Schizophrenia
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Schizophrenia

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This powerpoint is about schizophrenia. It includes the diagnostic criteria of the DSM-5, changes from the DSM IV-TR in the diagnosis of schizophrenia, the populations that are most affected, the ...

This powerpoint is about schizophrenia. It includes the diagnostic criteria of the DSM-5, changes from the DSM IV-TR in the diagnosis of schizophrenia, the populations that are most affected, the prevalence, the age of onset, genetic risk factors, neurodevelopmental abnormalities, environmental risk factors, environmental stressors, treatment options (pharmacotherapy and psychosocial treatment), and a link to videos that allow you to experience what schizophrenia is like.

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  • Delusion: A belief held in the face of evidence to the contrary, that is resistant to all reason (includes persecutory, referential, grandiose, delusions of control, and others)Hallucination: False sensory perception experienced without real external stimulus (auditory hallucinations are the most common in schizophrenia) Derailment: Consistently jumping from one topic to another; the topics are unrelatedIncoherent speech refers to speech that is unintelligible and lacks clarity and organization (sounds like gibberish) Catatonic behavior: Experiencing an extreme loss of motor skill or even constant hyperactive motor activityNegative symptoms: Thoughts, feelings, or behaviors normally present in healthy individuals that are absent or diminished in a person with a mental disorder Avolition: General lack of drive or lack of motivation to pursue meaningful goals
  • First episode: First manifestation of the disorderMultiple episodes may be determined after a minimum of two episodesAn acute episode is a time period in which the symptom criteria are fulfilledPartial remission is a period of time during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partially fulfilledFull remission is a period of time after a previous episode during which no disorder- specific symptoms are present
  • The image is a comparison of the ventricle size of the well twin and the twin with schizophrenia. In the right part of the image, the person with schizophrenia displays enlarged ventricles.
  • Clozapine and olanzapine appear to have more side effects than the other atypical psychotics
  • Clozapine and olanzapine appear to have more side effects than the other atypical psychotics
  • Command hallucinations: Hallucinations that command the patient to perform certain acts

Schizophrenia Schizophrenia Presentation Transcript

  • SCHIZOPHRENIA By Emily Dee
  • DIAGNOSING SCHIZOPHRENIA FROM THE DSM-5 • Criterion A (Active- phase symptoms): Two or more of the following, each present for a significant portion of time during a 1-month period. One of these MUST be (1), (2), or (3). –1. Delusions –2. Hallucinations –3. Disorganized speech (e.g., frequent derailment or incoherence) –4. Grossly disorganized or catatonic behavior –5. Negative symptoms (i.e., diminished emotional expression or avolition)
  • DIAGNOSING SCHIZOPHRENIA FROM THE DSM-5 CONTINUED • Criterion B: The level of functioning in one or more major areas such as work, interpersonal relations, or self-care, is below the level achieved prior to the onset. -If the onset is in childhood or in adolescence, there is failure to achieve expected levels of interpersonal, academic, or occupational functioning.
  • DIAGNOSING SCHIZOPHRENIA FROM THE DSM-5 CONTINUED • Criterion C: – 1. Disturbance persists for at least 6 months – 2. The 6th month period must include at least 1 month of symptoms that meet Criteria A – 3. The 6th month period may include prodromal (early signs) or residual symptoms (recurrence of symptoms) – 4. During these prodromal or residual periods, the signs of disturbance must only be exhibited by: » Negative symptoms » Two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs , unusual perceptual experiences)
  • DIAGNOSING SCHIZOPHRENIA FROM THE DSM-5 CONTINUED • Criterion D: Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out • Criterion E: The physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition has been ruled out
  • DIAGNOSING SCHIZOPHRENIA FROM THE DSM-5 CONTINUED • Criterion F: If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month
  • DIAGNOSING SCHIZOPHRENIA FROM THE DSM-5 CONTINUED • The following course specifiers are only to be used after a 1- year duration of the disorder. • Specify if…. – First episode, currently in acute episode – First episode, currently in partial remission – First episode, currently in full remission – Multiple episodes, currently in acute episode – Multiple episodes, currently in partial remission – Multiple episodes, currently in full remission – Continuous – Unspecified
