Chapter 11 – Schizophrenia
- Diagnosis for schizophrenia has existed for over a century and spawned more research than any other
- Schizophrenia is a psychotic disorder characterized by major disturbances in thought, emotion, and
behavior: disordered thinking in which ideas are not logically related, faulty perception and attention, flat
or inappropriate affect, and bizarre disturbances in motor activities.
- People with schizophrenia withdraw from other people and reality, often into a fantasy life of delusions
- 0.2%-2% prevalence in the general population; lifetime prevalence is 1%
- There may be real variation in schizophrenia across geographical regions around the world, Asian
populations having the lowest prevalence rates.
- Incidence is higher in males than in females.
- Can sometimes begin in childhood, but usually in late adolescence or early adulthood; somewhat earlier
for men than women.
- People with schizophrenia usually have a number of acute episodes of their symptoms and between
these episodes; they have less severe but still very debilitating symptoms.
- Usually treated in the community, but sometimes hospitalization is necessary.
- About 10% of schizophrenics commit suicide.
- The chronic disability can be attributed to symptoms inherent to schizophrenia, as well as the comorbid
disorder from which approximately 50% of those with schizophrenia suffer from.
- Early treatment adaptations in case of early non-remission are mandatory.
Schizophrenia and Comorbidity
- Comorbid conditions appear to play a role in the development, severity, and course of schizophrenia.
- Comorbid personality disorders are common and have implications for the course and clinical
management of schizophrenia, and treatment should include evaluation of co-occurring substance use
disorders & attention to associated mood & anxiety syndrome may be important for optimal outcomes.
- Comorbid substance abuse is a major problem for people with schizophrenia.
- In a study, 40% of the patients suffering from schizophrenia were also depressed relative to a non-
depressed group, were more likely to use relapse-related mental health services; to be a safety concern;
to have substance-related problems; and to report poorer life satisfaction, quality of life, mental
functioning, family relationships, and medication adherence.
- OCD and PTSD are also comorbid (PTSD for veterans with schizophrenia).
- Prospectively identified prodromal individuals (developing phase of schizophrenia) experience a wide
variety of comorbid psychiatric syndromes, especially MDD and cannabis dependence; cannabis use may
be causal in terms of subsequent psychotic symptoms.
Clinical Symptoms of Schizophrenia (353)
- Symptoms involve disturbances in several major areas: thought, perception, and attention; motor
behavior; affect or emotion; and life functioning.
- Schizophrenia is a very heterogeneous disorder, more so than many other disorders.
- Two main categories of symptoms: Positive and negative. There are also symptoms that do not fit neatly
into these two categories.
Positive Symptoms (353)
- Comprise excess or distortio