What Is Schizophrenic in Acute and Transient Psychotic Disorder?
Schizophrenic Disorder PPT OK
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Schizophrenic Disorders
By Sawiji, S.Kep.Ns., MSc.*
E-mail: [email protected]
Mobile Phone: !1 "#! #!"""
$EP%&'MEN' () N&S+N B%S+ S+ENE
M%MM%$+/% (MB(N E%0' S+ENE +NS'+''E
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Topics of discussion
1. Sympoms o2 Schi3oph4enia
#. $iagnosic consi5e4aions
". (nse an5 o64se7. Special 'opic: 6l64e an5 schi3oph4enia
8. Eiological 2aco4s
9. 6lne4abiliy ma4;e4s
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What is schizophrenia?
Schi3oph4enia is 6s6ally ho6gh o be :
a mental disorder or illness
which disturbs how a person
thinks, feels and behaves. Andalso how it affects the person
changes over time.
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Etiology of schizophrenia
'his is an a4ea o2 g4ea 5ebae. Many
heo4ies ha>e been p6 2o4wa45 in he
pas which ha>e no been s6ppo4e5 bylae4 scieni2ic 4esea4ch.
It is probable that there are a
number of different causes.
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1. Mo5e4n echni?6es ha>e 5emons4ae5 ha
some affected people have changes in
the structure of their brains.#. 'he4e is also e>i5ence ha some of these
individuals may have been affected by
infections before they were born.
". (ccasionally the disorder appears to run
in families affecting many members.
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7. +nc4easingly, i has been shown ha some of thechemical messengers in the brain(particularly two called serotonin anddopamine) are not working correctly.
8. 'he in5i>i56als b4ea;5own may occ64 as a resultof drug or alcohol misuse, emotionalstress or difficulties in life experiences.
'he4e is no scieni2ic e>i5ence o s6ppo4 he i5ea
ha how pa4ens b4ing 6p hei4 chil5 can ca6seschi3oph4enia.
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Schizophrenic Symptoms
There are three :
a. positive symptoms
b. negative symptoms
c. disorganized symptoms
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%n eAcess o4 5iso4ion o2 no4mal
26ncions.
Posii>e sympoms 5o no 4e2e4 ogoo5C sympoms, b6 o 26ncions
ha a4e p4esen ha sho6l5 no be.
'hese a4e sympoms 6s6ally e?6ae5wih c4a3inessC
a. Positive (psychotic)
symptoms :
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a.1. Hallucinations
-heighene5 senso4y Dpe4cep6aleApe4iences ha a4e no 56e o eAe4nal
sim6li -Possible o eApe4ience hall6cinaions h4o6gh
any o2 he 8 senso4y mo5es
-Mos common hall6cinaion is auditoryEAample: ea4ing wo >oices ca44ying on a 46nningcon>e4saion abo6 e44ible pe4son yo6 a4e
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a.2. Delusions
-Belie2s 4igi5ly hel5 alho6gh p4epose4o6sin na64e ha 6s6ally in>ol>e a
mis4ep4esenaion o2 pe4cepions an5
eApe4iencesEAample: Belie2 ha yo6 alone can en5 sa4>aion
in he wo4l5
EAample: Belie2 ha s?6i44els a4e aliens sen oea4h on a 4econnaissance mission
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b. Negative symptoms
% loss o4 5e2ici in no4mal 26ncions.
Negai>e sympoms 5o no 4e2e4 o ba5C
sympoms, b6 o 26ncions ha a4e absenha sho6l5 be p4esen.
'hese a4e aspecs o2 behavior and socialrelationships ha sho6l5 be he4e, b6 a4e
no.
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b.1. lunted affect
!affecti"e flattening# -&es4icion o4 2laening o2 non>e4bal5isplay o2 emoion
-+magine i2 people wo4e mas;s all he ime. /o6co6l5 comm6nicae wih hem, b6 yo6 co6l5 no
4ea5 hei4 2acial emoional 4eacions.
EAample: % pe4sons >oice may lac; no4malchanges in pich an5 >ol6me when 5esc4ibing
somehing eAciing ha happene5 o hem.
