Transcript Diagnosis: Major Mental Illness

Major Mental Illnesses
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Thought Disorders
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Schizophrenia
Mood Disorders
Major Depressive Disorder
 Bipolar Disorder (Manic-depression)
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Characteristics of an Illness
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Affect
Individuals
Across
Populations
Signs and
Symptoms
Course
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Heredity
Diagnosis
Causes
Treatment
Understanding
Schizophrenia
Common Symptoms of
Schizophrenia
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Positive Symptoms
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Disturbances of thinking and
perception
Negative Symptoms
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Loss or decrease of normal functions
Positive Symptoms of
Schizophrenia
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Disordered thinking
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Delusions
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Thoughts “jump” between completely unrelated
topics or may be “blocked”.
Fixed, false beliefs (not based in reality)
Outside of cultural norms
Hallucinations
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False perceptions
Usually auditory
Delusions of Schizophrenia
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Persecution
Control
Grandiose
Reference
Influence
Religious
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Somatic
Mind reading
Thought
broadcasting
Thought insertion
Thought withdrawal
Guilt, sin
Hallucinations of
Schizophrenia
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Auditory
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70%
Voices commenting
Voices conversing
Voices commanding
Visual
Somatic, tactile
Olfactory
30%
15%
5%
Negative Symptoms of
Schizophrenia
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Affect blunted or flat
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Avolition
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Lacking energy, spontaneity, initiative
Alogia
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Lacking emotional expression
“Blank” face, little eye contact, few gestures
Diminished amount of speech, or content
Anhedonia
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Lack of interests, or lack of pleasure
Diagnostic and Statistical
Manual of Mental Disorders,
fourth edition (DSM-IV)
DSM-IV Schizophrenia
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Characteristic symptoms for one month
Impairment in functioning
Continuous signs for 6 months
Not do to a “look-alike”
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mood disorder
substance abuse
general medical condition
autism
Types of Schizophrenia
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Paranoid type
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Disorganized type
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Disorganized speech, disorganized behavior, flat or
inappropriate affect
Catatonic type
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Preoccupation with delusions or frequent auditory
hallucinations
Immobility, peculiar movements, purposeless and
excessive activity
Undifferentiated type
Residual type
Who Gets Schizophrenia?
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One of every one hundred people
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2.5 million people in the United States
All ethnicities
Societies throughout the world
Equal among men and women
More prevalent in poorer communities
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“Downward drift”
The Course of Schizophrenia
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Most commonly begins between ages 15-25
Usually begins later in women
One, or multiple episodes
Full or partial recovery between episodes
Positive symptoms lessen with age
Negative symptoms increase with age
Tends to stabilize later in course
What Causes Schizophrenia?
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Unclear
Likely a complex group of brain
illnesses with multiple causes
Heredity
Biochemical theory
Brain anatomy
Brain development
Causes of Schizophrenia
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Heredity
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Genetic component to schizophrenia (runs
in families)
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Adoption studies
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Inherit a vulnerability to schizophrenia
Lifetime Risk of Developing
Schizophrenia
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General population
1%
Child of one parent w/schizophrenia 10-15%
Child of 2 parents w/ schizophrenia 30-40%
Sibling with schizophrenia 10%
Fraternal twins
10%
Identical twins
50%
“For every complex problem
there is a solution that is neat,
simple and wrong.”
H. L. Menken
Examples of Stimulus
Overload
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“Everything seems to grip my attention although I
am not particularly interested in anything. I am
speaking to you just now, but I can hear noises going
on next door and in the corridor. I find it difficult to
shut these out, and it makes it more difficult for me
to concentrate on what I am saying to you.”
“My concentration is very poor. I jump from one
thing to another. If I am talking to someone they
only need to cross their legs or scratch their heads
and I am distracted and forget what I was saying. I
think I could concentrate better with my eyes shut.”
Schizophrenia
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IS
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Biological disease of the brain
Disabling and emotionally devastating
Relatively common
Misunderstood and stigmatized
Treatable
IS NOT
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Caused by bad parenting
A personal weakness
Split personality
Treatment of
Schizophrenia and
Other Psychotic
Disorders
Long Acting
Antipsychotics
Haldol Decanoate
(Haloperidol)
 Prolixin Decanoate
(Fluphenazine)
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Clozapine
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Pros
Gold standard for refractory
schizophrenia
 Effective for positive symptoms
 Does not produce EPS or TD
 May improve cognition
 Effective for mood symptoms
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Clozapine
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Cons
Agranulocytosis, blood draws,
monitoring
 Seizure risk
 Other side effects
 Titration
 Acquisition cost
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Risperidone
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Pros
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Effective for positive symptoms
Less EPS than with conventional agents
May help cognitive and mood symptoms
Cons
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Dose dependent EPS
Dose dependent prolactin elevation
Olanzapine
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Pros
Effective for positive symptoms
 Low EPS and TD liability
 FDA indication for mania
 May improve cognition
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Cons
Weight gain
 Acquisition cost
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Quetiapine
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Pros
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Effective for positive symptoms
Very low EPS liability
Limited data for mood symptoms, cognition
Cons
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Titration, split dosing, sx break through
Sedation, weight gain
Psychosocial
Treatments
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Patient and family
psychoeducation
Vocational training
Social Skills training
Clubhouse model
Schizophrenics Anonymous
Psychosis
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Defined by impaired reality testing
Characterized by:
 thought content: delusions
 perception: hallucinations
 thought stream: grossly disorganized
 behavior: grossly disorganized