SCHIZOPHRENIA

Stories of Schizophrenia
 HISTORY
 Kraepelin-dementia precox
 Bleuler-schism between thought, emotion and
behavior in affected patients
 4 A’s
– ambivalence
– associations
– affect
– autism
 Clinical Description of
Schizophrenia
 No single essential symptom
– Heterogeneity of symptoms across patients
 Delusions
 Grandeur
 Guilt
 Jealousy
 Passivity
 Persecution
 Poverty
 Reference
 Negative Symptoms: Behavioral
deficits
 Avolition  Negative symptoms
– Lack of interest; apathy
 Alogia predict poor quality
– Reduction in speech of life post-
 Anhendonia
– Inability to experience hospitalization (Ho
pleasure et al., 1998)
 Consummatory pleasure
 Anticipatory pleasure
 Flat affect
– Exhibits little or no affect
in face or voice
 Asociality
– Inability to form close
personal relationships
 Disorganized Symptoms
 Disorganized speech (Formal thought disorder)
– Incoherence
 Inability to organize ideas
– Loose associations (derailment)
 Rambles, difficulty sticking to one topic
 Disorganized behavior
– Odd or peculiar behavior
 Silliness, agitation, unusual dress
– e.g., wearing several heavy coats in hot weather
 Other Symptoms of
Schizophrenia
 Cognitive Dysfunction
 Dysphoria
 Absence of Insight
 Sleep disturbance
 Suicide
 Illusions
 Echopraxia
Epidemiology
 Differential diagnosis
 Organic syndrome
– Drug
– Temporal lobe epilepsy
– Delirium
– Dementia
– Diffuse brain disease
 Psychotic mood disorder
 Personality disorder
 Schizoaffective disorder
 Types of schizophrenia
 Paranoid schizophrenia
 Disorganized schizophrenia
 Catatonic schizophrenia
 Undifferentiated schizophrenia
 Residual schizophrenia
Paranoid type is characterized by
 persecutory (feeling victimized or spied on)
or grandiose delusions,
 Hallucinations
 Excessively religiosity (delusional focus)
or hostile and aggressive behavior.
Disorganized type is characterized by
 Grossly inappropriate or flat affect
 Incoherence
 Loose associations
 Extremely disorganized behavior.
Catatonic type is characterized by
 marked psychomotor disturbance, either
motionless or excessive motor activity.
 Motor immobility may be manifested by
catalepsy (waxy flexibility) or stupor.
Undifferentiated type is characterized by
 Mixed schizophrenic symptoms (of other
types) along with disturbances of thought,
affect, and behavior.
Residual type is characterized by
 At least one previous, though not a current,
episode
 Social withdrawal
 Flat affect
 Looseness of associations.
 F20.4 Postschizophrenic
Depression
 A depressive episode, which may be prolonged,
arising in the aftermath of a schizophrenic illness.
Some schizophrenic symptoms, either „positive“
or „negative“, must still be present but they no
longer dominate the clinical picture.
 These depressive states are associated with an
increased risk of suicide.
 Factors related to good
prognosis in Schizophrenia
 Late onset
 Obvious precipitating factors
 Acute onset
 Good premorbid social, sexual, and work history
 Married
 Family/Personal history of mood disorders
 Good support systems
 Positive symptoms
 Factors related to poor
prognosis in Schizophrenia
 Young and insidious onset
 No precipitating factors
 Poor premorbid social, sexual, and work histories
 Withdrawn, autistic behavior; assaultive history
 Single, divorced or widowed
 Neurological signs and symptoms/prenatal trauma
 Family history of schizophrenia
 No remission in 3 years; many relapses
 Treatment
 Chlorpromazine (Thorazine); Fluphenazine
(Prolixin); Haloperidol (Haldol); Thiothixene
(Navane); Thioridazine (Mellaril) & Perphenazine
(Trilafon)
 Benzodiazepines
– Valium (diazepam)
– Librium (chordiazepoxide)
 Tardive dyskenesia
 Newer drugs (Risperdal, Clozaril & Zyprexa)
 Tablet or liquid form with “depot formulations”
 Common antipsychotic
medication side effects
 Dry mouth
 Constipation
 Blurred vision
 Drowsiness
 Less common antipsychotic
medication side effects
 Decreased sexual desire
 Menstrual changes
 Stiff muscles on one side of the neck or jaw
 Serious antipsychotic
medication side effects
 Restlessness
 Muscle stiffness
 Slurred speech
 Extremity tremors
 Agranulocytosis
 Psychological Treatments
 Family therapy to reduce Expressed Emotion
– Educate family about causes, symptoms, and signs of relapse
– Stress importance of medication
– Help family to avoid blaming patient
– Improve family communication and problem-solving
– Encourage expanded support networks
– Instill hope
 Social skills training
– Teach skills for managing interpersonal situations
 Completing a job application
 Reading bus schedules
 Make appointments
– Involves role-playing and other practice exercises, both in
group and in vivo
 Psychological Treatments
 Cognitive behavioral therapy
– Recognize and challenge delusional beliefs
– Recognize and challenge expectations associated with
negative symptoms
 e.g., “Nothing will make me feel better so why bother?”
 Cognitive enhancement therapy (CET)
– Improve attention, memory, problem solving and other
cognitive based symptoms
 PSYCHO SOCIAL
THERAPIES
 This may include advice, reassurance,
education, modeling, limit setting, and
reality testing with the therapist.
Encouragement in setting small goals and
reaching them can often be helpful.
 Work Behavior Strengths
 Minimal physical limitations
 Generally have at least average IQ
 Medications provide good control over
symptoms for most
 If onset in late 20s, the consumer may have
a work history of > HS education
 Work Behavior Limitations
 Difficulty multitasking
 Difficulty interacting with co-workers
 Difficulty accepting criticism or supervision
 May have difficulty with customer service
or customer contact
 Cyclic symptoms lead to inconsistent perf.
 Needs work space with limited stimulation
 Common types of work
accommodations
 Flexible schedule to allow time off during
times when symptoms exacerbate or need
“treatment”
 Loss stress, low stimulation work environment
 Training and education staff
 Modifying simple job tasks
 Developing on site services (e.g. EAP)
THANK YOU