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Breeze Lee

on 14 September 2011

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Transcript of Schizophrenia

Symptoms Positive Negative abnormal behaviors that are additional
– what the disorder adds to the person. absence of normal behaviors
– what the disorder takes away from the person. Delusions
•Believe that people are plotting/spying on them – usually wanting them dead
•Bizarre ideas
•Believe they are important like a famous or important person like God
•Think they have unusual powers Hallucinations
•Sensations that only exist in the mind
- however are experienced as convincingly real
•(smell, touch, sound, sight) Disorganized speech:
•Fragmented thinking- can’t process words, get things done normally/productive ways
•Trouble concentrating and maintaining train of thought
•Respond to questions with unrelated or disconnected answers
•Start sentences and end somewhere completely different
•Say illogical things

World Salad- the mixture of random words, arranged in phrases that appear to have meaning, but actually don’t have significance. Disorganized behavior:
•Goals are disrupted
•Impairment to the ability to take car of oneself
•Hard to interact with others Flattened or blunted affect:
•Lack of emotional expression and eye contact
•Flat voice
•Blank/restricted facial expressions Avolition
•Lack of interest and enthusiasm
•Stop doing the things they enjoy - sit at home doing nothing
•No ability to pursue goals Alogia
•Speak without making sense
•The lessening of speech – short/empty replies
•Thoughts are slowed or blocked Schizophrenia The mind illness that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. It’s the disruption of a person’s entire perception of the world, and all aspects of life. Causes No one is sure the exact cause of this mental illness. The triggers are very vague and even experts in this field aren’t persuaded exactly what the root of it is. Theories suggest that no single cause of schizophrenia exists. The factors are... Schizophrenia tends to run in families. Twins have been known to both get schizophrenia too. If one develops schizophrenia, it’s very likely the other will too, even when living in two completely different places. Genetics Enviornment Evidence implies that environmental factors may trigger people to develop schizophrenia who have the inherited tendency of getting the illness.
They believe that schizophrenia is developed from the combination of both environmental and inherited factors.
Viral infection
Poor social interactions
Highly stressful situations
Winter and spring births (when colds are around) 5-8% higher risk of getting it
Large families short intervals between siblings (2 year difference)
A Mothers exposure to viruses while pregnant (Rh incompatibility, maternal influenza and maternal malnutrition) Brain Chemistry Chemical imbalances in the brain, either producing too much or too little dopamine is believed to play a role in schizophrenia.

Increased dopamine leads to positive symptoms: (hallucinations/delusions)

Decreased dopamine leads to negative symptoms:
(lack of interest, motivation, function, energy)

- neurotransmitter that sends messages to nerve cells.
- schizophrenics tend to have more dopamine receptors that the average person.

The imbalance affects how the person reacts to stimuli such as sound, smell, touch, or sight. Antipsychotic medication, the most common schizophrenia treatment that blocks the absorption of dopamine. By blocking the brain's receptors, antipsychotic medication reduces the severity of schizophrenia symptoms. Brain abnormality It’s found that abnormalities in the structure of the brain disrupt connections between the nerve cells. This could impair the information being processed and affect all mental functions. However, this type of abnormality isn’t found in all schizophrenics and occurs in people without the illness. Treatment There are ways to manage schizophrenia, but still not a cure for it. Reducing the chance of relapse of the symptoms is the only way of handling we have. Untreated schizophrenia is dangerous, but when taken care of, it can be controlled and patients can usually go about their daily lives. However, it’s typical that the patients won’t stay on their medicine because they believe they can either take care of themselves, and end up finding any excuse or way to get out of taking them - makes this illness tough to treat. It’s believed that the smarter the patient is, the harder they are to treat. Treatment for schizophrenia may include: Medications Psychosocial Therapy The key medications are called antipsychotics. They do not cure schizophrenia but help relieve the most disturbing symptoms (delusions, hallucinations, thinking problems) The newest and most used medications now to treat schizophrenia are:
Risperdal, Clozaril, Seroquel, Geodon, Zyprexa, and Abilify. Helps the behavioral, psychological, social, and occupational problems related to the illness. Patients learn how to control their symptoms, identify early warning signs of relapse, and develop a relapse prevention plan.
Some of these therapies are: helps people with schizophrenia live as independently as possible by focusing on social skills and goal oriented things like jobs. Rehabilitation Individual psychotherapy help understand their illness better by learning how to cope solve problems. Family therapy help families effectively deal and help their loved one who has schizophrenia Group therapy provide shared support Hospitalization help stabilize conditions for people with severe symptoms. Electroconvulsive therapy Rarely used unless all medications are unsuccessful or if depression/catatonia is making the treatment tricky. This therapy is when electric shocks are sent to the brain, stimulating seizures, which causes neurotransmitters to be released. With the suitable amount of funds made for this illness, experts believe that a cure could be found by 2013.
Not many people in the world develop this illness so money goes toward other more common mental illnesses, slowing the process of finding a cure for schizophrenia. Statistics Eugen Bleuler Four A's of Schizophrenia: The word "schizophrenia" comes from the Greek word “schizo”, meaning “split”, and “phrene”, meaning “mind” to describe the fragmented thinking of people with the illness. It’s however just a myth that a schizophrenics mind is actually split or that they have two personalities which is what schizophrenia was characterized as long ago. The definition of schizophrenia is always changing as scientists discover more about the illness. Without knowing the exact causes of this disease, scientists can only base their classifications off the symptoms. Perception Healthy brain- takes information, ideas, and experiences and combines them to make logical associations between the two. The brain and the way it stores all information is the reason for the inaccurate perception.

