DIAGNOSIS AND TREATMENT

SCHIZOPHRENIA

CLINICAL PSYCHOLOGY DONNA P. SOMBREA, MPSY ADAMSON UNIVERSITY

TARGETS

DIAGNOSTIC CRITERIA
PREVALENCE
ETIOLOGY
TREATMENT
 SCHIZOPHRENIA

1. Schizophrenia is not the same as having a split personality.

2. Despite portrayals in the media, people with schizophrenia are far

from likely to be the victims of violence than to commit violent acts
themselves.
Schizophrenia was first identified as a pathological condition by
Kraepelin (1922) who described it in terms of a set of specific
symptoms, originally subdivided into positive and negative
symptoms. ‘Disorganized’ symptoms are in an additional category
distinct from positive and negative symptoms.

POSITIVE NEGATIVE DISORGANIZED

SYMPTOMS SYMPTOMS SYMPTOMS
 POSITIVE NEGATIVE DISORGANIZED
SYMPTOMS SYMPTOMS SYMPTOMS

-inappropriate
Flat affect emotional reaction
Avolition - disorganized thoughts
Delusions Asocial behavior -disorganized or
Hallucinations Poverty of speech abnormal motor
Anhedonia behavior (catatonia)
Alogia
 EXCLUSION

x associated with a mood or developmental disorder

could be associated to the long-term effects of drug use
 NOTES:
No history of ASD or a communication disorder of childhood onset

Substance or order medical condition

-drug use and psychosis: visual hallucinations, spatial and time disorientation and
cognitive problem (drug that cause acute psychosis: SHABU, MARIJUANA,
ECSTASY, COCAIN)

Organic psychosis:
-underlying medical condition: traumatic brain injury, epilepsy, brain tumor,
Parkinson’s disease, systemic lupus, and other cause

Postpartum psychosis
-delivery of child (but not common)
- Woman may have hallucinations, delusions, and irrational thoughts
-Woman’s lack of judgement and can harm her baby pr herself
 REMEMBER
In the spectrum:

Schizotypal personality disorder : inability to maintain close relations as well as disordered

behavior and thoughts (but below the threshold of a schizophrenia diagnosis)

Brief psychotic disorder: between 1 day and 1 month

Schizophrenifrom: less than 6 months

Schizoaffective disorder: occurs with a mood related episode, either together or one after the
other
Delusional disorder: false beliefs lasting at least 1 month without the presence of other psychotic
symptoms
 ETIOLOGY
-heritability : 50%-80%

9% for Someone who has a schizophrenic A. Prenatal trauma

brother or sister B. Adverse events during childhood
12% if one of their parents is affected C. Social exclusion
D. Expressed emotions (EE)
50%- first degree relative, 5%- second degree
relatives,
25% of genetic material, grandparents, nieces,
and nephews
 BRAIN

DOPAMINE

Patients who are experiencing an acute

oPeople with Schizophrenia with enlarge ventricles also show
psychotic episode demonstrate increased
reductions in the white matter in the prefrontal areas of the
synthesis (production) of dopamine, and
brain and abnormal connection between the prefrontal
increased concentration of dopamine in the
cortex, the amygdala and hippocampus.
brain, relative to healthy control participants
 NOTES:
Serotonin neurons regulate dopamine neurons and some of the newest drugs for
schizophrenia bind to serotonin receptors. Thus, interaction between serotonin and
dopamine is critical in schizophrenia, not just dopamine.

Other research has found abnormal levels of neurotransmitters Glutamate and GABA in
people w/ schizophrenia.

Glutamate and GABA are widespread in the human brain, and deficiencies to these could
contribute to a host of cognitive and emotional symptoms.
 PREVALENCE
Between 0.3% and 0.66% of the adult population will be diagnosed with schizophrenia at
some point in their lives (lifetime prevalence), but this figure rises to 2.3% if all
schizophrenia spectrum disorders are included.

Men tend to be first diagnosed between the ages of 15 and 25 ( the average age of onset
is 18years), whereas women are typically diagnosed a few years later (the average age of
onset is 25 years)
 EPIDEMIOLOGY
Philippine Health Information System on
Mental Health (PHIS-MH) Malaysian study (foreign workers)

Filipinos

Schizophrenia

2,562 patients in the hospital nationwide from fourteen public and

private hospitals from May 2014 to May 15, 2015
 NOTES:
Most are men age twenty to forty four

Male patients are brought to seek medical care more

often than females affected with psychotic illness because
males are “more aggressive”
41% of 39 patients admitted to a Kuala Lumpur
Hospital

Filipinos 1. Schizophrenia
2. Acute and transient psychotic disorder
3. Bipolar affective disorder-Manic
4. Depression without psychotic feature
5. Adjustment disorders mostly with depressed
mood
6. Other diagnosis
 PHILIPPINES

Abnormal behaviors are sometimes associated with supernatural explanations (Lee

Mendoza, 2009)

Stigma associated with mental illness are reflected in its portrayal in local movies (e.g.
Tinimbang Ka Ngunit Kulang) as “dangerous-aggressive, simple and childlike,
vulnerability, unpredictability, and social outcasts)

Physician or traditional healer

Causative factor:
Psychotic presentation is labeled as victim of kulam (witchcraft), the
Masamang hangin (bad air)
family will bring the patient to a manggagamot. If there is no
Napabayaan ng Dios (abandoned by God)
improvement, the family will go to another manggagamot or will
Malas (bad luck)
finally consult a medical doctor
 POSSESSION AND SAPI
A cultural diagnosis bring us to an interesting phenomenon such as spirit possession and sapi (fused
with evil spirit)

“SANIB” “SAPI” = “loob”

The phenomenon of possession implies that the self is not a totally bounded self where entities
can be fused or join with tge “loob” of the person

Spirit possession- a condition where a person is believed to be indwelt by another being, usually a
discorporate, sentient entity.

The possessed person usually speaks with a small voice and exhibits a change body movement

“Sinapian”

“Orasyon” (litany of sacred words to counter the evil spirit)

 TREATMENT

1. DRUG THERAPY

Antipsychotic medication or neuroleptics are prescribed to decrease hallucinations, delusions, and aggressive behavior
(dopamine blocking drugs: chlorpromazine and haloperidol)
-amphetamine, and L-DOPA (increase dopamine activity, can trigger symptoms)

Atypical antipsychotics (risperidone, clozapine, and olanzapine) - fewer side effects but should be treated with cautious
 TREATMENT

PSYCHOTHERAPY

Psychosocial treatments (social skills)

- patients are taught to identify early signs of a relapse and medication management

Cognitive behavior therapy

Family therapy
Cognitive remediation
Social skills training
 INNOVATION

Computer animated avatars in therapy

AVATAR THERAPY PROJECT

(Targets auditory hallucinations)

The computer avatar give a form to these voices that they hear

Design and controlled by therapists according to the theme of the patients hallucinations

Patients are taught to oppose these voices so that eventually, the content of these hallucinations change
THANK YOU FOR LISTENING!
REFERENCES

Fields, M., Cartwright-Hatton, S. (2015). Essential Abnormal & Clinical Psychology.

SAGE Publication Ltd

Melgar, M.I., Lo, C. A., Melgar, M., Topacio, A.M. (2018). Beyond DSM: Casebook in
Abnormal Psychology and Mental Health, Ateneo de Manila University Press.