schizophrenia

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SCHIZOPHRENIA� Comes from Greek words

meaning “split” and “mind”

� People with schizophrenia

do NOT have split

personalities

� ‘split’ refers to loss of

touch with reality

� “split mind” refers to the

fact that people with

schizophrenia are split off

from reality and can’t

distinguish what is real

from what is not real

� Early writings indicating its

presence go back to the 12

century B.C.

� Not a single disorder

� A syndrome with multiple

variations and multiple

etiologies

� The label given to a group

of psychoses in which

deterioration of functioning

is marked by severe

distortion of thought,

perception and mood; by

bizarre behavior; and by

social withdrawal

� Equally frequency, males

have earlier onset

� 18 to 25 for men

� 26 to 45 for women

DESCRIPTIONA group of mental disorders characterized by;

� Psychotic features (hallucinations and delusions)

� Disordered thought process

� Disrupted interpersonal relationships

� Disturbances in affect, mood, behavior, and thought processes occur

DSM IV Criteria

� Schizophrenia

� Schizophreniform

� Schizoaffective

� Delusional Disorder

� Brief Psychotic Disorder

� Shared Psychotic Disorder

� Schizophrenia induced by: Medical conditions; Medications/ drugs /other substance

DSM IV Criteria� Schizophrenia : psychosis that are persistently

disturbing for at least 6 months, with 1 month of active-phase symptoms; age onset of late adolescence or early adulthood

� Schizophreniform : Symptoms of Schizophrenia with the duration of at least 1 month but less than 6 months and social / occupational function may not be impaired.

� Schizoaffective : Symptoms of both Schizophrenia and a mood disorder lasting for 1 month

DSM IV Criteria� Delusional Disorder : presence of one or more

nonbizaare delusions that persist for 1 month or more

� Brief Psychotic Disorder : at least one of the symptoms (hallucinations, delusions, disorganized speech or behavior disturbance) that last at least 1 day but less than 1 month; then a return to the premorbid level of functioning

DSM IV Criteria

� Shared Psychotic Disorder : a delusional disorder developed when the person is involved in a close relationship with an individual who has delusional psychotic disorder.

� Psychotic Disorder due to medical condition or induced by substance abuse : physiologic effect of medical condition; occurrences during intoxication or withdrawal stages but can last for weeks

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EtiologyEtiologyEtiologyEtiology ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia EtiologyEtiologyEtiologyEtiology ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia EtiologyEtiologyEtiologyEtiology ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia EtiologyEtiologyEtiologyEtiology ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia

� The etiology and pathogenesis of schizophrenia is not known

� It is accepted, that the etiology is multifactorial:

� Biological theories

� Biochemical

� Genetic

� Perinatal Risks

� Neurostructural

� Psychological theories

� Social theories

THEORIES� BIOLOGICAL

� BIOCHEMICAL� DOPAMINE HYPOTHESIS� Serotonin and glutamate

� NEUROSTRUCTURAL� INCREASED VBR, BRAIN ATROPHY, DECREASED

CREBRAL BLOOD FLOW

� GENETIC� IDENTICAL TWINS, 1ST DEGREE RELATIVES

� PERINATAL RISK FACTORS� EXPOSURE TO VIRUS, MINOR MALFORMATIONS,

COMPLICATIONS DURING LABOR AND PREGANCY, POVERTY

GeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGeneticsGenetics

� Idea that it is genetic

goes back at least as

far as the 18th century

� By the 19th century,

genetic hypothesis

was endorsed by

Kraepelin, Bleuler, and

many other experts on

schizophrenia.

RiskRiskRiskRisk FactorFactorFactorFactor RiskRiskRiskRisk FactorFactorFactorFactor RiskRiskRiskRisk FactorFactorFactorFactor RiskRiskRiskRisk FactorFactorFactorFactor

PerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisksPerinatalRisks

� There are also evidences that perinatalconditions may be an indicator of the risk of having schizophrenia.

