امير الظلام
13-05-2007, 10:50 PM
[Diagnostic Criteria for Schizophrenia
A. Two or more of the following symptoms present for one month:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (ie, affective flattening
, alogia, avolition)
B. Decline in social and/or occupational functioning since the onset of illness.
C. Continuous signs of illness for at least six months with at least one monthof active symptoms.
D. Schizoaffective disorder and mood disorder with psychotic features have been excluded
E. The disturbance is not due to substance abuse or a medical condition
F. If history of autistic disorder or pervasive developmental disorder is
present, schizophrenia may be diagnosed only if prominent delusions or hallucinations have been present for one month.
Clinical features of Schizophrenia
A. A prior history of schizotypal or schizoid
personality traits or disorder is often present.
Depressive symptoms may be present, but the
duration of these symptoms has usually been
brief, compared to duration of the psychotic
symptoms.
B. Symptoms of schizophrenia have been traditionally categorized as either positive or negative.
Depression and neurocognitive dysfunction are
gaining acceptance as terms to describe two other core symptoms of schizophrenia.
1. Positive symptoms
a. Hallucinations are most commonly auditory or
visual, but hallucinations can occur in any sensory modality.
b. Delusions
c. Disorganized behavior
d. Thought disorder characterized by loose
associations, tangentiality,incoherent thoughts,
neologisms, thought blocking, thought
insertion, thought broadcasting, and ideas of
reference
2. Negative symptoms
a. Poverty of speech (alogia) or poverty of
thought content
b. Anhedonia
c. Flat affect
d. Loss of motivation (avolition)
e. Attention deficits
f. Loss of social interest
3. Depression is common and often severe in schizophrenia and can
compromise functional status and response to treatment. Atypical antipsychotic often improve depressive signs and symptoms, but
antidepressants may be required.
4. Cognitive impairment. Cognitive dysfunction
(including attention and particular types of memory) contribute to
disability and can be an obstacle in long-term
treatment. There is evidence that the atypical
antipsychotics improve cognitive impairment.
C. The presence of tactile, olfactory or gustatory
hallucinations may indicate an organic etiology such
as complex partial seizure
D. Sensorium is intact.
E. Insight and judgment are frequently impaired.
F. No sign or symptom is pathognomonic of
schizophrenia.
III. Epidemiology of Schizophrenia
A. The lifetime prevalence of schizophrenia is one
percent.
B. Onset of psychosis usually occurs in the late teens
or early twenties.
C. Males and females are equally affected, but the
mean age of onset is approximately six years later
in females, and females frequently have milder
course of illness .
D. The suicide rate is 10-13%, similar to the rate
that occurs in depressive illnesses. More than
75% of patients are smokers, and the incidence of
substance abuse is increased (especially alcohol,
cocaine, and marijuana).
IV.Classification of Schizophrenia
A. Paranoid type Schizophrenia
1. Characterized by a preoccupation with one or
more delusions or frequent auditory hallucinations
2. Paranoid type schizophrenia is characterized by
the absence of prominent disorganization of
speech, disorganized or catatonic behavior, or flat
or inappropriate affect.
B. Disorganized type Schizophrenia is characterized
by prominent disorganized speech, disorganized
behavior, and flat or inappropriate affect.
C. Catatonic type Schizophrenia is characterized by
at least two of the following:
1. Motoric immobilit
2. Excessive motor activity
3. Extreme negativism or mutism
4. Peculiar voluntary movements such as bizarre
posturing
5. Echolalia or echopraxia
D. Undifferentiated type Schizophrenia meets
criteria for schizophrenia, but it cannot be
characterized as paranoid, disorganized, or
catatonic type.
E. Residual type Schizophrenia
is characterized by the absence of prominent
delusions, disorganized speech and grossly
disorganized or catatonic behavior and continued
negative symptoms or two or more attenuated
positive symptoms.
Management:
* Important of continuity of care.
* Medication
* Rehabilitation
* Psychoeducation program
Remember ...