  • DIAGNOSING SCHIZOPHRENIA FROM THE DSM-5 CONTINUED • Specify if… – With catatonia • Specify current severity – Severity is rated by an assessment of the primary symptoms of psychosis and negative symptoms. – May be rated for its current severity (more severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe) – Note: Diagnosis of schizophrenia can be made without using this severity specifier
  • OTHER COMMENTS MADE IN THE DSM-5 • Individuals with schizophrenia may display.. – Inappropriate affect (e.g., laughing in the absence of an appropriate stimulus) – A dysphoric mood that can take the form of depression, anxiety, or anger – A disturbed sleep pattern – Lack of interest in eating or food refusal – Cognitive deficits – Lack of insight or awareness of their disorder
  • WHEN DIAGNOSING, REMEMBER TO… • Remain culturally relativistic • Not confuse schizophrenia with schizoaffective disorder • Not confuse schizophrenia with schizophreniform disorder
  • SWITCHING FROM THE DSM-IV-TR TO THE DSM-5 • Negative symptoms are described in more detail in the DSM-5 • Two Criterion A symptoms are needed for a diagnosis for schizophrenia in the DSM-5 compared with one from Criterion A in the DSM-IV-TR (if the delusions were bizarre or they had auditory hallucinations where two or more voices conversed) • The DSM-5 now requires one out of three positive symptoms for a diagnosis of schizophrenia • The schizophrenia subtypes seen in the DSM-IV-TR (paranoid, disorganized, catatonic, undifferentiated, residual) have been removed • Catatonia (a subtype in the DSM-IV-TR) is now a specifier in the DSM-5
  • POPULATIONS AFFECTED • • • • • • • • • • African Americans Afro- Caribbeans More commonly diagnosed in men Veterans with PTSD Marijuana smokers Individuals with a family history of schizophrenia or other mental disorders Those with low socio-economic status (SES) Children who grow up in urban environments Migrants Individuals born in late winter or early spring
  • PREVALENCE • The lifetime prevalence appears to be approximately 0.3%- 0.7% • However, the DSM-5 notes that there is reported variation by race/ethnicity, across countries, and by geographic origin for immigrants and children of immigrants • The National Institute of Mental Health (NIMH) estimate that approximately 2.4 millions Americans have schizophrenia • Close to 1% of the world’s population will develop schizophrenia
  • ONSET • On average, onset occurs between the late teens and the mid-30s • Onset prior to adolescence is rare • New cases after 40 years old are uncommon • Late-onset cases (after 40 years old) occur mostly in females • For males: typical onset occurs in the early- to mid20s • For females: typical onset occurs in the late-20s
  • DIATHESIS- STRESS MODEL “The genetic risk for psychosis is ubiquitous and variable so that the more important question becomes what type of relationship genes and environment may have in shaping the risk for psychosis” (Read, J. et al 344). • In schizophrenia….. – There is no definitive cause. Genetic components and the environment interact together. – Synergism may occur. This is when genes and the environment reinforce one another to create a joint strong effect. – Parallelism may occur. This is when environmental factors “compete” with genetic factors to cause psychosis.
  • GENETIC RISK FACTORS • Schizophrenia has a heritability rate of 80% • Family history of schizophrenia – The likelihood of having schizophrenia increases when one parent or both parents have schizophrenia – Genain quadruplets were found to all have schizophrenia which suggests a large genetic component to the disorder – Negative symptoms have a strong genetic component
  • GENETIC RISK FACTORS • Chromosomal regions harbor genes associated with schizophrenia (6p, 8p, 10p, 13q, 15q, and 22q) • Over 200 genes have been associated with schizophrenia • Less dysbindin is found in the brain • Two genes, DTNBP1 and NGR1, are associated with schizophrenia – DTNBP1 impacts the dopamine and glutamate neurotransmitters in the brain • Two genes, COMT and BDNF, are associated with cognitive deficits in schizophrenia – COMT is associated with executive functions like planning, working, memory, and problem solving • Damage to the gene DISC1 – This gene is essential for brain signaling, learning, memory, and mood • Alteration of gene expression in the gene, NDST3 – NDST3 is critical to neurodevelopmental processes such as axon formation and synaptic function