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b.2. $nhedonia
-%n inabiliy o eApe4ience pleas64e
EAample: losing pleas64e in eaing, o4social 4elaionships ha yo6 wo6l5
ypically 2in5 enjoyable
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b.%. $logia !speechlessness#
-Po>e4y o2 speech ha may loo; li;e b4ie24eplies wih >e4y lile conen Dempy.
EAample
+ne4>iewe4: $o yo6 ha>e any chil54enF
lien: /es.
+ne4>iewe4: ow many chil54en 5o yo6 ha>eF lien: 'wo.
+ne4>iewe4: ow ol5 a4e heyF
lien: 'h4ee an5 se>en.
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b.&. $"olition
-'he lac; o2 >oliion o4 willpowe4 o iniiae
an5 pe4sis in goal-5i4ece5 aci>iies.
EAample: Showing lile ine4es in bahing,
b46shing eeh an5 combing ones hai4 Di.e.,
pe4sonal hygiene
EAample: No waning o go o a "pm class e>en-
ho6gh yo6 ha>e 54esse5 2o4 class
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c. Disorganized symptoms
Sympoms ha 5o no 2i he cha4ace4isics
o2 posii>e o4 negai>e sympoms.
&e2lec bi3a44e beha>io4s an5 5is64bancesin hin;ing.
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c.1. Disorganized speech
-Saying hings ha con>ey lile, i2 any,
meaning. Speech p4es6me5 o 4e2lec
6n5e4lying 5iso4gani3e5 hin;ing.
EAample- le6ce is a 4ans2o4maion o2 a 5ea5 co6ga4(especially US = PUMA ha s622e4e5 a 4elapse on
he lions oe.C
+ne4>iewe4: =hy a4e yo6 in he hospial, Ge22F
Ge22: + 4eally 5on wan o be he4e. +>e go ohe4 hings
o 5o. 'he ime is 4igh, an5 yo6 ;now, when
oppo46niy ;noc;sH
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c.2. izarre beha"iors
-Grossly disorganized behavior orcatatonic behavior , s6ch as 6n6s6albo5y mo>emens o4 inappropriate affect s6ch as emoional eAp4essions ha 5o nomach he si6aion
EAample: Mainaining a s?6aing pos64e ha is
4esisan o any e22o4s a changing he pos64e
EAample: iggling while 4elaying some pe4sonal4age5y
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Schizophrenia Symptoms
Posi1i>esymp1oms
Nega1i>esymp1oms
$iso4gani3e5symp1oms
.all6cina1ions Bl6n1e5
a22ec1
$iso4gani3e5
Speech
$el6sions %nhe5onia $iso4gani3e5Beha>io4
%logia
%>oli1ion
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Schizophrenic Disorders
Sympoms o2 Schi3oph4enia $iagnosic consi5e4aions (nse an5 o64se Special 'opic: 6l64e an5 schi3oph4enia Eiological 2aco4s 6lne4abiliy ma4;e4s '4eamens =ill no co>e4
I Phases o2 Schi3oph4enia
I Ne64opahology
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2. Diagnosing Schizophrenia
M6s show an impai4men in social o4
occupational 26ncioning
duration o2 a leas 9 monhs wih
conin6o6s 5is64bance, whe4e # o4 mo4e
posii>e, negai>e o4 5iso4gani3e5sympoms a4e p4esen 2o4 a leas 1 monh
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'(cluding related disorders
Be2o4e a 5iagnosis o2 schi3oph4enia can
be gi>en, 5iso45e4s wih simila4 sympoms
m6s be 46le5 o6 as a possibiliy
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'(ample of Diagnostic
e(clusion )o4 eAampleJ 564ing monh whe4e
posii>e, negai>e o4 5iso4gani3e5
sympoms a4e aci>e hose sympomsm6s appea4 in absence o2 a majo45ep4essi>e o4 manic episode
+2 5ep4ession an5 mania symptoms a4ep4esen, hei4 duration must be brie! in4elaion o he 564aion o2 aci>e an54esi56al schi3oph4enia sympoms.
