Schizophrenia and Other Psychoses

1. Schizophrenia and Other Psychoses Assessment & Diagnosis SW 593

2. Introduction • Arguably the most serious and debilitating of the mental disorders. • Involve distortions in the perceptions of reality; • Impairments in the capacity to reason, speak and behave rationally; • Impairments in affect and motivation. • Directly or indirectly disrupt all aspects of a client’s life.

3. Schizophrenia • Symptoms include severe disruptions in thinking • Gross disorganization in thoughts • May involve delusions (system of false beliefs that are not open to reason or appeal) • There will be perceptual disturbances including hearing voices. (auditory hallucinations)

4. Schizophrenia • Remaining symptoms (negative): • Absence of affect • Absence of motivation • Absence of interaction • There will be significant psychosocial impairment and/or distress • Symptoms must have begun at least 6 months earlier.

5. Schizophrenia • Subtypes are based by the predominant symptoms: • Paranoid type: delusions/hallucinations are elaborate and encompassing • Catatonic type: most rare of all subtypes • Disorganized type: disorganized speech and negative symptoms, some catatonia present • Residual type: negative symptoms alone • Undifferentiated type: no particular features are prominent.

6. Schizophreniform Disorder • Same features as schizophrenia but the time frame since the initial display of symptoms is between 1 and 6 months. • This diagnosis exists to ensure that the label of schizophrenia is not used too quickly. • Clients with this disorder may not evidence marked psychosocial problems.

7. Brief Psychotic Disorder • Sudden onset of positive symptoms that last more than one day but remit within 30 days. • Criteria includes a return to the premorbid level of functioning. • Should be provisional • A specifier is used to indicate whether there is a discernable stressor that has triggered the episode.

8. Schizoaffective Disorder • Includes the same symptoms as schizophrenia but also has symptoms that constitute one of the episodes of a mood disorder. • Periods when only the schizophrenic symptoms are evident. • Usually diagnosed after examination of the severe symptoms.

9. Delusional Disorder • Differs in both symptoms and impairment from schizophrenia • Disorganization and negative symptoms are not present • Social and vocational functioning effected but not as severe. • Content of delusional material is not considered bizarre.

10. Delusional Disorder • The distinction between bizarre and non-bizarre delusions is focused on whether the delusional situation could occur in real life.

11. Shared Psychotic Disorder • Occurs when a person who is closely associated with someone else with some psychotic disorder “buys into” the delusional system. • Fairly rare but it is more likely to occur when the individual with the original delusions exercises power over the other person.

12. Assessment • Assessment with these clients is accomplished through structured interviews commonly known as mental status examinations. • Designed to accrue information about the quality of the client’s mental processes.

13. Mental Status Examination • Cognitive functioning: • Normal intelligence? • Oriented to person, place, and time? • Evidence of problem-solving thinking? • Preoccupied? • Delusional thinking? Bizarre? • Thinking coherent and goal directed? • Exhibits good judgment? • Memory problems? (immediate, recent, remote) • Hallucinations? Peculiar speech?

14. Mental Status Examination • Emotional functioning • What emotions are described? • Congruent to thoughts? • Feeling over the past year? • Emotional state creating difficulties? • Emotionally stable? • Blunted or flattened affect? • Expansive?

15. Mental Status Examination • Physical functioning: • Level of energy? Past year? • Unusual motor behaviors? • Medical problems? • Recent physical exam? Results? • Any prescribed meds? What? • Any psychological treatment? • Presents with any disabilities?

16. Mental Status Examination • Substance use: • Alcohol? How much? • Other substances? • Social, legal, occupational troubles? • CAGE • Treatment?

17. Emergency Considerations • Dangerous behavior may occur • Mostly toward themselves • 60 – 80% will experience suicidal ideations • 10 – 15% will actually commit suicide • 50% will make a suicide attempt with younger clients making more attempts • The more positive the symptoms the greater likelihood.

18. Cultural Considerations • A disproportionately high number of cases of schizophrenia are found among disadvantaged ethnic cultures. • Greater in groups with high ethnic discrimination; low educational attainment; and low occupational status.

19. Social Selection Theory • Cultures that are oppressed and unable to attain high socioeconomic status have a greater number of individuals with disabilities and poor health. • The result of their oppressed status over the centuries and subsequent genetic predisposition rather than their ethnic background per se.

20. Cultural Factors • Play a role in the course of the illness. • Prognosis was more favorable in developing countries (Nigeria, India, Columbia) than in nine industrialized countries (the United Kingdom, the United States, the former Soviet Union). • Evidence has indicated that high expressed emotion (EE) within a U.S. family can have a negative impact on the person coping with schizophrenia.

21. Cultural Factors • Psychoeducational support for high EE families has been effective in reducing the relapse and rehospitalization of schizophrenic family members. • Social skills training is most effective with Caucasian individuals and families. • Less effective with Latinos.