Slide 1 ___________________________________ ___________________________________ Schizophrenic Disorders ___________________________________ Chapter 13 ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 ___________________________________ Onset and Course of the Disorder • Onset-typically occurs during ___________________________________ adolescence or early adulthood. • Period of risk-for the development of the disorder is thought to be between the ___________________________________ ages of 15 and 35. • The course of schizophrenia can follow many different patterns, but the problems of most patients can be divided into three ___________________________________ phases. ___________________________________ ___________________________________ ___________________________________ Slide 3 ___________________________________ Three Phases of Schizophrenic Onset • Promodol-precedes the phase of active ___________________________________ schizophrenia . • Active Phase: appearance of the positive symptoms. ___________________________________ • Residual Phase • Positive symptoms; such as hallucinations, delusions, and disorganized speech have improved. ___________________________________ • Symptoms similar to the promodal phase: negative symptoms become more pronounced ___________________________________ ___________________________________ ___________________________________
Slide 4 ___________________________________ Symptoms • Positive symptoms- psychotic ___________________________________ symptoms or the presence of aberrant behavior. • Negative symptoms- defined as ___________________________________ responses that are missing from the persons behavior . • Disorganization - include verbal communication problems and bizarre ___________________________________ behavior. ___________________________________ ___________________________________ ___________________________________ Slide 5 ___________________________________ Positive Symptoms • Hallucinations -sensory experiences that are ___________________________________ not caused by actual external stimuli. • Delusional Beliefs -beliefs held with the utmost conviction, even when presented ___________________________________ with contrary evidence. – Preoccupation with the delusions to the point that the patient finds it difficult to NOT talk about the delusion. ___________________________________ – Common delusions include the belief that thoughts are being inserted into the patient’s head, and that other people are reading the patient’s thoughts. ___________________________________ ___________________________________ ___________________________________ Slide 6 ___________________________________ Negative Symptoms • Blunted Affect -restriction of patients nonverbal ___________________________________ display of emotional responses. • Anhedonia -inability to experience pleasure • Social Withdrawal -early symptom that something is wrong, appears to be both a symptom of the disorder and a strategy that is actively employed by ___________________________________ some patients to deal with their other symptoms. • Avolition -lack of will do anything. Become apathetic and cease to work toward personal goals or to function independently. s. • Alogia -speech disturbance that refers to impoverished thinking. ___________________________________ – Poverty of speech- don’t have anything to say – Thought blocking- patient’s train of speech is interrupted before a thought or idea has been completed. ___________________________________ ___________________________________ ___________________________________
Slide 7 ___________________________________ Disorganized • Disorganized Speech-tendency of the schizophrenic to say ___________________________________ things that don’t make sense, including irrelevant responses to questions, expressing disconnected ideas, and using words in peculiar ways. – Loose association (derailment)-shifting topics too abruptly – Tangentiality-replying to a question with an irrelevant response. – Perseveration-persistently repeating the same word or phrase over and over again. ___________________________________ • Bizarre Behavior – Catatonia-most often refers to immobility and marked muscular rigidity. • Can also refer to excitement and overactivity such as purposeless pacing, repetitious movements. – Stupurous state-reduced responsiveness where the person seems unaware of their surroundings, though completely conscious and ___________________________________ believed able to hear and understand everything going on around them. – Inappropriate affect-`lack of adaptability in emotional expression. ___________________________________ ___________________________________ ___________________________________ Slide 8 ___________________________________ Diagnostic Criteria-DSM-IV • Characteristic Symptoms: Two or more of the ___________________________________ following present for a significant portion of time during a one month period: – Delusions – Hallucinations – Disorganized speech – Grossly disorganized or catatonic behavior ___________________________________ – Negative symptoms, such as flat affect, alogia or avolition • 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 is ___________________________________ markedly below the level achieved prior to the onset. • Duration-Continuous signs of disturbance persist for at least 6 months ___________________________________ ___________________________________ ___________________________________ Slide 9 ___________________________________ Subcategories: Five Subtypes • Catatonic-characterized by symptoms of motor ___________________________________ immobility or excessive and purposeless activity • Disorganized-characterized by disorganized speech, behavior and flat or inappropriate affect. • Paranoid- delusions of persecution or grandiosity frequent auditory hallucinations ___________________________________ • Undifferentiated Type- display psychotic symptoms but do not meet the criteria for a specific subtype • Residual Type- no longer meet the criteria for active phase, but still exhibit negative symptoms and some ___________________________________ forms of hallucinations, delusions, or disorganized speech said to be in a partial remission. ___________________________________ ___________________________________ ___________________________________
Slide 10 ___________________________________ Related Psychotic Disorders • Schizoaffective Disorder -defined by an episode in ___________________________________ which the symptoms of schizophrenia partially overlap with a major depressive episode or a manic episode. • Delusional Disorder – Do not meet the full symptomatic criteria for schizophrenia, but are ___________________________________ preoccupied for at least one month with delusions that are not bizarre. • Brief Psychotic Disorder- people who exhibit psychotic symptoms, such as delusions, hallucinations, disorganized speech for at least 1 ___________________________________ day but less than one month. The episode often follows a stressful event. ___________________________________ ___________________________________ ___________________________________ Slide 11 ___________________________________ Course and Outcome • Severe progressive disorder that most often ___________________________________ begins in adolescence. • Recent evidence indicates there can be marked improvement in the patient, but the prediction of which is difficult. ___________________________________ • Patient is thought to be improved in relation to symptom severity and occupational functioning relative to initial assessment. • Best predictor of future social adjustment ___________________________________ appears to be previous social adjustment. ___________________________________ ___________________________________ ___________________________________ Slide 12 ___________________________________ Epidemiology • Lifetime risk factors for the general ___________________________________ population are 1%. • Gender Differences ___________________________________ • Cross Cultural ___________________________________ ___________________________________ ___________________________________ ___________________________________
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