SCHIZOPHRENIA
-THOUGHT
-Full recovery has a low base rate of 1 in 7
patients
-In 19th century, Emil Kraepelin combined
several symptoms of insanity that had usually
been viewed as reflecting separate and distinct
disorders:
Catatonia- alternating immobility and excited
agitation
Hebephrenia- silly and immature
Paranoia - delusions of grandeur or persecution
-These symptoms shared similar underlying
features and included them under the Latin
term dementia praecox
-Kraeplin believed an early onset at the heart of
each disorder develops into “mental weakness”
-In 1908, Josef Bleuler introduced the term
schizophrenia.
-Schizophrenia comes from the Greek words for
“split” (skhizein) and“mind” (phren),
reflected Bleuler’s belief that underlying all the
unusual behaviors shown by people with this
disorder was an associative splitting of the basic
functions of personality.
Associative splitting- emphasized the “breaking
of associative threads” or the destruction of the
forces that connect one function to the next.
ONE OF THE PSYCHOTIC DISORDERS:
-EMOTION
-BEHAVIOR
-DISORDERED THINKING
-FAULTY PERCEPTION AND ATTENTION
-DISTURBANCES IN MOVEMENT OR BEHAVIOR
-DISRUPTED INTERPERSONAL RELATIONSHIP
GENERALLY COMPRISES OF THESE SYMPTOMS:
Positive Symptoms
Presence of inappropriate symptoms
Negative Symptoms
Absences of appropriate symptoms
Disorganized Symptoms
Movement Symptoms
POSITIVE SYMPTOMS
DELUSION- beliefs contrary to reality and firmly
held in spite of disconfirming evidence
-A person may believe that thoughts that are
not his or her own have been placed in his or
her mind by an external source this is called
thought insertion
-A person ay believe that his or her thoughts are
broadcast or transmitted, so that others know
what he or she is thinking this is called thought
broadcasting
-A person may have grandiose delusions, an
exaggerated sense of his or her own
importance, power, knowledge, or identity
-A person may have ideas of reference,
incorporating unimportant events within a
delusional framework and reading personal
significance into the trivial activities of others
Akala mo nangyayari sa paligid its because of
me. Associate sa simpleng bagay
DELUSION- beliefs contrary to reality and firmly
held in spite of disconfirming evidence
2 views bakit may delusion:
Motivational view- would look at these beliefs
as attempts to deal with and relieve anxiety
and stress
Delusion – they want to compensate, defense
mechanism
Sometimes creating stories that is not true just
to cover up, until they can’t differentiate which
on is true and which one is not.
Deficit view-sees these beliefs as a resulting
from brain dysfunction that creates these
disordered cognitions or perceptions
-or brain injury trauma kaya may impairment sa
thought
HALLUCINATION
-The experience of sensory events without any
input from the surrounding environment
-Often auditory than visual
-They believe voices are coming from
somewhere or someone else but is probably
their own thoughts they are "hearing"
CASE STUDY
Do you have suicidal thoughts, Nagawa mo na ba before
Or plan na gawin ito, Probe questions anong plano mo?
Paano mo naiisip gawin?
Confidentiality:
We often use in case study: Client DENIES hallucination or
delusion
NEGATIVE SYMPTOMS
Avolition - refers to a lack of motivation and a
seeming absence of interest in or an inability
to persist in what are usually routine activities
A person with avolition may struggle to get out
of bed in the morning, even though they know
they have important tasks to complete that day.
They might feel a lack of motivation to start
their day.
Asociality- severe impairments in social
relationships
Anhedonia- a loss of interest in or a reported
lessening of the experience of pleasure
person with anhedonia may have previously
enjoyed playing a musical instrument, but now,
when they try to play, they no longer
experience the same sense of pleasure or
satisfaction from it.
Affective Flattening - refers to a lack of
outward expression of emotion
Alogia- refers to a significant reduction in the
amount of speech
MOVEMENT SYMPTOMS
DISORGANIZED SPEECH - refers to problems in
organizing ideas and in speaking so that a
listener can understand (WORD SALAD)
Loose association or derailment- in which
case the person may be more successful in
communicating with a listener but has
difficulty sticking to one topic
Tangentiality- that is, going off on a tangent
instead of answering a specific question
DISORGANIZED BEHAVIOR- People with this
symptom may go into inexplicable bouts of
agitation, dress in unusual clothes, act in a
childlike or silly manner, hoard food, or collect
garbage
MDD only have psychotic symptom
hallucination and delusion but hindi na meet
other criteria either of 2 positive symptoms
Schizoaffective – meet lahat ng schiz and mood
disorder

