SCHIZOPHRENIA
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A psychotic disorder characterized
by bizarre and disorganized
behavior
One of the most serious and
debilitating of all psychological
disorders
DSM-IV-TR CRITERIA FOR
SCHIZOPHRENIA
A.
2 or more for at least a 1-month period:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic
behavior
5. Negative symptoms – flat affect,
alogia,avolition
CRITERIA FOR
SCHIZOPHRENIA
B. Social/Occupational Dysfunction
C. Duration: continuous signs of
disturbance for at least 6 months,
including at least 1 month of active
phase sx and periods of prodromal or
residual sx.
D. R/O Schizoaffective Disorder, Mood
Disorders, the effects of a substance,
and general medical conditions.
2 Categories of Symptoms
Positive Symptoms behavioral excesses/
problems; “normal”
people do not
experience
 Better treatment
outcomes
 Respond to
medication
Negative Symptoms behavioral deficits;
“normal” people do
experience
 More resistant to
medication
Positive Symptoms
 Hallucinations
 Delusions
 Disorganized
Speech
 Disorganized Behavior
Hallucinations
Sensory experience that is a product of
one’s mind; doesn’t exist in the outside
world
Modalities: Auditory, Visual, Tactile,
Olfactory, Gustatory, Somatic
 Auditory most common
 Distressing, give commands, “noise” in
their head
Delusions
Erroneous beliefs that can’t be influenced
or corrected by reason or contradictory
evidence
Themes: Persecutory, Referential,
Grandiose, broadcasting
Disorganized
Thought & Speech
Statements/thoughts aren’t logically
connected to each other & content often
makes no sense
 Tangential - loose associations
 Derailment - get off track
 Flight of ideas - jump from topic to topic
 Neologisms - make up words
 Incoherence - “word salad”
 Clanging - rhyming
Disorganized Behavior
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Disheveled appearance, unusual dress, basic
hygiene neglected
Inappropriate affect - doesn’t fit w/ the situation,
childlike silliness
Agitation – unpredictable, untriggered
Posturing – inappropriate, bizarre movements
Catatonia – lack of response to environment,
stupor (complete unawareness), rigid posturing,
negativism (resistant to instructions)
Negative Symptoms
 Poverty
of speech
 Flat affect
 Avolition
 Social isolation
 Motor retardation
 Anhedonia
Alogia
Poverty of speech  decrease in
speech fluency and productivity
 Severe reduction in speech – e.g.
brief replies
 Absence of speech
Flat Affect
Severe reduction in or absence of
emotional responses to environment.
Examples:
 Face is unresponsive or lacks expression
 Poor eye contact
 Reduced body language
 Diminished range of emotional expression
Avolition
 Lack
of will/motivation
 Inability to initiate or persist at tasks
 Little interest in social or work
activities
SUBTYPES OF
SCHIZOPHRENIA
 Paranoid
Schizophrenia
 Disorganized Schizophrenia
 Catatonic Schizophrenia
 Undifferentiated Schizophrenia
SCHIZOPHRENIA, PARANOID TYPE
 Most
common subtype
 Presence of prominent delusions
(persecutory most common) and
hallucinations (usually auditory)
 Delusions and hallucinations revolve
around a central theme
 Lack of catatonic sx, disorganized
speech or behavior; no negative
symptoms present
SCHIZOPHRENIA,
DISORGANIZED TYPE
 Disorganized
speech
 Disorganized behavior
 Flat or inappropriate affect
 No evidence of catatonia
SCHIZOPHRENIA, CATATONIC TYPE
Rare
form of schizophrenia
Catatonic symptoms (motor related) –
2 or more
Echolalia – mimic verbalizations
Echopraxia – mirror motor movements
SCHIZOPHRENIA,
UNDIFFERENTIATED TYPE
 Don’t
fit into any of the other 3
categories
 Display a mix of symptoms
Facts & Figures
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Prevalence: 1 in 100 people; approx. 4 million
in U.S.
Onset: men – mid 20’s (18-25); women – late
20’s (25-35)
Gender: women have a more favorable course
Prognosis: debilitating, long-term disorder;
chronic course; complete remission is rare
Living situation: 50% live with or rely on
family; many live in residential treatment
facilities
High suicide rates: 10-20%
Facts and Figures
 Large
percentage of the homeless
population (10-20%)
 High rates of substance abuse: 80-90%
use nicotine
 More likely to be born in Jan, Feb, March
 Strong genetic component: MZ twins 48%;
DZ twins 17%
Biological Theories of
Schizophrenia
 Genetic
theories
 Structural brain abnormalities
 Birth complications
 Prenatal viral exposure
 Elevated levels of D, NE, 5HT
 Lower levels of GABA & Glutamate
Treating Schizophrenia
 Psychoeducation
for patient and family
 Consistent medication management:
traditional antipsychotics vs. atypical
antipsychotics
 Supportive therapy
 Intensive psychosocial interventions:
intensive case management, outpatient
treatment programs, CBT, skills-based
training