Human Growth and

Development
Group Presentation
Summer Session Two
August 2008
Presented By:
Erin Allen
Laura Bielanowski
Joseph Palumbo
Bernd Weishaupt

Group Topic
Gender
Male

Developmental transitional
period
Adolescent to adult

Mental health issue

Schizophrenia
Schizosplit

Phrenia
-mind

Schizophrenia
A chronic severe debilitating psychotic
disorder
Characterized by:
Disturbances of thought often with
Delusions
Bizarre behavior
Inappropriate mood and
Disturbances of perception affecting
speech & emotions

 Irrational
Delusional
Confused
Distorted

Thought

 Unpredictable
Erratic
Irrational
Dramatic

Behavior

 Depressed
Disturbed
Exaggerated
Volatile

Mood

 Distorted

Bizarre
Unrealistic
Auditory &
Visual
Hallucinations

Perception

Positive Symptoms (Criteria A1-A4)

Excess or Distortion of Normal Functioning
A1-delusions
A2-hallucinations
A3-disorganized
speech
A4-grossly
disorganized or
catatonic
behavior

Delusions
False ideas believed by
the patient but not by
other people in the
culture.
Sensory experience that
is misinterpreted.
Person is convinced that
random events relate to
him
May be paranoid or
grandiose
CIA, FBI, NSA, aliens,
superman, Napoleon,
Jesus, etc.

I am Jesus Christ

Hallucinations
Gross distortions of
visual or auditory
stimuli
Brain may entirely
make up stimuli
Auditory are the
most common
Hearing voices,
seeing things
Religious visions &
voices not typically
included

You talkin to me?

Disorganized Speech
Answers to questions
may be unrelated
May jump topics in
same sentence
Speech may be
incomprehensible
Possibly connected
with disorganized
thinking

Grossly Disorganized or
Catatonic Behavior
Disorganizedrange from
childlike
silliness to
unpredictable
agitation
Catatonicdecrease in
reactivity to
environment

Negative Symptoms (Criteria A-5)

A Loss of Normal Functioning
All part of A-5
Affective
flattening
Alogia
Avolition

Affective Flattening
Persons face
appears
immobile & not
responsive
Range of
emotion is
diminished
Lack of eye
contact

Alogia
Lack of
speech
Brief or
minimalist
speech
Inability to
communicate

Avolition
No will power
Little or no social
activity
No interest in
work
No goals

Consider!
A person with Schizophrenia has
poor
occupational,
interpersonal
and
self-supportive abilities

Distressing Facts!
2.2 million Americans suffer from
Schizophrenia
Nearly half are not receiving treatment,
resulting in homelessness, incarceration,
and violence
Of those treated, they often receive
substandard care at general hospitals and
nursing homes that lack special psychiatric
care and rehabilitation capabilities

 26-53% untreated
medical problems
No coherent
account of
symptoms
High pain threshold
delays diagnosis
Side effects of
antipsychotic
medication
Unlikely to practice
oral hygiene

Medical Care

Unemployment
20-30% capable of
PT work
10-15% capable of
FT work
Few return to
competitive
employment

Homelessness
200,000 homeless
1/3 of homeless
population
Many eat from
garbage cans and
are regularly
victimized

Incarceration
16% of all inmates
40% in jail
32% discharged
from psychiatric
hospitals go to jail
Most are
misdemeanors
20% for violence
or felonies
10% physically
assaulted another

Privationno
Money

Food
Housing

Employment
Friends

Family
Medical care

 Suicide #1
cause of
premature
death
10-13%
Most
intended
Some
accidental
3 of 4 are
males

Hope is needed-help is available!

Competent Care
Team

Informed
practitioners
Physiological &
neurological testing
Basic lab work
Mental &
psychological testing
Education

Hospitalization
usually required initially, only 1of 3
treated in psychiatric hospitals

Alternatives To Hospitalization
Drugs by injection in ER or medical clinics
Partial hospitalization- day/night hospitals
Mobile treatment teams that make house
calls
Short term stay in semi-hospitals- IMDs
(institutions for mental diseases) & crisis
homes.
Public health nursing at home

Therapy Spectrum
Medication
Supportive counseling and
psychotherapy
Rehabilitation & support services
Cognitive Behavioral Therapy
ECT (Electroconvuslive Therapy)
Current Experimental Therapies
TMS (Transcranial Magnetic
Stimulation)
VNS (Vagal Nerve Stimulation)

Primary focus is on
Antipsychotics
Older medications
available since
1950
Effectively alleviate
positive symptoms
Not a cure for
Schizophrenia
Newer atypical
antipsychotic drugs
developed 1990s

Medication

Older Antipsychotic Medications

Chlorpromazine
(Thorazine)
Haloperiodol (Haldol)
Perpherenazine (Prolixin)

Cause extrapyramidal
side effects:
rigidity
muscle spasms
tremors
restlessness

Atypical Antipsychotics 1990s

All are effective without
causing extrapyramidal
symptoms
Goal was to reduce side
effects
Ex: Clozapine was
proven effective for
people who did not
respond to older
antipsychotics.

