Download Schizophrenia and Thought Disorders

Schizophrenia and Thought Disorders
DSM-IV Criteria
DSM-IV Diagnostic Criteria for Schizophrenia:
A. Characteristic symptoms: Two (or more) of the following, each present for a
significant portion of time during a 1-month period (or less if successfully treated):
 Delusions
 Hallucinations
 Disorganized speech (e.g., frequent derailment or incoherence)
 Grossly disorganized or catatonic behavior
 Negative symptoms, i.e., affective flattening, alogia, or avolition
Note: Only one Criterion A symptom is required if delusions are bizarre or
hallucinations consist of a voice keeping up a running commentary on the person's
behavior or thoughts, or two or more voices conversing with each other.
B. Social/occupational dysfunction: For a significant portion of the time since the
onset of the disturbance, one or more major areas of functioning such as work,
interpersonal relations, or self-care are markedly below the level achieved prior to
the onset (or when the onset is in childhood or adolescence, failure to achieve
expected level of interpersonal, academic, or occupational achievement).
C. Duration: Continuous signs of the disturbance persist for at least 6 months.
This 6-month period must include at least 1 month of symptoms (or less if
successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may
include periods of prodromal or residual symptoms. During these prodromal or
residual periods, the signs of the disturbance may be manifested by only negative
symptoms or two or more symptoms listed in Criterion A present in an attenuated
form (e.g., odd beliefs, unusual perceptual experiences).
D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and
Mood Disorder With Psychotic Features have been ruled out because either (1) no
Major Depressive Episode, Manic Episode, or Mixed Episode have occurred
concurrently with the active-phase symptoms; or (2) if mood episodes have
occurred during active-phase symptoms, their total duration has been brief relative
to the duration of the active and residual periods.
E. Substance/general medical condition exclusion: The disturbance is not due to
the direct physiological effects of a substance (e.g., a drug of abuse, a medication)
or a general medical condition.
F. Relationship to a Pervasive Developmental Disorder: If there is a history of
Autistic Disorder or another Pervasive Developmental Disorder, the additional
diagnosis of Schizophrenia is made only if prominent delusions or hallucinations
are also present for at least a month (or less if successfully treated).
Subtypes of Schizophrenia:
Paranoid Type:
A type of Schizophrenia in which the following criteria are met:
Preoccupation with one or more delusions or frequent auditory hallucinations.
None of the following is prominent: disorganized speech, disorganized or
catatonic behavior, or flat or inappropriate affect.
Catatonic Type:
A type of Schizophrenia in which the clinical picture is dominated by at least two
of the following:
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Motoric immobility as evidenced by catalepsy (including waxy flexibility)
or stupor
Excessive motor activity (that is apparently purposeless and not influenced
by external stimuli)
Extreme negativism (an apparently motiveless resistance to all instructions
or maintenance of a rigid posture against attempts to be moved) or mutism
Peculiarities of voluntary movement as evidenced by posturing (voluntary
assumption of inappropriate or bizarre postures),
Stereotyped movements, prominent mannerisms, or prominent grimacing
Echolalia or echopraxia
Disorganized Type:
A type of Schizophrenia in which the following criteria are met:
All of the following are prominent:
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Disorganized speech
Disorganized behavior
Flat or inappropriate affect
Undifferentiated Type:
A type of Schizophrenia in which symptoms that meet Criterion A are present, but
the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.
Residual Type:
A type of Schizophrenia in which the following criteria are met:
 Absence of prominent delusions
 Hallucinations
 Disorganized speech
 Grossly disorganized or catatonic behavior.
There is continuing evidence of the disturbance, as indicated by the presence of
negative symptoms or two or more symptoms listed in Criterion A for
Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual
experiences).
Definition
Schizophrenia is a category of mental disorders that cause a person to hallucinate,
lose a grasp on reality, create false beliefs and lose motivation, among other
abnormal behavior. Treatment for schizophrenia is long-term and focuses on
managing symptoms with proper medication and training people on how to deal
with individual daily stresses.
