Disorders of Thought and Volition

1. Disorders of Thought and Volition

2. Schizophrenia? • A chronic severe brain disorder; often they hear voices, believe media are broadcasting their thoughts to the world or may believe someone is trying to harm them. • In men it usually develops in teen years and early 20s; in women it usually develops in 20s and 30s.

3. Diagnosis • Currently there is no physical or lab test that can absolutely diagnose schizophrenia. • A psychiatrist usually comes to the diagnosis based on clinical symptoms.

4. Symptoms of Schizophrenia • Profound disruption in cognition and emotion, affecting the most fundamental human attributes: • Language • Thought • Perception • Affect • Sense of self

5. Positive Symptoms • Those that appear to reflect an excess or distortion of normal functions.

6. Positive Symptoms • Delusions. Those where the patient thinks he is being followed or watched are common; also the belief that people on TV, radio are directing special messages to him/her.

7. Positive Symptoms • Hallucinations. Distortions or exaggerations of perception in any of the senses. • Often they hear voices within their own thoughts followed by visual hallucinations.

8. Positive Symptoms • Disorganized thinking/speech. • Speech is tangential, loosely associated or incoherent enough to impair communication.

9. Positive Symptom • Grossly disorganized behavior. • Difficulty in goal directed behavior , unpredictable agitation or silliness, social dis-inhibition, or bizarre behavior. • There is a purposelessness to behavior.

10. Positive Symptom • Catatonic behavior. • Marked decrease in reaction to immediate environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.

11. Other Positive Symptoms • Inappropriate response to stimuli • Unusual motor behavior (pacing, rocking) • Depersonalization • Derealization • Somatic preoccupations

12. Summary of Positive Symptoms • Delusions • Hallucinations • Disorganized thinking • Disorganized behavior • Catatonic behavior • Inappropriate responses

13. FYI: Positive Symptoms • Positive symptoms are those that have a positive reaction from some treatment. • In other words, positive symptoms respond to treatment.

14. Negative Symptoms • Those that appear to reflect a diminution or loss of normal functions. • May be difficult to evaluate because they are not as grossly abnormal as positive symptoms.

15. Negative Symptoms • Affective flattening. • Reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language.

16. Negative Symptom • Alogia (poverty of speech) • Lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts; often manifested as short, empty replies to questions.

17. Negative Symptom • Avolition • The reduction, difficulty or inability to initiate and persist in goal-directed behavior. Often mistaken for apparent disinterest.

18. Examples of Avolition • No longer interested in going out with friends • No longer interested in activities that the person used to show enthusiasm • No longer interested in anything • Sitting in the house for hours or days doing nothing

19. Disorganized Symptoms • This one is somewhat new and may not be considered valid. • It is thought disorder, confusion, disorientation and memory problems.

20. Summary of Negative Symptoms • Lack of emotion • Low energy • Lack of interest in life • Affective flattening • Alogia • Inappropriate social skills • Inability to make friends • Social isolation

21. Cognitive Symptoms • Difficulties in concentration and memory: • Disorganized thinking • Slow thinking • Difficulty understanding • Poor concentration • Poor memory • Difficulty expressing thoughts • Difficulty integrating thoughts, feelings, behaviors

22. FYI: Negative Symptoms • Currently there is no treatment that has a consistent impact on negative symptoms.

23. Types of Schizophrenia • Paranoid • Hebephrenic • Catatonic • Residual • Schizoaffective • Undifferentiated

24. Paranoid Schizophrenia • Persons are very suspicious of others and often have grand schemes of persecution at the root of their behavior. • During this phase they may have hallucinations and frequent delusions.

25. Hebephrenic Schizophrenia • AKA disorganized schizophrenia; characterized by emotionless, incongruous, or silly behavior, intellectual deterioration, frequently beginning insidiously during adolescence. • May be verbally incoherent and may have moods and emotions that are not appropriate to the situation. • Hallucinations not usually present.

26. Catatonic Schizophrenia • Person is extremely withdrawn, negative and isolated. • May have marked psychomotor disturbances.

27. Residual Schizophrenia • Lacks motivation and interest in day-to-day living. • Person is not usually having delusions, hallucinations or disorganized speech.

28. Schizoaffective Disorder • There will be symptoms of schizophrenia as well as mood disorder (depression, bipolar, mixed mania).

29. Undifferentiated Schizophrenia • Conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the previous types. • Exhibits more than one of the previous types without a clear dominance of one.