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Real life case studies….Real life case studies….

SchizophreniaSchizophrenia

What is it and what are the What is it and what are the symptoms……symptoms……

The 1500’sThe 1500’s Disturbances Disturbances

mainly in thoughtsmainly in thoughts In the 15In the 15thth & 16 & 16thth

Centuries Europe – Centuries Europe – women with Sz women with Sz were thought to be were thought to be possessed by the possessed by the devil and tortured devil and tortured and burned to the and burned to the stake to exorcise stake to exorcise the devilthe devil

The 1800’sThe 1800’s Inmates were chained Inmates were chained

to the floor, and treated to the floor, and treated quite unkindly. "In the quite unkindly. "In the 18th century people 18th century people used to go there to see used to go there to see the lunatics. For a the lunatics. For a penny one could peer penny one could peer into their cells, view the into their cells, view the freaks and laugh at freaks and laugh at their antics, generally their antics, generally of a sexual nature or of a sexual nature or violent fights. Entry was violent fights. Entry was free on the first free on the first Tuesday of the month. Tuesday of the month. Visitors were permitted Visitors were permitted to bring long sticks with to bring long sticks with which to poke and which to poke and enrage the inmates enrage the inmates

TodayToday

Although in the 50’s and Although in the 50’s and 60’s most people 60’s most people diagnosed spent their lives diagnosed spent their lives in a psychiatric ward – in a psychiatric ward – today patients can live today patients can live independently at home – independently at home – usually under some usually under some supervision also supervision also undertaking a combination undertaking a combination of drug therapies and of drug therapies and psychotherapypsychotherapy

SchizophreniaSchizophrenia

John Nash thought John Nash thought foreign governments foreign governments were communicating were communicating with him. He had to with him. He had to live with the delusions live with the delusions that never left him – that never left him – and shows how you and shows how you can to a certain can to a certain degree live with the degree live with the conditioncondition

SchizophreniaSchizophrenia

The Greek meaning for sz means ‘split mind’.The Greek meaning for sz means ‘split mind’. It implies the person is split between reality and It implies the person is split between reality and

delusions.delusions. It is a psychotic disorder – lose touch with the It is a psychotic disorder – lose touch with the

worldworld The onset is more early in men than women The onset is more early in men than women

(20’s – 30’s)(20’s – 30’s) Sz patients suffer the greatest stigma – seen as Sz patients suffer the greatest stigma – seen as

‘mad’‘mad’

Classification of SZClassification of SZ To accurately diagnose (classify sz) To accurately diagnose (classify sz)

the DSMIV has distinguished between the DSMIV has distinguished between 5 main categories of sz so that is does 5 main categories of sz so that is does not get mixed up with other psychotic not get mixed up with other psychotic disordersdisorders

Some categories require that Some categories require that symptoms be present for a month and symptoms be present for a month and some 6 months before diagnosis can some 6 months before diagnosis can be accurately made.be accurately made.

There are 5 major categories for the There are 5 major categories for the classification of sz…classification of sz…

(use the handout to make a table as (use the handout to make a table as below:below:

DisorganisedDisorganised

Catatonic Catatonic

Unintelligible speechUnintelligible speech

Absence of emotionAbsence of emotion

Loss of interestLoss of interest

Classifications of psychotic Classifications of psychotic disordersdisorders

PSYCHOTIC PSYCHOTIC DISORDERDISORDER

MAIN MAIN SYMPTOMSSYMPTOMS

DURATIONDURATION

SchizophreniaSchizophrenia Delusions, hall, flat effect, Delusions, hall, flat effect, disorganised speech, disorganised speech, catatonic behaviourcatatonic behaviour

6 months +6 months +

Schizoaffective disorderSchizoaffective disorder As above plus mood As above plus mood disorderdisorder

6 months +6 months +

Delusional disorderDelusional disorder Delusions not associated Delusions not associated with sz, usually of grandeur, with sz, usually of grandeur, jealousy or persecutionjealousy or persecution

1 month +1 month +

EvaluationsEvaluations The catatonic type is relatively rare and may be due to The catatonic type is relatively rare and may be due to

certain types of drugs used to treat the disorder certain types of drugs used to treat the disorder (McGlashan and Fenton, 1991). Some argue it is not a (McGlashan and Fenton, 1991). Some argue it is not a true category of sz and so should be dropped as a true category of sz and so should be dropped as a classificationclassification

The undifferentiated classification is also controversial The undifferentiated classification is also controversial because it is said to be too vague and ill defined. Many because it is said to be too vague and ill defined. Many clinicians believe it to be over used and sometimes clinicians believe it to be over used and sometimes confused with other psychotic disorders .confused with other psychotic disorders .

Another example of confusion is where psychiatrists may Another example of confusion is where psychiatrists may wrongly diagnose an individual with sz instead of wrongly diagnose an individual with sz instead of schizoaffective disorder (which is sz with depression).schizoaffective disorder (which is sz with depression).

Exam questionsExam questions

(a)(a) Identify Identify one one sub-type of schizophrenia sub-type of schizophrenia and give and give two two symptoms typically symptoms typically associated with that sub-type. associated with that sub-type. (3 marks)(3 marks)

(b)(b) Explain one consequence of being Explain one consequence of being diagnosed with schizophrenia.diagnosed with schizophrenia. (4 marks) (4 marks)

Symptom similarities

Mis-diagnosis

treatmentActive/residual phase

support

onset

depressionSub-categories

Independent

Cost effective

Discharge

Drugs/therapy

Less chance of relapse

Remission

No cure but reduces the symptoms

Treatment