It has a problem with transmitting and piecing portions of information that should correlate with each other correctly. Schizophrenic’s brain- information is missing like holes in the mind which makes it tough to piece the experiences and information together reasonably. “Blind spots” - absent information in the mind. Because of the confusion, due to the holes (or missing info) the brain often times sticks inappropriate fragments of information together. Instead of forming accurate associations, it creates confusing ones which results in unordinary reactions.

•All logic goes askew
•See the world in a different and inaccurate way
•Reality and imaginary are hard to distinguish between
•Have a backward sense of reality
•Incapable of understanding the real perception of situations.
•In effect – makes them respond unusually "Everything is in bits. You put the picture up bit by bit into your head. It's like a photograph that is torn to bits in your head" Schizophrenic’s view on the world is completely twisted. The surroundings they see themselves in are perceived entirely different than what they formerly knew. World wide, about 1% of people are diagnosed and 51 million suffer from schizophrenia. • 2-6 million in China
• 4-8 million in India
• 2.2 million in USA
• 285,000 in Australia
• Over 280,000 in Canada
• Over 250,000 in Britain Schizophrenia typically begins at early adulthood
(however there have been cases even after 45 and in early childhood) Sometimes children get it around the age of 5.
-Hard to diagnose because it’s difficult to tell apart from other illnesses such as autism. Men and women equally get the illness, but women tend to get it more mildly and develop it later than men

men- late adolescence to mid 20’s
women- mid 20s to early 30’s Abuse of alcohol and drugs is more typical in schizophrenics than the average person
(misuse makes symptoms more severe) People with schizophrenia are far more likely to harm themselves than be violent toward the public.
(Violence is not a symptom of schizophrenia) Due to depression, there's a 50% risk of attempted suicide and 50x higher risk of attempting suicide than the general population. 60% of males attempt suicide. The risk for developing schizophrenia is higher for people who are born in cities, rather than in the country.
The longer one lives in the city, the higher the risk.
Scientists believe this is realted to the stress that comes from cities - triggering schizophrenia. The earlier someone with schizophrenia is diagnosed and treated, the better the recovery.

If medication for schizophrenia is stopped, the relapse rate is about 80 percent within 2 years.

With continued treatment, only about 40 percent of recovered patients will suffer relapses. There are more untreated people with schizophrenia than there are receiving care in hospitals.
(Approximately 90,000 individuals with schizophrenia are in hospitals) • 25% completely recovered
• 25% very improved, fairly independent
• 25% improved, but still need support
• 15% hospitalized, and unimproved
• 10% dead (mostly suicide) After 10 years: 25% completely recovered
35% very improved, fairly independent
15% improved, but still need support
10% hospitalized, and unimproved
15% dead (mostly suicide) After 30 years: 6% homeless
6% jail or prison
5- 6% hospital
10% nursing home
25% with a family member
28% live independently
20% supervised home Where are the People with Schizophrenia? 32% wanted to solve problem on their own
27% believed the problem would get better by itself
20% too expensive
18% unsure about where to go for help
17% believe “help” wouldn’t do any good
16% health insurance would not cover treatment People are untreated because: Risk of getting schizophrenia: Myths “People with schizophrenia all have the same symptoms” Many different kinds of schizophrenia - each with different symptoms.

