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Schizophrenia
Cara & MacCrae, Ch 7
OT 460a
What you need to know
Diagnostic Criteria: Criteria A-C
 Different types of schizophrenia
 Onset, prevalence, and prognosis
 Other Schizophrenic-like disorders, e.g.,
Schizophreniform Disorder, Schizoaffective
Disorder, Delusional Disorder, Brief
Psychotic Disorder
 Impact on Function
 Medical Management
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Definition
Affects 1/100 people; 2 million people will
develop in their lifetime
 Dx has been treated differently in history
in various physical, emotional, and
spiritual ways
 Sx: Psychosis; disorganized thoughts
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 Hallucinations;
delusions; bizarre behavior
 NOT ALL forms have LT cognitive deficits
Myths and misconceptions
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Split personality
Bad parenting
Drug experimentation
Lack of motivation
Rising incidence
Institutionalization and disability
Low intelligence
Danger and violence
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Predictors include male; poor med compliance;
excessive substance abuse
Onset and Prevalence
Onset typically between early adolescence
and mid thirties
 Lifetime prevalence is .6-1.9% of general
population
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Prognosis
LT outcome is not possible to predict
 Severity and prognosis may be affected by
cultural and environmental influences
 Presence or absence of cognitive deficits
= strongest indicator of LT functional
deficits
 Prognosis is also linked to tx quality
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Prognosis
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Recovery is now viewed as possible with
effective intervention
 50%
have good outcomes
 25% are able to lead satisfying lives with
ongoing supports
 25% who have repeated exacerbations have
poorer prognosis
Etiology
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Structural deficits:
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Enlarged ventricles; brain atrophy; abnormalities in
limbic structures; cerebellum; corpus collosum
Evidence of abnormalities in frontal lobe/ basal
ganglia
Possibility of a developmental disability that manifests
in puberty
Neurochemistry:
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Excess of dopamine or dopamine receptors
Norpinephrine, serotonin, glutamate; neuropeptides
Viral theory- prenatal exposure lies latent
 Dietary- used to understand cause and tx
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Fatty acids; fish oil; caffeine; vitamins
Positive Sx vs Negative Sx
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Delusions
Perceptual distortions
Language disturbance
Abnormal affect/
disorganized speech
Motor changesrestlessness, lethargy
Hallucinations- not
necessarily indicative
of severity of dx
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Affective blunting
Alogia (poverty of tht)
Avolition
Anhedonia
Inattention
Diagnostic Criterion
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Criterion A: Symptoms: two or more of the
following present for at least one month:
 Delusions;
hallucinations; disorganized
speech; disorganized or catatonic behavior;
negative sx: Alogia; avolition; flat affect
Social occupational dysfunction
 Some signs present for at least 6 months
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Diagnostic Criteria
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Criterion A: Presence of 2 or more of the
following symptoms:
 Delusions
 Hallucinations
 Disorganized
Speech
 Grossly disorganized or catatonic behavior
(positive symptoms)
 Positive symptoms are excesses or distoriions
of normal function as found in criterion A
Diagnostic Criteria
Criterion B: disturbance in one or more
areas of function, such as work,
interpersonal relations, or self-care
 Criterion C: Continuous signs of illness for
at least 6 months, including at least one
month of symptoms that meet Criterion A
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Diagnostic Criterion
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Negative Symptoms represent a loss or
absence of function:
 Restricted
emotion
 Decreased thought and speech
 Lack of motivation and initiative
 Inability to relate to others
Subtypes of Schizophrenia
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Paranoid type
 Preoccupation
with one or more delusions of
persecution or grandeur
 Frequent presence of auditory hallucinations
 Exhibition of fewer negative symptoms
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Disorganized type
 Marked
regression: demonstrates primitive,
disihibited, and disorganized behavior
Subtypes of Schizophrenia
Catatonic Type: Severe disturbances in
motor behavior involving stupor,
negativism, rigidity, excitement or
posturing
 Undifferentiated type: Used when client
doesn’t fit into one of the other categories
 Residual type: Used when there is
continued evidence of schizophrenic
behavior in absence of a complete set of
diagnostic criteria
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Other Psychotic Disorders
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Schizophreniform Disorder
 Individual
meets criteria for schizophrenia,
but episode lasts > one month but < 6
months
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Schizoaffective Disorder:
 Individual
has an uninterrupted period of
illness during which, at some time, there is a
major depressive, manic, or mixed episode
concurrent with symptoms in Criterion A
Other Psychotic Disorders
Delusional Disorder: Individual’s
predominant symptoms are non-bizarre
delusions with absence of other criterion A
symptoms
 Brief psychotic disorder
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 Individual
experiences at least one day but
less than one month with one or more
Criterion A symptoms of schizophrenia which
result from severe psychosocial stress
Interdisciplinary Tx
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Goal Setting
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Client centered; include family and others
Managed care may dictate goals
May be impaired by client’s delusions or lack of
insight
Medications: Stabilizes psychosis
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Act as antagonist to dopamine
High incidence of non-compliance
Non-compliance can be minimized by providing
education and interventions
Impact on Function
Many individuals exhibit cognitiveperceptual and social interaction skills that
affect all areas of occupations, including
ADLS, IADLs, Leisure, Social Participation,
Education, and Work
 Many demonstrate sensory processing
disorders
 Many exhibit difficulties with boundaries
which lead to socially inappropriate
behaviors
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OT Intervention
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Evaluation
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ACL
KELS
AMPS
Adult sensory profile
COPM
Intervention (see Table 7-1)
Groups good for social skills
 ADL training
 Activities with personal meaning / purpose
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