PSYC3102 Lecture Notes - Lecture 3: Dementia Praecox, Eugen Bleuler, Emil Kraepelin
Lecture 3 – Schizophrenia
History of Schizophrenia
●Emil Kraepelin (1899)
○Dementia praecox – literally means dementia of the young
●Eugene Bleuler (1911)
○First to use the term schizophrenia – literally means splitting of the mind
○Four core disturbances; they resemble our current definition of schizophrenia
■Affect
■Ambivalence
■Associations
■Preference for fantasy over reality
Epidemiology
●~1% prevalence in the general population
●Peak age of onset
○Males between 15-25 years
○Females between 25-35 years
○Onset before the age of 10 and after the age of 50 is rare
●Men are 30-40% more likely to develop schizophrenia than women
●Approximately 50% of all patients attempt suicide
●Found in all cultures and socioeconomic status groups
●In Western/industrialised nations, larger percentage in lower socioeconomic groups
○Theory 1: people in these groups more exposed to stressors
○Theory 2: people with schizophrenia are disadvantaged in terms of employment
○Lower socioeconomic status could thus be the cause or the consequence
●The most expensive of all mental disorders in terms of direct treatment costs, loss of
productivity and public assistance
●Shorter average lifespan due to increased suicide rate and associated difficulties e.g.
susceptibility to substance abuse, poor self-care etc.
Notable individuals with schizophrenia
●Schizophrenia can be limiting but many are still able to lead fulfilling lives
●Dr. Frese
○First breakdown at 25 years, experienced several classic symptoms such as
psychosis and paranoia
○Was hospitalised multiple times
○Eventually qualified as a clinical psychologist
●John Nash
○Mathematical genius
○Diagnosed with paranoid schizophrenia in the late 1950’s
○Awarded Nobel Prize in Economics in 1994
DSM-5 criteria
A. Characteristic Symptoms (two or more during one month and at least one needs to be
1, 2, or 3)
1. Delusions
2. Hallucinations
3. Disorganised speech (frequent derailment or incoherence)
4. Grossly disorganised or catatonic behaviour
5. Negative symptoms
■Affect flattening – reduced emotional expression, speaking
monotonously
■Alogia – impoverished thinking, seen through disturbances in speech
■Avolition – lack of motivation
B. Social Occupational Dysfunction
C. Duration continuous signs for 6 months
D. Symptoms must not be due to Schizoaffective and Mood Disorder
E. Symptoms must not be due to substance/general medical condition
F. Relationship to Autism Spectrum Disorder or a communication disorder (so long as
they have prominent delusions/hallucinations over at least a month)
Characteristic symptoms
●Disturbances in content of thought
○Delusion – misrepresentation of reality, false beliefs
■Persecution
●E.g. false belief that someone is out to get them or harm them
■Reference
●E.g. thinking that something on the radio is directly addressing
them
■Grandeur
●E.g. false belief about wealth or fame
●Disturbances in form of thought
○Difficulties in production and organisation of thought – revealed by peculiarities
of verbal expression (example of disorganised speech:
https://youtu.be/p9e1pQBEm_w)
■Loosening of associations
●Neologism – made-up words
●Perseveration – repeating phrases, words or sounds heard
●Word salad – mixtures of words that don’t make sense
●Circumstantiality – making a point, going off track and finishing
the thought
●Tangentiality – making a point and going off on a tangent e.g.
starting to answer a question but not doing so successfully
●Disturbances of perception
○Hallucinations – perceptions occurring in the absence of appropriate stimulus
and not under voluntary control
■Auditory – 75% of people with schizophrenia report hearing voices, often
multiple at the same time providing negative, derogatory running
commentary, though at times it can be pleasant (dramatisation:
https://youtu.be/Pr8IyNGAqlw)
■Visual – e.g. mouths moving, unhappy faces
■Olfactory
■Gustatory
■Tactile – e.g. something crawling on or touching skin
●Disturbances in affect
○Expression of outward emotion
■Restricted affect – least severe
■Blunted affect
■Flat affect – most severe, complete absence of emotional expression
●Disturbances in psychomotor behaviour
○Collectively called catatonia
■Catatonic stupor – slow, deliberate movements
■Catatonic rigidity – being fixed in a certain position
○Not as common as they were before the 50’s, possibly due to medication
●Positive and negative symptoms
○Positive: excess behaviours
■Delusions
■Hallucinations
■Loose associations
■Disorganised behaviour
○Negative: deficits of behaviour
■Flat affect
■Apathy
■Social withdrawal
■Poor attention
Schizophrenia specifiers
●Extra details in the DSM-5 to provide more information about the patient’s current state
and how the disorder presents e.g.
Document Summary
Dementia praecox literally means dementia of the young. First to use the term schizophrenia literally means splitting of the mind. Four core disturbances; they resemble our current definition of schizophrenia. Onset before the age of 10 and after the age of 50 is rare. Men are 30-40% more likely to develop schizophrenia than women. Approximately 50% of all patients attempt suicide. Found in all cultures and socioeconomic status groups. In western/industrialised nations, larger percentage in lower socioeconomic groups. Theory 1: people in these groups more exposed to stressors. Theory 2: people with schizophrenia are disadvantaged in terms of employment. Lower socioeconomic status could thus be the cause or the consequence. The most expensive of all mental disorders in terms of direct treatment costs, loss of productivity and public assistance. Shorter average lifespan due to increased suicide rate and associated difficulties e. g. susceptibility to substance abuse, poor self-care etc.
