Schizophrenia and Mood Disorders- Symptoms and Diagnosis

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Unipolar- symptoms and diagnosis

Symptoms

  • Emotional- Intense feelings of saddness, anxiety, lose feelings of affection
  • Motivational-Want to be alone, loss of sex drive, everything is an effort
  • Behavioural-Talk in a slow monotone, less productive, lack of eye contact
  • Cognitive-Hold negative views of themselves, irrationally guilty, suicidal thoughts
  • Physical/somatic-Headaches, weight change, sleep disturbance

Diagnosis

  • When certain symptoms regularly cluster together and follow a particular course, clinicians agree they form a particular disorder
  • Creates consistency among clinicians ensuring diagnosis isn't subjective
  • Having arbitary cut-off points may mean some people miss out on diagnosis and therefore support
  • Five or more sympotoms in the same two week period, at least one symptom should be depressed mood or loss of interest/pleasure
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Bipolar- key definitions

  • Manic- A period of abnormally elevated mood
  • Hypomanic- Mild mania
  • Hypermanic- Extreme mania
  • Mixed episode- Swing from a manic to a depressive state in the same day
  • Bipolar 1- Suffer from full manic and major depressive episodes. Likely to be secioned/hospitilised
  • Bipolar 2- Not as severe, maild mania with depression
  • Clyclothymia- Don't quite meet the description of mania
  • Rapid cyclers- Four cycles (depression --> mania) in one year
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Bipolar- symptoms and diagnosis

Symptoms of Mania

  • Emotional- Abnormally elevated mood, inflated sense of self (can reach grandiose proportions- psychotic)
  • Motivational- Crave constant excitement, excessive and not always apporpriate
  • Behavioural- Hyperactive, talk loudly, irresponsible behaviour, sexually innappropriate
  • Cognitive- Poor judgement, poor concentration, incoherent
  • Physical- Lots of energy, insomnia

Diagnosis

  • People are considered to be experiencing a full manic episode when they display an abnormally elevated mood for at least one week, along with atleast three days of other symptoms
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Schizophrenia

  • Approximately 1% of the population is affected
  • Equal numbers of men and women receive diagnosis and there are no cultural difference between cultures or socioeconomic groups- this suggest a biological cause
  • Age of onset is between adolescence and early adulthood
  • Symptoms are divided into three catagories: Positive, Negative and Psychomotor
  • Type 1: Schizophrenia is dominated by positive symptoms
  • Type 2: Schizophrenia is dominated by negative symptoms
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Schizophrenia- symptoms

Positive Symptoms

  • Delusions (a strong belief based on fact)- persecution: the belief you are being plotted against, reference: individual attaches significance to the actions of a person or object, grandeur: believe you are much more important than you really are, control: believe your fellings, thoughts and actions are being controlled by others
  • Heightened perceptions- senses are being 'flooded', everything is a lot louder, brighter and vivid
  • Disorganised thinking and speech- incapable of logical or rational thoughts, strange speech and loose associations, clang: speak in rhyme, neologisms: make up words
  • Hallucinations (perceptions that appear in the absence of anything being there)- Auditory: hear sounds and voices, voices are often critical and commanding, Tactile (touch): feel their skin burning, insects crawling under their skin, Somatic (health/physical): feel like their organs are shifting in their body, Taste (heightened perceptions): food tastes unusually wrong, Olfactory (smell): smell 'decay'
  • Inappropriate affect (mood)- experience/express moods that are not appropriate to the situation, drastic changes in moods
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Schizophrenia- symptoms

Negative Symptoms (lessening of normal behaviour)

  • Poverty of speech- decrease in speech, stop midsentence, speech is empty and lacks context
  • Blunted and flat affect- feel less emotional than normal (blunted), feel nothing (flat)
  • Loss of volition- no interest, energy or goals, common symptoms with long term sufferers
  • Social withdrawal- withdrawal emotionally and  socially, become very preoccupied with delusions and voices (distancing themselves from reality)

Psychomotor Symptoms

  • Stop moving normally
  • Odd expressions and gestures
  • Become reptitive and ritualistic
  • Catatonia- severe psychomotor symptoms, catatonic stupor: sit silent and unaware of surroundings, catatonic posturing: remain in odd positions for long periods of time
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Schizophrenia- diagnosis

  • Given when signs of the disorder continue for 6 months or more
  • At least one month be an active phase (pronounced symptoms) marked by two or more symptoms
  • A psychotic mood disorder e.g. bipolar, must be ruled out as wellas substance abuse or a general medical condition
  • Work, social relations and self care must have deteriorated

Problems with diagnosis

  • Overlapping symptoms between schizophrenia and bipolar
  • Arbitary cut off points means some people may not get diagnosed and miss out on treatment as a result 
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Schizophrenia- subtypes

Hebephrenic Schizophrenia

  • Normally diagnosed in teenagers or young adults
  • Mood is shallow and inappropriate
  • Though is disoraganisised and speech is incoherent
  • Behaviour is irresponsible and unpredictable
  • Delusions and hallucinations are fleeting and fragmentary
  • Extreme social withdrawal

Residual Schizophrenia

  • Symptoms lessen in intensity but remain in residual form
  • Diagnosis can change to this sub-type
  • Patients continue to display blunted or inappropriate emotions, social withdrawal, eccentric behaviour and some illogical thinking
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