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Distinguishing Schizophrenia
from other similar disorders (he4 5iso45e4s ha>e psychoic sympoms
as hei4 co4e sympoms, incl65ing:
Schi3oa22eci>e 5iso45e4
Schi3oph4eni2o4m 5iso45e4
B4ie2 psychoic 5iso45e4
$el6sional 5iso45e4
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Schizoaffecti"e "s.Schizophrenia
)o4 schi3oa22eci>e 5iso45e4
I 5el6sions an5 hall6cinaions m6s be p4esen2o4 a leas # wee;s wiho6 p4ominen moo5
sympoms. I Moo5 sympoms m6s be p4esen 2o4 a
substantial po4ion o2 he psychoic5is64bance
)o4 schi3oph4enia:
I he lengh o2 ime ha moo5 sympoms a4ep4esen is brie! in compa4ison o he 564aion
o2 psychoic 5is64bance
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Schizophreniform and rief
psychotic "s. Schizophrenia
B4ie2 psychoic Schi3oph4eni2o4m Schi3oph4enia
1 5ay 1 monh 9 monhs
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Delusional disorder "s.
Schizophrenia $el6sional 5iso45e4 is eAacly as i so6n5s.
Non-bi3a44e 5el6sions is he p4ominen
psychoic sympom
(he4 schi3oph4enic sympoms, s6ch as
hall6cinaions, 5iso4gani3e5 an5 negai>e
sympoms a4e absent in 5el6sional5iso45e4
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Schizophrenic Disorders
Sympoms o2 Schi3oph4enia $iagnosic consi5e4aions (nse an5 o64se Special 'opic: 6l64e an5 schi3oph4enia Eiological 2aco4s 6lne4abiliy ma4;e4s '4eamens =ill no co>e4
– Phases of Schizophrenia
– Neuropathology
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3. a. Onset of the disorder
0i2eime p4e>alence 4ae in gene4al
pop6laion is 1
men appea4 o ha>e an ea4lie4 age o2onse Dypically 1!-#8
onse 2o4 women is ypically #8-"8
0i;elihoo5 o2 onse 54ops signi2icanlya2e4 88
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%.b. )ourse
'he co64se 2o4 schi3oph4enia >a4ies.
No e>e4yone wih schi3oph4enia will
5ee4io4ae in 26ncioning o>e4 ime
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)hapter 1%* Schizophrenic
Disorders Sympoms o2 Schi3oph4enia $iagnosic consi5e4aions (nse an5 o64se Special 'opic: 6l64e an5 schi3oph4enia Eiological 2aco4s 6lne4abiliy ma4;e4s '4eamens =ill no co>e4
– Phases of Schizophrenia
– Neuropathology
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4. pecial topic!
"s schizophrenia solely
a #estern $isor$er Gane M. M64phy D1Le4e menalillness as 5e2ine5 in wese4n c6l64e was
p4esen in Non-=ese4n c6l64es
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)hoice of +nuit and ,orubas
EAamine5 +n6i 24om %las;a an5 /o46ba
o2 Nige4ia
hose hem beca6se hey we4e h6ne4gahe4e4 c6l64es Di.e., 5isincly 5i22e4en
han he wes an5 ha5 lile conac wih
wese4n c6l64e
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+nuit sample
0i>e5 wih +n6i 24om 1L87-1L88 in a
>illage o2 7LL +n6i
$aa came 24om one o2 he +n6i >illage4s,li2e hiso4ies o2 a 2ew +n6i an5 5aily
obse4>aions
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Yoruba sample
0i>e5 among a /o46ba 4ibe 564ing 1L91
an5 1L9"
$aa was gahe4e5 24om ine4>iews wih "nai>e heale4s an5 a membe4 o2 an
in5igeno6s c6l.
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'(amined - uestions
$o +n6i an5 /o46ba eAhibi beha>io4simila4 o he sympoms we callschi3oph4eniaF
+2 so, wha 5o hese beha>io4s loo; li;eF +s he4e a wo45 6se5 o label hese
beha>io4sF
%4e hese sympoms 5i22e4en 24om hoseeAhibie5 by wich 5oco4s an5 shamenF
+2 so, how a4e hey 5i22e4enF
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eha"iors similar toSchizophrenia/
Boh he +n6i an5 /o46ba ha5 in5i>i56als
wih beha>io4s ha 4esemble5schi3oph4enia.
