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Schizophrenia
Definition, Signs and Symptoms, Diagnostic Criteria, and Subt
CENAL, Noe L. | BSCP 3-1 | Prof. Serafina P. Maxino
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Schizophrenia
Schizophrenia is a chronic, severe, and disabling brain disorder that has affected peo throughout history. About 1 percent of Americans have this illne ss. People with the disorder may hear voices other people don’t hear. They may believe people are reading their minds, controlling their thoughts, or plotting to harm them. This can t people with the illness and make them withdrawn or extremely agitated. People with schizophrenia may not make sense when they talk. They may sit for hou without moving or talking. Sometimes people with schizophrenia seem perfectly fine until they ta about what they are really thinking. Families and society are affected by schizophrenia too. Many people with schizophreni have difficulty holding a job or caring for themselves, so they r ely on others for help. Treatment helps relieve many symptoms of schizophrenia, but most people who hav disorder cope with symptoms throughout their lives. However, many people wi th schizophrenia can rewarding and meaningful lives in their communities. Researchers are developing more effe medications and using new research tools to understand the causes of schizophrenia. In the yea come, this work may help prevent and better treat the illness. Signs and Symptoms
The symptoms of schizophrenia fall into three broad categories: positive symptoms, negative symp and cognitive symptoms. You're Reading a Preview
Unlock full access with a free trial. Positive symptoms Positive symptoms are psychotic behaviors not seen in healthy people. People with positive sympto often “lose touch” with reality. These symptoms come go. Sometimes they are severe and Downloadcan With Freeand Trial other times hardly noticeable, depending on whether the individual is receiving treatment. T include the following:
Hallucinations are things a person sees, hears, smells, or feels that no one else can see, hear, sme feel. “Voices” are the most common type of hallucination in schizophrenia. Many people with disorder hear voices. The voices may talk to the person about hisup ortoher behavior, order the pers Sign vote on this title do things, or warn the person of danger. Sometimes thevoices other. People Useful talk useful toNoteach schizophrenia may hear voices for a long time before family and friends notice the problem. Other types of hallucinations include seeing people or objects that are not there, smelling odors th
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Thought disorders are unusual or dysfunctional ways of thinking. One form of thought disorde called “disorganized thinking.” This is when a person has trouble organizing his or her thought connecting them logically. They may talk in a garbled way that is hard to understand. Another for called “thought blocking.” This is when a person stops speaking abruptly in the middle of a thou When asked why he or she stopped talking, the person may say that it felt as if the thought had b taken out of his or her head. Finally, a person with a thought disorder might make up meaning words, or “neologisms.”
Movement disorders may appear as agitated body movements. A person with a movement diso may repeat certain motions over and over. In the other extreme, a person may become catat Catatonia is a state in which a person does not move and does not respond to others. Catatonia is today, but it was more common when treatment for schizophrenia was not available.
Negative symptoms Negative symptoms are associated with disruptions to normal emotions and behaviors. Th symptoms are harder to recognize as part of the disorder and can be mistaken for depression or o conditions. These symptoms include the following: • “Flat affect” (a person’s face does not move or he or she talks in a dull or monoto voice) • Lack of pleasure in everyday life • Lack of ability to begin and sustain planned activities You're Reading a Preview • Speaking little, even when forced to interact. Unlock full access with a free trial.
People with negative symptoms need help with everyday tasks. They often neglect personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problem Download With Free Trial symptoms caused by the schizophrenia.
Cognitive symptoms Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be dif perfor to recognize as part of the disorder. Often, they are detected other tests are Signonly up towhen vote on this title Cognitive symptoms include the following: Useful Not useful • Poor “executive functioning” (the ability to understand information and use it to decisions)
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Diagnostic Criteria
DSM-IV-TR Diagnostic Criteria for Schizophrenia A. Characteristic symptoms: Two (or more) of the following, each present for a significant po of time during a 1-month period (or less if successfully treated): 1. delusions 2. hallucinations 3. disorganized speech (e.g., frequent derailment or incoherence) 4. grossly disorganized or catatonic behavior 5. negative symptoms, i.e., affective flattening, alogia, or avolition Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist voice keeping up a running commentary on the person's behavior or thoughts, or two or more v conversing with each other. B. Social/occupational dysfunction : For a significant portion of the time since the onset o disturbance, one or more major areas of functioning such as work, interpersonal relation self-care are markedly below the level achieved prior to the onset (or when the onset childhood or adolescence, failure to achieve expected level of interpersonal, academ occupational achievement). C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month p must include at least 1 month of symptoms (or less if successfully treated) that meet Criter (i.e., active-phase symptoms) and may include periods of prodromal or residual sympt During these prodromal or residual periods, the signs of the disturbance may be manifest You're Reading a Preview only negative symptoms or two or more symptoms listed in Criterion A present in an attenu form (e.g., odd beliefs, unusualUnlock perceptual experiences). full access with a free trial. D. Schizoaffective and mood disorder exclusion : Schizoaffective disorder and mood disorder psychotic features have been ruled out because either (1) no major depressive, manic, or m Download With Free Trial episodes have occurred concurrently with the active-phase symptoms; or (2) if mood epi have occurred during active-phase symptoms, their total duration has been brief relative t duration of the active and residual periods. E. Substance/general medical condition exclusion : The disturbance is not due to the d physiological effects of a substance (e.g., a drug of abuse, a medication) or a general me condition. Sign up to vote on this title F. Relationship to a pervasive developmental disorder : If there is a history of autistic disord Useful Not useful another pervasive developmental disorder, the additional diagnosis of schizophrenia is m only if prominent delusions or hallucinations are also present for at least a month (or l