New Atypical Antipsychotics

Risperidone
(Risperdal)
Olanzapine
(Zypreza)
Quetiapine
(Seroquel)
Sertindole
(Serdolect)
Ziprasidone
(Geodon)

Length of Drug Treatment

Schizophrenia is a
chronic disorder,
because every person
is different, how long
a patient takes
medication varies.
Some patients may
take medication
their entire lives

Supportive Counseling
Treatments designed to
assist patients who are
stabilized on medications
May include:
Individual counseling
Vocational counseling
Group counseling
Problem-solving
Psychoeducation
Co-occurring substance
abuse treatment

Rehabilitation & Support

Money management
Family education
Job training
Social skills training
Support Groups
Community resources
Hygiene
Transportation help

Cognitive Behavioral Therapy

Goals
Relieve symptoms for improved
functioning
Target delusional thinking and visual &
auditory hallucinations
Learn to differentiate between delusional
and rational thinking
Develop mastery by controlling or reducing
symptoms

Cognitive Behavioral Therapy

Core Beliefs
delusions
cant be
controlled

Ill
Never
Get
better

Reactions
Intermediate
Beliefs

Emotions
A Situation

Automatic
Thoughts

Activating
trigger or event

I must obey
the voices

Behaviors
Physiologica
l

Electroconvuslive Therapy
ECT: used during acute onset when confusion
and mood disturbances are present.
Also for
relapse
prevention
12-20
treatments
suggested
over 6 month
time period

Current Experimental Therapies

TMS (Transcranial
Magnetic Stimulation)

VNS (Vagal Nerve

Stimulation)

History
Emil Kraepelin
18561926 German
Psychiatrist developed
The concept of dementia
Praecox (premature
dementia)

History
Paul Eugen Bleuler
1857 1939
Swiss psychiatrist
coined the term
Schizophrenia.

History
Similar signs and symptoms are traced from ancient
documents by the Egyptians as far back as 2000 B.C.
Mental disturbances were associated with demons and
Evil spirits.
Spirits could be excised through such varied
means as music therapy or dangerous and deadly
means of drilling holes in patients skulls.
To let the demons out, other signs and symptoms
have been described in ancient writings by the
Greeks, Romans, and Chinese.

History of Diagnosis
Associative splitting: separation among
basic functions of human personality
(cognition, emotions, perception) that was
seen by some as the defining
characteristics of Schizophrenia.
Bleuler split the divided symptoms into
either positive or negative in 1911 and
divided the illness into four categories:
The four As: (autism, ambivalence, blunted
affect, and loosening of associations).

Four As: Fundamental symptoms

1. Autism: unresponsive to the world
2. Ambivalence: presence of
contradictory drives, tendencies,
emotions or thoughts
3. Affective disturbances: problems in
feeling or expressing full range of
emotions
4. Associative disturbances: thinking &
ideas are not connected.

DSM-IV
Schizophrenia is a group of psychotic
disorders characterized by disturbances in
perception, affect, behavior and
communication lasting longer than 6 months
(this includes psychotic behavior). The
person suffering from Schizophrenia has
deteriorated occupational, interpersonal and
self-supportive abilities.