People can have symptoms from more than one kind of schizophrenia the symptoms overlap and range. “People with schizophrenia are dangerous, and out of control.” “When their illness is treated with medication, individuals with schizophrenia are no more violent than the general population,” - Professor Dawn I. Velligan “Schizophrenia develops quickly.” Rare to have a dramatic spike in functioning.
Usually develops slowly starting with mild symptoms, gradually gaining severity. “Schizophrenia is purely genetic.” Research has confirmed that stress and environment plays a role in increasing a person’s susceptibility to developing schizophrenia. “While we can’t change genetic vulnerability, we can reduce the amount of stress in someone’s life, build coping skills to improve the way we respond to stress, and create a protective low-key, calm family environment without a lot of conflict and tension in hopes of reducing the risk of illness progression,” - De Sliva “Schizophrenia is untreatable.” Schizophrenia is not curable, but totally manageable like diabetes or heart disease. “Schizophrenics need to be hospitalized and can’t have productive lives.” Most properly medicated people with schizophrenia are fine living on their own and can live a regular life. Keeping up with the medication and finding the right one is key. “Medications make schizophrenics zombies.” People think all schizophrenics become lethargic, uninterested and vacant, due to medication, but usually these symptoms are either from schizophrenia itself or because of overmedication. “Antipsychotic medications are worse than the illness itself” Medication is the main part of a schizophrenic’s recovery. Antipsychotic medications successfully reduce hallucinations, delusions, and bizarre behaviors. They do have severe side effects, but it’s rare. “People with schizophrenia can never recover” “Schizophrenia seems to be a problem that’s reversible. There’s no line that once it’s crossed signifies that there’s no hope for a person with schizophrenia.”
- Dr. Rose "A person with schizophrenia has lower intelligence than a normal person." Just as smart as they would normally be without the illness - symptoms impair thinking, and behavior which leads people to thinking otherwise. A. Characteristic symptoms: At least two of the following are presented for a significant portion of time during a 1-month period.

1) Delusions
2) Hallucinations
3) Disorganized speech
4) Grossly disorganized or catatonic behavior
5) Negative symptom (affective flattening, alogia, or avolition)

Note: Only one criterion A symptom is required if delusions are bizarre or hallucinations consist of a a ongoing voice with remarks on the person’s behavior or thoughts, or two or more voices conversing with each other.

B. Social/occupational dysfunction: for a significant portion of the time since the onset of the disturbance, one or more major areas of functioning (such as work, interpersonal relations, or self-care) are markedly below the level achieved prior to the beginning (or when the onset is in childhood/adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement.)

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6 month period must include at least 1 month of symptoms that meet Criterion A and may include periods of prodromal or enduring symptoms. During these prodromal or enduring periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A, present in an weakened form. (odd beliefs, unusual perceptual experiences)

D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (drug abuse, a medication) or a general medical condition.

F. Relationship to a Pervasive Development Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated) DSM - Schizophrenia Schizophrenia Subtypes
The subtypes of schizophrenia are defined by the predominant symptomatology at the time of evaluation.

Paranoid Type
A type of Schizophrenia in which the following criteria are met:

A. Preoccupation with one or more delusions or frequent auditory hallucinations.

B. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.

Disorganized Type
A type of schizophrenia in which the following criteria are met:

A. All of the following are prominent:
1) Disorganized speech
2) Disorganized behavior
3) Flat or inappropriate affect

B. The criteria are not met for Catatonic Type

Catatonic Type
A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:

1) Motoric immobility as evidenced by catalepsy or stupor
2) Excessive motor activity (motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism.
3) Peculiarities of voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing
4) Echolalia or echoprazia

Undifferentiated Type
A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.

