Module 1 – Schizophrenia
Holds much public attention, research, and fascinations
There is no “main symptom” of schizophrenia: hard to find specific traits or characteristics that
are shared by all persons with this diagnosis. Instead, patients often have a combination of
different types of symptoms.
Symptoms of Schizophrenia
Positive symptoms: behaviours that increase in someone with schizophrenia
Negative symptoms: behaviours that decrease in someone with schizophrenia
Catatonic behaviours: consist of movement behaviours that an individual exhibits which are not
in response to any event in the environment.
Any given patient may experience only some of these symptoms, and the severity of symptoms
varies widely from one case to another.
Disorders of thought: schizophrenic thinking is characterized by loose associations; the
individual’s train of thought may consist of ideas that are often only loosely related to each
other. Speech may be vague and abstract, ex.: “I wish you a happy, joyful, healthy, blessed and
fruitiful year, and many good wine-years to come as well as a healthy and good apple-year, and
sauerkraut and cabbage and squash and seed year.” Patient started making associations with
the word fruit and trailed off from his original intent.
Delusions: The content of schizophrenic thought is often unusual. May contain fragmentary or
bizarre delusions. A delusion is a belief that is irrational, or unsupported by external evidence.
Common delusions involve the idea that the individual is being persecuted by others, or that
events or objects have special significance for the individual. Ex.: may think that a character on
television is speaking to or about them directly. Very often delusions are about thought or
thinking itself: these may include the delusion of thought broadcast – the belief that others can
hear one’s thoughts, or thought withdrawal, the belief that thoughts are being removed from
his head before he can think them, or thought insertion, the belief that thoughts are being place
in the individual’s head by others.
Hallucinations: perceptions of things that are not really there. Auditory hallucinations are more
common than visual hallucinations. The individual may report that she hears voices in her head,
or speaking to her from parts of her body. These voices are usually saying negative things,
commenting on the individual’s behaviour, or giving orders.
Decrease in the individual’s engagement with the outside world. Individual may become less
and less interested in people and events in the outside world, and more concerned with internal ideas or fantasies. Lead to growing estrangement from family and coworkers, and an increasing
neglect of one’s personal appearance. Emotional responses may also change.
Affect: refers to emotional responsiveness. A person with a flat or blunted affect shows very
little emotional response. A patient with inappropriate affect shows emotional reactions that
are inappropriate to the situation. Ex.: laugh when speaking about the loss of a family member.
Unrelated to stimuli from the outside world.
May involve a dramatic reduction in movement, sometimes to the point of ceasing to move at
all = cationic rigidity, or catatonic stupor. Individual may maintain a single posture for very long
periods of time, and resist being moved.
In other cases, catatonia involves a kind of “waxy flexibility’. A patients arms and legs can be
moved into a variety of positions – like a wax figure – and then very slowly move back to the
May be repeated or stereotyped motor movement that seem to have no purpose at all, and are
unrelated to what is going on around the person. Sometimes involve very active or even frantic
movements, a state called catatonic excitement.
Subtypes of Schizophrenia
DSM recognizes several subtypes of schizophrenia which are based on the pattern of symptoms
that dominate the clinical presentation.
Paranoid schizophrenia: dominant symptom is delusions or auditory hallucinations with a single
theme. Apart from the delusion, the individual’s thinking may be relatively coherent, with no
disturbed affect, or psychomotor disturbances. Shows anger or anxiety related to the disturbing
content of the delusions.
Catatonic schizophrenia: dominant symptoms are psychomotor disturbances. These may
include catatonic stupor, catatonic excitement, or alternation between the two. There may be
stereotyped postures or mannerisms, together with waxy flexibility.
Disorganized schizophrenia: considered to be the most severe and disruptive of all types of
schizophrenia. Thought and speech are markedly incoherent, with very loose associations, and
disorganized behaviour. Shows flat or inappropriate affect, and any delusions present are
incoherent ad fragmentary. May be marked psychomotor disturbance, and profound social
Some cases of schizophrenia do not neatly fit into one of the established subtypes. Researchers
can disagree about the appropriate characteristics that define a specific subtype.
Undifferentiated schizophrenia is used to categorize cases which do not fit into any of the other
Causes of Schizophrenia
Thought to develop when there is a genetic predisposition for the disorder and some
environmental stress that triggers the symptoms (diathesis-stress hypothesis). Epidemeological evidence for genetic predisposition is very consistent. Ex.: probability that an individual will
develop the symptoms of schizophrenia increases the more closely he or she is related to
someone who has the disorder and identical twins are more likely than fraternal twins to both
Adoption studies: schizophrenia is more common in biological relatives of adoptees than in non-
related members from their adoptive families. Not clear what this inherited disposition is.
Some researchers believe that it is abnormalities in brain structure or changes in levels of
Not sure what environmental events trigger schizophrenic symptoms. Stress and problems,
with relationships with others, especially immediate family, are possible causes.
Evidence of higher levels of dysfunction in the families of schizophrenics, but it’s difficult to tell
whether it was there before the disorder appeared, or occurred as the family tried to deal with
the individual’s symptoms.
Treatments of Schizophrenia
For many years, the only ‘treatment’ for schizophrenic symptoms was chronic care. Left
untreated, it is among the most debilitating of all disorders.
1960’s: effective drug treatments became widely available. Now the most common therapy.
Drugs are not equally successful with all patients, or with all types of symptoms.
Most drugs that are effective against the symptoms have unpleasant side effects of their own.
Some patients would rather experience symptoms of schizophrenia than the side effects of the
drug which can affect compliance rates.
Psychotherapy alone does not help very much in treating the major symptoms of schizophrenia.
But may help the patient develop new coping strategies once drugs have relieved their
CBT, patient is taught how to think about the psychosis in ways that allows him to better cope.
Learn to identify and avoid triggers or learn positive ways to react to these triggers. Often used
to encourage patients to comply with medicinal instructions though rewarding adherence. CBT
also addresses environmental factors that may have triggered the illness and continue to
contribute to it.
Some studies show that many of the families of people with schizophrenia have environments
of conflict and stress that can act as a trigger for psychotic episodes, or make it harder for
patients to cope with their symptoms. Family therapy aims to teach families how to interact in
positive and supportive manner. Family therapy also helps to educate the family about
schizophrenia and teach them how to react to episodes and best support the patient.
Module 2 – Dissociative Disorders
Category of disorders that was historically confused with schizophrenia. Symptoms that distance the individual, either physically or psychologically, from anxiety-
producing events or memories.
Dissociative Identity Disorder