Schizophrenia Schizophrenia is commonly defined as a mental disorder where a person sees or hears things that are not real. They hallucinate and they become out of touch with the real world. Four Types • Paranoid - hallucinations and delusional thoughts of conspiracy or accusation • Catatonic - disturbances in movement • Disorganized - disorganized thought processes • Undifferentiated - does not display specific enough symptoms to be classified in any one subtype - Either their symptoms constantly are changing over time or simply just do not fit into one Essential Features • Delusions • Hallucinations • Disorganized speech • Catatonic behavior • Negative symptoms Associated Features • Dizziness • Restlessness • Sleepiness • Tremor • Weight gain • Substance abuse • Suicide • Physical illness Differential Diagnosis • Delusional Disorder - paranoid beliefs • Schizotypal Personality Disorder - discomfort in close relationships - odd thoughts and behaviors - dismisses any close relationship - rather be alone • Paranoid Personality Disorder - suspicious and distrustful of others Diagnostic Criteria • Two or more of the essential features must be present for at least a month. If the delusions are bizarre or hallucinations consist of a voice keeping a running commentary of the person’s behavior and thoughts or two or more voices conversing, then only one of these may be present to be diagnosed. • For a significant amount of time, areas of functioning like work, self-care, academics and interpersonal relations are way below the level achieved prior to the disorder. • If continuous signs persist at least 6 months, these 6 months must include at least one month of periods of prodromal symptoms. • The disturbance must not be caused by physiological effects of a substance or general medical condition. • If the person has history of autism or other pervasive developmental disorder then schizophrenia is diagnosed only if delusions or hallucinations are present for at least a month. Causes • No definite cause and no way to prevent • Effects both men and women - more common in men - mild in women • Normally begins as a teenager or young adult • Symptoms progress slowly over months or years • Childhood schizophrenia begins after the age of five but is very rare - often hard to tell apart from autism or other developmental disorders Treatment • Antipsychotic medication• - twenty-five percent of treated patients get better from six months to two years. - thirty-five to forty percent see great improvement after a longer period of time and symptoms are reduced enough to let them live normal lives outside of hospitals. Psychosocial treatment - psychotherapy helps teach patients how to handle their disorder and act appropriately in the outside world Case Study An example of someone with schizophrenia is twenty-seven year old Jack. He graduated from high school, lived with his parents and started working at a video store. After about a half a year of work, he claimed to hear voices that put him down and told him negative things like saying he was no good. He accused his boss of planting video cameras in the returned tapes to see if he was making any mistakes. When work got busy, he became agitated and talked strangely to customers. “For example one customer asked for a tape to be reserved and Jack indicated that that tape may not be available because it had "surveillance photos of him that were being reviewed by the CIA."” After a year, Jack quit his job and exclaimed he could not handle being constantly watched in the store and at home. As the symptoms started increasing, his parents finally took him to a hospital. His psychiatrist prescribed Thorazine, but it had side effects of his muscles twisting and contracting. His prescription was switched to Haldol; however, sometimes Jack would stop taking his medication which caused his symptoms to strengthen. Throughout the past seven years, he has been hospitalized five times. He now receives Supplemental Security Income (SSI) and has used the help of a case manager to move into his own apartment. He is a member of a psychosocial clubhouse for people with mental illnesses, which he attends three times a week. In addition, Jack is worried about getting a job because of his disorder so he has been referred to Top Quality Rehabilitation (TQP) to provide supported employment services. Movies • • • • • A Beautiful Mind Donnie Darko Shutter Island Black Swan American Psycho