By

PREETY SHEKHARASSISTANT 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 characterizedby psychotic symptoms that significantly affectemotions, behavior, mental processes and mentalcontents.

According to Davison & Neale (1984), “Schizophrenia isa psychotic disorder characterised by majordisturbances in thoughts, emotion, and behaviour-disordered thinking in which ideas are not logicallyrelated; faulty perception and attention; flat orinappropriate affect; and bizarre disturbances in motoractivity. Patients with schizophrenia withdraw frompeople and reality, often into a fantasy life of delusionsand 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 timesrequiring temporary hospitalization to protect the individual or

others—most people with schizophrenia rely on family membersand 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 initiallyformulated by two European psychiatrists; EmilKraepelin and Eugen Bleuler.

❖ In 1898, Emil Kraepelin, the German psychiatrist, firstpresented his notion of DEMENTIA PRAECOX, theearly term of Schizophrenia.

❖ His term dementia praecox reflected what hebelieve 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 theconceptions 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 longerappropriate.

❖ In 1908, Bleuler proposed the term, Schizophrenia fromthe Greek word Schizein meaning “to split” and Phrenmeaning “mind”.

Kurt Schneider, a German psychiatrist, proposed thatparticular forms of hallucinations and delusions, whichhe calls First-Rank symptoms, are the central todefining 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 forSchizophrenia

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 ormore voices conversing with each other.

DSM-IV-TR Diagnostic Criteria forSchizophrenia

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 onsetis 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 symptomslisted 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 asdelusions, hallucinations , disorganized speech and

disorganized behavior. These symptoms are of an acute

episode of Schizophrenia.

• Negative symptoms: consisting of the absence or reductionof 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.

NegativeSymptoms 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 Schizophrenicseither have some type of thoughts disorder orhallucinations, they typically also show disturbances inseveral other symptoms categories as well. Eightcategories of symptoms are as follows:

1. Content of Thought: Here the major symptom is somedelusion or false belief.

2. Form of Thought: Formal thought disorder involvesabnormalities I the way a person’s thought processesare organised. “Loose association” in which ideas shiftfrom one unrelated topic to another, are a commonexample of this type of symptom.

Eight categories of symptoms of Schizophrenics

3. Perceptions: Hallucinations or the reporting ofexperiences for which there appear to be no tangiblestimuli are the major symptoms of this category.

4. Affect: This category involves disturbed emotions.Most common are emotions that are blunted, flat orinappropriate to the situation.

5. Sense of Self: These symptoms refers to persons’confusion about their identities; they may feel unreal oruncontrolled by forces outside their control.

Eight categories of symptoms of Schizophrenics

6. Volition: The symptoms involves reduced motivationand interest in pursuing almost any sort of goal. Theyinterfere severely with a person’s ability to work.

7. Relationship to the external world: Schizophrenicsoften withdraw from the external world and becomepreoccupied with internal fantasies and odd ideas.These symptoms are sometimes called “autistic”.

8. Psychomotor behaviour: Abnormalities of movementinclude rocking, pacing, stereotyped actions, andbizarre behaviour rituals. Some schizophrenicsbecomes almost totally immobile; others take on avery dishevelled look or dress very strangely.

Prevalence• Approximately 1% of people worldwide have schizophrenia(Gottesman, 1991; Tandon, Keshavan, & Nasrallah, 2008).

Comorbidity• Over 90% of people with schizophrenia also have anotherdisorder. The most frequent comorbid disorders are mood,

anxiety, and substance-related disorders.

Onset• Men are more likely to develop the disorder between 18 and25, whereas women are more likely to develop it between 26

and 45 years old.

Schizophrenia: Facts at a Glance

Course• About two thirds of people who have had one episode willgo on to have subsequent episodes.

• About a third of people with schizophrenia becomechronically ill, without much reduction of symptoms; for most

others, the symptoms subside.

Gender Differences• Schizophrenia affects men more frequently than women(1.4:1 male-to-female ratio; McGrath, 2006), and—as notedabove—women tend to develop the disorder at older agesthan do men.

• Women have fewer negative symptoms than do men.

Schizophrenia: Facts at a Glance

Cultural Differences• Schizophrenia is more common among those living in urbanareas and those from lower socioeconomic groups (Freeman,

1994; Mortensen et al., 1999; Saha et al., 2005).

• In non-Western countries, people with schizophreniagenerally function better in society than do those in Western

countries (Hopper et al., 2007).

• In a given country, immigrants are almost twice as likely todevelop schizophrenia as are native-born residents (Saha et

al., 2005).

• Within the United States, Latinos and Whites are less likely todevelop schizophrenia than are Blacks (Zhang & Snowden,

1999).

Source: Unless otherwise noted, citations for above data are: American

Psychiatric Association, 2000.

Schizophrenia: Facts at a Glance

❖ Schizophrenia is a chronic and severe mental

disorder affecting 20 million people worldwide.

❖ Schizophrenia is characterized by distortions in

thinking, perception, emotions, language, sense of

self and behaviour. Common experiences include

hallucinations (hearing voices or seeing things that

are not there) and delusions (fixed, false beliefs).

❖ Worldwide, schizophrenia is associated with

considerable disability and may affect educational

and occupational performance.

WHO Key Facts regardingSchizophrenia

❖ People with schizophrenia are 2-3 times more likely to die

early than the general population. This is often due to

preventable physical diseases, such as cardiovascular

disease, metabolic disease and infections.

❖ Stigma, discrimination and violation of human rights of

people with schizophrenia is common.

❖ Schizophrenia is treatable. Treatment with medicines and

psychosocial support is effective.

❖ Facilitation of assisted living, supported housing and

supported employment are effective management strategies

for people with schizophrenia.

WHO Key Facts regardingSchizophrenia

THANK YOU

To be continued…Volume II