ul><li>Develop mastery by controlling or reducing symptoms </li></ul>
  48. 50. Cognitive Behavioral Therapy “ Reactions” Emotions Behaviors Physiological A Situation Automatic Thoughts Core Beliefs I’ll Never Get better Intermediate Beliefs delusions can’t be controlled Activating trigger or event I must obey the voices
  49. 51. Electroconvuslive Therapy <ul><li>ECT: used during acute onset when confusion </li></ul><ul><li>and mood disturbances are present. </li></ul><ul><li>Also for </li></ul><ul><li>relapse </li></ul><ul><li>prevention </li></ul><ul><li>12-20 </li></ul><ul><li>treatments </li></ul><ul><li>suggested </li></ul><ul><li>over 6 month </li></ul><ul><li>time period </li></ul>
  50. 52. Current Experimental Therapies <ul><ul><li>TMS (Transcranial </li></ul></ul><ul><ul><li>Magnetic Stimulation) </li></ul></ul><ul><ul><li>VNS (Vagal Nerve </li></ul></ul><ul><ul><li>Stimulation) </li></ul></ul>
  51. 53. History
  52. 54. History <ul><li>Emil Kraepelin </li></ul><ul><li>1856–1926 German </li></ul><ul><li>Psychiatrist developed </li></ul><ul><li>The concept of dementia </li></ul><ul><li>Praecox (premature dementia) </li></ul>
  53. 55. History <ul><li>Paul Eugen Bleuler </li></ul><ul><li>1857 –1939 </li></ul><ul><li>Swiss psychiatrist </li></ul><ul><li>coined the term </li></ul><ul><li>Schizophrenia. </li></ul>
  54. 56. History <ul><li>Similar signs and symptoms are traced from ancient </li></ul><ul><li>documents by the Egyptians as far back as 2000 B.C. </li></ul><ul><li>Mental disturbances were associated with demons and </li></ul><ul><li>Evil spirits. </li></ul><ul><li>Spirits could be excised through such varied </li></ul><ul><li>means as music therapy or dangerous and deadly </li></ul><ul><li>means of drilling holes in patients skulls. </li></ul><ul><li>To let the demons out, other signs and symptoms </li></ul><ul><li>have been described in ancient writings by the </li></ul><ul><li>Greeks, Romans, and Chinese. </li></ul>
  55. 57. History of Diagnosis <ul><li>“ Associative splitting: separation among basic functions of human personality (cognition, emotions, perception) that was seen by some as the defining characteristics of Schizophrenia. </li></ul><ul><li>Bleuler split the divided symptoms into either positive or negative in 1911 and divided the illness into four categories: </li></ul><ul><ul><li>The four A’s: (autism, ambivalence, blunted affect, and loosening of associations).” </li></ul></ul>
  56. 58. Four A’s: Fundamental symptoms <ul><li>Autism: unresponsive to the world </li></ul><ul><li>Ambivalence: presence of contradictory drives, tendencies, emotions or thoughts </li></ul><ul><li>Affective disturbances: problems in feeling or expressing full range of emotions </li></ul><ul><li>Associative disturbances: thinking & ideas are not connected . </li></ul>
  57. 59. Diagonsis
  58. 60. Nosology of Schizophrenia
  59. 61. DSM-IV <ul><li>Schizophrenia is a group of psychotic </li></ul><ul><li>disorders characterized by disturbances in </li></ul><ul><li>perception, affect, behavior and </li></ul><ul><li>communication lasting longer than 6 months </li></ul><ul><li>(this includes psychotic behavior). The </li></ul><ul><li>person suffering from Schizophrenia has </li></ul><ul><li>deteriorated occupational, interpersonal and </li></ul><ul><li>self-supportive abilities. </li></ul>
  60. 62. Coding Schizophrenia <ul><ul><li>Schizophrenia </li></ul></ul><ul><ul><ul><li>295.20 Catatonic type </li></ul></ul></ul><ul><ul><ul><li>295.10 Disorganized type </li></ul></ul></ul><ul><ul><ul><li>295.30 Paranoid type </li></ul></ul></ul><ul><ul><ul><li>295.60 Residual type </li></ul></ul></ul><ul><ul><ul><li>295.90 Undifferentiated type </li></ul></ul></ul><ul><ul><li>295.40 Schizophreniform disorder </li></ul></ul><ul><ul><li>295.70 Schizoaffective disorder </li></ul></ul>