Coding Schizophrenia
Schizophrenia
295.20 Catatonic type
295.10 Disorganized type
295.30 Paranoid type
295.60 Residual type
295.90 Undifferentiated type

295.40 Schizophreniform disorder

295.70 Schizoaffective disorder

Making A Diagnosis (Criterion A-F)

A. Characteristic (active B. Social/Occupational
phase) Symptoms
Dysfunction
2 or more (less if treated
Underachievement for an
successfully)
Adolescent: failure to
1. Delusions
2. Hallucinations
achieve expected
3. Disorganized speech
academic, social, and
4. Disorganized/catatonic
occupational
5. Negative symptoms
Only 1 symptom required if
developmental levels
Delusions are bizarre or
hallucinations include persistent
voice(s)

Making A Diagnosis (Criterion A-F)

C. Duration
6 months continuous
includes at least 1
month of Criterion A
symptoms (less if treated
successfully). During the
residual periods
symptoms must be
negative or reduced
Criterion A symptoms

D. Schizoaffective &
Mood Disorder
Exclusion
Rule out schizoaffective
disorder and mood
Disorder: (1) no concurrent
major depressive, manic or
mixed episodes during
active phase symptoms (2)
if the did occur they must
be very brief

Making A Diagnosis (Criterion A-F)

E. Substance & General F. Relationship To
Pervasive
Medical Condition
Developmental
Exclusion
Disorder
If Autistic Disorder or
Rule out medication,
general medical condition Developmental Disorder
is present, diagnosis of
and/or substance abuse
Schizophrenia is added
only if pronounced
delusions or hallucinations
meet criterion C (30+ days)

295.40 Schizophreniform Disorder

Identical to Criterion-A with 2 differences:

1. Total Duration between 1 & 6 months through three
phases (prodromal, active, & residual)
2. Impaired functioning may or may not be present

This diagnosis is considered provisional

because recovery is uncertain

If symptoms persist beyond 6 months a diagnosis of

Schizophrenia is needed
1/3 recover within 6 months, 2/3 progress to
Schizophrenia or Schizoaffective Disorder.

295.70 Schizoaffective Disorder

Uninterrupted illness characterized by one of the
following concurrent with Criterion A for
Schizophrenia:
Major Depressive Episode (must include Criterion A1
depressed mood.
Manic Episode
Mixed Episode

Delusions or hallucinations must be present at

least 2 weeks w/o prominent mood symptoms
Mood episodes present during active & residual
Bipolar Type: manic, mixed &/or major
depressive episode
Depressive Type: only Major Depressive
Episode

295.20 Catatonic Type

The essential feature of catatonic type of
Schizophrenia is a marked psychomotor
disturbance that may involve motoric
immobility, excessive motor activity, extreme
negativism, mutism, peculiarities of
voluntary movement, echolalia, or
echopraxia the excessive motor activity is
apparently purposeless and is not influenced
by external stimuli. DSM-IV-TR (2000) p. 315

295.10 Disorganized Type

The essential feature of the disorganized
type of Schizophrenia are disorganized
speech, disorganized behavior, and flat or
inappropriate affect. The disorganized
speech may be accompanied by silliness and
laughter that are not closely related to the content of
the speech. The behavioral disorganization (i.e.,
lack of goal orientation) may lead to severe
disruption in the ability to perform activities of daily
living DSM-IV-TR (2000) p. 314

295.30 Paranoid Type

The presence of prominent delusions or
auditory hallucinations in the context of a
relative preservation of cognitive functioning
and affect. DSM-IV-TR (2000) p. 313
Delusions are typically persecutory or
grandiose, or both, but delusions with other
themes (e.g., Jealousy, religiosity, or
somatization) may occur. (Ibid) p. 313

295.60 Residual Type

The residual type of Schizophrenia should
be used when there has been at least one
episode of Schizophrenia, but the current
clinical picture is without prominent positive
psychotic symptoms (e.g., delusions,
hallucinations, disorganized speech or
behavior). DSM-IV-TR (2000) p. 316

295.90 Undifferentiated Type

The essential feature of undifferentiated
type of Schizophrenia is the presence of
symptoms that meet Criterion A of
Schizophrenia but that do not meet criteria
for the paranoid, disorganized, or catatonic
type. DSM-IV-TR (2000) p. 316

Associated Features
Poor insight into acknowledgement of the
disease.
Poor insight is a symptom of disease, not
a failure to cope with diagnosis.
Controversy exists whether persons
diagnosed with Schizophrenia exhibit
greater incidences' of violence.

Etiology
Schizophrenia is one
of the most serious,
and most mysterious
of all mental illnesses.
It has been described
as a monster, a
chimera and a
disaster for those who
get it.

What is its source?

Etiology
Many theories stress unfavorable social and
emotional experiences as the probable
cause. Harmful family influences or faulty
child-rearing practices are blamed during the
formative years.
Some theorists claim the double-bind (nowin) situation as critical: the patients
mother was always ready to criticize him for
doing one thing and rejecting him for doing
the opposite, resulting in constant
frustration.

