WPA The Essence of Schizophrenia Originally called “dementia praecox”Originally called “dementia praecox” Produces severe incapacity – “dementia”Produces severe incapacity – “dementia” Typically begins in adolescence – “praecox”Typically begins in adolescence – “praecox”

WPA The Tragedy of Schizophrenia A catastrophic illnessA catastrophic illness Tends to persist chronicallyTends to persist chronically 10% suicide rate10% suicide rate Very common % of populationVery common % of population The “cancer of mental illness”The “cancer of mental illness”

WPA The Complexity of Schizophrenia No single defining featureNo single defining feature Multiple characteristic symptomsMultiple characteristic symptoms Symptoms from multiple domainsSymptoms from multiple domains EmotionEmotion PersonalityPersonality CognitionCognition Motor ActivityMotor Activity Probably a multisystem disorder, analogous to syphilisProbably a multisystem disorder, analogous to syphilis

WPA Simplifying the Complexity of Schizophrenia Division of symptoms into two broad groupsDivision of symptoms into two broad groups Positive: distortions or exaggerations of normal functionsPositive: distortions or exaggerations of normal functions Negative: diminution of normal functionsNegative: diminution of normal functions

WPA Hughlings-Jackson: Positive and Negative Symptoms Disease that is said to “cause the symptoms of insanity.” I submit that disease only produces negative mental symptoms answering to the dissolution, and that all elaborate positive mental symptoms (illusions, hallucinations, delusions, and extravagant conduct) are the outcome of activity of nervous elements untouched by any pathological process; that they arise during activity on the lower end of evolution remaining.Disease that is said to “cause the symptoms of insanity.” I submit that disease only produces negative mental symptoms answering to the dissolution, and that all elaborate positive mental symptoms (illusions, hallucinations, delusions, and extravagant conduct) are the outcome of activity of nervous elements untouched by any pathological process; that they arise during activity on the lower end of evolution remaining.

WPA Positive Symptoms SymptomHallucinationsDelusions Disorganized Speech Bizarre Behavior Function Distorted Perception Inferential thinking Thought/Language Behavioral monitoring

WPA Negative Symptoms SymptomAlogia Affective blunting AvolitionAnhedonia Function Diminished Fluency of speech/thought Emotional expression Volition and drive Hedonic capacity

WPA The Importance of Negative Symptoms Impair ability to function in daily lifeImpair ability to function in daily life Holding a jobHolding a job Attending schoolAttending school Forming friendshipsForming friendships Having intimate family relationshipsHaving intimate family relationships

WPA Subdivision of Symptoms into Three Dimensions PsychoticPsychotic Delusions Hallucinations DisorganizedDisorganized Disorganized speech Disorganized behavior Inappropriate affect NegativeNegative Poverty of speech Avolition Affective Blunting Anhedonia

WPA Types of Hallucinations AuditoryAuditory VisualVisual TactileTactile OlfactoryOlfactory

WPA Types of Delusions PersecutoryPersecutory GrandioseGrandiose ReligiousReligious JealousJealous SomaticSomatic

WPA Historical Concepts Emil KraepelinEmil Kraepelin Eugen BleulerEugen Bleuler Kurt SchneiderKurt Schneider Others (e.g., Leonhard, Kleist, Langfeldt)Others (e.g., Leonhard, Kleist, Langfeldt)