SCHIZOPHRENIA Schizophrenia is a syndrome or disease process affecting the brain that causes distorted and bizarre thoughts, perceptions,

emotions, movements and behavior. It is usually diagnosed in late adolescence or early adulthood. The peak incidence of onset is 15-25 years of age for men and 25 to 35 years of age for women (American Psychiatric Association, 2000) Positive and negative symptoms of schizophrenia Positive or hard symptoms Ambivalence - holding seemingly contradictory beliefs or feelings about the same person, event or situation Associative looseness - fragmented or poorly related thoughts and ideas Delusions fixed false beliefs that have no basis in reality Echopraxia imitation of the movements and gestures of another person whom the client is observing Flight of ideas continuous flow of verbalization in which the person jumps rapidly to one another Hallucinations false sensory perceptions or perceptual experiences that do not exist in reality Ideas of reference false impressions that external events have special meaning for the person Perseveration persistent adherence to a single idea or topic; verbal repetition of a sentence, word or phrase; resisting attempts to a change the topic Negative or soft symptoms Alogia tendency to speak very little or to convey little substance of meaning (poverty of content) Anhedonia feeling no joy or pleasure from life or any activities or relationships Apathy feelings of indifference toward people, activities and events Blunted effect restricted range of emotional feeling; tone or mood

Catatonia psychologically induced immobility occasionally marked by periods or agitation or excitement; the client seems motionless, as if in a trance Flat effect absence of any facial expression that would indicate emotions or mood Lack of volition absence of will, ambition, or drive to take action to take action or accomplish tasks

Types of schizophrenia according to DSM-IV-TR Schizophrenia, paranoid type: characterized by persecutory (feeling victimized or spied on) or grandiose delusions, hallucinations, and occasionally excessive religiosity (delusional religious focus) or hostile and aggressive behavior. Schizophrenia, disorganized type: characterized by grossly inappropriate or flat affect, incoherence, loose associations, and extremely disorganized type. Schizophrenia, catatonic type: characterized by marked psychomotor disturbance, either motionless or excessive motor activity. Motor immobility may be manifested by catalepsy (waxy flexibility) or stupor. Excessive motor activity is apparently purposeless and is not influenced by external stimuli. Other features include extreme negativism, mutism, peculiarities of voluntary movement, echolalia and echopraxia. Schizophrenia, undifferentiated type: characterized by mixed schizophrenic symptoms (of other types) along with disturbances of thought, affect and behavior Schizophrenia, residual type: characterized by at least one previous, though not a current, episode; social withdrawal; flat affect ; and looseness of associations Causes The cause of schizophrenia is unknown and schizophrenia cannot be cured, but it can be treated. Predictors for good treatment outcomes are normal adjustment before the onset of the disease and little or no family history of schizophrenia, confusion, paranoia, depression, or catatonic behavior. Some predictors for a poor outcome are: earlier age of onset, a family history of the

illness, withdrawal, apathy, and prior history of a thought disorder. There are various theories to explain the development of this disorder. Genetic factors may play a role, as close relatives of a person with schizophrenia are more likely to develop the disorder. Psychological and social factors, such as disturbed family and interpersonal relationships, may also play a role in development.. Clinical Course Onset may be abrupt or insidious, but most clients slowly and gradually develop signs and symptoms such as social withdrawal, unusual behavior, loss of interest in school or work, and neglected hygiene. The diagnosis of schizophrenia usually is made when the person begins to display more actively positive symptoms of delusions, hallucinations and disordered thinking (psychosis). Immediate course: in the years immediately after the onset of psychotic symptoms, two typical clinical patterns emerge. In one pattern, the client experiences ongoing psychosis and never fully recovers, although symptoms may shift in severity over time. In another pattern, the client experiences episodes of psychotic symptoms that alternate with episodes of relatively complete recovery from psychosis. Long-term course: the intensity of psychosis tends to diminish with age. Many clients with long term impairment regain some degree of social and occupational functioning. Over time, the disease become less disruptive to the persons life and easier to manage, but rarely the client can overcome the effects of many years of dysfunction. In later life, these clients may live independently or in a structured family-type setting and may succeed at jobs with stable expectations and supportive work environment. Related disorders Schizophreniform disorder: the client exhibits the symptoms of schizophrenia but for less than 6 months necessary to meet the diagnostic criteria for schizophrenia. Social or occupational functioning may or may not be impaired.

Delusional disorder: the client has one or more non bizarre delusions that is, the focus of the delusion is believable. Psychosocial functioning is not markedly impaired and behavior is not obviously odd or bizarre.

Brief-psychotic disorder: the client experiences the sudden onset of at least one psychotic symptom, such as delusions, hallucinations, or disorganized speech or behavior, which lasts from 1 day to 1 month. The episode may or may not have an identifiable stressor or may follow childbirth.

Shared psychotic disorder (folie a deux): two people share a similar delusion. The person with this diagnosis develops this delusion in the context of a close relationship with psychotic delusions.

Diagnostic evaluation 1. Clinical diagnosis is developed on historical information and thorough mental status examination. 2. No laboratory findings have been identified that can diagnose schizophrenia. Management Patients may receive treatment in inpatient settings or in community-based outpatient programs or psychiatric home care. Schizophrenia generally require long term treatment; therefore, a case management approach is important in order to coordinate multiple services. Pharmacologic therapy with either the typical or atypical neuroleptics (antipsychotics) is the treatment. The typical neuroleptics have multiple adverse effects that require careful management. The atypical neuroleptics have fewer adverse effects and may also be more effective in decreasing the negative symptoms of schizophrenia. Pharmacologic therapy with both the typical atypical neuroleptics can include the use of long-lasting or depot injections. Psychosocial treatments (social skills training, ADL instruction) Supportive therapy that is reality oriented and pragmatic Family therapy