PSY240 Lecture 5 June 4: Schizophrenia & Psychotic Disorders (Chapter 11)
In Canada, 0.5-2% of the population has been diagnosed with a schizophrenia-spectrum disorder
Age of onset: Males late teens or early 20s
Women late 20s, early 30s
Is it more common in men than women? Some say there are differences in the way gender
progresses in different genders.
o Some say women have better premorbid functioning possibly due to later age of onset,
and so they show fewer cognitive deficits than men.
Schizophrenia may be relatively culture free, however, in that worldwide prevalence appears to
be uniformly around 1%
It has become one of the most stigmatized psychological disorders, and people have become
experts at hiding away loved ones with this disorder
Diagram of where schizophrenic individuals may be living
E. Fuller Torrey has become advocate of familiar support for individuals with schizophrenia. He
promotes having SAFE attitude: sense of humour, acceptance of illness, family balance,
expectations that are realistic.
Schizophrenia: a psychotic disorder
The most striking characteristic of schizophrenia is psychosis: the inability to tell difference
between what is real and what is unreal
Psychosis may manifest in many different ways; common feature is a break from reality
Hallucinations and delusions
DSM recognizes a number of psychotic disorders other than schizophrenia (e.g., delusional
disorder, brief psychotic disorder)
Schizophrenia exacts heavy costs: more than 90% of people with schizophrenia seek treatment
in mental health/general facility in any given year
Most people develop schizophrenia in late teens, early adult years
o The disorder strikes, preventing them to contributing their unique talents to society.
People with schizophrenia may need continual services, and need them for the rest of
Positive vs. negative symptoms
Positive symptom: excess or distortion in normal repertoire of behaviour (these are things like
Negative symptoms: absence or deficit of behaviours normally present
Positive or Type I Symptoms
Delusions (these are strongly held beliefs)
Hallucinations (auditory, visual, tactile, or somatic)
Disorganized thought and speech (e.g. word salad)
Disorganized or catatonic behaviour (e.g., disheveled appearance, inappropriate clothing,
agitated, repetitive behaviours)
42 1. Delusions: ideas than individual believes are true, but are highly unlikely and often impossible.
Self-deceptions different from delusions: they are not completely implausible (delusions often are);
people harbouring self-deceptions may think about these beliefs occasionally (people with delusions
tend to be preoccupied with them and try to look for evidence to support them); people holding self-
deceptions typically acknowledge that their beliefs may be wrong (people with delusions are highly
resistant to arguments/compelling facts).
Persecutory being watched, conspired against by others. This is most common/
Reference random events directed at oneself (e.g. newspaper articles interpreted to be about
them). Sometimes reference delusions are part of grandiose belief system in which all events are
meaningful to believer.
Grandiose one has great powers/abilities, or famous
Being controlled thoughts/feelings/behaviour controlled by external force
Thought broadcasting thoughts being broadcast so others can hear
Thought insertion person or object inserting thoughts into ones head
Thought withdrawal thoughts being removed from ones head
Guilt or sin one has committed terrible act, responsible for terrible event
Somatic ones appearance or part of body is diseased or altered
Unreal perceptual experiences
o Auditory hear things others cant hear (this is the most common hallucination, and can
take form of someone/group of people talking to individual, etc.)
o Visual see things others cant see while awake, often accompanied by auditory
o Tactile feel things outside body (e.g. bugs crawling on ones back)
o Somatic feel things inside body
3. Disorganized thought and speech
Formal thought disorder: disorganized thinking of people with schizophrenia
Loose associations/derailment move from one topic to an unrelated one with little coherent
Word salad speech so disorganized, incoherent to listener
Neologisms made up words that only make sense to speaker
Clangs associations between words made up based on sound. E.g. Dog is Spog
Perseverations repeating some word or saying over and over again
People with schizophrenia show deficits in smooth pursuit eye movement: when they are
asked to keep their head still and track a movement, they have greater difficult doing this than
people without schizophrenia.
They also show deficits in working memory making it difficult for them to suppress
unwanted/irrelevant information or to pay attention to relevant information
4. Disorganized or catatonic behaviour
Behaviour that is highly predictable, bizarre or shows complete lack of responsiveness for long
periods of time
Catatonia complete lack of responsiveness to outside world
o Untriggered agitation (shouting, swearing, pacing)
o Disheveled and dirt inappropriately dressed for weather
o Holding strange poses for hours;
o Catatonic excitement wild agitation, no response, difficult to subdue, may be infused
with angry outbursts; may reveal nature of hallucinations/delusions
43Negative or type II symptoms (deficits in behaviour)
* People with negative symptoms are have lower educational attainments, less success in holding
jobs, poorer performance on cognitive tasks, poorer prognosis, less responsive to medication.
1. Affective flattening (or blunted affect) severe reduction or complete absence of affective
(emotional) responses to the environment (doesnt mean they dont feel just lack of expression
of the emotions). Persons face may remain immobile, body language may be unresponsive to
what is occurring in environment, may speak in monotone.
2. Alogia severe reduction or absence of speech. May not initiate speech with others, when asked
questions may only give brief, empty replies. This presumably reflects lack of thinking or might
reflect lack of motivation to speak.
3. Avolition inability to persist at common, goal-oriented tasks. Person has trouble completing
tasks, is disorganized and careless, apparently completely unmotivated.
Other symptoms of schizophrenia
Inappropriate affect laughing at sad things, crying at happy things
Anhedonia loss of interest in and across all realms of life. They lose ability to experience
emotion, no matter what happens dont feel happy or sad. This emotional void itself can be
Impaired social skills more often caused by negative symptoms. Difficultly maintaining
relationships, holding conversation, holding job. The difficulties in social skills may be due
more to negative symptoms than positive symptoms.
Small genetic component: if parents have schizophrenia, you have 10% chance of havi