� 2nd trimester (4-6 months) – brain development

� Conditions that could result in brain injury are:� Maternal starvation; poor nutrition – anemia

� Obstetric complications� Fetal hypoxia

� Maternal alcohol or drug abuse

� Toxin exposure or viral infection – influenza virus

� Incidence of birth trauma and injury

BiochemicalBiochemicalBiochemicalBiochemical::::BiochemicalBiochemicalBiochemicalBiochemical::::

DopamineDopamineDopamineDopamine HypothesisHypothesisHypothesisHypothesis DopamineDopamineDopamineDopamine HypothesisHypothesisHypothesisHypothesis


DopamineDopamineDopamineDopamine HypothesisHypothesisHypothesisHypothesis DopamineDopamineDopamineDopamine HypothesisHypothesisHypothesisHypothesis

� Overactivity of dopamine neurons in the mesolimbic pathway may cause positive symptoms.

� Underactivity of dopamine neurons in the mesocortical pathway in the prefrontal cortex may cause negative symptoms

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SerotoninSerotoninSerotoninSerotonin HypothesisHypothesisHypothesisHypothesis SerotoninSerotoninSerotoninSerotonin HypothesisHypothesisHypothesisHypothesis


SerotoninSerotoninSerotoninSerotonin HypothesisHypothesisHypothesisHypothesis SerotoninSerotoninSerotoninSerotonin HypothesisHypothesisHypothesisHypothesis

� Serotonin (5HT)

mediates dopamine

levels

� LSD and psilocybin are

potent 5HT receptor

agonists and cause

positive symptoms of

Shiz. (in people who do

not have schiz.)

� Atypical antipsychotics

are potent 5HT receptor

antagonists


GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis



� Glutamate functions in the:

� Relay of sensory information and in the regulation of various motor and spinal reflexes

� Regulation of N-methyl-D-aspartate (NDMA)

Decreased levels of

Glutamate

Decreased regulation of

NMDA

Impaired cognitive

processesPsychotic symptoms




GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis GlutamateGlutamateGlutamateGlutamate HypothesisHypothesisHypothesisHypothesis Clinical Observation

� PCP (“angel dust”) and ketamine (an anesthetic) mimic the positive and negative symptoms of schizophrenia (Javitt & Cole, 2004)

� These drugs block the action of a form of glutamate receptor (NMDA receptor)

� NMDA receptor blockade may produce the dopamine dysfunction seen in schizophrenia, as if too little dopamine were present in the prefrontal cortex (negative symptoms) and too much dopamine in the mesolimbic area (positive symptoms)

NeurostructuralNeurostructuralNeurostructuralNeurostructural::::NeurostructuralNeurostructuralNeurostructuralNeurostructural::::

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NeurostructuralNeurostructuralNeurostructuralNeurostructural::::NeurostructuralNeurostructuralNeurostructuralNeurostructural::::

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Theories

Psychoanalytical Psychodynamic

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�EmotionallyEmotionallyEmotionallyEmotionally withholdingwithholdingwithholdingwithholding

�DomineeringDomineeringDomineeringDomineering

�RejectingRejectingRejectingRejecting attitudesattitudesattitudesattitudes

�OverOverOverOver----protectionprotectionprotectionprotection

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IntrapsychicIntrapsychicIntrapsychicIntrapsychic conflictconflictconflictconflict

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DysfunctionalDysfunctionalDysfunctionalDysfunctional ParentalParentalParentalParental InteractionInteractionInteractionInteraction DysfunctionalDysfunctionalDysfunctionalDysfunctional ParentalParentalParentalParental InteractionInteractionInteractionInteraction


DysfunctionalDysfunctionalDysfunctionalDysfunctional ParentalParentalParentalParental InteractionInteractionInteractionInteraction DysfunctionalDysfunctionalDysfunctionalDysfunctional ParentalParentalParentalParental InteractionInteractionInteractionInteraction

DysfunctionalDysfunctionalDysfunctionalDysfunctional parentalparentalparentalparental

interactioninteractioninteractioninteraction

SchismaticSchismaticSchismaticSchismatic

marriagemarriagemarriagemarriage

SkewedSkewedSkewedSkewed marriagemarriagemarriagemarriage

InterferenceInterferenceInterferenceInterference withwithwithwith personalitypersonalitypersonalitypersonality

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simultaneouslysimultaneouslysimultaneouslysimultaneously

DefaultsDefaultsDefaultsDefaults inininin interpretinginterpretinginterpretinginterpreting meaningmeaningmeaningmeaning

DisorderDisorderDisorderDisorder ofofofof cognitioncognitioncognitioncognition andandandand

metacommunicationmetacommunicationmetacommunicationmetacommunication

SocialSocialSocialSocial stressorsstressorsstressorsstressors andandandand lifelifelifelife eventseventseventsevents SocialSocialSocialSocial stressorsstressorsstressorsstressors andandandand lifelifelifelife eventseventseventsevents

