1. Schizophrenia and Other Psychotic Disorders
Chapter 12

2. Outline Perspectives on Schizophrenia
Clinical Description, Symptoms and Subtypes
Prevalence and Causes of Schizophrenia
Treatment of Schizophrenia

3. Perspectives on Schizophrenia
Schizophrenia is characterized by a broad spectrum of disturbances in thinking (delusions), perception (hallucinations), speech, emotions, and behavior
Diagnosis of schizophrenia requires that two or more positive, negative and/or disorganized symptoms be present for at least 1 month
Affects 1% of population
Complete recovery from schizophrenia is rare

4. Perspectives on Schizophrenia
Emil Kraepelin
Dementia praecox (premature loss of mind) shares following symptoms
Catatonia (disorder of movement involving immobility or excited agitation)
Hebephrenia (silly and immature emotionality)
Paranoia (delusions of grandeur or persecution)
Eugen Bleuler
Introduced the term schizophrenia (split of mind)
Associative splitting of basic functions of personality (cognition, emotions, perception etc.)
Does not mean split of personality or multiple personality

5. Clinical Description, Symptoms and Subtypes
Psychotic behavior
Unusual behavior characterized by hallucinations, delusions and loss of contact with reality
Positive symptoms
More active manifestations of abnormal behavior (delusions and hallucinations)
Negative symptoms
Deficit in normal behavior (avolition, alogia, anhedonia, affective flattening)
Disorganized symptoms
Rambling speech, erratic behavior, inappropriate affect

6. Clinical Description, Symptoms and Subtypes
Positive symptoms
Delusions
Disorder of thought content, strong beliefs that misrepresent reality
Delusion of grandeur, delusions of persecution, Capgras syndrome, Cotard’s syndrome
Hallucinations
Perceptual disturbance in which things are seen or heard or otherwise sensed although they are not real or actually present
Auditory hallucinations are most frequent (Broca’s area)

7. Clinical Description, Symptoms and Subtypes
Negative symptoms
Avolition
Apathy, inability to initiate and persist in activities
Alogia
Absence of speech (poor communication skills)
Anhedonia
Lack of pleasure
Affective flattening
Don’t show emotions when a reaction would be expected
 Pos vs. neg symptoms

8. Clinical Description, Symptoms and Subtypes
Disorganized symptoms
Disorganized speech
Lack of insight
Jump from topic to topic, talk illogically, lack of coherence
Inappropriate affect and disorganized behavior
Laugh or cry at improper times
Motor dysfunctions (agitation or immobility)

9. Clinical Description, Symptoms and Subtypes
Schizophrenia subtypes  Etta
Paranoid type
Delusions, hallucinations but cognitive skills and affect are relatively intact, better prognosis
Disorganized type
Disrupted speech and behavior, delusions, hallucinations, flat or silly affect, self-absorbed
Catatonic type
Motor disturbance predominate (echolalia, echopraxia)
Undifferentiated type
Major symptoms of schizophrenia (no particular type)
Residual type
People who experienced at least one episode of schizophrenia but no longer manifest major symptoms

10. Clinical Description, Symptoms and Subtypes
Other psychotic disorders
Schizophreniform disorder
Experience symptoms of schizophrenia for a few months only (up to 6 months)
Schizoaffective disorder
Symptoms of schizophrenia and also major mood disorder
Delusional disorder
Persistent belief contrary to reality (delusion) without other symptoms of schizophrenia (onset between 40 and 49)
Brief psychotic disorder
involves delusions, hallucinations, disorganized speech or behavior that lasts less than 1 month (often reaction to stressor)
Shared psychotic disorder
A person develops a delusion similar to that of a person with whom he or she shares a close relationship

11. Prevalence and Causes of Schizophrenia
0.2% to 1.5% of population (equivalent for men and women)
Onset in early adulthood (16-25)
Children who later develop schizophrenia have abnormal emotional reactions very early (less positive and more negative affect)
Genes are responsible for making some individuals vulnerable to schizophrenia (the risk varies according to how many genes an individual shares with someone who has the disorder)
Family studies, twin studies, adoption studies, genetic markers

12. Prevalence and Causes of Schizophrenia

13. Prevalence and Causes of Schizophrenia
Dopamine system is too active in people with schizophrenia (neuroleptics – dopamine antagonists)
Enlargement of ventricles
Hypofrontality (DLPFC)
Viral infections (second-trimester)
Stress
If the level of criticism, hostility and emotional overinvolvement expressed by families is high, patients tend to relapse

14. Treatment of Schizophrenia
Neuroleptic drugs  treatment
Problem with compliance of patients
Psychological treatment
Self-care training
Social skills training
Self-help groups
Prevention (family environment)