Statistics
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According to the National Institute for Mental Health, 1 in 100 people is
likely to develop schizophrenia
The peak onset period is between ages 15 and 30
Approximately 1 percent of the general public develops the disorder after
the age of 15
Schizophrenia is equally as likely to appear in men as it is in women.
Symptoms in men occur usually in the late teens to early 20s, while women
often see symptoms in their 20s to early 30s.
Causes
Little is known about a specific cause for schizophrenia; however, there are
common theories:
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Malfunction in the brain's neurotransmitters, which are chemicals that
communicate with nerve endings to produce behavior
Nerve cells processing the neurotransmitters dopamine and serotonin have
often been shown to exhibit abnormalities in people with schizophrenia
Symptoms
Symptoms are generally severe enough to interfere with social interaction,
employment and basic self-care and are categorized as either positive
(hallucinations, delusions) or negative (slow thinking, speech, movement).
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Delusions
Hallucinations
Disorganized speech
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Grossly disorganized or catatonic behavior (extremely agitated or zombielike)
Negative symptoms (abnormal symptoms of dullness, or flatness feeling)\
The symptoms cause social and occupational dysfunction
Course of Illness
The first episode of schizophrenia usually occurs in teenage years, although some
cases may occur in the late thirties or forties. Onset prior to puberty is rare,
though cases as early as five years old have been reported. Schizophrenia itself is
not fatal, although a small percentage of people may be prone to violent outbursts
or self harm. The disorder is manageable, but expected to be lifelong.
Diagnosis
The diagnosis of schizophrenia is made on the basis of symptoms, course of
illness, and, when available, family history. The diagnostic criteria
for schizophrenia is described in the Diagnostic and Statistical Manual for Mental
Disorders, fourth edition (DSM-IV).
**see DSM-IV criteria section above
Treatment
Medication:
Antipsychotics help relieve the positive symptoms of schizophrenia by helping to
correct an imbalance in the chemicals that enable brain cells to communicate with
each other.
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Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Thiothixene (Navane)
Trifluoperazine (Stelazine)
Perphenazine (Trilafon)
Thioridazine (Mellaril)
Risperidone (Risperdal)
Clozapine (Clozaril)
Olanzapine (Zyprexa)
Psychosocial Rehabilitation:
People with schizophrenia who attend structured psychosocial rehabilitation
programs and continue with their medical treatment manage their illness best.
Supportive psychotherapy:
Individual or family counseling may be a helpful adjunct to reduce risk for relapse.
Community programs:
Beneficial in providing support, social skills training, and vocational
rehabilitation.
Hospitalization:
People who experience acute symptoms of schizophrenia may require intensive
treatment including hospitalization. Hospitalization is necessary to treat severe
delusions or hallucinations, serious suicidal thoughts, an inability to care for
oneself, or severe problems with drugs or alcohol.
Accommodations
Maintaining Stamina during the Workday (e.g. – restlessness, increased or
decreased energy):
Flexible scheduling
Allow longer or more frequent breaks
Provide additional time to learn new responsibilities
Provide self-paced work load
Provide backup coverage for when the employee needs to take breaks
Allow for time off for counseling
Allow for use of supportive employment and job coaches
Allow employee to work from home during part of the day or week
Part time work schedules
Maintaining Concentration (e.g. – restlessness, distractibility, racing thoughts):
Reduce distractions in the work area
Provide space enclosures or private office
Allow for use of white noise or environmental sound machines
Increase natural lighting or provide full spectrum lighting
Allow the employee to work form home and provide necessary equipment
Plan for uninterrupted work time
Allow for frequent breaks
Divide large assignments into smaller tasks and goals
Restructure job to include only essential functions
Difficulty Staying Organized and Meeting Deadlines (e.g.- difficulty making
decisions, impaired cognitions):
Make daily TO-DO lists and check items off as they are completed
Use several calendars to mark meetings and deadlines
Remind employee of important deadlines
Use electronic organizers
Divide large assignments into smaller tasks and goals
Working Effectively with Supervisors (e.g. – blunted affect, suspicious
behavior, avoidance, responding negatively to criticism):
