Schizophrenia

1. Schizophrenia

2. General Background.. Perceptual symptoms • Auditory hallucinations – hearing things that are not there. People often hear voices saying abusive or critical things. • Sometimes people see, smell or taste things that are not there.

3. Social symptoms • Social withdrawal- not taking part in or enjoying social situations. In some cases people might be aloof or avoid eye contact.

4. Cognitive symptoms Delusions – believing things that are not true. People can have delusions of grandeur (where they believe they are more important than they are e.g. that they are the KING) or of a paranoia and persecution (where they believe that their behaviour is being controlled by someone or something else).

5. Cognitive symptoms continued • Thought control – believing that your thoughts are being controlled e.g. thought insertions is where people feel that someone is putting thoughts into their heads. Withdrawal is when they believe that someone is removing their thoughts. They might also believe that people can read their thoughts (this is called broadcasting).

6. Cognitive symptoms continued • Language impairments – irrelevant and incoherent speech. People often show sighs of cognitive distractibility where they cannot maintain a train of thought. They might also repeat sounds (echolalia), jumble their words (word salad), make nonsensical rhymes (clang associations) and invent words (neologisms)

7. Affective/Emotional symptoms • Depressive symptoms – a lack of energy and interest in things especially in personal care and hygiene. • Lack of emotion – not reacting to typically emotional situations. This is also called emotional blunting. • Inappropriate emotions- reacting in an inappropriate way. E.g. laughing at bad news.

8. Behavioural Symptoms • Stereotyped behaviours- continuously repeating actions which are often strange and do not have a purpose. • Psychomotor disturbance – not having control of your muscles. People may experience catatonia, where they sit in an awkward position for a long time. In this state people will sometimes stay in whatever position they are put in (so if you lift their arm over their head it will stay like that until you move it back).

9. Behavioural Symptoms continued • Catatonic stupor- lying rigidly and not moving for long periods of time. People are conscious during these episodes and can remember what was going on around them although they do not seem aware of it at the time.

10. Symptoms Type 1 – Positive symptoms • Auditory hallucinations • Delusions • Thought control • Language problems, e.g. jumbled speech. Type 2- Negative symptoms. This is where people do not display ‘normal’ behaviours for example; • Withdrawn • Unresponsive • lack of emotion/affection

11. Watch the video and state which sub-category best describe Gerard’s’ symptoms & why?

12. The DSM-IV • The DSM-IV (the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders) contains a list of mental health disorders. Individuals are rated on a multiple axes/dimensions and diagnostic categories are used.

13. DSM-IV continued • For a person to be diagnosed with schizophrenia, the DSM-IV states that their symptoms must significantly impair reality testing - the ability to function in the real world. The symptoms have to have been present for at least six months. • The DSM-IV aims to give a diagnosis which has both reliability and validity. These factors are however not always easy to achieve.

14. Watch the DVD (approximately one hour long) –How mad are you?Find out how easy it is to diagnose mental Illness. This programme last about an hour,

15. THE ICD-10 • Considers the following groups of symptoms important there is a minimum requirement for at least one of the symptoms listed under one or two to be present for a period of at least one month. • NB: that the examples given to illustrate the symptoms are included here for the purpose of clarification but are not included in the ICD list of symptoms.

16. THE ICD-10 continued • Section one of the ICD-10 – part (a) • Thought control. There are a number of different types. These are; • Thought withdrawal - thoughts are being extracted from the person’s mind • Thought insertion – unwelcome thoughts are being inserted into the person’s mind. • Thought broadcast – private thoughts have become accessible to other people.

17. THE ICD-10 continued • Section one of the ICD-10 – part (b) • Delusions of control influence and passivity - a delusion is a distorted belief. The individual does not feel in control of their own thoughts, feelings and will (that is the ability to make things happen).

18. THE ICD-10 continued • Section one of the ICD-10 – part (c) • Hallucinatory voices – these are voices that do not exist but feel real to the person hearing them. The content of the voices is very variable but often takes the form of a running commentary on the person’s behaviour.

19. THE ICD-10 continued • Section one of the ICD-10 – part (d) • Other persistent delusions – these are distorted beliefs that are culturally inappropriate or involve impossible powers and capabilities (e.g. believing themselves to be great politicians or religious leaders)

20. THE ICD-10 continued • Section two of the ICD-10 – part (a) • Persistent hallucinations- these are distorted perceptions arising from any of the senses they are however usually auditory.

21. THE ICD-10 continued • Section two of the ICD-10 – part (b) • Incoherent or irrelevant speech- which can be either be so jumbled that it is meaningless or an individual starts to use made up words (neologisms).

22. THE ICD-10 continued • Section two of the ICD-10 – part (c) • Catatonic behaviour- the adoption of unusual body movements or postures which are often keep for a period of time.

23. THE ICD-10 continued • Section two of the ICD-10 – part (d) • Negative symptoms - these include apathy and a general lack of drive or motivation.

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