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Schizophrenia
Nick Gruberg
Nature of Schizophrenia and Psychosis: An Overview!
n Schizophrenia vs. Psychosis!n Psychosis – Cluster of disorders; hallucinations and/
or loss of contact with reality!n Schizophrenia – A type of psychosis!
n Affects 1 in 100 persons, $65 Billion annually!n Historical Background!
n Emil Kraeplin – 1896; Used the term dementia praecox, focused on onset and outcomes!
n Eugene Bleuler – 1911 he introduced the term “schizophrenia” or “splitting of the mind” !
Prevalence of Schizophrenia!n Prevalence of 1% worldwide!
n 2 × Alzheimer’s!n 5 × Multiple Sclerosis!n 6 × Insulin-dependent (Type I) Diabetes!n 60 × Muscular Dystrophy!
n Schizophrenia Is Generally Chronic!n Moderate-to-severe lifelong impairment!n Life expectancy is slightly less than average!
n Equal Gender Distribution!n Women - better long-term prognosis!n Onset differs between men and women!
Gender differences in onset of schizophrenia in a sample of 470 patients
Howard et al., 1993
Diagnosis: DSM IV!n Symptoms (2 or more):!
n Delusions (content)!n Hallucinations!n Disorganized speech (form)!n Disorganized or catatonic behavior!n Negative symptoms (flat affect etc.)!
n Social / Occupational Dysfunction!
n Duration: 6-months (1 month of symptoms)!
n Not caused by substances!
n Not Schizoaffective/Mood Disorder!
Symptoms of Schizophrenia!Positive (Type 1)
Negative (Type II)
Disorganized
Thematic Delusions Avolition (apathy) Grossly Bizarre Behavior
Thematic Hallucinations Alogia (Poverty of Speech/Content)
Incoherent hallucinations or delusions
Bizarre Behavior Anhedonia Disorganized Affect
“Good” intellect Flat Affect Disorganized Speech
Asociality
Better Prognosis Poor Prognosis Poor Prognosis
Lenzenweger, Dworkin & Wethington (1991)
The “Positive” Symptoms!n Active manifestations of abnormal
behavior or distortions of normal behavior!
n Delusions - 90%!n Somatic: “Snake living inside my
abdomen” !n Grandeur: “Chosen by God”!n Persecution: “ ‘They’ are monitoring
me”!n Manifestations: Thought broadcasting,
ideas of reference, thought withdrawal!
The “Positive” Symptom Cluster !
n Hallucinations!n Sensory events without environmental
input!n Auditory are the most common (can be
any sensory modality)!n Speech vs. auditory processing studies!
Some major language areas of the cerebral cortex
The “Negative” Symptom Cluster !
n Absence or insufficiency of normal behavior!n Spectrum of Negative Symptoms !
n Avolition (or apathy) – Inability to initiate and persist in activities!
n Alogia – A relative absence of speech !
n Anhedonia – Inability to experience pleasure or engage in pleasurable activities!
n Flat affect – Show little expressed emotion, but may still feel emotion !
“Disorganized” Symptoms:!
n Severe and excess disruptions in:!n Speech !Therapist: I was sorry to hear that your uncle Bill
died a few years ago. How are you feeling about him these days?”!
David: Yes, he died. He was sick, and now he’s gone. He likes to fish with me, down at the river. He’s going to take me hunting. I have guns. I can shoot you and you’d be dead in a minute.!
“Disorganized” Symptoms"Speech!
n Cognitive slippage – Illogical and incoherent speech!
n Tangentiality – “Going off on a tangent” and not answering a question directly !
n Loose associations or derailment – Taking conversation in unrelated directions!
n ??!
“Disorganized” Symptoms!n Affect!
n Inappropriate affect (e.g., crying when one should be laughing)!
n Behavior !n Disruption in goal directed behavior!n Decline in routine daily functioning!n Catatonia – Spectrum from wild agitation,
waxy flexibility, to complete immobility !
Symptoms of Schizophrenia!Positive (Type 1)
Negative (Type II)
Disorganized
Thematic Delusions Avolition (apathy) Grossly Bizarre Behavior
Thematic Hallucinations Alogia (Poverty of Speech/Content)
Incoherent hallucinations or delusions
Bizarre Behavior Anhedonia Disorganized Affect
“Good” intellect Flat Affect Disorganized Speech
Asociality
Better Prognosis Poor Prognosis Poor Prognosis
Lenzenweger, Dworkin & Wethington (1991)
Subtypes of Schizophrenia!n Paranoid Type!
n Intact cognitive skills and affect, and do not show disorganized behavior!
n Hallucinations and delusions thematic (e.g., grandeur or persecution)!
n Disorganized Type!n Marked disruptions in speech, behavior, affect!n Fragmented hallucinations and delusions!n Develops early, tends to be chronic, lacks periods of
remissions!
Subtypes (cont.)!n Catatonic Type!
n Unusual motor responses and odd mannerisms (e.g., echolalia, echopraxia)!
n ? Need for consistency!n Tends to be severe and quite rare!
n Undifferentiated Type!n Symptoms, but don’t meet criteria for another type!
n Residual Type!n One past episode of schizophrenia!n Continue to display less extreme residual symptoms
(e.g., odd beliefs)!
Problems with Diagnosis!
n Heterogeneity of symptoms!n Symptoms change as the disorder develops!n Schizophrenics ‘slip back into reality’!
n Treatment response varies!n Is it a unitary disorder?!n Is it distinct from normal experience?!
“Schizophrenia appears to be a disorder with no particular symptoms, no particular course, no particular outcome and which responds to no
particular treatment” [Bentall, 1990]
Other Psychotic Disorders!n Schizophreniform Disorder!
n Schizophrenic symptoms for less than 6 months!
n Associated with good premorbid functioning; most resume normal lives!
n Schizoaffective Disorder!n Symptoms of schizophrenia and a mood
disorder!n 10-year outcome better than Schizophrenia
(Harrow et al., 2000)!
Other Psychotic Disorders!n Delusional Disorder!
n Delusions without other major schizophrenia symptoms!
n May show other negative symptoms!n Type of delusions include erotomanic,
grandiose, jealous, persecutory, and somatic!n This condition is extremely rare!
Additional Disorders with Psychotic Features!
n Brief Psychotic Disorder!n One or more positive symptoms of schizophrenia!n Usually precipitated by extreme stress or trauma!n Lasts < 1 month!
n Shared Psychotic Disorder!n Delusions from one person manifest in another
person!n Little is known about this condition!
n Schizotypal Personality Disorder!n May reflect a less severe form of schizophrenia!