  61. 63. Making A Diagnosis (Criterion A-F) <ul><li>Characteristic (active phase) Symptoms </li></ul><ul><li>2 or more (less if treated successfully) </li></ul><ul><ul><li>Delusions </li></ul></ul><ul><ul><li>Hallucinations </li></ul></ul><ul><ul><li>Disorganized speech </li></ul></ul><ul><ul><li>Disorganized/catatonic </li></ul></ul><ul><ul><li>Negative symptoms </li></ul></ul><ul><li>Only 1 symptom required if </li></ul><ul><li>Delusions are bizarre or </li></ul><ul><li>hallucinations include persistent </li></ul><ul><li>voice(s) </li></ul><ul><li>Social/Occupational Dysfunction </li></ul><ul><li>Underachievement for an </li></ul><ul><li>Adolescent: failure to </li></ul><ul><li>achieve expected </li></ul><ul><li>academic, social, and </li></ul><ul><li>occupational </li></ul><ul><li>developmental levels </li></ul>
  62. 64. Making A Diagnosis (Criterion A-F) <ul><li>Duration </li></ul><ul><li>6 months continuous </li></ul><ul><li>includes at least 1 </li></ul><ul><li>month of Criterion A </li></ul><ul><li>symptoms (less if treated </li></ul><ul><li>successfully). During the </li></ul><ul><li>residual periods </li></ul><ul><li>symptoms must be </li></ul><ul><li>negative or reduced </li></ul><ul><li>Criterion A symptoms </li></ul><ul><li>Schizoaffective & Mood Disorder Exclusion </li></ul><ul><li>Rule out schizoaffective </li></ul><ul><li>disorder and mood </li></ul><ul><li>Disorder: (1) no concurrent </li></ul><ul><li>major depressive, manic or </li></ul><ul><li>mixed episodes during </li></ul><ul><li>active phase symptoms (2) </li></ul><ul><li>if the did occur they must </li></ul><ul><li>be very brief </li></ul>
  63. 65. Making A Diagnosis (Criterion A-F) <ul><li>Substance & General Medical Condition Exclusion </li></ul><ul><li>Rule out medication, </li></ul><ul><li>general medical condition </li></ul><ul><li>and/or substance abuse </li></ul><ul><li>Relationship To Pervasive Developmental Disorder </li></ul><ul><li>If Autistic Disorder or </li></ul><ul><li>Developmental Disorder </li></ul><ul><li>is present, diagnosis of </li></ul><ul><li>Schizophrenia is added </li></ul><ul><li>only if pronounced </li></ul><ul><li>delusions or hallucinations </li></ul><ul><li>meet criterion C (30+ days) </li></ul>
  64. 66. 295.40 Schizophreniform Disorder <ul><li>Identical to Criterion-A with 2 differences: </li></ul><ul><ul><li>Total Duration between 1 & 6 months through three phases (prodromal, active, & residual) </li></ul></ul><ul><ul><li>Impaired functioning may or may not be present </li></ul></ul><ul><li>This diagnosis is considered “provisional” because recovery is uncertain </li></ul><ul><ul><li>If symptoms persist beyond 6 months a diagnosis of Schizophrenia is needed </li></ul></ul><ul><ul><li>1/3 recover within 6 months, 2/3 progress to Schizophrenia or Schizoaffective Disorder. </li></ul></ul>
  65. 67. 295.70 Schizoaffective Disorder <ul><li>Uninterrupted illness characterized by one of the following concurrent with Criterion A for Schizophrenia: </li></ul><ul><ul><li>Major Depressive Episode (must include Criterion A1 depressed mood. </li></ul></ul><ul><ul><li>Manic Episode </li></ul></ul><ul><ul><li>Mixed Episode </li></ul></ul><ul><li>Delusions or hallucinations must be present at least 2 weeks w/o prominent mood symptoms </li></ul><ul><li>Mood episodes present during active & residual </li></ul><ul><li>Bipolar Type: manic, mixed &/or major depressive episode </li></ul><ul><li>Depressive Type: only Major Depressive Episode </li></ul>
  66. 68. 295.20 Catatonic Type <ul><li>“ The essential feature of catatonic type of </li></ul><ul><li>Schizophrenia is a marked psychomotor </li></ul><ul><li>disturbance that may involve motoric </li></ul><ul><li>immobility, excessive motor activity, extreme </li></ul><ul><li>negativism, mutism, peculiarities of </li></ul><ul><li>voluntary movement, echolalia, or </li></ul><ul><li>echopraxia… the excessive motor activity is </li></ul><ul><li>apparently purposeless and is not influenced </li></ul><ul><li>by external stimuli.” DSM-IV-TR (2000) p. 315 </li></ul>