Provide positive praise and reinforcement
Provide written job instructions
Develop written work agreements including the agreed upon accommodations,
clear expectations of responsibilities and the consequences of not meeting
performance standards
Allow for open communication to managers and supervisors
Establish written long term and short term goals
Develop strategies to deal with problems before they arise
Develop a procedure to evaluate the effectiveness of the accommodation
Memory Deficits:
Use voice activated recorder to record verbal instructions
Provide written information
Provide checklists
Prompt employee with verbal cues (reminders)
Post written or pictorial instructions on frequently-used machines
Performing Calculations: (e.g. – impaired cognition)
Allow use of calculator
Large-display calculator
Talking calculator
Use counter or ticker
Provide talking tape measure
Use liquid level indicators
Mark the measuring cup with a "fill to here" line
Disorganization:
Minimize clutter
Color-code items or resources
Provide 1-2-3 chart
Divide large tasks into multiple smaller tasks
Label items or resources
Use symbols instead of words
Use print labels instead of hand-written labels
Time Management/Performing or Completing Tasks: (e.g. - limitations in
adaptive skills, slow reaction time)
Provide verbal prompts (reminders)
Provide written or symbolic reminders
Use alarm watch or beeper
Use jig for assembly to increase productivity
Arrange materials in order of use
Use task list with numbers or symbols
Avoid isolated workstations
Provide space for job coach
Provide additional training or retraining as needed
Difficulty Handling Stress and Emotions (e.g. – poor judgment, hallucinations,
delusions):
Provide praise and positive reinforcement
Refer to counseling and employee assistance programs
Allow telephone calls during work hours to doctors and others for needed support
Provide sensitivity training to coworkers and supervisors
Allow the presence of a support animal
Reinforce peer supports
Attendance Issues (e.g. – loss of interest):
Provide flexible leave for health problems
Provide a self-paced work load and flexible hours
Allow employee to work from home
Provide part-time work schedule
Allow the employee to make up time missed
Additional Information on Thought Disorders
Formal thought disorders are not unique to individuals displaying schizophrenia
symptoms. Loose associations and preservation may also be manifested in
individuals during episodes of mania. Also, even when people function normally,
they may organize statements loosely or on occasion use words that others fail to
understand, especially when they're tired or ill. Incidences of formal thought
disorders however, are much more common and severe. Research has found that
some disorganized speech or thinking may appear long before an entire pattern of
schizophrenia unfolds and/or is diagnosed.
Recommended Readings
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Job Accommodations Network (JAN) The Job Accommodation Network (JAN) is a free consulting service that
provides information about job accommodations, the Americans with
Disabilities Act (ADA), and the employability of people with disabilities.
http://www.jan.wvu.edu/links/
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Psychiatric Disabilities: Reasonable Accommodations: This on-line resource provides information about reasonable
accommodations for people with psychiatric disabilities, specifically in
order to aid employers and educators. Reasonable accommodations are
those adjustments within a work or school site that allow an otherwise
qualified employee or student with a disability to perform the tasks
required.
http://www.bu.edu/cpr/reasaccom/
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Mental Health Matters Mental Health Matters, was founded to supply information and resources
to mental health consumers, professionals, students and supporters. While
the percentage of people facing a diagnosable Mental Disorder in any
given year is substantial, the acceptance of these problems can be hard to
come by. Essentially, Mental Health Issues are hidden illnesses. The main
purpose is to provide a structured source of information about mental
health issues. To this end, Mental Health Matters will offer detailed
technical briefs on disorders, symptoms, treatment modes, and in time, a
"comparison engine" that allows users to compare different aspects of
disorders. With this information, we hope to educate consumers and guide
them towards intelligent decisions in their pursuit of Mental Health.
http://www.mental-health-matters.com/disorders/index.php
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Research Article Mueser, K.T., Bellack, A.S., Douglas, M.S., & Morrison, R.L. (1991).
Prevalence and stability of social skills deficits in schizophrenia.
Schizophrenia Research, 5, 167-176.