  • GENETIC RISK FACTORS • Copy- number variations (CNVs) mutations found in neurodevelopmental pathways – A CNV is an abnormal copy (a deletion or duplication) of a section or sections of DNA • Single nucleotide polymorphisms (SNPs) have been linked to schizophrenia – A SNP is a variation in the DNA sequence
  • NEURODEVELOPMENTAL ABNORMALITIES • Prefrontal cortex (involved in speech, decision making, emotion, and goal-directed behavior) is heavily affected: – The dopamine hypothesis: – – – – Reductions of gray matter GABA transmission is disrupted Decreased density of serotonin 5-HT2 receptors Abnormalities of cell formation
  • NEURODEVELOPMENTAL ABNORMALITIES • Problems in the temporal cortex: – Decreased left and hippocampi size – Structural and functional abnormalities in the temporal gyrus, amygdala, and anterior cingulate – Reduction in cortical gray matter – HPA axis is disrupted • Other abnormalities: – Increased blood flow found in Broca’s area during auditory hallucinations • Broca’s area is involved in producing speech – Low levels of glutamate – Ventricular enlargement – Smaller brain volume
  • ENVIRONMENTAL RISK FACTORS • Preconception factors: – Advanced paternal age (55+) – Prolonged delay between pregnancies – Parental smoking, drinking, and substance abuse – Exposure to pollution
  • ENVIRONMENTAL RISK FACTORS • Prenatal factors: – Mother’s exposure to…….during gestation • • • • • • Viral pathogens Respiratory infections Genital and reproductive infections Influenza Rubella Polio – Maternal stress and anxiety • Increased cortisol – Nutritional deficiencies • • • • • Folate Vitamin D Iron Fatty acids Retinoids
  • ENVIRONMENTAL RISK FACTORS • Perinatal factors: – Brain hypoxia (low oxygen levels) – Shorter gestation periods – A low birth weight
  • ENVIRONMENTAL STRESSORS • Child abuse or child neglect • Sexual abuse • Parental separation or divorce • Placement outside of the home (foster care) • Loss of a loved one • Witnessing domestic violence
  • TREATMENT OPTIONSPHARMACOTHERAPY • Antipsychotics help reduce active- phase symptoms • Antipsychotics can come in pill form, liquid form, or in shot injections
  • TREATMENT OPTIONSPHARMACOTHERAPY • Two main types of psychoactive medications: – Typical antipsychotics (“first generation”):
  • TREATMENT OPTIONSPHARMACOTHERAPY – Atypical antipsychotics (“second generation”):
  • TREATMENT OPTIONSPHARMACOTHERAPY • The Benefits of Psychoactive Medications: – Block postsynaptic dopamine receptors called D2 receptors – Reduces the effects of positive and negative symptoms – May improve mental functioning – Clozapine reduces the risk of suicide
  • TREATMENT OPTIONSPHARMACOTHERAPY • The Downfalls of Psychoactive Medications:
  • TREATMENT OPTIONSPHARMACOTHERAPY • The Downfalls of Psychoactive Medications:
  • TREATMENT OPTIONSPHARMACOTHERAPY • The Downfalls of Psychoactive Medications: – Atypical psychotics are costly (Average monthly cost has been determined to be $200- $700 depending on which drug is used) – They have a high discontinuation rate – Most antipsychotics are approved only for adults
  • TREATMENT OPTIONSPHARMACOTHERAPY – Supporting add-on drugs: • Antidepressants help treat depression and reduce the risk of suicide in patients with schizophrenia • Anti- anxiety drugs such as Benzodiazepines have some effect on psychotic symptoms and may help treat restlessness and agitation
  • TREATMENT OPTIONS- PSYCHOSOCIAL TREATMENT • Cognitive Behavioral Therapy (CBT): – Is gaining recognition in treating psychosis and modifying delusional thought processes in patients with schizophrenia – Questions abnormal beliefs, encourages self-monitoring, and teaches coping strategies – Commonly targets active- phase symptoms but can target negative symptoms and psychological distress too – Prevents relapse and reduces command hallucinations – May help patients who are not taking psychoactive medication
  • CBT CONTINUED
  • TREATMENT OPTIONS- PSYCHOSOCIAL TREATMENT • Social Skills Training (SST) – Focuses on social deficits in order to improve social competence – Involves role-playing, modeling, group exercises, and doing things in actual situations – Teaches how to manage interpersonal relations such as: • • • • • Filling out job applications Interviewing for a job Ordering meals at a restaurant Interacting with others at a supermarket Balancing one’s checkbook – SST reduces negative symptoms, reduces the risk of relapse, increases functional capacity, and improves their ability to cope