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What do these behaviors
look like?=ihin he +n6i hese beha>io4s we4e:al;ing o onesel2, sc4eaming a someone who5oes no eAis, belie>ing ha a chil5 o4 h6sban5
was m645e4e5 by wichc4a2 when nobo5y elsebelie>es i,C
Some o2 he /o46ba beha>io4s incl65e5:
hea4ing >oices an5 4ying o ge ohe4 people osee hei4 so64ce ho6gh none can be seen,as;ing onesel2 ?6esions an5 answe4ing hem,pic;ing 6p sic;s an5 lea>es 2o4 no p64poseeAcep o p6 hem in a pile
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0as there a ord used to
describe these beha"iors/ /es.
'he +n6i e4m was "uth#aviha#
$ere was he wo45 6se5 by he /o46bas
'hese beha>io4s we4e so 5isinc o4
5i22e4en 24om no4mal +n6i an5 /o46ba
beha>io4 ha each c6l64e ha5 labele5
hem.
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$re beha"iors different
than those of the Shaman/ No.
Some o2 hese beha>io4s s6ch as seeing
hings ha ohe4s 5o no see an5 loo;ing inohe 2664e we4e a4ib6e5 o shaman in he
+n6i an5 /o46ba >illage
'he shaman was no 4e2e44e5 o as $ere o4"uth#aviha#
=hyF
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Shaman beha"ior
'he shaman we4e seen as con4olling
when hey wo6l5 eAhibi hese beha>io4s
I EAample: =hen he shaman is healing he iso6 o2 his min5, b6 he is no crazy .C
'he shamans beha>io4s we4e 6se5 2o4 a
speci2ic p64pose wihin hese c6l64es
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olition and multiple
beha"iors 'hose who eAhibi $ere an5 "uth#aviha#
a4e 5i22e4en 24om he Shaman in wo
p4ima4y ways Shaman >ol6na4ily hea4 >oices o4 see
hings. 'he beha>io4s o2 $ere an5"uth#aviha# a4e in>ol6na4y.
'hose wih $ere o4 "uth#aviha# eAhibipae4ns o4 m6liple beha>io4s. 'heshaman 5o no eAhibi m6liple beha>io4s.
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Overall conclusion
M64phy 2o6n5 ha h6ne4 gahe4e4 c6l64es
wih limie5 conac wih wese4n c6l64e
ha5 4ecogni3e5 an5 labele5 se>e4e menalillness.
e4 2in5ings ha boh wese4n an5 non-
wese4n c6l64es eAhibi sympoms o2schi3oph4enia ha>e been s6ppo4e5 by
epi5emiological 5aa, s6ch as hose 24om
he =o4l5 ealh (4gani3aion.
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Pre"alence of Schizophrenia
across 0est and Non30est
0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.%
!i"etimemorbid risk
#in percents$
n&land
'apan
(ussia
)nited *tates
+reland
)rban +ndia
(ural +ndia
,enmark
%ase$ on a narro# $efinition of schizophrenia
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Schizophrenic Disorders
Sympoms o2 Schi3oph4enia $iagnosic consi5e4aions (nse an5 o64se Special 'opic: 6l64e an5 schi3oph4enia Eiological 2aco4s 6lne4abiliy ma4;e4s '4eamens =ill no co>e4
– Phases of Schizophrenia
– Neuropathology
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-. 'tiological factors* a. 4enes
)amily an5 win s65ies in5icae a
geneic in2l6ence
pai4wise conco45ance 4aes show: I M conco45ance 7! pe4cen
I $ conco45ance 1< pe4cen
'win conco45ance 4ae also implicaeohe4 2aco4s beyon5 geneics
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'tiology* b. Social 5actors ighes p4e>alence 2o6n5 in he lowe4
socioeconomic sa6s
# hypoheses abo6 why his occ64s
ypohesis 1 is social causation:
low socioeconomic 2aco4s, s6ch as,
s4ess26l li2e e>ens, social isolaion o4
poo4 n64iion lea5s o 5e>eloping
Schi3oph4enia
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'tiology*
Social 5actors con6t ypohesis # is social selection : 56e o cognii>e an5 social impai4mens
associae5 wih people who 5e>elopschi3oph4enia, hey a4e less able o
p4og4ess o highe4 le>els o2 e56caion, o4
;eep high paying jobs, which lea5s hem o54i2 ino a low socioeconomic sa6s
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c. Psychological factors*
'(pressed 'motion !''# EE is a gene4al negai>e o4 in46si>e
ai65e owa45s schi3oph4enic paien
igh EE wo6l5 be c4iical, hosile o4
emoionally o>e4-in>ol>e5
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Relapse rate for EE and
level of contact
0
10
20
30
40
50
0
-i&h %% !o. %%
-i&h contact
#/35 hr.k$!o. contact
#35 hr.k$
&igh EE fa'ilies close contact ris( of relapse
)o# EE fa'ilies close contact ris( of relapse
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7ultiple pathays
to schizophrenia 'he 5e>elopmen o2 schi3oph4enia 6n2ol5s o>e4
ime.