Residual Type
A type of Schizophrenia in which the following criteria are met:

A. Absence of prominent delusions, hallucination, disorganized speech, and grossly disorganized or catatonic behavior.

B. There is ongoing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in as attenuated form. Cognitive abnormal symptoms related to how a person thinks Difficulty paying attention
• Inability to maintain focused
• Short attention span
• Spacey / “out of it.” Bad memory
•Effects working memory - kind of memory you use to keep things in your head for a short period of time. (Digits of a phone number you’re about to dial) Difficulty planning things
•Reduced executive control - hard to make mental steps needed to complete a task
•Have difficulty completing steps in a proper order
•Get distracted very easily
•Hard keeping track of what they are trying to do Lack of insight
•Have a hard time understanding or accepting that they are ill. 1.) Affect- diminished emotional response
2.) Associations- reduced understanding of relationships
3.) Ambivalence- inability to make decisions
4.) Autism- preoccupation with ones own thoughts and awareness Over 2.2 million people in the US are suffering from schizophrenia

1.5 million people will be diagnosed with it this year Stages 1.) Prodromal Stage: This is the stage before the actual illness develops usually the year before.
The signs of the prodromal stage are not specific to schizophrenia.
The person in this stage usually goes through depression or is bipolar.
Relatives can sense that something isn’t right with their family member, but there isn’t enough proof in this
stage to diagnose someone with schizophrenia.
You can’t be diagnosed with schizophrenia in this stage until psychotic symptoms are experienced in the next stage. Characteristics of stage:
People frequently isolate themselves
Stop spending time with family and friends
Not interested in school
Relationships suffer
Decreased motivation
Loss of interest in activities
Become intensely interested with religion or philosophy
People view them as “lazy”, rather than being “ill”
Can last weeks or months 2.) Active Stage: Stage when psychotic symptoms are experienced - mainly just positive symptoms (hallucinations, delusions, disorganized behavior)
Suggests full development of schizophrenia.
Hospitalization may be necessary if symptoms are severe.
Could last for several weeks or months.
Without treatment, could go on longer years
Some patients have only one episode of schizophrenia more likely to have multiple episodes. 3.) Residual Stage The final stage of schizophrenia - very similar to the prodromal stage.
Patients don’t appear psychotic - however may experience negative symptoms (lack of emotional expression / no energy.)
Don’t have delusions or hallucinations, but may still have strange beliefs. (example: people are plotting against you) However, there are other outlets: Many schizophrenics use art, and music to help numb/escape their illness embroidery drawings music/singing paintings -when diagnosing someone, they may have a mix of symptoms from more than one kind of schizophrenia. Symptoms overlap each other Paranoid Disorganized Catatonic Paranoid schizophrenia is the most common kind.
Main symptoms are delusions or hallucinations.
Don’t usually have a thought disorder, disorganized behavior, or affective flattening (no expression of emotion)
More capable of working and are better at relationships than the other kinds of schizophrenia. People with this condition have bizarre delusions.
Most of them are paranoia over things that don't relate to them. (example: thinking something on the t.v. is related to them) Many hallucinations are "voices" that:
•Comment on the ill person's behavior
•Order him or her to do things
•Warn them of future danger (usually ridiculously dramatic)
•Talk to each other (typically about the ill person) Based around the unusual thought processes.
Regular living is the toughest in this kind of schizophrenia.

Difficulty organizing thoughts or connecting them logically.
Jumbled speech - hard to understand.
Say irrational/absurd things (they have super powers)
Unexpectedly stop talking in the middle of sentences – “thought blocking” (Schizophrenics similarly explain that their thought was taken out of their head)
Make up and use words that only make sense to them - "neologisms" Disorganized behavior is also a factor
•Flat or inappropriate affect – showing no emotion
•Monotone voice
•Normal activities are difficult (showering, getting dressed, fixing food)
•Very giddy - laugh and find unrelated things humorous Catatonic excitement - hyper activity
•Repeat certain motions over and over – repeat what others say/do
•Have involuntary movements

Catatonic stupor - reduction in activity
•Don’t move at all – sluggish
•Hold positions for hours (in extreme cases)
•Unresponsive / seem disconnected from the world - however they hear and see everything going on around them. Many believe that other people are intentionally:
•Cheating them
•Harassing them
•Poisoning them
•Spying on them
•Plotting against them (prosecution or conspiracy) The disturbance of movement.
The rarest kind of schizophrenia.
Categorized either as catatonic excitement or stupor. Other Symptoms:
•Clumsy / uncoordinated
•Frown – seem completely unhappy
•Have odd gestures/positions Brianna Gariepy All reflect a schizophrenics fragmented mind
Confussing patterns
Unfinished bits
Bizarre designs or Therapy Medication
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