Schizoprenia I: Diagnostic criteria and symptoms

pg 183 caie pg 234 hodders

What is a psychotic disorder?

• major break from reality/loose contact with reality

• percieve the world in a vastly different way than others

• schizo is an example of a severe psychotic disorder

What is the diagnostic criterita of schizoprenia?

SCHIZOPRENIA diagnosed when:

(ACCORDING TO ICD 11)

• one of the core symptoms is shown for at least ONE month (duration)

• Two symptoms may be necessary in a less clear-cut case

• Other causes of the symptoms must be eliminated before a diagnosis is made: eg

  • substance misuse

  • medicine side effcts

  • underlying physical conditon such as brain tumor

What must be elliminated before a diagnosis is made? (confounding)

• Other causes of the symptoms must be eliminated before a diagnosis is made:

  • substance missuse

  • medicine side effcts

  • underlying physical conditon such as brain tumor

What are the ICD 11 categories for symptoms

• 6 (dimensional) descriptors

  • each dimension rated on a four-point scale

    • includes POSITIVE and NEGATIVE symptoms

    • + symptoms relating to

      • mood

      • cognition

      • behaviour

WHAT IS A POSITIVE SYMPTOM?

• an experience that is “an addition to” or “distortion of a normal experience

• “presence of psychological abnormality”

What is a NEGATIVE SYMPTOM?

• level of functioning falls BELOW normal levels

• “absence of thoughts, feelings or behaviours that would generally be considered psychologically normal”

Types of POSITIVE syptoms:

CORE SYMPTOMS:

• (PERSISTENT) HALLUCINATIONS

  • sensory experiences

  • involuntary perceptual experiences that happen in the absence of external stimuli

  • eg. people with schizophrenia may HEAR or SEE things others cant - without control over it.

    • TYPES OF HALLUCINATIONS

      • visual

      • olfactory

      • somatosensory

• EXPERIENCES OF INFLUENCE, PASSIVITY OR CONTROL

  • subjective experience that thoughts, feelings and actions are influenced or controlled by something EXTERNAL

  • ICD calls these feelings EXPERIENCESSS.

    • delusional beliefs may develop as a way of explaining these experiences

      • EX, believing that aliens are implanting thoughts into our brains because of a feeling that they don’t belong to us

  • TYPES:

    • thought withdrawal- feeling that thoughts are being removed

    • thought insertion- feeling that thoughts are being implanted

    • thought broadcasting: feeling that thoughts are being transmitted to others

• DELUSIONS

  • fixed beliefs that conflict with reality

    • some relate to everyday situations, some can be bizarre

  • TYPES:

    • GRANDEUR - strongly held belief that you re someone with abilities of special powers … seeing themselves as exceptional in some way

    • PERSECUTION - strongly held belief that they are in danger, others are conspiring against you in an attempt to do you harm

    • REFERENCE - strongly held belief that situations or events have personal significance That events in the environment are related to them: eg that the television program is talking abt them.

WHAT ENTAILS HALLUCINATIONS

• (PERSISTENT) HALLUCINATIONS

  • sensory experiences

  • involuntary perceptual experiences that happen in the absence of external stimuli

  • eg. people with schizophrenia may HEAR or SEE things others cant - without control over it.

    • TYPES OF HALLUCINATIONS

      • visual

      • olfactory

      • somatosensory

WHAT ENTAILS “experiences of influence, passivity or control) (CORE POS SYMPTOM)

• EXPERIENCES OF INFLUENCE, PASSIVITY OR CONTROL

  • subjective experience that thoughts, feelings and actions are influenced or controlled by something EXTERNAL

  • ICD calls these feelings EXPERIENCESSS.

    • delusional beliefs may develop as a way of explaining these experiences

      • EX, believing that aliens are implanting thoughts into our brains because of a feeling that they don’t belong to us

  • TYPES:

    • thought withdrawal- feeling that thoughts are being removed

    • thought insertion- feeling that thoughts are being implanted

    • thought broadcasting: feeling that thoughts are being transmitted to others

WHAT ENTIALS DELUSIONS (core positive symptom)

• DELUSIONS

  • fixed beliefs that conflict with reality

    • some relate to everyday situations, some can be bizarre

  • TYPES:

    • GRANDEUR - strongly held belief that you’re someone with abilities of special powers … seeing themselves as exceptional in some way

    • PERSECUTION - strongly held belief that they are in danger, others are conspiring against you in an attempt to do them harm

    • REFERENCE - strongly held belief that situations or events have personal significance and That events in the environment are related to them: eg that the television program is talking about them.

What are predomal symptoms

• before schizoprenia diagnosis weaker versions of core symotoms shown: called PREDOMAL SYMPTOMS

  • eg someone with persecutory ideation may hold FALSE BELEIFS that they arent AS strong - eg thinking people might have been talking about you VS being convinced that they were talkin about you.

WHAT are some OTHER positive symptoms other than the 3 core symptoms:

• derailment - losing train of thought

  • leads to muddled speech

  • ideas jumbled

• neologism

  • new words created by mixing words together

• behavior may be disorganized

  • actions

  • gestures

  • posture

become UNEXPECTED, inappropriate or purposeless

NEGATIVE SYMPTOMS

• ABSENCE OF THOUGHTS FEELINGS OR BEHAVIOURS CONSIDERED PSYCHOLOGICALLY NORMAL

  • basically functioning on a level is lower than it would be in a normal person (eg lower motivation to carry out a goal directed behaviour = avoliton)

    • experiences:

      • flattened effect: Not experiencing typical emotional

        highs and lows (blunted emotional expression

      • avoltion - unable to carry out goal directed behaviours - lack of motivation

      • Alogia- lack of a spoken language

      • asociality - social withdrawal

      • anhedonia - unable to experience pleasure

AGE OF ONSET OF SCHIZOPRENIA

• prevlance

  • similar for males and females (0.3-0.7%)

• age of onset

  • EARLIER FOR MALES (EARLY TO MID 20S)

  • late onset more common in femalees (from age 40)

  • rarely diagnosed in children under age of 13

Why is schizoprenia rarely diagnosed in clildren under 13?

• symptoms can overlap with other disorders such as autism and OCD

  • diagnosis is difficult and unreliable

  • UNLESSSSS………..

    • diagnosis is clearly obvious (Eg eneji et al 2018)