By
PREETY SHEKHAR
ASSISTANT PROFESSOR & HEAD, DEPARTMENT OF PSYCHOLOGY
GAUTAM BUDDHA MAHILA COLLEGE, GAYA
MAGADH UNIVERSITY, BODH GAYA
Volume I
SCHIZOPHRENIA
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› What is Schizophrenia?
› History of the Concept of Schizophrenia
› DSM-IV-TR Diagnostic Criteria for Schizophrenia
› Symptoms of Schizophrenia
✓Positive Symptoms of Schizophrenia
✓Negative Symptoms of Schizophrenia
› Eight categories of symptoms of Schizophrenics
› Schizophrenia: Facts at a Glance
› WHO Key Facts regarding Schizophrenia
What is Schizophrenia?
Schizophrenia is a psychological disorder characterized
by psychotic symptoms that significantly affect
emotions, behavior, mental processes and mental
contents.
According to Davison & Neale (1984), “Schizophrenia is
a psychotic disorder characterised by major
disturbances in thoughts, emotion, and behaviour-
disordered thinking in which ideas are not logically
related; faulty perception and attention; flat or
inappropriate affect; and bizarre disturbances in motor
activity. Patients with schizophrenia withdraw from
people and reality, often into a fantasy life of delusions
and hallucinations.”
Schizophrenia is a major psychiatric disorder that can
have a profound effect on the individual, his or her family
members, and society at large.
Schizophrenia is characterized by a combination of
psychotic symptoms, such as hallucinations and delusions,
and negative (or deficit) symptoms, such as apathy,
paranoia, and blunted affect.
Symptoms of the disease is impaired functioning,
including the ability to participate in meaningful and
reciprocal relationships with others, to take care of
oneself, and to function at work, school, or as a parent.
What is Schizophrenia?
Because of the long-term impact of schizophrenia on
functioning, and the episodic nature of psychotic symptoms
that tend to vary in their presence and intensity—at times
requiring temporary hospitalization to protect the individual or
others—most people with schizophrenia rely on family members
and disability benefits to meet their basic needs. The loss in
functional capacity, combined with the intermittent need for
inpatient psychiatric treatment, makes schizophrenia a costly
disease to society (Rice, 1999; Samnaliev & Clark, 2008).
In fact, due to the loss of productivity and premature death
attributed to schizophrenia, it is considered one of the top 10 of
all diseases in the world contributing to disability burden (Murray
& Lopez, 1996).
What is Schizophrenia?
History of the
Concept of Schizophrenia
❖ The concept of Schizophrenia was initially
formulated by two European psychiatrists; Emil
Kraepelin and Eugen Bleuler.
❖ In 1898, Emil Kraepelin, the German psychiatrist, first
presented his notion of DEMENTIA PRAECOX, the
early term of Schizophrenia.
❖ His term dementia praecox reflected what he
believe was the common core-
✓ Praecox- an early onset.
✓ Dementia- deteriorating course marked by a
progressive intellectual deterioration.
History of the
Concept of Schizophrenia
❖ Eugen Bleuler, the Swiss psychiatrist , contributed to the
conceptions of Schizophrenia and coined the term.
❖ Bleuler broke with Kraepelin on two major points:
✓ He believed that the disorder did not necessarily
have an early onset.
✓ He also believed that it does not inevitably
progress towards dementia.
❖ Thus the label dementia praecox was no longer
appropriate.
❖ In 1908, Bleuler proposed the term, Schizophrenia from
the Greek word Schizein meaning “to split” and Phren
meaning “mind”.
Kurt Schneider, a German psychiatrist, proposed that
particular forms of hallucinations and delusions, which
he calls First-Rank symptoms, are the central to
defining Schizophrenia and it’s diagnosis.
✓ Voices Arguing,
✓ Voices commenting on 1’s action,
✓ Thought withdrawal,
✓ Thought Insertion,
✓ Thought Broadcasting,
✓ Made feelings,
✓ Made Impulses,
✓ Made Volitional acts,
✓ Delusional perception &
✓ Somatic Passivity
DSM-IV-TR Diagnostic 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
(4) grossly disorganized or catatonic behavior
(5) negative symptoms, i.e., affective flattening, alogia, or
avolition
Note: Only one Criterion A symptom is required if delusions are
bizarre or hallucinations consist of a voice keeping up a running
commentary on the person’s behavior or thoughts or two or
more voices conversing with each other.
DSM-IV-TR Diagnostic Criteria for
Schizophrenia
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, are
markedly below the level achieved prior to the onset (or when the onset
is in childhood or adolescence, failure to achieve expected level of
interpersonal, academic, or occupational achievement).
C. Duration: Continuous signs of the disturbance persist for at least 6
months. This 6-month period must include at least 1 month of symptoms
(or less if successfully treated) that meet Criterion A (i.e., 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 (e.g., odd beliefs,
unusual perceptual experiences).
Source: The Diagnostic and Statistical Manual of Mental Disorders, Text Revision, Fourth Edition,
(Copyright 2000) American Psychiatric Association.
Symptoms of Schizophrenia
The criteria for schizophrenia in DSM-IV-TR fall into two clusters:
• Positive symptoms: it comprise excesses or distortions such as
delusions, hallucinations , disorganized speech and
disorganized behavior. These symptoms are of an acute
episode of Schizophrenia.
• Negative symptoms: consisting of the absence or reduction
of normal mental processes, mental contents, feelings, or
behaviors, including speech, emotional expressiveness, and/or
movement. It consist of behavioral deficits, such as avolition,
alogia, anhedonia, flat affect, and asociality.
Positive
Symptoms of Schizophrenia
Positive symptoms are so named because they are
marked by the presence of abnormal or distorted
mental processes, mental contents, or behaviors.
Positive symptoms of schizophrenia are:
• hallucinations (distortions of perception),
• delusions (distortions of thought),
• disorganized speech, and
• disorganized behavior.
Negative
Symptoms of Schizophrenia
In contrast to positive symptoms, negative symptoms
are marked by the absence or reduction of normal
mental processes, mental contents, or behaviors.
DSM-IV-TR specifies three types of negative symptoms:
• flat affect,
• alogia, and
• avolition.
Each of these reflects the lack of a normal mental
process, expression of feeling, or behavior, but they
differ in what—specifically—is lacking.
Eight categories of symptoms of
Schizophrenics
While at some point in their disorder all Schizophrenics
either have some type of thoughts disorder or
hallucinations, they typically also show disturbances in
several other symptoms categories as well. Eight
categories of symptoms are as follows:
1. Content of Thought: Here the major symptom is some
delusion or false belief.
2. Form of Thought: Formal thought disorder involves
abnormalities I the way a person’s thought processes
are organised. “Loose association” in which ideas shift
from one unrelated topic to another, are a common
example of this type of symptom.
Eight categories of symptoms of
Schizophrenics
3. Perceptions: Hallucinations or the reporting of
experiences for which there appear to be no tangible
stimuli are the major symptoms of this category.
4. Affect: This category involves disturbed emotions.
Most common are emotions that are blunted, flat or
inappropriate to the situation.
5. Sense of Self: These symptoms refers to persons’
confusion about their identities; they may feel unreal or
uncontrolled by forces outside their control.
Eight categories of symptoms of
Schizophrenics
6. Volition: The symptoms involves reduced motivation
and interest in pursuing almost any sort of goal. They
interfere severely with a person’s ability to work.
7. Relationship to the external world: Schizophrenics
often withdraw from the external world and become
preoccupied with internal fantasies and odd ideas.
These symptoms are sometimes called “autistic”.
8. Psychomotor behaviour: Abnormalities