CopingCopingCopingCoping MechanismsMechanismsMechanismsMechanisms UsedUsedUsedUsed CopingCopingCopingCoping MechanismsMechanismsMechanismsMechanisms UsedUsedUsedUsed


CopingCopingCopingCoping MechanismsMechanismsMechanismsMechanisms UsedUsedUsedUsed CopingCopingCopingCoping MechanismsMechanismsMechanismsMechanisms UsedUsedUsedUsed

� Denial and Suppression

� Denial – Failure to acknowledge an unbearable

condition; failure to admit the reality of a

situation or how one enables the problem to

continue

� Suppression – Conscious acceptable behavior to

make up for or negative unacceptable thoughts

and feelings from conscious awareness


StressStressStressStressStressStressStressStress--------VulnerabilityVulnerabilityVulnerabilityVulnerability ModelModelModelModel VulnerabilityVulnerabilityVulnerabilityVulnerability ModelModelModelModel


StressStressStressStressStressStressStressStress--------VulnerabilityVulnerabilityVulnerabilityVulnerability ModelModelModelModel VulnerabilityVulnerabilityVulnerabilityVulnerability ModelModelModelModel

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VulnerabilityVulnerabilityVulnerabilityVulnerability

PersonalPersonalPersonalPersonal ProtectorsProtectorsProtectorsProtectors

CopingCopingCopingCoping MedicationsMedicationsMedicationsMedications

StressorsStressorsStressorsStressors

EnvironmentalEnvironmentalEnvironmentalEnvironmental StimulationStimulationStimulationStimulation

FamilyFamilyFamilyFamily ConflictConflictConflictConflict

LifeLifeLifeLife EventsEventsEventsEvents

SymptomsSymptomsSymptomsSymptoms

DecreasedDecreasedDecreasedDecreased

socialsocialsocialsocial andandandand

OccupationalOccupationalOccupationalOccupational

functioningfunctioningfunctioningfunctioning

EnvironmentalEnvironmentalEnvironmentalEnvironmental ProtectorsProtectorsProtectorsProtectors

ProblemProblemProblemProblem SolvingSolvingSolvingSolving SocialSocialSocialSocial SupportSupportSupportSupport

ASSESSMENT

Physical Characteristics

� Unkempt appearance

� Body Image distortions

� Maybe preoccupied with somatic complaints

� May neglect hygiene, eating, sleeping, and elimination

ASSESSMENT

Motor Activity

� Catatonic posturing: Holding bizaare postures for long periods of time

� Catatonic excitement: Moving excitedly, with no environmental stimuli present

� Possible total immobilization

� Inability to respond to commands or responding only to commands

� Waxy flexibility

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ASSESSMENT

Motor Activity� Repetitive or stereotyped movements

� Motor activity that may be increased as evidenced by agitation, pacing, inability to sleep, loss of appetite and weight, and impulsiveness

� Possible inability to initiate activity (anergia)

ASSESSMENT

Emotional Characteristics� Mistrust may be present

� View of the world as threatening and unsafe

� Affect may be blunted, flat, or inappropriate

� May display feelings of ambivalence, helplessness, anxiety, anger, guilt, or depression

ASSESSMENT

Emotional Characteristics� Compulsive rituals: Performed as an attempt to solve

conflicting feelings by constant, repetitive activity

� Overcompliance: Attempt to deny responsibility for any action by doing only what another person instructs exactly

� Affective disturbances (flat, inappropriate, altered thought process)

ALTERED THOUGHT PROCESS�Impaired reality testing�Fragmentation of thoughts�Thought blocking�Loose associations�Echolalia�Distorted perception of the environment�Neologisms�Magical thinking�Inability to conceptualize meaning in words or

thoughts�Inability to organize facts logically�Delusions associated with thought processes or content

TYPES OF DELUSIONS� DELUSION OF PERSECUTION

� DELUSION OF GRANDEUR

� SOMATIC

� Loss of reference in which the client believes that certain events, situations, or interactions are related directly to self