Many 2aco4s play a 4ole in someone 5e>elopingschi3oph4enia, as well as he co64se he 5iso45e4a;es
enes, biological 2aco4s Dn64iion, psychosocial
2aco4s Da5>e4se economic ci4c6msances incombinaion o4 sing6la4ly ells a so4y o2 whysomeone 5e>elope5 schi3oph4enia
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7ultiple pathays to
schizophrenia
combine5
liabiliy
a5olescence yo6ng a56l mi55le age
'ime
chizophrenia
&ints of
psychosis
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Schizophrenic Disorders
Sympoms o2 Schi3oph4enia $iagnosic consi5e4aions (nse an5 o64se Special 'opic: 6l64e an5 schi3oph4enia Eiological 2aco4s 6lne4abiliy ma4;e4s '4eamens =ill no co>e4
– Phases of Schizophrenia
– Neuropathology
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. )haracteristics of
ulnerability 7ar8ers Ma4;e4 m6s 5ising6ish hose wihschi3oph4enia 24om ohe4 g4o6ps
Ma4;e4 m6s be a sable cha4ace4isico>e4 ime Ma4;e4 mo4e common among 1s 5eg4ee
4elai>es han gene4al pop6laion Ma4;e4 sho6l5 p4e5ic 2664e episo5es o2
schi3oph4enia among hose who ha>e hema4;e4, b6 ha>e no eApe4ience5 a
psychoic episo5e
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0hy search for "ulnerability
mar8ers +mpo4an o ;now who is a 4is;
D>6lne4able 2o4 5e>eloping psychosis.
P4o>i5es cl6es o he ca6se o2schi3oph4enia
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'ye3Trac8ing Dysfunction
$i22ic6ly wih smooh-p64s6i eyemo>emen
I pa4ic6la4ly when 4ac;ing he moion o2 a
pen56l6m o4 simila4 oscillaing sim6l6s +n5i>i56als wih schi3oph4enia ypically
eAhibi 4api5 eye mo>emen
a4ge non Sc3 s6bjec Sc3 s6bjec
+s ' T 8in D sf n ti n
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+s 'ye3Trac8ing Dysfunction aulnerability 7ar8er for
Schizophrenia/ Ma4;e4 m6s 5ising6ish hose wih
schi3oph4enia 24om ohe4 g4o6ps
I (nly ! o2 gene4al pop6laion show eye-4ac;ing 5ys26ncion compa4e5 o a
s6bsanial po4ion o2 people wO schi3oph4enia
Ma4;e4 m6s be a sable cha4ace4isic
o>e4 ime
I E>i5ence o s6ppo4 eye-4ac;ing 5ys26ncion
as a sable 4ai o2 schi3oph4enia
' 8
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+s 'ye3Trac8ing a
ulnerability 7ar8er !con6t# Ma4;e4 mo4e common among 1s 5eg4ee4elai>es han gene4al pop6laion
I hal2 o2 1s 5eg4ee 4elai>es show simila4 eye-4ac;ing impai4mens
Ma4;e4 sho6l5 p4e5ic 2664e episo5es o2
schi3oph4enia among hose who ha>e he
ma4;e4, b6 ha>e no eApe4ience5 a
psychoic episo5e
I no mar#ers !ound to do this yet
-
8/19/2019 Schizophrenic Disorder PPT OK
61/68
61
Schizophrenic Disorders