Etiology
Other researchers see Schizophrenia as a
physical disease of the nervous system. For
example, the patient may be intoxicated by
some chemical (possibly similar to LSD, DMT, or
mescaline) which his body may be producing
due to a genetically inherited error in
metabolism.
Recently, advances in technology (supported by
brain imaging ) and research findings suggest
that Schizophrenia is a biologically based
disease of the brain.

Diathesis Stress Model

The diathesis-stress model is a model that
combines interaction of biological and
genetic factors to explain disorders.
Diathesis refers to a hereditary
predisposition toward disease or disorder.

Diathesis Stress Model

Diathesis Stress Model

Figure 1 illustrates a contemporary
version of the diathesis-stress model that
encompasses all of the factors that are
currently considered to play a significant
etiologic role in Schizophrenia. This
model postulates that constitutional
vulnerability to Schizophrenia (i.e., The
diathesis) can result from both inherited
and acquired constitutional factors. p. 422
walker et. al.

Diathesis Stress - Model

The picture that has emerged from
research on Schizophrenia, as well as
other psychotic disorders, is best
described in an expansion of the diathesis
stress model that has dominated the field
for several decades. P.422 walker et.al.,

Preschizophrenic Children
Premorbid Development
Schizophrenia is diagnosed in late adolescence or early
childhood (normally)
Signs are usually present before diagnosis, subtle but
can be seen when compared to adolescence with
healthy outcomes

Cognitive Functioning of children who later develop

Schizophrenia
Perform below age level
Poor grades
Has hard time interpreting information and able to use
that information
Inability to sustain attention

Preschizophrenic Children
Social Situations

Less responsive
Less positive emotion
Poor social adjustment
More negative facial expressions during first year
of life

Motor Development
Delays and abnormalities
Late walkers

*Early and middle childhood aged children

are rarely diagnosed with Schizophrenia.

Adolescence
Symptoms

Major adjustment problems

Depression
Social withdrawal
Irritability
Noncompliance

*The problem is these symptoms do not go along

with just Schizophrenia they are present in mood
disorders, substance abuse, and some other
behavioral disorders

Schizotypal Personality Disorder (SPD)

Sometimes preschizophrenic adolescents have
sings of psychotic symptoms, the DSM IV defines
these as SPD
Diagnostic Criteria for SPD

Social anxiety/withdrawal
Affective abnormalities
Eccentric behavior
Unusual ideas
Persistent beliefs in extrasensory phenomena

Unusual sensory experiences

Repeated experiences with confusing noises with peoples
voices
Seeing objects move
*(All of these symptoms are recurring)
*Schizotypal Personality Disorder patients symptoms are not as severe
as having delusions or hallucinations

Schizotypal Personality Disorder

Schizophrenia
The transition from SPD to Schizophrenia
usually happens in young adulthood
Studies show that 10% to 40% of youth with
SPD signs eventually show an Axis I
Schizophrenia spectrum disorder
The others with SPD either end up with
adjustment problems or a complete decrease of
symptoms in young adulthood
*Research is being done to see if prevention programs
could be used with youth with SPD to prevent
Schizophrenia from developing

SPD and Schizophrenia have

some similar functional
abnormalities
Motor abnormalities
Cognitive deficits
Increase in cortisol (stress hormone)

References
American Psychiatric Association. (2000). Diagnostic and statistical.
manual of mental disorders (4th ed.). Washington, DC: author.
Annual Review. Psychology. 2004. 55:401-30.
http://associatedcontent.com/article/76943.
Durand, V. M. & Barlow, David. H. (2006). Essentials of abnormal
psychology. (4th ed.) Belmont, CA: Thomson Wadsworth, Inc.
Journal of Clinical Psychology, May, 1993, vol. 49, no. 3.
Journal of Clinical Psychology, November, 1984, vol. 40 no.
Mental Health America. (2006). Schizophrenia: What you need to
know. [Brochure]. Alexandria, VA: Author.
National Institute of Mental Health. (2007). Schizophrenia. [Brochure].
Bethesda, MD: Author.
Noll, Richard A. (Ed.). (2000) Schizophrenia and other psychotic
disorders. New York: Facts On File, Inc.
http://samian.colorado.edu.
http://Schizophrenia.com/history.htm.
Torrey, E. F, (2006). Surviving Schizophrenia: A manual for families,
patients and providers. New York: HarperCollins Publishers.
http://www.usefilm.com/image/765556.html
http://web.ebscohost.com/ehost/delivery.