The Schizophrenias and
Delusional Disorder
Schizophrenias mental disorders characterized by
the breakdown of integrated persoanolity
functioning, withdrawal from reality, emotional
blunting and distortion, and disturbances in
thought and behavior.
Psychosis- a significant loss of contact with reality, as
when hallucinations or delusions are present.
Delusional Disorder a paranoid disorder in which a
person nurtures, gives voice to, and sometimes
takes action on beliefs that are considered
completely false and absurd by others.
Entrance into a delusional system.
Brief Psychotic Disorder
The Schizophrenias
Origins go back to Benedict Morel
Demence Precoce (mental deterioration at early age)
Adopted by Kraeplin
Term is misleading however, as there is no compelling evidence
of progressive brain degeneration in the natural course of the
disorder
In 1911 Eugen Bleuler termed these disorders
“schizophrenia” (split mind). A disorganization of
thought processes:
Split between the intellect and emotion
Split between the intellect and external reality
Split Mind: Prevalence & Onset
Difficult to assess based on cultural beliefs
(can you think of some in local cultures?)
Lifetime prevalence (0.7)
During any given year in the U.S. 1% meet
criteria (over 2 million)
Diagnosis in 40% of all state hospital
admissions
No gender differences in prevalence
Split Mind: Prevalence & Onset
Three fourths of onsets occur between
the ages of 15 and 45 with a median
age in the mid 20s
Males have earlier onset (early 20s)
Females have later onset (late 20s)
Based on brain imaging studies it
appears that males develop more
severe forms of these disorders
Onset
The Clinical Picture in
Schizophrenia
(see next slide)
Positive-syndrome
Negative-syndrome
Type I schizophrenia
Type II schizophrenia
Type I & II Association to Pos & Neg
Positive Syndrome
Negative Syndrome
Hallucinations
Delusions
Derailment of Assoc.
Bizarre Behavior
Min. Cog Impairment
Sudden Onset
Variable Course
Emotional Flattening
Poverty of Speech
Asociality
Apathy
Sig. Cog Impairment
Insidious Onset
Chronic Course
TYPE I.-------------------The above plus
Type II.------------------Plus
Good Med Response
Limbic System
Abnormality
Normal Brain Ventricles
Uncertain Med Response
Frontal Lobe Abnormality
Enlarged Brain Ventricles
The Clinical Picture in Schizophrenia
Disturbances of associative thinking
Cognitive Slippage or Loosening of Associations
Disturbances of thought content
Delusions (false beliefs; thoughts controlled by others)
Disruption of perception
Hallucinations (auditory, olfactory, visual, etc.)
Unable to sort out and process sensory information
Emotional dysfunction
Anhedonia (inability to experience joy)
Blunting
The Clinical Picture in Schizophrenia
Confused sense of self
Disrupted volition
Disruption in goal directed behavior
Retreat to an inner world
Rejection of external world
Loosened ties to external world
Disturbed motor behavior
Psychomotor agitation and
retardation & other peculiarities
of movement
Schizophrenia DSM-IV Criteria
A. Characteristic Symptoms (2 or more during a 1
month period)
Delusions
Hallucinations
Disorganized Speech
Grossly disorganized or catatonic behavior
Negative symptoms
B. Social/Occupational Dysfunction
C. Duration
D. Schizoaffective and Mood Disorder Exclusions
E. Substance/General Medical Condition Exclusion
F. Relationship to a Pervasive Developmental Dis.
The Classic Subtypes
Undifferentiated (waste basket)
Catatonic (pronounced motor signs both
extreme stupor and excitement)
Disorganized (earlier more severe
disintegration of the personality)
Paranoid (person becomes centered on
themes of suspiciousness, persecution,
and/or grandeur)
Schizophrenia Residual (considerable
recovery with mild signs of past disorder)
Split Mind: Causal Factors I
Biological Factors
Genetic studies demonstrate heritablility
Adoption studies demonstrate moderate genetic effect
(heritability)
Biochemical factors appear to include dopamine
Neurophysiological factors
Cognitive dysmetria and smooth pursuit eye movement
Neuroanatomical factors
Brain mass anomalies include enlargement of ventricles and
sulci are noted
Onset
Split Mind: Causal Factors II
Psychosocial Factors
Damaging Parent-Child and Family Interactions
Popular view in the 1950’s
Faulty communication and the double blind
Sociocultural Factors
Less common in less “well-developed” countries
In U.S. lower socioeconomic status is associated
with a higher prevalence
Treatments and Outcomes
Antipsychotic Medication
Psychosocial Approaches
Family Therapy (focus on expressed emotion)
Individual Psychotherapy (coping skills and
personal management)
Social-Skills Training
Outcome studies demonstrate around 40%
social recoveries with medication use in
conjunction with other treatment
Delusional Disorder I
Individual feels singled out and taken
advantage of, mistreated, plotted against,
stolen from, spied on, ignored or otherwise
mistreated
Hold a delusional system usually centered
on one theme
Aside from delusional system such
individuals may appear perfectly normal in
conversation, emotionality, and conduct
Delusional Disorder
A. Nonbizarre delusions (i.e., involving situations that occur in real
life, such as being followed, poisoned, loved at a distance, or deceived
by spouse or lover, or having a disease) of at least 1 month's
duration.
B. Criterion A for Schizophrenia has never been met.
Note: Tactile and olfactory hallucinations may be present if they are
related to the delusional theme.
C. Apart from the impact of the delusion(s) or its
ramifications, functioning is not markedly impaired and
behavior is not obviously odd or bizarre.
D. If mood episodes have occurred concurrently with
delusions, their total duration has been brief relative to the
duration of the delusional periods.
E. The disturbance is not due to the direct physiological
effects of a substance (drug abuse, medication or a medical
condition)
Delusional Disorder
Types (based on theme)
Persecutory (they are being subjected to spying, stalking,
rumors)** most common of the types.
Jealous (sexual partner is being unfaithful)
Erotomanic (a high status person wants to start a sexual
liaison with them)
Somatic (belief of having some physical illness or disorder
whose nature is delusionally absurd)
Grandiose (person has extrordinary status, power, ability,
talent, beauty, etc.)
Mixed (combinations of the above themes)
Delusional Disorder II
Causal Factors and Treatment
Poorly understood
Delusional Disorder: Causal Factors
Brief Psychotic Disorder
1) Presence of one (or more) of the following symptoms:
delusions
hallucinations
disorganized speech (e.g., frequent derailment or incoherence)
grossly disorganized or catatonic behavior
Note: Do not include a symptom if it is a culturally sanctioned response pattern.
2) Duration of an episode of the disturbance is at least 1 day but less
than 1 month, with eventual full return to premorbid level of fx.
3) The disturbance is not better accounted for by a Mood Disorder With
Psychotic Features, Schizoaffective Disorder, or Schizophrenia and is
not due to the direct physiological effects of a substance (e.g., a drug
of abuse, a medication) or a general medical condition.
Specify if: with Marked Stressor, without Marked Stressor, or
Postpartum onset.