Sympoms o2 Schi3oph4enia $iagnosic consi5e4aions (nse an5 o64se Special 'opic: 6l64e an5 schi3oph4enia Eiological 2aco4s 6lne4abiliy ma4;e4s '4eamens =ill no co>e4
– Phases of Schizophrenia
– Neuropathology
-
8/19/2019 Schizophrenic Disorder PPT OK
62/68
62
9. Treatment considerations
%lho6gh 5ec4easing se>e4iy o2 sympoms in
schi3oph4enia is impo4an i is no he only
4eamen consi5e4aion
Being able o ineg4ae ha paien bac; ino
he comm6niy h4o6gh symptom/medicine
management skills, daily living skills, an5
social skills nee5s o also be consi5e4e5 %s s6ggese5 by 4esea4ch on EE, teaching
families how o cope wih schi3oph4enia will
lessen he li;elihoo5 o2 a5>e4se o6comes
T
-
8/19/2019 Schizophrenic Disorder PPT OK
63/68
63
Treatment*
1# antipsychotic medication %lso ;nown as neuroleptics beca6se heyin56ce si5e e22ecs ha 4esemble he
moo4 sympoms o2 Pa4;insons $isease
I motor side effects incl65e eA4apy4ami5al
sympoms DEPS s6ch as m6sc6la4 4igi5iy,
4emo4s, an5 pec6lia4 in>ol6na4y pos64es
I tardive dyskinesia (!" is anohe4 si5e e22echa incl65es abno4mal in>ol6na4y mo>emens
o2 he mo6h an5 2ace an5 spasmo5ic
mo>emens o2 limbs an5 46n; o2 bo5y
-
8/19/2019 Schizophrenic Disorder PPT OK
64/68
64
Symptom impro"ement
1O7 o2 he paiens who 6se ne64olepics show noimp4o>emen an5 "-7 show limie5
imp4o>emen
0
5
10
15
20
25
30
35
40
no improvement partialimprovement
% .ith smptom
improvement
-
8/19/2019 Schizophrenic Disorder PPT OK
65/68
65
:elapse rates
0
10
20
30
40
50
0
0
1r 2nd r
discontinue meds
continue meds
proper med dosa&e
use
65-70- relapse 1st year #ith $iscontin/ation of 'e$s
s. 40- if contin/e to /se 'e$s. t 2yr interal een in
the est case scenario half #ill still relapse
T t t
-
8/19/2019 Schizophrenic Disorder PPT OK
66/68
66
Treatment*
2# atypical antipsychotics nli;e ne64olepics, atypical
antipsychotics 5o no p4o56ce he
moo4 sympoms associae5 wih EPS May no be associae5 wih an inc4ease5
4is; o2 5e>eloping he syn54ome '$
lo3apine an5 &espe4i5one a4e wo o2he mos wi5ely 6se5
T
-
8/19/2019 Schizophrenic Disorder PPT OK
67/68
67
Treatment:3) Psychosocial
+ne4ese5 in long-e4m s4aegies o imp4o>e
aspecs o2 paiens li2e ohe4 han he 4e56cion
o2 psychoic sympoms Some psychosocial 4eamens aim o imp4o>e
family coping skills an5 reduce relapse.
I 1 Eliminaing 6n4ealisic eApecaions 2o4 he paien
I # +mp4o>ing comm6nicaion an5 p4oblem-sol>ing
s;ills o2 2amily membe4s
-
8/19/2019 Schizophrenic Disorder PPT OK
68/68
Treatment* Psychosocial
(he4 psychosocial 4eamens s6ch as
social s;ills 4aining an5 asse4i>e
comm6niy 4eamen a554ess social an5
occ6paional 26ncioning