  67. 69. 295.10 Disorganized Type <ul><li>“ The essential feature of the disorganized </li></ul><ul><li>type of Schizophrenia are disorganized </li></ul><ul><li>speech, disorganized behavior, and flat or </li></ul><ul><li>inappropriate affect. The disorganized </li></ul><ul><li>speech may be accompanied by silliness and </li></ul><ul><li>laughter that are not closely related to the content of </li></ul><ul><li>the speech. The behavioral disorganization (i.e., </li></ul><ul><li>lack of goal orientation) may lead to severe </li></ul><ul><li>disruption in the ability to perform activities of daily </li></ul><ul><li>living…” DSM-IV-TR (2000) p. 314 </li></ul>
  68. 70. 295.30 Paranoid Type <ul><li>“ The presence of prominent delusions or </li></ul><ul><li>auditory hallucinations in the context of a </li></ul><ul><li>relative preservation of cognitive functioning </li></ul><ul><li>and affect.” DSM-IV-TR (2000) p. 313 </li></ul><ul><li>“ Delusions are typically persecutory or </li></ul><ul><li>grandiose, or both, but delusions with other </li></ul><ul><li>themes (e.g., Jealousy, religiosity, or </li></ul><ul><li>somatization) may occur.” (Ibid) p. 313 </li></ul>
  69. 71. 295.60 Residual Type <ul><li>“ The residual type of Schizophrenia should </li></ul><ul><li>be used when there has been at least one </li></ul><ul><li>episode of Schizophrenia, but the current </li></ul><ul><li>clinical picture is without prominent positive </li></ul><ul><li>psychotic symptoms (e.g., delusions, </li></ul><ul><li>hallucinations, disorganized speech or </li></ul><ul><li>behavior).” DSM-IV-TR (2000) p. 316 </li></ul>
  70. 72. 295.90 Undifferentiated Type <ul><li>“ The essential feature of undifferentiated </li></ul><ul><li>type of Schizophrenia is the presence of </li></ul><ul><li>symptoms that meet Criterion A of </li></ul><ul><li>Schizophrenia but that do not meet criteria </li></ul><ul><li>for the paranoid, disorganized, or catatonic </li></ul><ul><li>type.” DSM-IV-TR (2000) p. 316 </li></ul>
  71. 73. Associated Features <ul><li>Poor insight into acknowledgement of the disease. </li></ul><ul><li>Poor insight is a symptom of disease, not a failure to cope with diagnosis. </li></ul><ul><li>Controversy exists whether persons diagnosed with Schizophrenia exhibit greater incidences' of violence. </li></ul>
  72. 74. Etiology
  73. 75. Etiology <ul><li>Schizophrenia is one </li></ul><ul><li>of the most serious, </li></ul><ul><li>and most mysterious </li></ul><ul><li>of all mental illnesses. </li></ul><ul><li>It has been described </li></ul><ul><li>as a monster, a </li></ul><ul><li>chimera and a </li></ul><ul><li>disaster for those who </li></ul><ul><li>get it. </li></ul><ul><li>What is it’s source? </li></ul>
  74. 76. Etiology <ul><li>Many theories stress unfavorable social and </li></ul><ul><li>emotional experiences as the probable cause. Harmful family influences or faulty child-rearing practices are blamed during the formative years. </li></ul><ul><li>Some theorists claim the “double-bind” (no-win) situation as critical: “…the patient’s mother was always ready to criticize him for doing one thing and rejecting him for doing the opposite, resulting in constant frustration.” </li></ul>
  75. 77. Etiology <ul><li>Other researchers see Schizophrenia as a physical disease of the nervous system. For example, the patient may be “intoxicated” by some chemical (possibly similar to LSD, DMT, or mescaline) which his body may be producing due to a genetically inherited error in metabolism. </li></ul><ul><li>Recently, advances in technology (supported by brain imaging ) and research findings suggest that Schizophrenia is a biologically based disease of the brain. </li></ul>
  76. 78. Diathesis – Stress Model The diathesis-stress model is a model that combines interaction of biological and genetic factors to explain disorders. Diathesis refers to a hereditary predisposition toward disease or disorder.