Abnormal psychomotor behavior refers to a

disturbances in movement behavior
Catatonia is the prime example of this
symptom
Delusional disorder- is troubled by persistent
delusions of persecutory or by a delusional
jealousy

Attenuated psychosis syndrome- less severe

SCHIZOPHRENIA SPECTRUM AND OTHER
PSYCHOTIC DISORDER
-Two brief psychotic disorders are
presentation of delusions, hallucinations, or
disorganized speech in past month occurring at
least once/ week
Episode only

schizophreniform disorder and brief psychotic

disorder.

The symptoms of schizophreniform disorder

are the same as those of schizophrenia but last
only from 1 to les than 6 months.

Brief psychotic disorder lasts from 1 day to 1

month and is often brought on by extreme
stress, such as bereavement.

Schizoaffective disorder- comprises a mixture

of symptoms of schizophrenia and MOOD
DISORDERS

Full criteria of schist and mood disorder or

bipolar disorder

How to differentiate MDD with Psychotic Erotomanic type = akala niya lahat may gusto
symptoms or schizoaffective sakanya

Grandiose = ggss, pinaka

Jealous type = feeling mo partner mo I s
unfaithful
Persecutory = feeling na may mananakit
sakanila
TREATMENT OF SCHIZOPHRENIA
Pagbibgay ng gamot is just to manage the
symptoms

BIOLOGICAL
ETIOLOGY OF SCHIZOPHRENIA
Antipsychotic Medications
EVALUATION OF GENETIC RESEARCH
-First generation antipsychotics-
-Genetics doesn't completely explain disorder
Haldol and Thorazine

Effective for approx. 60-70% of people

NEUROTRANSMITTERS
However, they experience unpleasant side
-DOPAMINE THEORY effects

Increased limbic dopamine activity (positive -Second generation Antipsychotics-

symptoms) Risperidone and Olanzapine

Decreased frontal dopamine activity (negative Researches shows better efficacy, though
symptoms) small, in preventing symptoms reemergence

Dopamine abnormalities mainly related to Newer drugs had fewer serious side effects
positive symptoms than conventional antipsychotics

Mas mahirap bumangon early morning

-NOREPINEPHRINE THEORY

Increased level of norepinephrine levels No theraphy can cure cause impaired ccognition
sa sxhizphrenia

-GABA HYPOTHESIS

Decreased GABA activity

-DIATHESIS- STRESS MODEL

Genetic factors constitute underlying

preposition

Stress triggers onset

FEEDING AND EATING DISORDERS 02 BIOLOGICAL INFLUENCES

-Inherited vulnerability (unstable or excessive

neurobiological response to stress associated
-Characterized by a persistent disturbance of
with impulsive eating)
eating or eating related behavior that results in
altered consumption or absorption of food and
significantly impairs physical health or
03 PSYCHOLOGICAL INFLUENCES
psychosocial functioning.
-Anxiety focused on appearance and
presentation to others
MAJOR TYPES OF EATING DISORDERS
-Distorted body image

ANOREXIA NERVOSA
PICA DISORDER
- The person eats nothing beyond minimal
Diagnostic Criteria
amounts of food, so body sometimes drops
dangerously.

BINGE-EATING DISORDER

- Individuals may binge repeatedly and find it

distressing, but they do not attempt to purge
the food.

WHAT'S NON NUTRITIVE?

