Schizophrenia corcoran 2013

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  • 1. SCH IZO PH R EN SCH IZO PH R EN IAIA Jacqueline Corcoran, Ph.D. Virginia Com m onwealth University
  • 2. Schizophrenia Schizophrenia abnormal patterns of thought and perception, Persist for at least 6 months, At least one month of at least 2 “active phase” symptoms 1) Delusions 2) Hallucinations 3) Disorganized speech or disorganized behavior v=dkB2CGL769o
  • 3. Positive: exaggerations of normal behavior. Hallucinations: are sense perceptions of external objects when those objects are not present Delusions: false beliefs that a person maintains even though overwhelmingly contradicted by social reality disorganized thought processes tendencies toward agitation Negative: diminution of what would be considered normal behavior. flat or blunted affect (the absence of expression) social withdrawal non-communication anhedonia (blandness) or passivity ambivalence in decision-making. SYMPTOMS OFSYMPTOMS OF SCHIZOPHRENIASCHIZOPHRENIA
  • 4. SCHIZOAFFECTIVE DISORDERSCHIZOAFFECTIVE DISORDER “criterion A” symptoms for Schizophrenia – At least 2: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior And negative symptoms such as flat affect, poverty of thought, anhedonia, and withdrawal Symptoms of mood episodes must be present for a substantial portion of the total duration of the illness. A manic episode A major depressive episode, or A mixed episode The delusions or hallucinations must persist for at least 2 weeks in the absence of prominent mood symptoms
  • 5. PR EVALEN CE PR EVALEN CE 1% worldwide 1.5% U.S.
  • 6. ComorbidityComorbidity 79.4% meet the criteria for one or more other disorders depression (52.6%) anxiety disorders (62.9%) substance abuse (26.8%) schizophrenia is often comorbid with the schizotypal, schizoid, and paranoid personality disorders
  • 7. POSSIBLE CAUSES OFPOSSIBLE CAUSES OF SCHIZOPHRENIASCHIZOPHRENIA Biological/Genetic Factors Dopamine and serotonin (and probably other neurotransmitter) activities Enlargement of brain ventricles Small limbic system Brain trauma (birth complications) Prenatal viral exposure Older age of father Social Childhood physical and sexual abuse Low SES
  • 8. CO UR SE CO UR SE AN D AN D R ECOVERY R ECOVERY Chronic Variable course depending on risk and protective factors Premature death Suicide Lifestyle factors and risks related to poverty
  • 9. EFFECTS OF SCHIZOPHRENIA ON THEEFFECTS OF SCHIZOPHRENIA ON THE FAMILYFAMILYA chronic state of emotional burden develops which is shared by all members of the family. Common emotional reactions include: Stress Grief Resentment and anger Depression Anxiety Factors which influence the family’s coping well or poorly include: Severity of the disorder (greater severity implies better coping) The proactive seeking out of information and assistance The ability to find time for other activities The presence of support outside the family
  • 10. Work on dopamine A reduction in dopamine causes adverse effects  akathisia (restlessness and agitation)  dystonia (muscle spasms)  parkinsonism (muscle stiffness and tremor)  tardive dyskinesia (involuntary smooth muscle movements of the face and limbs) Anticholinergic medications are often prescribed to combat these effects, even though they have their own adverse effects of blurred vision, dry mouth, and constipation FIRST GENERATIONFIRST GENERATION ANTIPSYCHOTICSANTIPSYCHOTICS
  • 11. differentially affects the dopamine receptors, as well as having an impact on serotonin and other receptors Risperidone Olanzapin may provide marginally significant benefits for consumers in terms of clinical improvement over the first-generation antipsychotics small increased risk for diabetes 22NDND GENERATIONGENERATION ANTIPSYCHOTICSANTIPSYCHOTICS
  • 12. Com pliance Com pliance Discontinuance 74% from medication No difference between 1st and 2nd generation
  • 13. PsychosocialPsychosocial Family Psychoeducation Case Management – not found effective except for ACT Crisis Management Supported Employment
  • 14. ACT (ASSERTIVE COMMUNITYACT (ASSERTIVE COMMUNITY TREATMENT)TREATMENT)  assertive engagement  "in vivo" delivery of services  a multidisciplinary team approach  staff continuity over time  low staff-to-client ratios (10 to 1), and frequent client contacts  In a systematic review of randomized, controlled studies, ACT reduced hospital readmittance rates, length of time in hospital, and improved housing and employment outcomes over standard community care, although no differences between these types of intervention were found for mental state or social functioning (Marshall & Lockwood, 2000)
  • 15. CRISIS MANAGEMENTCRISIS MANAGEMENT  involves a multidisciplinary team offering intensive services often on a 24-hour basis  review of randomized, controlled studies although almost half (45%) of the crisis/home care group were hospitalized and no statistical difference was found between crisis care and hospitalization, repeat admission was avoided and family burden was reduced through crisis care. Furthermore, patients and their families found crisis care more satisfactory.
  • 16. SUPPORTED EMPLOYMENTSUPPORTED EMPLOYMENT Found more effective than prevocational programs
  • 17. http://w w w .jacquelinecorco http://w w w .jacquelinecorco M ental Health in Social W ork: A Casebook on Diagnosis and Strengths-Based Assessm ent. Allyn & Bacon. 2012.