  77. 79. Diathesis – Stress Model
  78. 80. Diathesis Stress – Model <ul><li>“ Figure 1 illustrates a contemporary version of the diathesis-stress model that encompasses all of the factors that are currently considered to play a significant etiologic role in Schizophrenia. This model postulates that constitutional vulnerability to Schizophrenia (i.e., The diathesis) can result from both inherited and acquired constitutional factors.” p. 422 walker et. al. </li></ul>
  79. 81. Diathesis Stress - Model <ul><li>“ The picture that has emerged from research on Schizophrenia, as well as other psychotic disorders, is best described in an expansion of the diathesis stress model that has dominated the field for several decades.” P.422 walker et.al., </li></ul>
  80. 82. Developmental Issues
  81. 83. Preschizophrenic Children <ul><li>Premorbid Development </li></ul><ul><ul><li>Schizophrenia is diagnosed in late adolescence or early childhood (normally) </li></ul></ul><ul><ul><li>Signs are usually present before diagnosis, subtle but can be seen when compared to adolescence with healthy outcomes </li></ul></ul><ul><li>Cognitive Functioning of children who later develop Schizophrenia </li></ul><ul><ul><li>Perform below age level </li></ul></ul><ul><ul><li>Poor grades </li></ul></ul><ul><ul><li>Has hard time interpreting information and able to use that information </li></ul></ul><ul><ul><li>Inability to sustain attention </li></ul></ul>
  82. 84. Preschizophrenic Children <ul><li>Social Situations </li></ul><ul><ul><li>Less responsive </li></ul></ul><ul><ul><li>Less positive emotion </li></ul></ul><ul><ul><li>Poor social adjustment </li></ul></ul><ul><ul><li>More negative facial expressions during first year of life </li></ul></ul><ul><li>Motor Development </li></ul><ul><ul><li>Delays and abnormalities </li></ul></ul><ul><ul><li>Late walkers </li></ul></ul><ul><li>  </li></ul><ul><li>*Early and middle childhood aged children are rarely diagnosed with Schizophrenia. </li></ul>
  83. 85. Adolescence <ul><li>Symptoms </li></ul><ul><ul><li>Major adjustment problems </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Social withdrawal </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Noncompliance </li></ul></ul><ul><li>*The problem is these symptoms do not go along with just Schizophrenia they are present in mood disorders, substance abuse, and some other behavioral disorders </li></ul>
  84. 86. Schizotypal Personality Disorder (SPD) <ul><li>Sometimes preschizophrenic adolescents have sings of psychotic symptoms, the DSM IV defines these as SPD </li></ul><ul><li>Diagnostic Criteria for SPD </li></ul><ul><ul><li>Social anxiety/withdrawal </li></ul></ul><ul><ul><li>Affective abnormalities </li></ul></ul><ul><ul><li>Eccentric behavior </li></ul></ul><ul><ul><li>Unusual ideas </li></ul></ul><ul><ul><ul><li>Persistent beliefs in extrasensory phenomena </li></ul></ul></ul><ul><ul><li>Unusual sensory experiences </li></ul></ul><ul><ul><ul><li>Repeated experiences with confusing noises with peoples voices </li></ul></ul></ul><ul><ul><ul><li>Seeing objects move </li></ul></ul></ul><ul><li>*(All of these symptoms are recurring) </li></ul><ul><li>*Schizotypal Personality Disorder patient’s symptoms are not as severe as having delusions or hallucinations </li></ul>
  85. 87. Schizotypal Personality Disorder  Schizophrenia <ul><li>The transition from SPD to Schizophrenia usually happens in young adulthood </li></ul><ul><li>Studies show that 10% to 40% of youth with SPD signs eventually show an Axis I Schizophrenia spectrum disorder </li></ul><ul><li>The others with SPD either end up with adjustment problems or a complete decrease of symptoms in young adulthood </li></ul><ul><li>*Research is being done to see if prevention programs could be used with youth with SPD to prevent Schizophrenia from developing </li></ul>
  86. 88. SPD and Schizophrenia have some similar functional abnormalities <ul><li>Motor abnormalities </li></ul><ul><li>Cognitive deficits </li></ul><ul><li>Increase in cortisol (stress hormone) </li></ul>
  87. 89. Conclusion
  88. 90. References <ul><li>American Psychiatric Association. (2000). Diagnostic and statistical. </li></ul><ul><li>manual of mental disorders (4 th ed.). Washington, DC: author. </li></ul><ul><li>Annual Review. Psychology. 2004. 55:401-30. </li></ul><ul><li>http://associatedcontent.com/article/76943 . </li></ul><ul><li>Durand, V. M. & Barlow, David. H. (2006). Essentials of abnormal psychology . (4 th ed.) Belmont, CA: Thomson Wadsworth, Inc. </li></ul><ul><li>Journal of Clinical Psychology, May, 1993, vol. 49, no. 3. </li></ul><ul><li>Journal of Clinical Psychology, November, 1984, vol. 40 no. </li></ul><ul><li>Mental Health America. (2006). Schizophrenia: What you need to know . [Brochure]. Alexandria, VA: Author. </li></ul><ul><li>National Institute of Mental Health. (2007). Schizophrenia . [Brochure]. Bethesda, MD: Author. </li></ul><ul><li>Noll, Richard A. (Ed.). (2000) Schizophrenia and other psychotic disorders . New York: Facts On File, Inc. </li></ul><ul><li>http://samian.colorado.edu . </li></ul><ul><li>http://Schizophrenia.com/history.htm . </li></ul><ul><li>Torrey, E. F, (2006). Surviving Schizophrenia: A manual for families, patients and providers . New York: HarperCollins Publishers. </li></ul><ul><li>http://www.usefilm.com/image/765556.html </li></ul><ul><li>http://web.ebscohost.com/ehost/delivery . </li></ul>
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