What does schizophrenia mean
Split mind
- psychotic disorder, loss of contact with reality
- most severe debilitating
- most patients unable to care for themselves
Stats on schizophrenia
- 10-20% of homeless
- 40-60% live w family
- begins early in life (16-25)
- Suicide rates 8-10%
- 2x as common as Alzheimers
- 5x as common as MS
- 300x as common as Cystic fibrosis
- 1/100 ppl diagnosed, 300k in canada
- 1/12 hospital beds
- $6.85 billion annually in Canada
Groups of symptoms of schizo
1) Disordered thinking (speech)
2) Delusions (false beliefs)
3) Hallucinations
4) Disorganized motor behaviour (gross disorganized or catatonic)
5) Negative symptoms
1-4: Positive symptoms
Details of disordered thinking symptoms
- Formal thought disorder (form/style not content)
- Inchoherence - word salad
- Neologisms - new (neo) words (logos)
- loose associations
- perseveration (stuck in one line of thinking - Wisconson card sort task
- thought blocking
Details of delusions symptoms
Types
- Reference (things have special significance)
- grandeur
- control (controlled by external)
- persecution
- somatic
Thought insertion
thought broadcasting
thought withdrawl (others removing thoughts frm head)
Most common form of hallucination
- auditory
two types of disorganized motor behaviour
1) Disorganized - pacing, agitated, strange dress, talking,
2) Catatonic - waxy flexibility
Describe Negative symptoms
- Alogia - poverty of speech (a - lack of; logia - speech)
- anhedonia
- flat affect
- avolition - lack of motivation
- social withdrawl (one of the first signs)
- these are less responsive to antipsychotic meds
Name the positive symptoms of schizo
- disordered thinking
- delusions
- hallucinations
- disorganized motor behaviour
Define Alogia, Anhedonia, Avolition
Alogia - poverty of speech
Anhedonia - loss of enjoyment of pleasurable activities
Avolition - lack of motivation
Phases of Schizophrenia
Prodromal -> Active -> Residual
- Prodromal: clear deterioration of functioning
- Residual: attenuated symptoms following active phase
- tends to be episodic
Diagnostic criteria for active phase
- at least one month
1) 2 or more symptoms - delusions, hallucinations, diorganized speech, gross disorganized or catatonic behaviour, negative symptoms
- or -
2) 1 symptom if - bizarre delusion; or, auditory hallucination of voice keeps a running commentary, or two or more voices conversing
Bizarre: impossible
Non-bizarre: could possibly be true (plot to be killed by neighbour)
Diagnostic criateria for schizophrenia
- active phase at least 1 mos
- all phases at least 6 months
If less than 6 months:
- Brief psychotic disorder (<1 mos)
- schizophreniform disorder (1-6 mos)
Subtypes of schizophrenia
1) Paranoid type
2) Disorganized
3) Catatonic
4) Undifferentiated
5) Residual
Which subtype has best and worst prognosis
Best: paranoid
Worst: disorganized
Features of paranoid subtype
- delusions, auditory hallucinations (only)
- no disorganized speech, behaviour or affect
- most common, least severe
Features of disorganized subtype
- disorganized speech, behaviour
- inappropriate affect
Features of Catatonic subtype
- immobile, waxy flexibility, mutism, posturing, grimacing, echolalia, echopraxia,
- behaviour excitement, agitation
- more common in less developed countries, was more common 50 yrs ago in N America
Difference between Echolalia and Echopraxia
- echolalia (repeat back others SAY)
- echopraxia (imitate BEHAVIOURS)
Undifferentiated subtype
doesn’t meet criteria for paranoid, disorganized, catatonic
Residual subtype
- negative symptoms, attenuated positive symptoms
- no delusions, hallucinations, disorganized speech or behaviour
Prognosis rates of schizophrenia
- severity reduces with aging
- 22% one episode only, complete recovery
- 35% several episodes,normal functioning between
- 8% several episodes, never return to normal between
- 35% continual deterioration, reduced functioning between episodes
Shortened life-span (10 yrs reduction)
- infectious diseases, circulatory disease
- 8-10% suicide
Prevalence rates of schizophrenia
- 1% of population
- men = women
- men (15-24), women (25-34)
- men more severe
- similar rates around world
- different symptoms around world
- better recovery in developing countries (better social family networks) than in developed countries
- more common in lower SES (Social drift theory)
List other psychotic disorders
1) Mood disorder with psychotic features
2) brief psychotic disorder (<1 mos)
3) Schizophreniform disorder (1-6mos)
4) Schizzoaffective disorder
5) delusional disorder (erotomanic, grandios, persecutory, somatic)
6) Shared psychotic disorder (folie a deux)
7) Substance-induced psychotic disorders
