Schizophrenia
 Ultimate
in psychological breakdown
 The “Mad”
 Characterized by:
– Gross distortions in reality
– Withdrawal from relationships
– Disorganization and fragmentation of
perception, thought, emotion
 Typically
early onset in adolescence
early adulthood
Kraeplin (1898)
 Dementia
Praecox
– Praecox: early onset
– Dementia: deteriorating course
Bleuler (1911)



“Schizophrenia”  split mind or split between thought and
emotions
Not split in personality not multiple personality!
Primary Characteristics (4 A’s):
– Affect (blunt, flat, inappropriate)
– Associations (loosening of associations)
– Ambivalence (abnormal psychomotor state in which the
patient physically vacillates between two opposing courses
of action like catanoia)
– Autism (loss of contact with reality, withdrawal)
Schizophrenia – Major
Characteristics
 Emotion/Affect:
– Emotional blunting
– Inappropriate affect
– Flat affect
Schizophrenia – Major
Characteristics
 Thought
– Disorder of Thought Form
 Neologisms
 Loose
Associations
 Clang Associations
 Perseveration
 Blocking
Neologism
I
am here from a foreign university..
And you have to have a plausity of all
acts of amendment to go through for
the children’s code…it is an amorition
law… there is nothing to disturb me…
it is like their privatilinia.. And the
children have to have this accentuative
law so they don’t go into the mortite
law of the church (Vetter, 1969)
Loose Associations
 The
problem is insects…My brother
used to collect insects...He’s a man 5
foot and 10 inches... You know, 10 is my
favourite number… I also like to dance,
draw, and watch television
Clang Associations
 How
are you feeling:
– Well, hell, its well to tell
 The
weather:
– So hot, you know it runs on a cot
Perseveration
 Repeat
again
words and statements again and
Blocking

I may be thinking quite clearly and tellling
someone something and suddenly I get stuck.
You hve seen me do this and you may think I
am just lost for words or that I have gone into
a trance, but that is not what happens. I
suddenly stick on a word or an idea in my
head and I just can’t move past it. It seems to
fill my mind and there’s no room for
anything else. This might go on for a while
and suddenly its over.
Disorganized Speech
 Word
Salad: complete breakdown of
associational process
– Its all over for a squab true tray and there
ain’t no music, there ain’t no nothing
besides my mother and father who stand
alone upon the Island of Capri where there
is no ice, there is no nothing.
Schizophrenia – Major
Characteristics
 Thought:
– Lack of insight
– Disorder of Thought Content
 Delusions
–
–
–
–
–
–
–
Thought Broadcasting
Thought Insertion
Thought Withdrawal
Delusions of Control
Persecutory Delusions
Delusions of Grandeur
Delusions of Reference
Thought Broadcasting
 21
year old student: As I think, my
thoughts leave my head on a type of
mental ticker tape. Everyone has only
to pass the tape through their mind and
they know my thoughts
Thought Withdrawal
 22
year old female: I am thinking about
my mother and suddenly my thoughts
are sucked out of my mind by a
phrenological vacuum extractor and
there is nothing in my mind. It is
empty
Delusion of Control

The inmates here hate me because I am
sane…by telepathy and imagination
they force me to say orally whatever
they desire. I never said a word of my
own. I never created a thought or
image of my own.
Positive & Negative Symptoms

Positive and
Disorganization
Symptoms:

Thoughts, sensory
experiences, and
behaviors not ordinarily
present in individuals—
an excess or distortion of
normal functions
Negative
Symptoms:
 Absence or diminution
of normal cognitions,
feelings or behaviors
normally present in
individuals

The Three Christs of Ypsilanti
(1964)
 Case
study by Milton Rokeach,
 Ypsilanti State Hospital (Michigan)
 Rokeach brought together three men
who each claimed to be Jesus Christ and
confronted them with each other's
conflicting claims
 Not helpful
Schizophrenia – Major
Characteristics
 Perception
and Attention
– Information filtering
– Hallucinations
 Visual
 Auditory
 Taste
 Smell
 Touch
Auditory Hallucinations

The voices…were mostly in my head, though
I often heard them in the air or in different
parts of the room. Every voice was different
and each beautiful and, generally, speaking
or singing in a different tone and measure
and resembling those of relations or friends.
There seemed to be many in my head. I
should say upwards of fourteen. I divide
them as they styled themselves, or one
another, into voices of contrition and voices
of joy and honour.
Schizophrenia – Major
Characteristics
 Volition
– Motivation
Schizophrenia – Major
Characteristics
 Motor
Behaviour:
– Catatonia
– Waxy Flexibility
Schizophrenia – Broad Subtypes
 Process
 Reactive
 Other
subtypes listed in text
Erotomania (de Clerambault’s
Syndrome
Delusional disorder in which person believes
he or she is loved by someone else
 May have passing or nonexistent relationship
 Predominantly female
 Reported in early work even by Hippocrates
 1623: Maladie d’Amour or Melancolic
Erotique

Examples
John Hinckley, Jr.
 Ann Murray

Stalkers
Schizophrenia Treatment
 Before
1950  prognosis poor
 Advent of Major Tranquillizers
 Now
– 80% of admitted discharged within a
month or two
– re-admission rates still very high
Social Recovery
 Ability
to manage independently as an
economically effective and
interpersonally connected member of
society
Treatments
 Family
Therapy
 Individual
 Social Skills Training
Viral Infection Model
 Schizophrenia
result of brain infection
– Incidence increase in late 1800’s
(suggestion due to virus)
 Finger
print data: among MZ twins discordant
1/3 have different fingerprints
 One drug, clozapine, is a powerful antiviral
 Inconsistent research on maternal exposure to
influenza