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Schizophrenia

Learn about the symptoms, subtypes, and diagnostic criteria for Schizophrenia and Schizoaffective Disorder according to the DSM-IV-TR. Understand the range of emotional and cognitive dysfunction, positive and negative symptoms, and social/occupational dysfunction associated with these disorders.

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Schizophrenia

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  1. Schizophrenia and Schizoaffective Disorder DSM-IV-TRTM American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000 • Russell L. Smith, M.S., LPA, HSP-PA, CCBT, MAC, FABFCE, NCP

  2. In Schizophrenia, “Psychotic” refers to • delusions, • any prominent hallucinations, • disorganized speech, or • disorganized or catatonic behavior.

  3. Subtypes • 295.30 Paranoid • 295.10 Disorganized • 295.20 Catatonic • 295.90 Undifferentiated • 295.60 Residual

  4. Course Specifiers • Episodic With Interepisode Residual Symptoms • Episodic With No Interepisode Residual Symptoms • Continuous • Single Episode in Partial Remission* • Single Episode in Full Remission* • Other Or Unspecified Pattern *With Prominent Negative Symptoms can be added ...

  5. Range of Emotional & Cognitive Dysfunction* • Perception • Inferential thinking • Language & communication • Behavioral monitoring • Affect • Fluency & productivity of thought & speech • Hedonic capacity • Volition & drive • Attention * Associated with impaired occupational or social functioning

  6. Positive Symptoms Reflect an excess or distortion of normal functions • “psychotic dimension” • Thought content • Perception • “disorganization dimension” • Language & thought processes • Self-monitoring of behavior

  7. Negative Symptoms A decrease or loss of normal functions • Range & intensity of emotional expression • Fluency & productivity of thought and speech • Initiation of goal-directed behavior

  8. SchizophreniaDiagnostic Criterion A • A. Characteristic symptoms: two or more ... for significant portion of 1-month (or less if successfully treated): • Delusions • Hallucinations • Disorganized speech (e.g., frequent derailment or incoherence) • Grossly disorganized or catatonic behavior • Negative symptoms, i.e., affective flattening, alogia, or avolition Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.

  9. SchizophreniaDiagnostic Criterion B • B. Social/Occupational Dysfunction ... • ... for a significant portion of time since onset ... • one or more major areas of functioning such as work, interpersonal relations, or self-care ... markedly below level prior to onset • If onset in childhood or adolescence ... failure to achieve expected level of interpersonal, academic, or occupational achievement

  10. SchizophreniaDiagnostic Criterion C • C. Duration • Continuous signs persist for at least 6 months • at least one month meet Criterion A (less than month if effectively treated) • may include prodromal or residual symptoms • may be manifested by only negative symptoms or two or more symptoms listed in Criterion A presented in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

  11. SchizophreniaDiagnostic Criterion D • D. Schizoaffective and Mood Disorder have been ruled out because either • there has been no Major Depressive, Manic, or Mixed Episodes, or • if mood episodes have occurred during the active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

  12. SchizophreniaDiagnostic Criterion E • E. Substance/general medical condition exclusion: • The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) • The disturbance is not due to a general medical condition.

  13. SchizophreniaDiagnostic Criterion F • F. Relationship to Pervasive Developmental Disorder • If there is a history of Autism Disorder or another Pervasive Developmental Disorder ... • the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present ... • for at least one month (or less if successfully treated).

  14. 295.30 Paranoid Type • Preoccupation with one or more delusions or frequent auditory hallucinations. • None of the following is prominent: • disorganized speech • disorganized or catatonic behavior • flat or inappropriate affect.

  15. 295.10Disorganized Type • All of the following are prominent: • disorganized speech • disorganized behavior • flat or inappropriate affect. • The criteria are not met for Catatonic Type.

  16. 295.20 Catatonic Type • At least two of the following: • motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor • excessive motor activity (purposeless and not influenced by external stimuli) • extreme negativism or mutism • peculiarities of voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing • echolalia or echopraxia

  17. 295.90 Undifferentiated Type • ... the presence of symptoms that meet Criterion A of Schizophrenia but that do not meet criteria for the Paranoid, Disorganized, or Catatonic Type.

  18. 295.60 Residual Type • Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. • There is continuing evidence of the disturbance ... • presence of negative symptoms, or • two or more of the symptoms listed in Criterion A but in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

  19. Schizophrenia:Features • Cultural & Socioeconomic • Beliefs & Religion • Language, Emotional Expression & Nonverbal style • Industrial vs Developing • Men: Onset 18-25 years ... more negative symptoms (flat affect, avolition, social withdrawal) • Women: Onset 25 to mid-30s (3% to 10% onset after 40) ... better permorbid functioning, more affective symptoms, paranoid delusions, and hallucinations

  20. 295.70 Schizoaffective Disorder • An uninterrupted period of illness during which, at least some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia. • During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.

  21. 295.70 Schizoaffective Disorder • Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness. • Not due to drug of abuse, medication or a general medical condition. Specify Type: Bipolar Type: ... if Manic or Mixed Episodes (or Manic or Mixed and Major Depressive Episodes) Depressive Type: Major Depressive Episodes

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