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INTERVENTIONS�Interact based on reality�Encourage the client to express feelings�Do not dispute the client or try to convince the client

that delusions are false�Initially initiate activities on one-on-one basis�Alter hospital routines as necessary, such as using

canned or packaged food or food from home�Recognize accomplishments and provide possible

feedback for successes

PERCEPTUAL DISTORTIONS� Illusions

� Hallucinations

HALLUCINATIONA sense perception (occurs with one of the five senses)

for which no external stimuli exist; can have an organic or functional cause

Types

� Auditory

� Visual

� Gustatory

� Olfactory

� Tactile

INTERVENTIONS� Ask the client directly about the hallucination

� Avoid reacting to the hallucination as if it were real

� Decrease stimuli or move the client to another area

� Do not negate the client’s experience

� Focus on reality based topics

INTERVENTIONS� Attempt to engage the client’s attention through a

concrete activity

� Respond verbally to anything real that the client talks about

� Avoid touching the client

� Monitor for signs of increasing anxiety or agitation, which may indicate that the hallucinations are increasing

For Active Hallucinations

�Monitor for hallucination cues and assess content�SAFETY is the First PRIORITY�Ensure that the client does not have an auditory

command telling him or her to harm self or others�Intervene with one-on-one contact�Avoid touching the client�Encourage to express feelings�Provide easy activities and structured environment

with routine ADL�Administer medications as prescribed

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TYPES OF SCHIZOPHRENIA� PARANOID

� DISORGANIZED

� CATATONIC

� UNDIFFERENTIATED

� RESIDUAL

PARANOID� Suspiciousness

� Hostility

� Delusions

� Auditory hallucinations

� Anxiety and anger

� Aloofness

� Persecutory themes

� Violence

DISORGANIZED� Extreme social withdrawal

� Disorganized speech or behavior

� Flat or inappropriate affect

� Silliness unrelated to speech

� Stereotyped behaviors

� Grimacing mannerisms

� Inability to perform ADL

CATATONIC� Psychomotor disturbances

� Immobility

� Stupor

� Waxy flexibility

� Excessive purposeless motor activity

� Echolalia

� Automatic obedience

� Stereotyped or repetitive behavior

UNDIFFERENTIATED� Does not meet the criteria for paranoid, disorganized,

or catatonic

� Delusions and hallucinations

� Disorganized speech

� Disorganized or catatonic behavior

� Flat affect

� Social withdrawal

RESIDUAL� Diagnosed as Schizophrenic in the past

� Time limited between attacks but may last for many years

� Exhibits social isolation and withdrawal, and impaired role functioning

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INTERVENTIONS

FOR SCHIZOPHRENIA�Assess the client’s physical needs�Set limits on the client’s behavior�Maintain a safe environment�Spend time with the client �Monitor for altered thought process�Set realistic goals�Monitor for suicide risk�Reorient the client as necessary�Provide short, brief, and frequent contact �Provide simple, concrete activities�Assist the client to use alternative means to express

feelings through music, art or writing

INTERVENTIONS� MEDICATIONS

� TYPICAL AND ATYPICAL ANTIPSYCHOTICS

� NURSE-PATIENT RELATIONSHIP

� FOCUS IS ON INTERPERSONAL

COMMUNICATION, SOCIALIZATION SKILLS, INDEPENDENCE AND SURVIVAL SKILLS FOR POSTHOSPITALIZATION

� FAMILY INVOLVEMENT

� SUPPORT AND EDUCATION

� MILIEU THERAPY

INTERVENTIONS

� MILIEU MANAGEMENT

�Disruptive behavior:� Set limits

� Decrease environmental stimuli

� Observe escalation of aggression

� Remove objects potential weapon

� Once violation of limits occurs, remind the patient of the consequences

� For restraints, assure the safety of client

INTERVENTIONS

� Withdrawn behavior :

� Arrange for a non-threatening activities and

socialization

� Arrange in semicircle group activities

� Provide decision-making activities /

opportunities

� Reinforce appropriate grooming and hygiene

� Provide remotivation and resocialization

� Provide psychosocial rehabilitation

INTERVENTIONS� Impaired communication

� Provide opportunities for decision-making

� Be patient and do not pressure patients to make

sense

� Involve clients to nonthreatening activity

� Provide for purposeful psychomotor activities

(painting, ceramic work, exercise)

