Schizophrenic Disorders
Symptoms
Diagnosis
Causes
Treatment and Management
OVERVIEW

Psychosis - A state of being profoundly out of
touch with reality

Most common symptoms: changes in the
way a person thinks, feels, and relates to
other people and the outside environment.

Involves disruptions of mental functions

No single symptom or specific set of
symptoms is characteristic of patients.
OVERVIEW

Devastating disorder for both the
patients & families.

Among mental disorders, the second
leading cause of disease burden.
OVERVIEW
Onset typically occurs during
adolescence or early adulthood. The
period of risk is considered to be
between 15 and 35.
 The problems of most patients can be
divided into three phases of variable and
unpredictable duration:

 prodromal phase (developing)
 active phase (psychotic symptoms)
 residual phase (no longer psychotic
but still showing signs of
schizophrenia)
What Schizophrenia Isn’t…
 Debunking
myths -
 Not “split personality”
 Not inherently violent or homicidal
SYMPTOMS
 Positive
Symptoms--Type I
 Hallucinations
○ Perceptual disturbances
○ Can occur in any of the senses
○ Persistent over time
SYMPTOMS
 Delusional Beliefs
○ FALSE Idiosyncratic beliefs that are rigidly
held in spite of their preposterous nature.
 Subtypes:
-
Grandeur
Persecution
Reference
Nihilistic
- Capgras’ syndrome
- Cotard’s syndrome
SYMPTOMS
 Disorganization
 Thinking Disturbances
○ Involves disorganized speech – say things
that do not make sense.
 Word salad
 Loose associations or derailment
 Perserveration
Symptoms
• Disorganized speech or thought
• Neologisms
• Clang associations
• Echolalia
SYMPTOMS
 Disorganization
 Bizarre Behavior
○ Catatonia
 Stuporous state – reduced responsiveness.
 Echopraxia
 Disheveled
 Childlike Behavior
○ Inappropriate affect
SYMPTOMS
 Negative
Symptoms--Type II
 Lack of initiative, social withdrawal, deficits in
emotional responding.
○ Affective flattening, Blunted affect
○ Anhedonia – inability to experience
pleasure.
○ Apathy - Socially withdrawn
 Both a symptom and coping strategy
○ Avolition – lack of will, motivation
○ Alogia – impoverished thinking, poverty of
speech.
Classifying Schizophrenia: The
DSM-IV-TR Criteria

Two or more of the following:
 Delusions
 Hallucinations
 Disorganized speech
 Grossly disorganized or catatonic
behavior
 Negative symptoms
 Social/occupational
dysfunction
and decline
 Six month duration of symptoms
TABLE 13-1 Diagnosis Criteria for Schizophrenia
A. Characteristic Symptoms: Two (or more) of the following, each
present for a significant portion of time during a 1-month period (or less if
successfully treated):
1. Delusions
2. Hallucinations
3. Disorganized speech (such as frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. Negative symptoms, such as affective flattening, alogia, or avolition
B. Social/Occupational Dysfunction: For a significant portion of the time since
the onset of the disturbance, one or more major areas of functioning such as
work, interpersonal relations, or self-care is markedly below the level achieved
prior to the onset.
C. Duration: Continuous signs of the disturbance persist for at least six months.
This six-month period must include at least one month of symptoms that meet
Criterion A (active phase symptoms), and may include periods of prodromal or
residual symptoms. During these prodromal or residual periods, the signs of
the disturbance may be manifested by only negative symptoms or two or more
symptoms listed in Criterion A present in an attenuated form (such as odd
beliefs, unusual perceptual experiences).
DIAGNOSIS
 Subtypes
 Schizophrenia is a heterogeneous
disorder with many different clinical
manifestations and levels of severity.
○ Paranoid Type
○ Disorganized Type
○ Catatonic Type
○ Undifferentiated Type
○ Residual Type
DIAGNOSIS

Related Psychotic Disorders

Brief psychotic disorder = symptoms < 1 month
Schizophreniform disorder = symptoms for 1-6
months
“Schizophrenic spectrum” also includes:
 Schizoaffective disorder
 Delusional disorder
 Shared delusional disorder
 Paranoid and schizotypal personality disorders


FREQUENCY
 Gender
Differences
 ♂: 30 to 40% more likely to develop
schizophrenia than ♀.
 Differences between ♂ and ♀ onset,
symptoms, and course of the disorder.
CAUSES
TWIN STUDIES
ADOPTION STUDIES
The average concordance
rate for MZ twins is 48%,
whereas the comparable
figure for DZ twins is 17%.
 Suggests strong genetic
factors.
 Also compelling evidence
for the importance of
environment.
 Genain quadruplets


Genetic factors play
role in development
of the disorder
(Heston).
CAUSES
PREGANANCY AND
BIRTH COMPLICATIONS


More likely than the
general population to
have been exposed to
various problems during
their mother’s pregnancy
and to have suffered
birth injuries.
Dietary factors
VIRAL INFECTIONS

Somewhat more
likely to have been
born during the
winter/spring when
viral infections are
more prominent.
Disorder seems to affect many
different regions of the brain.
Enlarged lateral ventricles
Differences (decreased size) in
parts of the limbic system.
FIGURE 13-3
CAUSES
 Biological
Components: Immediate
Causes
 Brain function abnormalities:
hypofrontality, neurotransmission,
dopamine hypothesis
 Brain structure abnormalities
 Neuropsychological/neurophysiological
abnormalities: impaired cognition, sensory
gating, visual tracking
CAUSES
The dopamine hypothesis
Interactions of multiple
neurotransmitters
Focuses on the function
of dopamine in the limbic
area of the brain.
 Hypothesis grew out of
attempts to understand
how antipsychotic drugs
improve the adjustment
of schizophrenic
patients.


Current research
focuses many
neurotransmitters:
 Serotonin
 GABA
 Glutamate
CAUSES

Psychological Factors
 Expressed Emotion
○ The family environment does have a
significant impact on the course (as
opposed to the etiology) of schizophrenia.
○ Patients who relapsed seemed to react
negatively to some feature of their close
relationship with their family.
○ See Figure 13.5
TREATMENT
 Antipsychotic
Medication
 Have a relatively specific effect- reduce
psychotic symptoms
 Positive symptoms respond better than
negative symptoms.
 A substantial minority of patients,
perhaps 25% do not improve on classical
antipsychotic drugs.
 See Figure 13.7 relapse rate
TREATMENT
 Antipsychotic Medication
 Motor Side Effects
○ Extrapyramidal symptoms
○ Tardive dyskinesia
TREATMENT
 Antipsychotic
Medication
 Second-Generation Antipsychotics
○ Atypical antipsychotics
○ Work on both serotonin and dopamine
○ Impact both positive and negative symptoms