* Important of assessment
* Try to built a good relationship
* Be patient
* patient social interaction
* Don't agree or argue in case of delusion
* Don't try to control patient alone during
excitement
* Observe patient sleep, appetite, eat and behavior
particularly risk patient
* Patient education
A. Two or more of the following symptoms present for one month:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (ie, affective flattening
, alogia, avolition)
B. Decline in social and/or occupational functioning since the onset of illness.
C. Continuous signs of illness for at least six months with at least one monthof active symptoms.
D. Schizoaffective disorder and mood disorder with psychotic features have been excluded
E. The disturbance is not due to substance abuse or a medical condition
F. If history of autistic disorder or pervasive developmental disorder is
present, schizophrenia may be diagnosed only if prominent delusions or hallucinations have been present for one month.
Clinical features of Schizophrenia
A. A prior history of schizotypal or schizoid
personality traits or disorder is often present.
Depressive symptoms may be present, but the
duration of these symptoms has usually been
brief, compared to duration of the psychotic
symptoms.
B. Symptoms of schizophrenia have been traditionally categorized as either positive or negative.
Depression and neurocognitive dysfunction are
gaining acceptance as terms to describe two other core symptoms of schizophrenia.
1. Positive symptoms
a. Hallucinations are most commonly auditory or
visual, but hallucinations can occur in any sensory modality.
b. Delusions
c. Disorganized behavior
d. Thought disorder characterized by loose
associations, tangentiality,incoherent thoughts,
neologisms, thought blocking, thought
insertion, thought broadcasting, and ideas of
reference
2. Negative symptoms
a. Poverty of speech (alogia) or poverty of
thought content
b. Anhedonia
c. Flat affect
d. Loss of motivation (avolition)
e. Attention deficits
f. Loss of social interest
3. Depression is common and often severe in schizophrenia and can
compromise functional status and response to treatment. Atypical antipsychotic often improve depressive signs and symptoms, but
antidepressants may be required.
4. Cognitive impairment. Cognitive dysfunction
(including attention and particular types of memory) contribute to
disability and can be an obstacle in long-term
treatment. There is evidence that the atypical
antipsychotics improve cognitive impairment.
C. The presence of tactile, olfactory or gustatory
hallucinations may indicate an organic etiology such
as complex partial seizure
D. Sensorium is intact.
E. Insight and judgment are frequently impaired.
F. No sign or symptom is pathognomonic of
schizophrenia.
III. Epidemiology of Schizophrenia
A. The lifetime prevalence of schizophrenia is one
percent.
B. Onset of psychosis usually occurs in the late teens
or early twenties.
C. Males and females are equally affected, but the
mean age of onset is approximately six years later
in females, and females frequently have milder
course of illness .
D. The suicide rate is 10-13%, similar to the rate
that occurs in depressive illnesses. More than
75% of patients are smokers, and the incidence of
substance abuse is increased (especially alcohol,
cocaine, and marijuana).
IV.Classification of Schizophrenia
A. Paranoid type Schizophrenia
1. Characterized by a preoccupation with one or
more delusions or frequent auditory hallucinations
2. Paranoid type schizophrenia is characterized by
the absence of prominent disorganization of
speech, disorganized or catatonic behavior, or flat
or inappropriate affect.
B. Disorganized type Schizophrenia is characterized
by prominent disorganized speech, disorganized
behavior, and flat or inappropriate affect.
C. Catatonic type Schizophrenia is characterized by
at least two of the following:
1. Motoric immobilit
2. Excessive motor activity
3. Extreme negativism or mutism
4. Peculiar voluntary movements such as bizarre
posturing
5. Echolalia or echopraxia
D. Undifferentiated type Schizophrenia meets
criteria for schizophrenia, but it cannot be
characterized as paranoid, disorganized, or
catatonic type.
E. Residual type Schizophrenia
is characterized by the absence of prominent
delusions, disorganized speech and grossly
disorganized or catatonic behavior and continued
negative symptoms or two or more attenuated
positive symptoms.
Management:
* Important of continuity of care.
* Medication
* Rehabilitation
* Psychoeducation program
Remember ...
* Important of assessment
* Try to built a good relationship
* Be patient
* patient social interaction
* Don't agree or argue in case of delusion
* Don't try to control patient alone during
excitement
* Observe patient sleep, appetite, eat and behavior
particularly risk patient
* Patient education