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Paranoid schizophrenia, which tends to have a later onset than the other subtype characterized primarily by hallucinations and delusions. Other symptoms, such as loosenin associations, bizarre behavior, or flattened or inappropriate affect, are either absent or relatively m The hallucinations are generally auditory and typically hostile or threatening. The delusions are gen persecutory and referential. Voices warn patients that their supervisors plot against them. They be suspect that their co-workers talk about them behind their backs and laugh quietly as they pas Newspaper headlines pertain to them; the CIA is involved; meal portions at the factory cafeteri secretly poisoned, and patients may refuse to eat at work. At times these patients may appeal t police for help, or they may suffer their slights in rigid silence. Their attitude becomes one of int constrained anger and suspiciousness. Occasionally they may move away to escape their persecutors, yet eventually the “followed.” At times they may turn on their supposed attackers, and violent outbursts may be see paranoid schizophrenia, more so than in the other subtypes, the delusions may be some systematized, even plausible. In most cases, however, inconsistencies appear, which, however, ha impact on the patients. Often, along with persecutory delusions, one may also see some gran delusions. Patients believe themselves persecuted not for a trivial reason; others now know tha patient recently acquired a controlling interest in the company. Rarely, grandiose delusions ma more prominent than persecutory ones and may dominate the entire clinical picture. A patient believe herself anointed with holy oil; trumpets blared forth her appearance as a prophet. She message that will save the world, and sets about spreading it.
Catatonic schizophrenia manifests in one of two forms: stuporous catatonia or ex You're Reading a Preview catatonia. In the stuporous form one sees varying combinations of immobility, negativism, mu posturing, and waxy flexibility. One patient curled into ball and lay on the bed, unspeakin Unlock full access withaarigid free trial. days, moving neither for defecation nor urination, and catheterization was eventually required. drooled from the mouth, and as there was no chewing, food simply lay in the oral cavity and ther Download With Free Trial danger of aspiration. Another patient stood praying in a corner, mumbling very softly. A degree of flexibility was present, and the patient’s arm would, for a time, remain in any position it was placed eventually to slowly return to the position of prayer. In the excited form of catatonia one may see purposeless, senseless, frenzied activity, mu stereotypies, and at times extreme impulsivity. Patients may scream, howl, beat their sides repea jump up, hop about, or skitter back and forth. A patient leaped Sign upup to and vote attacked on this titlea bystander reason, then immediately returned to a corner and restlessly marched in place, squeaking loudly. O Useful Not useful speech is extremely stereotyped and bizarre. Patients may shout, declaim, preach, and pontificate incoherent fashion. Words and phrases may be repeated hundreds of times. Typically, despite
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Although delusions and hallucinations are present, they are relatively minor, and the clinical pict dominated by bizarre behavior, loosened associations, and bizarre and inappropriate affect. Overa behavior of these patients seems at times a caricature of childish silliness. Senselessly they may themselves first with this, then with that, generally to no purpose, and often with silly, shallow laug At other times they may be withdrawn and inaccessible. Delusions, when they occur unsystematized and often hypochondriacal in nature. Some may display very marked looseni associations to the point of a fatuous, almost driveling incoherence.
Simple schizophrenia has perhaps the earliest age of onset, often first beginning in childh and shows very gradual and insidious progression over many years. Delusions, hallucinations, loosening of associations are sparse, and indeed are for the most part absent. Rather the clinical pi is dominated by the annihilation of the will, impoverishment of thought, and flattening of a Gradually over the years these patients fall away from their former goals and often become col distant with their former acquaintances. They may appear shiftless, and some are accused of laziness. Few thoughts disturb their and they may seem quite content to lie in bed or sit in a darkened room all day. Occasionally bizarre behavior or a fragmentary delusion may be observed. For the most part, however, these pa do little to attract any attention; some continue to live with aged parents; others pass from homeless mission to another.
Undifferentiated schizophrenia is said to be present when the clinical picture of any indiv case does not fit well into one of the foregoing subtypes. This is not uncommonly the case, and i You're Reading a Preview appears that in some instances the clinical picture, which initially did “fit” a subtype description gradually change such that it no longer squares withwith one of trial. the specific subtypes: this appears Unlock full access a free more common with the catatonic and hebephrenic subtypes than with paranoid or simple schizophrenia.
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