Chapt12schizo

Features and Epidemiology

Causes and Prevention

Assessment and Treatment




Positive Symptoms

Delusions Rigid, bizarre, irrational beliefs

HallucinationsSensory experiences in the absence of actual stimuli

Disorganized speechJumbled speech or speech conveys little information

Inappropriate affectShowing emotions that do not suit a given situation

CatatoniaUnusual motor symptoms marked by severe restriction of movement or extreme excitability




Negative Symptoms

Alogia Speaking very little to others

AvolitionInability or unwillingness to engage in goal-directed activities

Anhedonia Lack of pleasure or interest in life activities

Flat affect Showing little emotion in different situations

Lack of insight Poor awareness of one’s mental condition




Psychotic Disorganized NegativePossible

Others

Degree to which one experiences positive symptoms of delusions and hallucinations

Degree to which one experiences reality distortions, fragmented speech, odd behavior, and inappropriate affect

Degree to which one experiences deficit behaviors such as flat affect, alogia, and avolition

Degree to which one experiences depressive, manic, and motor behaviors




• Paranoid• Disorganized• Catatonic• Undifferentiated• Residual




Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms.

Possible interference in daily functioning.

An episode of the disorder, including prodromal, active, and residual phases, lasts 1-6 months.

Characteristic Symptoms of Schizophrenia




Characteristic Symptoms of Schizophrenia

(Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms) with a major depressive, manic, or mixed episode.

Delusions or hallucinations for at least 2 weeks without prominent symptoms of a mood disorder.

Symptoms of a mood disorder are present during a substantial portion of the active and residual phases of the psychotic disorder.




No characteristic symptoms of schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms), though tactile or olfactory hallucinations may be present if they are related to the person’s delusion.

If mood symptoms are present, they are brief compared to the delusional symptoms.

No significant interference in daily functioning and the person’s behavior is not obviously odd or bizarre.

Delusions that are not bizarre but last at least one month.




Delusions

Hallucinations

Disorganized speech

Grossly disorganized or catatonic behavior




Schizotypal Paranoid

Schizoid

“Distorted reality”Odd ideasEccentricityUnusual experiencesSuperstition, religiositySuspiciousnessReclusiveness

ParanoiaDistrustful nature

Doubts loyaltyKeeps grudgesEasily offended

“Delusional/paranoid”

“Social withdrawal”Aloof

Uninterested in othersSolitary, socially withdrawn

Unaffected by praise and criticism

Negative symptoms of schizophrenia




Genetics

Brain differences

Neurochemical differences

Cognitive defects




Prevalence Rate0 2 4 6 8 10 14

General Population

Siblings

Uncles and Aunts

Grandchildren

Half Siblings

25% Overlap

50% Genetic Overlap

Nephews and Nieces

Parents

Children

12










Cognitive Deficits

Memory

Attention

Learning

Language

Executive functions




1.15

0.95

1.00

1.05

1.10

First Admission

Readmissions

0.85

0.90

MonthsJan Feb Apr May Jun Sep NovOctMar Jul Aug Dec

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Biological vulnerabilities: Early viruses and infections, genetic contributions, pregnancy complications

Key brain and neurochemical differences: Enlarged ventricles, frontal and temporal lobe differences, excess dopamine

Psychological vulnerabilities: Cognitive deficits, academic and motor problems, comorbid substance abuse and depression

Stressful life events, increased life demands, lack of social support and intervention

Possible psychotic disorder




The idea that you should be punished for your sins.

The idea that something serious is wrong with your body.

The idea that something is wrong with your mind.

The idea that someone else can control your thoughts.

Hearing voices that other people do not hear.

Other people being aware of your private thoughts.

Having thoughts that are not your own.

Sample Items from the Psychoticism Subscale of the Symptom Checklist 90-R

How much were you distressed by:










74% improve over time

Education

Chapt12schizo