Schizophrenia and Bipolar Disorder

schizophrenia 

• a severe and chronic mental disorder characterized by disturbances in thought, perception, and behavior

• is characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction

dsm-v criteria for schizophrenia

• Outlines the following criterion to make a diagnosis

• Two or more of the following for at least 6 months (or longer) period of time, and at least one of them must be 1, 2, or 3:

● Delusions

● Hallucinations

● Disorganized speech

● Grossly disorganized or catatonic behavior

● Negative symptoms, such as diminished emotional expression

diagnositic criteria history of schizophrenia

considered a '“spectrum disorder with subtypes” 

The following are related to symptoms rather than  diagnostic classification (change from the DSM-IV): 

• paranoid 

• disorganized speech, behavior, flat/inappropriate affect 

• undifferentiated 

positive symptoms 

Behavior not seen in most other persons 

• hallucinations 

• delusions

• disorganized behavior and thinking 

negative symptoms

Absence of typical functioning

• flat affect

• social withdrawal

• decreased task initation

- Greater impact on functioning

schizophreniform

• psychosis with hallucinations, delusions, and disorganized speech

• short term condition- symptoms last longer than 1 and fewer than 6 months

delusional disorder

main symptom is the presence of one or more delusions

often experience realistic delusions that could invovle real life situations

may become preoccupied with delusions to the point of occupational disruption

schizoaffective disorder

a chronic mental health condition characterized symptms of schizophrenia (ex. hallucinations and delusions) and symptoms of mood disorder (ex. mania and depression)

dsm-v criteria for schizoaffective disorder

Must have uninterrupted duration of illness where there is a major mood episode (manicor depressive) with two or more of the following Criterion A for schizophrenia for a significant amount of time in a month period:

• delusions

• hallucinations

• disorganized speech

• grossly disorganized or catonic behavior

• negative symptoms

- Hallucinations and delusion for 2+ weels in absence of major mood episode

- Symptoms of major mood epsiodesare present for the majority of the illness

- Symptoms cannot be a result of substance use or underlying medical conditions

associated features

● Inappropriate affect (laughing in the absence of a stimulus)

● Disturbed sleep pattern

● Dysphoric mood (can be depression, anxiety, or anger)

● Depersonalization (detachment or feeling of disconnect from self)

● De-realization (a feeling that surroundings aren’t real)

● Cognitive deficits impacting language, processing, executive function, and/or memory

● Lack of insight into the disorder

● Social cognition deficits

● Hostility and aggression

etiology of schizophrenia

biological predispostion + stress = schizophrenia

• exact causes are unknown

• 46% of patients reported a stressful event in the three weeks prior to a psychotic episode

genetics

there is a greater chance of an individual developing the disease if it runs in their family

brain chemistry and structure 

brain fucntion and structure may be different in individuals with this disease 

drug use

psychoactive drugs, such as LSD, have been linked to the development of schizophrenia

course of illness

• prodomal

• active

• residual

prevalence of schizophrenia

• About 24 million people will be diagnosed; approx 1.2% Americans

• Schizophrenia can affect people throughout the lifespan, although new instances of the illness

  are most likely to occur in early adulthood

• The incidence of new cases of schizophrenia increases in teen years, reaching a peak of

  vulnerability between the ages of 16 and 25 years

epidemiology of schizophrenia

• African Americans are more likely to be misdiagnosed with schizophrenia and are less likely to receive treatment (5x more likely)

• Hispanic or Latino individuals are 3x more likely to develop schizophrenia

client factors

Eccentric values are characeristic of persons with schizophrenia

• problems with reality perception are often linked to a tendecy to hyper reflect

unique considerations of schizophrenia

• people with this disorder are 2-3 times more liekly to die early than the general population, this is often due to physical diseases like cardiovascular, metabolic, and infections as well as increased risk of smoking and substance use

• people with this disorder are often targets of violence rather than perpetrators of violent acts

bipolar disorder episodes

distinct periods and features of mood disturbance

• depressive episde

• manic episode

• mixed episode

• hypomanic episode

dsm-v criteria for bipolar disorder

a person must have experienced at least one epsiode of mania or hypomania, to be considered manic, the elavated, expansive, or irritable mood must last for at least ine week and be present most of the day nearly every day

brain structure and functioning 

some evidence suggests that the brains of people with _ differ from the brains of people who dont have the disorder  

genetics in bipolar disorder

• some evidence suggests that people with certain genes are more likely to develop

• people who have a parent or sibling with the disorder have an increased chance of having it themselves

• many genes are involved, though, not one gene can cause the disorder

prevalence and course

typicaly develops in ado;escence or early adulthood

• average age of onset is 18

• 10-15% of adolescents with recurrent major depressive episodes will develop bipolar I

ongoing condition

• more than 90% of people who have a single manic episode go on to have future episodes

• about 60-70% of manic or hypomanic episodes occur before or after a MDE

• frequency of swings during a lifetime is increases in those with bipolar II versus others

• lifetime prevalence of bipolar diorder I - 1%; all types - 4.4%.

gender within bipolar disorder 

• females with bipolar I tend to have a more rapid cycling and mixed feature episode than males do

• they tend to have co-occuring eating disorders 

• females with bipolar I and II are more likely to experience depressive episodes 

race within bipolar disorder

• Hispanic and latino individuals reprot higher levels of psychotic symptoms and have a higher rate of bipolar I

• African Americans more commonly experience manic symptoms over depressice symptoms

• Asian-Americans are 20% more liekly to be diagnosed with bipolar I, are least likely to use medication and mental health services

client factors of bipolar disorder

• mania bringd about feelings of grandosity, excessive confidence

• paranoia can result in beleifs of distrust and a profound fear of rejection

• depression

context within bipolar disorder

personal:

men-

• first episode is most likely to be a manic episode

• number of manic episodes equals or exceeds number of major depressive episodes

women-

• first episode most liekly to be a depressive episode

• major depressive predominates manic

• rapid cycling is more common

• mixed or depressive symtpoms during manic episodes may be more common

• have an increased risk of developing subsequent epsiodes in immediate postpartum 

unique consideration in bipolar disorder

• the rate is estimated 15x higher than others for this risk of suicide- 19% completion rate for suicide 

• substance abuse is common in adolescents and adults 

• higher depression rater in children and adolescents 

• more liekly to be invoved in domestic abuse cases