  • TREATMENT OPTIONS- PSYCHOSOCIAL TREATMENT • Family intervention: – The goals of family education: • Maximize the family’s adaptive functioning • Minimize disruption to family life • Minimize long-term grief, stress, and burden experienced by the family – Important elements that should be a part of family intervention: • • • • Psychoeducation Crisis intervention Emotional support Training on how to cope with symptoms of schizophrenia – Reduces relapses, re-admissions to a hospital, symptoms of schizophrenia, and family distress
  • TREATMENT OPTIONS- PSYCHOSOCIAL TREATMENT • Cognitive remediation training: – Targets various cognitive domains (learning, memory, attention, social cognition, and psychomotor speed) in an attempt to improve cognitive skills through training – Includes paper-and-pencil tests and computerized exercises – Improves cognitive abilities in problem solving, attention, social cognition, social adjustment, and functional outcomes
  • TREATMENT OPTIONS- PSYCHOSOCIAL TREATMENT • Supported Employment: – Guides individuals with schizophrenia in achieving their vocational goals – Helps transition clients into competitive employment – Provides extensive skills training – Improves employment outcomes and global functioning
  • TREATMENT OPTIONS- PSYCHOSOCIAL TREATMENT • Case Management: – Case managers are able to get patients with schizophrenia in contact with the services they need – They can help provide services in the community such as: • • • • • • Medication Treatment for substance abuse Money management Psychotherapy Vocational training Assistance in obtaining house and employment – Helps in reducing time spent in the hospital, improves housing stability, and reduces symptoms
  • TREATMENT OPTIONS- PSYCHOSOCIAL TREATMENT • Other Types of Psychosocial Treatment: – Inpatient psychiatric care – Individual psychotherapy – Residential treatment – Support group
  • MOST EFFECTIVE TREATMENTS • Clozapine is considered the most effective of the antipsychotics because it has been effective when other antipsychotics are not and also has been empirically proven to reduce the rate of suicide • There is an extensive amount of research that support the efficacy of SST and family intervention • CBT and cognitive remediation are also common treatments
  • WHAT IT’S LIKE TO HAVE SCHIZOPHRENIA • This link contains two videos that allow you to experience what it is like to have schizophrenia: http://onemansblog.com/2007/06/13/what-its-reallylike-to-be-schizophrenic/ • Listen and watch with headphones to experience a more accurate representation of schizophrenia • WARNING: These videos may be emotionally disturbing for some viewers!!!
  • SOURCES • http://books.google.com/books?hl=en&lr=&id=1dsnAgAAQBAJ&oi=fnd&pg=PT2 &dq=dsm-5+schizophrenia&ots=B17iFKerDq&sig=-7GTdlainKN9CzfKM0xpTIhXj0#v=onepage&q=dsm-5%20schizophrenia&f=false • http://journals.psychiatryonline.org/data/Journals/PSS/3793/07ps245.pdf • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292287/#!po=5.00000 • http://www.jstor.org.proxy.wichita.edu/stable/40701056?seq=1 • http://cdp.sagepub.com.proxy.wichita.edu/content/19/4/260.full.pdf+html • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181651/ • http://www.nimh.nih.gov/health/publications/the-numbers-count-mentaldisorders-in-america/index.shtml#Schizophrenia • http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)622461/fulltext • http://bjp.rcpsych.org/content/178/40/s18.full • http://bjp.rcpsych.org/content/190/3/194.full • http://www.dsm5.org/Documents/Schizophrenia%20Fact%20Sheet.pdf • http://ccpweb.wustl.edu/pdfs/2013_defdes.pdf • http://psychcentral.com/encyclopedia/2008/delusion/ • http://www.wisegeek.com/what-are-delusions-of-control.htm • http://schizophreniabulletin.oxfordjournals.org/content/26/3/699.full.pdf
  • SOURCES • • • • • • • • • • • • http://pro.psychcentral.com/2013/dsm-5-changes-schizophrenia-psychoticdisorders/004336.html# http://www.schizophrenia.com/sznews/archives/005007.html http://www.nytimes.com/1993/09/22/health/scientists-trace-voices-inschizophrenia.html http://dn3kg6nn2s.search.serialssolutions.com.proxy.wichita.edu/?sid=jstor:jstor&genre= article&issn=00207411&volume=42&pages=%202332&spage=23&epage=32&atitle=Environmental%20Risk%20Factors%20and%20Schizophre nia&date=2013&issue=1 http://www.psychiatrictimes.com/schizophrenia/auditory-hallucinations-psychiatricillness/page/0/1 http://www.minddisorders.com/Br-Del/Delusions.html http://en.wikipedia.org/wiki/Thought_disorder http://www.psychiatrictimes.com/schizophrenia/abcs-cognitive-behavioral-therapyschizophrenia/page/0/1 http://umm.edu/health/medical/reports/articles/schizophrenia http://www.consumerreports.org/health/resources/pdf/best-buydrugs/AntipsychoticsFINAL.pdf http://healingattention.org/documents/doc_litreviewpsychosis.pdf http://www.news-medical.net/news/20131120/Researchers-discover-new-genetic-riskfactor-for-schizophrenia-bipolar-disorder.aspx