Download Schizophrenia and Other Psychoses

Schizophrenia and Other
Psychoses
Assessment & Diagnosis
SW 593
Introduction
• Arguably the most serious and debilitating
of the mental disorders.
• Involve distortions in the perceptions of
reality;
• Impairments in the capacity to reason,
speak and behave rationally;
• Impairments in affect and motivation.
• Directly or indirectly disrupt all aspects of a
client’s life.
Schizophrenia
• Symptoms include severe disruptions in
thinking
• Gross disorganization in thoughts
• May involve delusions (system of false
beliefs that are not open to reason or
appeal)
• There will be perceptual disturbances
including hearing voices. (auditory
hallucinations)
Schizophrenia
• Remaining symptoms (negative):
– Absence of affect
– Absence of motivation
– Absence of interaction
• There will be significant psychosocial
impairment and/or distress
• Symptoms must have begun at least 6
months earlier.
Schizophrenia
• Subtypes are based by the predominant
symptoms:
– Paranoid type: delusions/hallucinations are
elaborate and encompassing
– Catatonic type: most rare of all subtypes
– Disorganized type: disorganized speech and
negative symptoms, some catatonia present
– Residual type: negative symptoms alone
– Undifferentiated type: no particular features
are prominent.
Schizophreniform Disorder
• Same features as schizophrenia but the
time frame since the initial display of
symptoms is between 1 and 6 months.
• This diagnosis exists to ensure that the
label of schizophrenia is not used too
quickly.
• Clients with this disorder may not evidence
marked psychosocial problems.
Brief Psychotic Disorder
• Sudden onset of positive symptoms that
last more than one day but remit within 30
days.
• Criteria includes a return to the premorbid
level of functioning.
• Should be provisional
• A specifier is used to indicate whether
there is a discernable stressor that has
triggered the episode.
Schizoaffective Disorder
• Includes the same symptoms as
schizophrenia but also has symptoms that
constitute one of the episodes of a mood
disorder.
• Periods when only the schizophrenic
symptoms are evident.
• Usually diagnosed after examination of the
severe symptoms.
Delusional Disorder
• Differs in both symptoms and impairment
from schizophrenia
• Disorganization and negative symptoms
are not present
• Social and vocational functioning effected
but not as severe.
• Content of delusional material is not
considered bizarre.
Delusional Disorder
• The distinction between bizarre and nonbizarre delusions is focused on whether
the delusional situation could occur in real
life.
Shared Psychotic Disorder
• Occurs when a person who is closely
associated with someone else with some
psychotic disorder “buys into” the
delusional system.
• Fairly rare but it is more likely to occur
when the individual with the original
delusions exercises power over the other
person.
Assessment
• Assessment with these clients is
accomplished through structured
interviews commonly known as mental
status examinations.
• Designed to accrue information about the
quality of the client’s mental processes.
Mental Status Examination
• Cognitive functioning:
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Normal intelligence?
Oriented to person, place, and time?
Evidence of problem-solving thinking?
Preoccupied?
Delusional thinking? Bizarre?
Thinking coherent and goal directed?
Exhibits good judgment?
Memory problems? (immediate, recent, remote)
Hallucinations? Peculiar speech?
Mental Status Examination
• Emotional functioning
– What emotions are described?
– Congruent to thoughts?
– Feeling over the past year?
– Emotional state creating difficulties?
– Emotionally stable?
– Blunted or flattened affect?
– Expansive?
Mental Status Examination
• Physical functioning:
– Level of energy? Past year?
– Unusual motor behaviors?
– Medical problems?
– Recent physical exam? Results?
– Any prescribed meds? What?
– Any psychological treatment?
– Presents with any disabilities?
Mental Status Examination
• Substance use:
– Alcohol? How much?
– Other substances?
– Social, legal, occupational troubles?
– CAGE
– Treatment?
Emergency Considerations
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Dangerous behavior may occur
Mostly toward themselves
60 – 80% will experience suicidal ideations
10 – 15% will actually commit suicide
50% will make a suicide attempt with
younger clients making more attempts
• The more positive the symptoms the
greater likelihood.
Cultural Considerations
• A disproportionately high number of cases
of schizophrenia are found among
disadvantaged ethnic cultures.
• Greater in groups with high ethnic
discrimination; low educational attainment;
and low occupational status.
Social Selection Theory
• Cultures that are oppressed and unable to
attain high socioeconomic status have a
greater number of individuals with
disabilities and poor health.
• The result of their oppressed status over
the centuries and subsequent genetic
predisposition rather than their ethnic
background per se.
Cultural Factors
• Play a role in the course of the illness.
• Prognosis was more favorable in developing
countries (Nigeria, India, Columbia) than in nine
industrialized countries (the United Kingdom, the
United States, the former Soviet Union).
• Evidence has indicated that high expressed
emotion (EE) within a U.S. family can have a
negative impact on the person coping with
schizophrenia.
Cultural Factors
• Psychoeducational support for high EE
families has been effective in reducing the
relapse and rehospitalization of
schizophrenic family members.
• Social skills training is most effective with
Caucasian individuals and families.
• Less effective with Latinos.