DIAGNOSTIC CRITERIA FOR SCHIZOPHRENIA
SCHIZOPHRENIA & OTHER PSYCHOTIC
DISORDERS
• A. Characteristic symptoms: two ore more of the
following, each present for a significant period of time
during a 1-month period
–
–
–
–
–
1) delusions
2) hallucinations
3) disorganized speech
4) grossly disorganized or catatonic behaviour
5) negative symptoms (affective flattening
flattening, alogia)
• NOTE: Only one Criterion A symptom is required if
delusions are bizarre or if hallucinations consist of a
voice keeping a running commentary of the person’s
behaviour or thoughts, or 2 or more voices are
conversing with each other.
Schizophrenia
1
SCHIZOPHRENIA & OTHER PSYCHOTIC DISORDERS
• SCIZOPHRENIA: DSM-IV includes five subtypes
of schizophrenia, as shown below:
– CATATONIC: at least two of the following
psychomotor disturbances…immobility, excessive
motor activity, extreme negativism, posturing,
repetition of speech, sounds
2
VARYING DEGREES OF PARANOID THINKING
• MILD
– AVERAGE PERSON: occasional suspicious thoughts
• MODERATE
– PARANOID:
O
ppreoccupation
p
with one or more delusions
or frequent auditory hallucinations, absence of
prominent schizophrenic symptoms such as
disorganized speech or behaviour, catatonic behaviour,
or flat or inappropriate affect
– UNDIFFERENTIATED: meets criteria for
schizophrenia but does not meet criteria for catatonic,
paranoid, or disorganized subtype
Schizophrenia
Schizophrenia
3
– PARANOID PERSONALITY: a suspicious cognitive style
– PARANOID PERONALITY DISORDER: a suspicious cognitive
style so strong that is impairs effective behaviour. There are no
delusions. Reality testing is intact.
– DELUSIONAL (PARANOID)
(
) DISORDER: a stable
bl andd chronic
h i
delusional system. Reality testing good in all other areas.
• SEVERE
– PARANOID SCHIZOPHRENIA: multiple delusions that are likely
to be fragmented, accompanied by marked loosening of associations,
obvious hallucinations, and other evidence of disorganization.
Reality markedly distorted.
Schizophrenia
4
1
FOUR TYPES OF DELUSIONS
• DELUSIONS
– persistent false beliefs, not in keeping with individual cultural
background (e.g. suicide in war in middle east), it is accepted as
truth by individual
•
Persecution – the RCMP is out to get me
•
Reference – people on the bus talk about me,
neighbours are making fun of me
•
Being controlled – the devil is controlling my
thoughts and behaviours
•
Grandeur – I am Jesus, on a special mission from the
Lord.
• HALLUCINATION
– a mental phenomenon that is independent of external organs. a
person believes he sees or hears things that have no basis in
objective
bj ti stimuli
ti li
• ILLUSIONS
– an erroneous perception of a real sensory impression
Schizophrenia
5
Schizophrenia
DIFFERENCES BETWEEN POSITIVE-SYMPTOM (TYPE 1) AND
NEGATIVE-SYMPTOM (TYPE 2) SCHIZOPHRENIA
FOUR DIMENSIONS OF SCHIZOPHRENIA
• EMOTIONAL
Positive (Type 1)
Schizophrenia
Negative (Type 2)
Schizophrenia
SYMPTOMS
delusions
hallucinations
incoherence
bizarre behaviour
poverty of speech
flat affect
social withdrawal
apathy
PREMORBID
ADJUSTMENT
good
poor
PROGNOSIS
good
poor
SEX
DISTRIBUTION
more likely to be
women
more likely to be
men
– flat affect, disorganized, inappropriate, child-like
• COGNITIVE
– delusions, hallucinations, poor concentration
• BEHAVIOURAL
– disorganized, inappropriate, catatonic
• PHYSIOLOGICAL
– Sleep, sex, autonomic differences (GSR)
Schizophrenia
6
7
Schizophrenia
8
2
100
accepted, more support systems, married
MEN
WOMEN
50
0
-2
26 5
-3
36 5
-4
46 5
-5
56 5
-6
66 5
-7
5
75
+
16
testosterone) - reduction in symptoms when
pregnant
Schizophrenia
9
10
and genetic risk, fewer coping skills taught, less access to
health care
1.9
2) DOWNWARD DRIFT
1.3
0.9
3) VIRUS and PREGNANCY PROBLEMS 08
0.8
schizophrenics
hi h i births
bi th higher
hi h in
i late
l t winter
i t & early
l spring
i andd
this is reversed in southern climates. Small increase 5-50%
above expectancy, poorer health care
0.4
Lower
Schizophrenia
WHY?
1) HIGHER STRESS - psychologically, increased biological
Economic Status and Schizophrenia
2
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
2) WOMEN HAVE MORE MOOD
SYMPTOMS AND YOUNG MALES
MORE
O
AGG
AGGRESSIVE
SS
4) BIOLOGICAL FACTORS (estrogen,
Age at onset
% o f R is k
Numbee r of indiv iduals
EXPLANATION FOR GENDER
DIFFERENCES
1) SOCIAL ROLES - problems or differences
150
Lowermiddle
Middle
Schizophrenia
Uppermiddle
Upper
11
Schizophrenia
12
3
Minor Physical Anomalies
Schizophrenia
Minor Physical Anomalies
13
Minor Physical Anomalies
Schizophrenia
14
RELAPSE ISSUES
• Families high in expressed emotion (EE) are
defined by:
– emotional over involvement with a patient; and
– a tendency to become hostile and make negative
patient
comments to the p
Schizophrenia
15
Schizophrenia
16
4
RELAPSE ISSUES
• High expressed emotion:
– predicts schizophrenic relapse; and
– is probably both a cause and consequence of patients’
p
symptoms.
y p
schizophrenic
Schizophrenia
17
5