Some prognostic factors that tell us
or not a patient with schizophrenia
is going to do really
well or not so well
are things such as the onset
of the illness, okay?
If somebody is presenting with
an illness a little bit older,
they’re going to have a better prognosis
than if they’re presenting
at a very young, tender age.
Also, having good social
supports from family, friends,
care providers, prognosis.
all of these things are going to
lead towards a better prognosis.
And when it comes
we know that having
so things like paranoia, hallucinations,
delusions, thought disorder.
These things actually all trend
towards a better prognosis.
You think of them as
little bit easier to treat
than somebody who has
that leads to a little bit
of a worst prognosis.
Somebody who has new symptoms
is also going to have
a better prognosis than
somebody without mood symptoms.
Mood disorder can be treated
and therefore, if that’s targeted,
a person can have a good outcome.
And usually females tend to do a little bit
better than males in terms of prognosis.
And any patient who is
diagnosed with schizophrenia
will probably experience and hopefully
experience remissions from their disorder.
However, relapses are possible,
but for those patients who have
very few and far between relapses,
they’re going to do much
better in the long run
than a patient who’s having very
frequent relapses of their disorder.
And another key variable is what the
premorbid functioning was for a patient.
So somebody, say, like Mr. B who was
doing really well before their symptoms,
in college, engaged with their
family, having hobbies, et cetera,
that person’s going to
be more likely to do
really well and have a
good prognosis overall.
Here’s an important
question for you.
Are patients with schizophrenia
more likely to be violent?
Individuals with schizophrenia
are more likely
to be victims of violence
a very important
point to remember.
So when you think about Mr. B,
what is your prognosis for him,
this young college student who has found
himself diagnosed with schizophrenia.
Well, he actually shows some
really good prognostic factors
and these are very important to
emphasize to both him and his family.
So some of the factors supporting
a favourable outcome for him
include being enrolled at college,
this indicates he has a high intelligence
and a good premorbid functioning.
Beyond that, there’s the presence of his
supportive family, which is very hopeful.
And this appears to be Mr. B’s
first episode of psychosis.
And with the right
treatment and compliance,
he might not have
may future episodes
and can actually do very
well despite his illness.
Let’s talk about the behavioral
therapy treatment in schizophrenia.
This is aimed to improve a
patient’s ability to do well
and actually function
So therapy is aimed at developing
social skills, self-sufficiency,
and also an ability to act
appropriately in public
and this all the aim
of behavorial therapy.
There can be cognitive problems
associated with schizophrenia.
Can you think of what any of those are?
Well, deficits and processing of
complex information can occur.
Maintaining a steady focus of attention,
working memory can be impaired.
Distinguishing between relative and
irrelevant stimuli can also happen.
And abstract thinking
can also be disrupted.
When it comes to social skills training,
what limitations are there in
training persons with schizophrenia?
Well, there is a difficulty
in generating information –
There is a difficulty in
generalizing information learned
into real life setting
for some patients.
The best approach in terms of being a
therapist and working with a patient
who has schizophrenia is to be
direct and straightforward.
Take an active and assertive
posture to provide structure.
And when it comes to group therapy,
note that it’s not very well tolerated
in individuals with psychosis
because of the overstimulation.
Only very high functioning and stable persons
can tolerate insight oriented groups.
I want to review briefly the
culture specific psychoses.
These include disorders that occur
in different parts of the world.
Koro is occurring in
the Asian culture.
This is the belief that the penis is
shrinking and that it may cause death.
Another disorder is amok.
This is in Malaysian and
Southeast Asian cultures.
It’s a sudden, unprovoked outburst of
violence, often followed by suicide.
There’s also something called
brain fag which occurs in Africa.
This is where patients complain of a
headache, fatigue, visual disturbances
and it’s often occurring
in male students.
Some other syndromes that are important
to be aware of are as follows.
This is the delusion that imposters
have replaced familiar people.
Fregoli’s syndrome is a
delusion that a persecutor
is taking on a variety
of faces like an actor.
Lycanthropy is a delusion
of being a werewolf.
Heutoscopy is the false
belief that one has a double.
Cotard syndrome, this is
the delusional belief
that an individual has lost everything
including their body organs.
And Folie a deux is a
shared psychotic disorder
or shared delusion between
more than one person.
This summarizes schizophrenia and some
other related psychotic disorders.
Very important to know the
history, background, epidemiology,
the causes of schizophrenia,
and the treatments.