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Schizophrenia

Rochelle Blumenstock. Schizophrenia. Etiology. Genetics 10% chance of developing the disorder if you have an immediate relative with it 40-65% chance of both twins being diagnosed with the disorder No single gene associated Many rare genetic mutations . Environment

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Schizophrenia

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  1. Rochelle Blumenstock Schizophrenia

  2. Etiology Genetics • 10% chance of developing the disorder if you have an immediate relative with it • 40-65% chance of both twins being diagnosed with the disorder • No single gene associated • Many rare genetic mutations Environment • Exposure to viruses or malnutrition before birth • Problems during birth • Other unknown psychosocial factors • Research is vague about the effects of neglect or maltreatment • Genetic disposition must be present

  3. Etiology Brain Chemistry • Current research focuses on at-risk children • Scans during emotional stimulation and decision-making tasks show hyper-activity • Neurotransmitters; i.e. over activity of dopamine neurons

  4. Etiology Brain Structure • Enlargement of fluid filled cavities called ventricles • Thalamus- filtering mechanism of sensory information- up to 17% smaller than control www.treatmentadvocacycenter.org

  5. Epidemiology • About 1% of Americans are diagnosed with Schizophrenia • Affects gender and ethnicity equally • Usually notice symptoms between 16 and 30 • Women tend to develop symptoms a bit later than men • Childhood-onset schizophrenia is being researched • 4% of all cases are reported before age 15 • Almost 50% of children with COS have at least 1 first degree relative with schizophrenia or schizophrenia spectrum disorder (SSD)

  6. Adult Symptoms Positive Negative Cognitive Hallucinations Delusions Thought Disorders Movement Disorders “Flat Affect” Lack of pleasure in everyday life Lack of ability to begin and sustain planned activities Speaking little, even when forced to interact Poor “executive functioning” Difficulty with “working memory” Trouble focusing or paying attention

  7. Characteristics-Strengths • Creativity • Mathematical Ability A Beautiful Mind

  8. Childhood-onset Schizophrenia • Difficult to discern between delusions and imaginative fantasies • Language and cognitive abilities are still developing • School psychologists, pediatricians, and general therapists are not well trained in diagnosis and treatment • Clinicians are hesitant to diagnose due to strong stigma • Often parents know something is strangely and extremely wrong

  9. In 2011, over 371,000 students received special education and related services under the category of “emotional disturbance” • Emotional disturbance means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance: • (A) An inability to learn that cannot be explained by intellectual, sensory, or health factors. • (B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. • (C) Inappropriate types of behavior or feelings under normal circumstances. • (D) A general pervasive mood of unhappiness or depression. • (E) A tendency to develop physical symptoms or fears associated with personal or school problems. • (ii) Emotional disturbance includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance under paragraph (c)(4)(i) of this section. Emotional Disturbance IDEA Category of Disability

  10. Externalizing comorbid disorders • 31% of children with schizophrenia meet criteria for conduct disorder or oppositional defiant disorder • 37% meet criteria for major depressive disorder Emotional Disturbance Comorbidity within EBD

  11. Characteristics-Needs Language &Communication Social Development Motor Activity Delays in language and communication Impaired conversational skills Use of neologisms Monotonous inflections Clanging Echolalia Drastic social withdraw Lack of peer relationships Severe anxiety or fear Extreme moodiness Odd or eccentric behavior Perseveration Impaired coordination Hand flapping “According to a report by the National Institute of Mental Health (NIMH), if a child shows any interest in friendships, even if they fail at maintaining them, it is unlikely that they have schizophrenia” (Gonthier & Lyon, 2004, p. 804).

  12. Characteristics-Needs • Illogical thinking • Intellectual functioning deteriorates for 24-48 months after onset of psychosis • Difficulty with information processing and retention • Inability to acquire new skills and information • 10-20% of children diagnosed have IQ on or below 80 (IDD) • Disorganized thinking Executive Function

  13. Information Processing Model Executive Functioning and Emotional Context

  14. Educational Adaptations-EBD • Behavior Management • Self-monitoring, Self-instruction training, Self-evaluation training, self-reinforcement • Recording when an unwanted behavior has occurred • Helps student be aware of behavior coming on • Encourages a sense of control • Lightens the monitoring load of the gen ed teacher Language & Communication Social Development Motor Activity Speech therapy Social skills training Problem Solving Skills Basic life skills training Occupational Therapy Physical Therapy Behavior Management • Social Skills Training • Cooperation, assertion, responsibility, empathy, self-control • Goal is to produce socially appropriate behavior • Generalization of skills to multiple scenarios • Many studies show discouraging results • Intensity and long term commitment required

  15. Functional Behavior Assessment • Noncompliance or disrespectful comments are considered a sign of stress of psychotic disorder, not behavior that needs punishing or correcting • Target source of stress • Intervention support that teaches coping techniques for this kind of stress • Problem focused coping • Emotion focused coping • Psychosis focused coping • Minimizes time out of classroom • Increases time for academic, social, and emotional learning • Does not exacerbate problems like reward/consequence sequence does

  16. Accommodations • “Safe place” • Low stress environment • Awareness of medications and side effects • Around the clock supervision

  17. References • Gonthier, Misty, & Lyon, Mark A. (2004). Childhood-onset Schizophrenia: An Overview. Psychology in the Schools, 41 (7), 803-811. • http://idea.ed.gov • http://nichcy.org • Lewis, Shon W., Buchanan, Robert W. (2007). Fast Facts: Schizophrenia. Health Press Limited: www.fastfacts.com. • Perreault, Kyle. (2008). The Educational Implications of Childhood Onset Schizophrenia (Ed.S. Research Paper). Retrieved from http://www2.uwstout.edu • U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. (2007). Schizophrenia (NIH Publication No. 06-3517). Retrieved from http://permanent.access.gpo.gov/lps87125/nimhschizophrenia.pdf • Walters, Anne. (2009). Educating and treating children with schizophrenic spectrum disorders. Brown University Child and Adolescent Behavior Letter, 25 (4), 1-7.

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