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Monday, December 22, 2014

82 facts about schizophrenia and other psychotic disorders: clinical diagnosis and differential assessment


Schizophrenia

POSITIVE SYMPTOMS

Thought disorder (delusions & hallucinations)

Disorganized speech or behavior

NEGATIVE SYMPTOMS

Flattened

Catatonic behavior (motor activity) - not moving, "frozen"

Emotional response lacking

Poverty of speech

Lack of initiative

Persistent inability to experience pleasure


Typical behavior of people with Schizophrenia


Often sees things, experiences sensations or hears voices that do not exist (hallucinations)

Persistently believe in fixed ideas despite proof that they are false (delusions)

Unable to think in a logical manner (thought disorder)

Lack will or motivation to complete a task or accomplish something

Function at much lower level than in the past at work, relationships or taking care of themselves

Develop symptoms of major depression or of mania along with other symptoms on this list

Have delusions involving real life situations, such as that they are being followed, poisoned, infected, loved from a distance, or deceived by a spouse.

Less common behavior of people with Schizophrenia


Talking in rambling, disconnected or incoherent ways

Make odd or purposeless movements; not talk or move at all

Repeat others’ words or mimic their gestures

Show few, if any feelings; respond with inappropriate emotions


5 Types of Schizophrenia

Disorganized Type (Hebrophrenic) Catatonic Type
Paranoid Type
Undifferentiated Type
Residual Type


Disorganized Type

Marked incoherence, lack of systemized delusions and blunted or silly affect.

Catatonic Type

Marked by stupor, negativism, rigidity, bizarre posturing, and excessive motor activity.

Paranoid Type

Marked by one or more systemized delusions, auditory hallucinations with a single theme, absence of incoherence, marked loosening of associations, flat or inappropriate affect, catatonic behavior, and grossly disorganized behavior

Undifferentiated Type

Marked by delusions, hallucinations, incoherence, and/or grossly disorganized behaviors. Diagnosed when symptoms don’t meet the criteria for one of the specific types.

Residual Type

Diagnosed when the individual is not currently displaying psychotic symptoms but has displayed these symptoms in the past and continues to exhibit residual symptoms – eccentric behavior, illogical thinking, or inappropriate affect

The Experience of Schizophrenia

Visual Experience

Heightened sensitivity to light and color

Loss of perspective of figures

Illusionary changes in faces and objects

Distortions in size

Auditory Experience


Heightened sensitivity to noise Hallucinations

Inability to screen out background noise

Distortions in voices Muting of sounds

Physical Experience


Heightened sensitivity to touch Tactile hallucinations

Inability to interpret internal sensations

Olfactory hallucinations

Cognitive Experience


Loose associations
Distractibility
Delusions
Fragmentation
Inability to filter out irrelevant data
Over stimulation of thoughts (flooding) Increased or decreased speed of thinking Idiosyncratic explanatory systems

Three phases of Schizophrenia

Prodromal or Residual Phases

Significant social isolation or withdrawal

Impairment in role functioning

Peculiar behavior

Blunted or inappropriate affect
Odd beliefs or magical thinking

Unusual perceptual experiences

Lack of initiative, interests or energy

Impaired hygiene/grooming Impaired speech


Interventions for people diagnosed with schizophrenia

First, establish a relationship by...

Respecting the client’s inner experiences

Making no suggestions of change.

Accepting client’s agenda.

Concrete and formal communication style.

Affirming strengths and sense of self.

Allowing maintenance of protective defenses.

After relationship has been established...

Education and advice Encouragement and praise.

Manipulate environment to strengthen competence.


Treating Schizophrenia:

adverse psychological effects of medication


Dependency issues

Normal ambivalence, issues of self-determination Negative self-image, inability to function without medication. Powerlessness.

Dependence on doctor or social worker.

Anger. Why me? "You've changed."
Social Stigma
Abdicate Self-Responsibility - playing the sick role. Unresponsible for behavior - problems with discrimination of can & can’t.

Flat out non-compliance and/or inappropriate activities.



Shared Psychotic Disorder

Disturbance that develops in a person who is influenced by someone else who has established delusion with similar content.


Brief Psychotic Disorders

Psychotic disturbance that lasts more than 1 day and remits within 1 month.


Schizoaffective Disorder

Disturbance in which a mood episode and the active phase symptoms of schizophrenia occur together.

Preceded or followed by at least 2 weeks of hallucinations or delusions without prominent mood symptoms.

Schizophreniform Disorder

Symptomatic presentation equivalent to schizophrenia, except for duration.

One to six months in duration.

Absence of the requirement of a decline in functioning.

Delusional Disorder

Many types of delusional disorder.

Eromantic, grandiose, jealous, persecutory, somatic (body/physical), mixed (combo).

Tend to have more ability to function "normally."

The false beliefs are not bizarre.

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