Catatonic Type of Schizophrenia

[DSM-IV]

(butcher, p. 497)

• immobile body or stupor

• excessive motor activity that is purposeless and unrelated to outside stimuli

• Extreme negativism (reistance to being moved, or to follow instructions) or mutism

• bizarre postures, or stereotyped movements or mannerisms

• Echolalia or echopraxia

• alternating periods of:

- extreme excitement

- extreme withdrawal

• pronounced motor signs (excited or stuporous)

• Catatonic Stupor > resist efforts to change position & refuse to comply

• some = highly suggestable > automatically obey commands or imitate (echopraxia, echolalia)

Undifferentiated Type of Schizophrenia

[DSM-IV]

• meets the usual criteria for schizophrenia, incl:

- delusions, halluciations, disorganized thoughts, and bizzare behaviours

• but, does NOT clearly fit one of the other types because of mixed symptoms

• all the primary indications of schizophrenia are seen in a rapicly changing patter

Residual type of schizophrenia

[DSM-IV]

•Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behaviour

• continue evidence of schizophrenia:

- negative symptoms

- mild psychotic symptoms:

-- odd beliefs

-- unusual perceptual experiences

Residual type of schizophrenia

• at least 1 episode of schizophrenia

(in remission)

* mostly negative symptoms:

- flat affect

• mild positive symptoms:

- odd beliefs

- eccentric behaviors

=================

• NOT now show prominent positive symptoms

(NO hallucinations - NO delusions - NO disorganized speech - NO disorganized behavior)

Schizoaffective Disorders

[DSM-IV]

• At some point, there is either:

1) a Major Depressive Episode

2) a Major Manic Episode

3) Mixed Episode, with symptoms of schizophrenia"

- delusions

- halluciations

- disorganized speech

- disorganized behaviour

- negative symptoms

• at least 2 weeks where dilusions and halluciations have been present without mood symptoms

• mood symptoms are present for a substantial proportion of the total illness time

people who have features of schizophrenia and sever mood disorder

• 2 subtypes

- bipolar

- unipolar

• better outcome for schizoaffective disorder than schizophremia

Schizophreniform disorder

[DSM-IV]

• An episode of schizophrenia, incl:

- prodromal, active, and residual phases

• that lasts between 1-6 months

• for schizophrenia-like psychosis

• lasts at least 1mos, but less 6 mos

(so no qualify for schizophrenia dx)

• prognosis is better than for established forms of schizophrenia

Delusional disorder

[DSM-IV]

• nonbizzare delusions (i.e., involving situations that could occur in real life (being followed or poisoned)

• lasts for at least 1 month

• no evidence of full-blown schizophrenia

• behaviour not odd or bizzare, apart from delusions

give voice to, and sometimes to actions on the basis of, beliefs that are considered completely fals and obsurd

• otherwise behave quite normally

Brief Psychotic disorder

[DSM-IV]

Presence of one or more of the following:

- delusions

- hallucinations

- disorganized speech

- grossly disorganized or catatonic bhvr

• lasts 1 day to 1 month > full return to normal functioning

• r/o mood disorder with psychotic features;

- schizoaffective disorder

- schizophrenia

• sudden and brief onset of psychotic symptoms or grossly disorganized or catatonic behavior

• great emotional turmoil

• the episode is usually quite brief

• last less than a month > too short to warrent schizophreniform disorder

• triggered by stress

Shared Psychotic Disorder

[DSM-IV]

• delusion develops in the context of a close relatoinship with another person who already has an established delusion

• the delusion is similar in content to that of the person who already 

• other psychotic disorders are ruled out

• mad feelings or impulses: thoughts, feelings, actions ctrl by someone else

• thought insertion

• though withdrawal

• delusions of reference (event = special meaning)

• delusions of bodily changes

A) Prenatal Viral Infection: flu in 2nd Trimester

B) Rhesus (Rh-) Incompatability: 

C) problems with delivery: oxygen deprivation

D) Nutritional deficiency

Three types of prevention programs

r/t schizophrenia

A) Primary Prevention: prevent new cases, improve obstetric care

B) Secondary Prev'n: early intervention (for at risk)

C) Tertiary prevention: early treatment (for dx), vocational rehab, family support, cognitive tx

A) meantal changes with LSD had scientists interested in schizophrenia consider a possible biochem cause

B) Chlorpromazine blocks dopamine receptors

C) + Amphetamines showed > too much dopamine > psychosis (paranoid, delusions) that look like schizo

D) studies that Tx Ss but increasing availability of dopamine.

Conventional medications

- Haldol

- Thorazing

• dopamine antagonist

• onset: 1-3 weeks > peak 6-8 weeks

• work best for +ve symptoms

• S/E - drowsy

- dry mouth

weight gain

extra-pyramidal effects

- tardive kyskinesia

- neuroleptic malignant syndrom

Novel medications:

- Clozal

- Risperday

- Zyprexa

- Seroquel

- Geodon

• cause fewer extrapyramidal symptoms

• dont block D2 receptors, but block much broader range of receptors, incl D4 Dopamin receptor

• relative +ve and -ve symptoms

• less likely to be rehospitalized

loss of contact with reality