BULIMIA NERVOSA
• Paper, Soap, Cloth, Hair, String, Wool, Soil,
- Out of control eating episodes, or binges, are
chalk, Talcum powder, Paint, Gum, Metal,
followed by self-induced vomiting, excessive
Pebbels, Charcoal, Ash, Clay, Starch, Ice
use of laxatives, or other attempts to purge the
food.

RUMINATION DISORDER
CAUSES OF EATING DISORDERS

01 SOCIAL DIMENSIONS

-Cultural pressures to be thin

-Family interactions/pressures

(social presentation)
Regurgitation - The voluntary or involuntary AVOIDANT/RESTRICTIVE FOOD INTAKE
return of partially digested food from the DISORDER
stomach to the mouth.

Re-chewing - The act of chewing food that has

been regurgitated.

Re-swallowing - The act of swallowing food that

has been regurgitated.

Spitting out - The act of expelling regurgitated

food from the mouth, without swallowing.

Repetitive - This behavior occurs repeatedly,

often daily, over a period of at least one month.

Not a medical or gastrointestinal condition -

Rumination Disorder is not due to a medical or
gastrointestinal issue, but rather a behavioral
pattern.

Not associated with nausea, disgust, or other

gastrointestinal issues - Unlike other disorders
involving regurgitation, rumination is not
accompanied by signs of nausea, disgust, or
gastrointestinal distress.
Involuntary muscle contractions - Rumination
often involves involuntary contractions of the
abdominal muscles.
Social and occupational impairment -
Rumination Disorder can lead to difficulties in
social, academic, or occupational functioning.
Often develops in infancy or early childhood -
While rumination can develop at any age, it
often begins in infancy or early childhood.
Can persist into adulthood - Rumination
Disorder can persist into adulthood if not
addressed.
Limited Food Preferences: Individuals with
ARFID often have a narrow range of preferred
foods and may be unwilling to try new foods.
Avoidance of Certain Textures or Smells: They
may be sensitive to the textures, smells, or
tastes of certain foods, which can lead to
avoidance.
Lack of Interest in Food: Unlike other eating
disorders, ARFID is not motivated by concerns
about weight or body image. Instead, it's driven
by a general disinterest in food.
Nutritional Deficiencies: Due to restricted food
intake, individuals with ARFID may be at risk for
nutritional deficiencies.

Impairment in Social or Occupational

Functioning: ARFID can lead to difficulties in
social situations, at school, or in the workplace,
particularly during meal times.
May Develop in Childhood: ARFID often starts ANOREXIA NERVOSA
in childhood, but it can also persist into
Diagnostic Criteria
adolescence and adulthood if not addressed.

Not Associated with Body Image Concerns:

Unlike anorexia nervosa, individuals with ARFID
do not have a desire to lose weight or a
distorted body image.

Fear of Negative Consequences: Some

individuals with ARFID may have a fear of
choking, vomiting, or other negative
consequences associated with eating.

May Require Multidisciplinary Treatment:

Treatment for ARFID often involves a team
approach, including a registered dietitian,
therapist, and potentially other healthcare
professionals.
Growth and Developmental Concerns: In
children and adolescents, ARFID can lead to
growth and developmental issues if not
addressed.
• Restricting type- during period of anorexia, no
purging happens.
• Binge-eating/purging type- there is binge-
eating or purging behavior
• Extreme cases may lead to depression.
• Commonly begins during adolescence or
young adulthood.

• Onset is usually by stressful life event ex.

DEVELOPMENT AND COURSE
Leaving home for college.
-Can arise at any age.
• VS. avoidant/restrictive food intake, there is
-Could be irritable and may appear apathetic an intense fear of getting fat
and withdrawn during feeding.

-Might be caused by parent-child interaction.

ANOREXIA NERVOSA

-3 CHARACTERISTICS:

-restriction of behaviors to promote a healthy

body weight

-an intense fear of gaining weight and being

fat, and

-a distorted body image.