� Disordered perception

� Provide distracting activities

� Monitor television selections

� Monitor hallucinations

� Presence and availability of staff for interaction

� Present reality

INTERVENTIONS

� Disorganized

� Provide less stimulating and calm

environment

� Provide safe and simple activities

� Provide and use information boards

� Protect patient from “embarassing” himself

� Assist in grooming and hygiene

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INTERVENTIONS� Altered levels of activity

� Hyperactivity� Provide safe environment and place

� Activities that does not require fine motor skills or intense concentration

� Immobility� Minimize circulatory problems and loss of muscle tone

� Provide adequate diet, exercise and rest

� Maintain bladder and bowel functioning

� Protect client from “victimization”

SummarySummarySummarySummary ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia SummarySummarySummarySummary ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia SummarySummarySummarySummary ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia SummarySummarySummarySummary ofofofof SchizophreniaSchizophreniaSchizophreniaSchizophrenia

SummarySummarySummarySummary ofofofof EtiologicalEtiologicalEtiologicalEtiological FactorsFactorsFactorsFactors SummarySummarySummarySummary ofofofof EtiologicalEtiologicalEtiologicalEtiological FactorsFactorsFactorsFactors SummarySummarySummarySummary ofofofof EtiologicalEtiologicalEtiologicalEtiological FactorsFactorsFactorsFactors SummarySummarySummarySummary ofofofof EtiologicalEtiologicalEtiologicalEtiological FactorsFactorsFactorsFactors

EtiologicalEtiologicalEtiologicalEtiological FactorsFactorsFactorsFactors

BiologicBiologicBiologicBiologic TheoriesTheoriesTheoriesTheories PsychologicalPsychologicalPsychologicalPsychological TheoriesTheoriesTheoriesTheories

PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms

BiochemicalBiochemicalBiochemicalBiochemical

TheoriesTheoriesTheoriesTheories

NeurostructuralNeurostructuralNeurostructuralNeurostructural


Genetic Theory Perinatal Risks PsychodynamicPsychodynamicPsychodynamicPsychodynamic


PsychoanalyticalPsychoanalyticalPsychoanalyticalPsychoanalytical


SocialSocialSocialSocial StressorsStressorsStressorsStressors andandandand

LifeLifeLifeLife EventsEventsEventsEvents

PositivePositivePositivePositive SymptomsSymptomsSymptomsSymptoms NegativeNegativeNegativeNegative SymptomsSymptomsSymptomsSymptoms

PositivePositivePositivePositive PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms PositivePositivePositivePositive PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms PositivePositivePositivePositive PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms PositivePositivePositivePositive PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms

PositivePositivePositivePositive SymptomsSymptomsSymptomsSymptoms

CognitiveCognitiveCognitiveCognitive DisturbancesDisturbancesDisturbancesDisturbances

AlterationsAlterationsAlterationsAlterations inininin ThoughtThoughtThoughtThought andandandand LanguageLanguageLanguageLanguage(((( ))))

DelusionsDelusionsDelusionsDelusions

ReligiousReligiousReligiousReligious


GrandioseGrandioseGrandioseGrandiose


NihilisticNihilisticNihilisticNihilistic


PersecutoryPersecutoryPersecutoryPersecutory


PerceptualPerceptualPerceptualPerceptual DisturbancesDisturbancesDisturbancesDisturbances

AlterationAlterationAlterationAlteration inininin ThoughtThoughtThoughtThought

ContentContentContentContentAlterationAlterationAlterationAlteration inininin FormFormFormForm ofofofof

ThoughtThoughtThoughtThought

LooseLooseLooseLoose AssociationsAssociationsAssociationsAssociations PovertyPovertyPovertyPoverty ofofofof

ContentContentContentContent

FlightFlightFlightFlight ofofofof

IdeasIdeasIdeasIdeas

HallucinationsHallucinationsHallucinationsHallucinations

SomaticSomaticSomaticSomatic


ImpairedImpairedImpairedImpaired SensorySensorySensorySensory

FilteringFilteringFilteringFiltering

AuditoryAuditoryAuditoryAuditory

BizaareBizaareBizaareBizaare BehaviorsBehaviorsBehaviorsBehaviors

AgitatedAgitatedAgitatedAgitated

UnpredictableUnpredictableUnpredictableUnpredictable

BehaviorBehaviorBehaviorBehavior

RepetitiveRepetitiveRepetitiveRepetitive orororor

StereotypedStereotypedStereotypedStereotyped

BehaviorBehaviorBehaviorBehavior

IdeasIdeasIdeasIdeas ofofofof

ReferenceReferenceReferenceReference

NegativeNegativeNegativeNegative PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms NegativeNegativeNegativeNegative PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms NegativeNegativeNegativeNegative PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms NegativeNegativeNegativeNegative PsychoticPsychoticPsychoticPsychotic SymptomsSymptomsSymptomsSymptoms

