Schizophrenia and Mood Disorders- 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

• 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

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

• 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

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

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

• 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 

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