46-355 Lecture Notes - Brief Psychotic Disorder, Thought Disorder, Delusional Disorder
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SCHIZOPRHENIA - 1
A. Early description/diagnosis of schizophrenia
1. Emil Kraepelin:
a. Combined catatonic (i.e., alternating immobility and excited
agitation), hebephrenia (i.e., silly and immature emotionality),
and paranoia (i.e., delusions of grandeur and persecution) and
labeled them as falling under the heading dementia praecox.
b. Distinguished dementia praecox from manic-depressive illness
by emphasizing onset and outcome. (Schiz. Onset early, poor
2. Eugen Bleuler, a Swiss psychiatrist
a. First to introduce the term schizophrenia; a term derived from
the Greek words for split (skhizen) and mind (phren).
b. Bleuler believed that the core of schizophrenia rests in an
associative splitting of basic personality functions. This concept
emphasized the following:
i. "Breaking of associative threads," or the breakdown of
forces that connect one function to the next.
ii. Bleuler also believed that an inability to keep a constant
train of thought was the cause of all schizophrenic
B. Schizophrenic symptoms are heterogeneous--number of symptoms and
behaviors that are not shared by all persons with the diagnosis.
II. Clinical Description, Symptoms, and Subtypes
A. The term psychotic refers to either delusions or hallucinations.
B. Positive symptoms:
1. Delusions refer to a belief that would be seen by most members of
society as a misrepresentation of reality; often referred to as a
disorder of thought content. Delusions often are called the basic
characteristic of madness. Some research suggests that delusions give
some patients a sense of meaning and purpose in life and result in less
depression. Thus, delusions may serve an adaptive function. Types of
a. Delusions of grandeur, or the belief that one is particularly
famous or important.
b. Delusions of persecution, or the belief that other people are
out to get or harm the person.
c. More unusual delusions include Capgras syndrome, or the
belief that someone a person knows has been replaced by a
double, and Cotard’s syndrome, where the person believes
that a part of the body (e.g., brain) has changed in some
SCHIZOPRHENIA - 2
2. Hallucinations can involve any of the senses; though auditory
hallucinations are most common in persons with schizophrenia.
a. Single photon emission tomography (SPECT) has been used
to study cerebral blood flow in schizophrenic patients during
their auditory hallucinations. The part of the brain most active
during auditory hallucinations is Broca’s area (i.e., the area
involved in speech production), not Wernicke's area (i.e., the
area involved in understanding and language comprehension).
This research supports the idea that auditory hallucinations do
not involve hearing voices of others, but rather listening to one’s
own thoughts or voices, and a failure to recognize the difference.
1. Avolition (inc. show little interest in performing even the most basic
daily functions, such as personal hygiene)
2. Alogia (inc. brief replies to questions with little content, delayed
comments or slowed responses to questions, or as disinterest in
4. Affective flattening, or flat affect (inc. little change in facial
expression, but not the experience of appropriate emotions)
D. Disorganized symptoms:
1. Disorganized speech:
a. Cognitive slippage often manifests as illogical and incoherent
speech where the person jumps from one topic to the next.
b. Tangentiality manifests as "going off on a tangent" rather than
answering a question directly.
c. Loose associations or derailment
2. Other disorganized symptoms:
a. Inappropriate affect
b. Disorganized behavior (e.g., hoarding objects or acting in
unusual ways in public). Including:
i. Catatonia (inc. catatonic immobility and/or waxy
SCHIZOPRHENIA - 3
E. Schizophrenia subtypes
1. Paranoid type
relatively intact cognitive skills and affect
do not generally show disorganized speech or flat affect
associated with the best prognosis.
a. Delusions and hallucinations usually have a theme of grandeur
b. DSM-IV-TR criteria specify a preoccupation with one or more
delusions or auditory hallucinations but without marked display
of disorganized speech, disorganized or catatonic behavior, or
flat or inappropriate affect.
2. Disorganized type (hebephrenia)
marked disruptions in their speech and behavior, including flat or
inappropriate affect, and self-absorption
If hallucinations or delusions are present, they tend to be organized
around a theme, but are quite fragmented.
typically show problems early and their problems tend to be chronic,
lacking periods of remissions that characterize other forms of this
3. Catatonic type
unusual motor responses and odd mannerisms.
often show echolalia (i.e., repeating or mimicking the words of
echopraxia (i.e., imitating the movements of others).
This subtype is relatively rare.
4. Undifferentiated type do not neatly fit into any of the other subtypes
and include people with major symptoms of schizophrenia but who do
not meet criteria for paranoid, disorganized, or catatonic types.
5. Residual type have had at least one episode of schizophrenia but are
no longer displaying the major symptoms.
Often display residual symptoms, such as negative beliefs, unusual or
bizarre ideas, social withdrawal, inactivity, and/or flat affect.
Onset early, poor prognosis. : eugen bleuler, a swiss psychiatrist. First to introduce the term schizophrenia; a term derived from the greek words for split (skhizen) and mind (phren): bleuler believed that the core of schizophrenia rests in an associative splitting of basic personality functions. Delusions often are called the basic characteristic of madness. Some research suggests that delusions give some patients a sense of meaning and purpose in life and result in less depression. The part of the brain most active during auditory hallucinations is broca"s area (i. e. , the area involved in speech production), not wernicke"s area (i. e. , the area involved in understanding and language comprehension). Inappropriate affect: disorganized behavior (e. g. , hoarding objects or acting in unusual ways in public). Including: catatonia (inc. catatonic immobility and/or waxy flexibility). Often display residual symptoms, such as negative beliefs, unusual or bizarre ideas, social withdrawal, inactivity, and/or flat affect.