-usually begins in the early teen years

-more common in women than men

-Bodily changes that can occur after severe
weight loss can be serious and life threatening
-About 70% of women with anorexia eventually
recover, but it can take many years.
BULIMIA NERVOSA
-involves both bingeing and compensatory
behavior.
-Bingeing often involves sweet foods and is
more likely to occur when someone is alone,
after a negative social encounter, and in the
morning or afternoon
-One striking difference between anorexia and
bulimia is weight loss:
People with anorexia nervosa lose a
tremendous amount of weight, whereas people
with bulimia nervosa do not.
-Bulimia typically begins in late adolescence
and is more common in women than men.
-Depression often co-occurs with bulimia, and
each condition appears to be a risk factor for
the other.
-Dangerous changes to the body can also occur
as a result of bulimia, such as menstrual
problems, tearing in the stomach and throat,
and swelling of the salivary gland.
BINGE-EATING DISORDER
BINGE-EATING DISORDER
-Most (but not all) people who suffer from it are
obese (having BMI greater than 30).
Not all obese people meet criteria for binge
eating disorder-- only those who have binge
episodes and report feeling a loss of control
over their eating qualify.
-More common than anorexia and bulimia
-More common in women than men, though
gender difference is not as great as it is in
anorexia and bulimia.
-About 60% of people with binge eating
disorder recover, but it takes even longer than
recovery for anorexia or bulimia.
ETIOLOGY TREATMENT

Genetic factors -Antidepressants medications have shown

some benefit in the tx of bulimia, but not
-Serotonin may play a role in bulimia, with
anorexia.
studies finding a decrease in
-However, people with bulimia are more likely
serotonin metabolites and smaller responses to
to discontinue the medication than to
serotonin agonists.
discontinue therapy
-Dopamine may play a role in restrained eating.
-Psychological tx of anorexia must first focus on
weight gain.

Cognitive Behavioral Factors -Family therapy is common for anorexia.

-focus on body dissatisfaction, preoccupation -Most effective tx for bulimia is CBT.

with thinness, and attention and memory.
CBT alone is more effective than medication
-The Restraint Scale measures concerns about tx, though antidepressants can help lessen
dieting and overeating. comorbid depression.

CBT is also effective for binge eating.

-Sociocultural Factors

Society’s preoccupation with thinness

Media portrayals of thin models

Stigma associated with overweight

-Personality Characteristics

Perfectionism may play a role

-Psychodynamic Factors

Troubled family relationships are fairly

common among people with

eating disorder, but this could be a result of the

disorder, not necessarily a cause of it

High rates of sexual and physical abuse

Anorexia Nervosa:
Primary Feature: Severe food restriction leading
to significantly low body weight.
Body Image: Intense fear of gaining weight or
becoming fat, along with a distorted body
image.
Compulsive Behaviors: Often involves excessive
exercise and rigid control over food.
Physical Effects: Emaciation, fatigue, potential
organ damage, and other serious health risks.
Treatment: Requires medical, nutritional, and
psychological intervention.
Bulimia Nervosa:
Primary Feature: Involves recurrent episodes of
binge eating followed by compensatory
behaviors (e.g., vomiting, excessive exercise, or
fasting).
Body Image: Individuals typically maintain a
relatively normal weight or may be slightly
overweight.
Binge Eating: Episodes marked by a lack of
control and consuming large amounts of food
within a short period.
Compensatory Behaviors: Actions taken to
"undo" the effects of a binge.
Treatment: Therapy, nutritional education, and
potentially medication.
Binge-Eating Disorder (BED):
Primary Feature: Involves recurrent episodes of
binge eating without the use of compensatory
behaviors.
Body Image: Can occur in individuals of varying
body weights.
Binge Eating: Lack of control during episodes.
Physical Effects: Can lead to obesity and related
health issues.
Treatment: Therapy, nutritional counseling, and
sometimes medication.
Avoidant/Restrictive Food Intake Disorder
(ARFID):
Primary Feature: Limited food preferences,
avoidance of certain foods, or lack of interest in
eating, not driven by concerns about body
weight or shape.
Avoidance: Often due to sensory sensitivities,
fear of negative consequences, or disinterest in
food.
Body Image: Not a primary factor.
Nutritional Deficiencies: Risk due to restricted
intake.
Treatment: Often involves a multidisciplinary
approach, including a registered dietitian and
therapist.