NegativeNegativeNegativeNegative SymptomsSymptomsSymptomsSymptoms

MoodMoodMoodMood DisturbancesDisturbancesDisturbancesDisturbances

ReducedReducedReducedReduced emotionalemotionalemotionalemotional

responsivenessresponsivenessresponsivenessresponsiveness

PoorPoorPoorPoor EyeEyeEyeEye

ContactContactContactContact

AnhedoniaAnhedoniaAnhedoniaAnhedonia BluntedBluntedBluntedBlunted AffectAffectAffectAffect

MotorMotorMotorMotor BehaviorBehaviorBehaviorBehavior

DisturbanceDisturbanceDisturbanceDisturbance

ThoughtThoughtThoughtThought andandandand LanguageLanguageLanguageLanguage

AlterationsAlterationsAlterationsAlterations

PovertyPovertyPovertyPoverty ofofofof

SpeechSpeechSpeechSpeech

SocialSocialSocialSocial WithdrawalWithdrawalWithdrawalWithdrawal

SocialSocialSocialSocial IsolationIsolationIsolationIsolation

PhysicalPhysicalPhysicalPhysical AnergiaAnergiaAnergiaAnergiaIncreasedIncreasedIncreasedIncreased

LatencyLatencyLatencyLatency ofofofof

ResponseResponseResponseResponse

AvolitionAvolitionAvolitionAvolition

Predictors of course and outcome in

schizophreniaFactorFactor Good OutcomeGood Outcome Poor OutcomePoor Outcome

Age at onsetAge at onset About 20About 20--2525 Below 20Below 20

SexSex Possibly femalesPossibly females Possibly malesPossibly males

Socioeconomic statusSocioeconomic status High, middle High, middle lowlow

Occupational recordOccupational record stablestable irregularirregular

Other adverse social Other adverse social factorsfactors

absentabsent presentpresent

Family history of Family history of mental illnessmental illness

affectiveaffective schizophreniaschizophrenia

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schizophrenia

FactorFactor Good OutcomeGood Outcome Poor OutcomePoor Outcome

Precipitating factorsPrecipitating factors presentpresent absentabsent

onsetonset Acute, lateAcute, late insidousinsidous

Rate of progressionRate of progression rapidrapid slowslow

Length of episode prior Length of episode prior to assessmentto assessment

Months or lessMonths or less yearsyears

Initial clinical Initial clinical symptomssymptoms

Catatonia, paranoia, Catatonia, paranoia, depression depression schizoaffective schizoaffective diagnosis, atypical diagnosis, atypical symptoms, confusionssymptoms, confusions

Negative symptoms Negative symptoms ((e.ge.g flat affect, poverty flat affect, poverty of thought, apathy, of thought, apathy, asocialityasociality; obsessive; obsessive--compulsive symptomscompulsive symptoms


schizophreniaFactorFactor Good Good

OutcomeOutcome

Poor Poor

OutcomeOutcome

CT/MRI studiesCT/MRI studies Normal Normal morphologymorphology

Dilated Dilated ventricles, brain ventricles, brain atrophyatrophy

Early treatment Early treatment with with medicationsmedications

presentpresent absentabsent

Response to Response to medications medications initiallyinitially

presentpresent absentabsent

Course of schizophrenia over 10 and 30

years

� over a 10-year period, 25 % of patients recover completely, 25% improve greatly and become relatively independent, 25% improve but require extensive help, 15% remain hospitalized and do not improve, and finally, 10% die mostly by suicide.

Course of schizophrenia over 10 and 30

years�over a 30-year period, 25% of patients

recover fully, 35% improve significantly and reach relative independence, 15% improve but require extensive support, 10% remain hospitalized and unimproved, and finally, 15% die mostly as a result of suicide

schizophrenia

Documents

delusional psychotic

mood disorder

pathogenesis of schizophrenia

symptoms hallucinations

single disorder

positive symptoms of

little dopamine

dopamine dysfunction