Psychopathology of Undifferentiated Schizophrenia

Predisposing Factors Genetics Neuro-anatomy Neuro-chemical Unknown Precipitating Factors Environment Immunovirologic Factors

Neuro-anatomy: Less brain tissue and cerebrospinal fluid Enlarged ventricles in the brain Cortical atrophy Diminished glucose metabolism and oxygen in frontal area

Neuro-chemical: Increased dopamine Increased serotonin Excessive neurotransmitters

CT scan MRI PET

Viral exposure Cytokine inflammatory mediator increase Cold environment Triggers

Changes in neural activity: Symptoms

Positive or Hard Symptoms Ambivalence Associative looseness Delusions Echopraxia Flight of ideas Hallucinations Ideas of reference Perseveration

Negative or Soft Symptoms Alogia Anhedonia Apathy Blunted Affect Catatonia Flat Affect Poor eye contact

SCHIZOPHRENIA

PARANOID

CATATONIC

DISORGANIZED RESIDUAL

UNDIFFERENTIATED

Legend: Predisposing & Precipitating Factors Sequence of Events Signs and Symptoms Laboratory test

Schizophrenia is characterized by a broad range of behaviors marked by a loss of the persons sense of self, significant impairment in reality testing, and disturbances in feelings, thinking and behavior. The individual is unable to distinguish the accuracy of their own perceptions and thoughts from external reality (Zide M.R and Gray S.W, 2001). The disorder occurs in all countries and cultures. Estimated prevalence rate ranges from 0.5% to 1.5% (APA, 200): the United States Surgeon General estimates a 1.3% one year prevalence rate among adults 18-54 years of age (USDHHS, 1999). The incidence has been estimated to range from 0.5 to 5.0 in 10,000 per year (APA, 2000). Birth cohort studies suggests that the incidence maybe higher among individuals born in urban settings versus rural and maybe somewhat lower in later-born birth cohorts (APA, 2000). Stressors might contribute to the vulnerability-stress model of causation. Stressors as risk factors, in the perinatal period include many circumstances that can be categorized as maternal stressors: maternal prenatal poverty, poor nutrition, depression, exposure to influenza outbreaks, war zone exposure, and Rh-factor incompatibility. Infants affected by these maternal stressors may demonstrate conditions that create their own risk: low birth weight, short gestation, and early developmental difficulties. In childhood, stressors may include central nervous system infections caused by crowded living

conditions and influenza. In general, poverty and minority social status affect the life-time course of schizophrenia. Most people who develop schizophrenia are diagnosed in late adolescence and early adulthood. Men diagnosed earlier than women due to estrogen which play a protective role against the development of schizophrenia that disappears as estrogen levels drop during menopause (USDHHS, 1999). In the United States and the United Kingdom, studies have found that schizophrenia is more often diagnosed among African Americans and Asian Americans (APA, 2000). First degree biologic relatives of an individual with schizophrenia may have a ten times greater risks for schizophrenia than the general population. Other relatives may have an increased risk for disorders that are within the schizophrenia spectrum (a group of disorders with some similarities of behavior, like schizoaffective disorder and schizotypal personality disorder.) There are several factors that cause schizophrenia when it comes to biologics theories. aFirst is the genetic factors which states that when there is family history of schizophrenia there are 50% risk of schizophrenia in identical twins, 15% risk in fraternal twins and if one biologic parents have history of the disorder there is a 15% risk and if both parents has the history there is 35% risk. Second is the neuroanatomic and neurochemical factors, findings have demonstrated that people with schizophrenia have relatively less brain tissue and cerebrospinal fluid than those who do not have schizophrenia, enlarged ventricles in brain and cortical atrophy can be seen through CT scan. Glucose metabolism and oxygen are diminished in the frontal cortical structure of the brain seen through PET scan and there is a decreased brain volume and abnormal function in the frontal and temporal alterations in the neurotransmitter system in the brain. There is also excess dopamine and serotonin which contributes to the development of the disorder. Third is the immunovirologic factor wherein alteration in brain physiology was caused by exposure to a virus or the bodys immune response to a virus. In diagnosing schizophrenia, self-reported experiences by the person and abnormalities in behavior reported by the family and friends are considered. In assessing patient; history, thought process and content, general appearance, motor behavior, speech, mood and affect, sensorium and intellectual process, judgment and insight, self-concept, roles and relationships, physiologic and self-care considerations are important in the diagnosis of the disorder. There are two major categories of symptoms of schizophrenia: positive or hard symptoms and negative or soft symptoms. The positive symptoms consists of ambivalence,

associative looseness, delusions, echopraxia, flight of ideas, hallucination, ideas of reference, perseveration. The negative symptoms are not present in schizophrenia but are normally found in healthy person, it includes alogia, anhedonia, apathy, blunted affect, catatonia, flat affect, and poor eye contact. Diagnostic and Statistical Manual of Mental Disorders (4th Edition) Text Revision (DSM IV-TR; American Psychiatric Association, 2000 Symptoms of Schizophrenia: Positive Symptoms: Associative looseness, delusions, ambivalence, flight of Ideas, echopraxia, hallucinations, ideas of reference, perseveration Negative Symptoms: Alogia, apathy, blunt affect, catatonia, flat affect, lack of volition, Anhedonia The patient was diagnosed with undifferentiated type schizophrenia. Patient with this type of schizophrenia exhibit the major features of the disorder but have not met the full assessment distinctions for paranoid, disorganized, or catatonic type. The characteristics are virtually indistinguishable from the three other categories; essentially this determination is made of exclusion rather than that based entirely on symptomatology. The process of making an assessment of undifferentiated-type schizophrenia is basically using whats left over. Some individuals do not quite fit in to the previously reviewed subtypes. In other words, the person has met all the basic criteria for schizophrenia, but has not met specific criteria for paranoid, disorganized, and catatonic types of schizophrenia.

Created by: Marlon Reyes, RN February 2011