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Chapter 11


Course Code
Konstantine Zakzanis

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Chapter 11 ± Schizophrenia
schizophrenia ± a group of psychotic disorders characterized by major disturbances in thought, emotion,
and behavior; disordered thinking in which ideas are not logically related; faulty perception and attention;
interpersonal relations; the patient withdraws from people and reality, often into a fantasy life of delusions
and hallucinations
- estimates in the prevalence in the population vary between 0.2-2%, in part dependent upon the
measurement instrument; however, its lifetime prevalence is about 1%
- the incidence is significantly higher in males than in females (male:female ratio = 1:4)
- although schizophrenia sometimes begins in childhood, it usually appears in late adolescence or early
adulthood, somewhat earlier for men than for women
- people with schizophrenia typically have a number of acute episodes of their symptoms; between
episodes, they often have less severe but still very debilitating symptoms
- most people with schizophrenia are treated in the community, however, hospitalization is sometimes
- in Canada, hospitalization rates are typically much higher among young men relative to young women
- about 10% of people with schizophrenia commit suicide
- 50% of people with schizophrenia have comorbid disorders
Schizophrenia and Comorbidity
- comorbid conditions appear to play a role in the development, severity, and course of schizophrenia
- comorbid substance abuse is a major problem for patients with schizophrenia, occurring in as many as
70% of them
- research suggests that childhood conduct disorder problems are potent risk factors for substance use
disorders in schizophrenia
- WKHUHVFRPRUELGLW\EHtween schizophrenia and depression
- comorbid anxiety disorders are also common and can impose an additional burden on people with
schizophrenia and result in further decline in their perceived quality of life
- comorbidity with OCD is also related to a previous history of suicidal ideation and suicide attempts
- PTSD is highly prevalent and underdiagnosed among military veterans with schizophrenia
Clinical Symptoms of Schizophrenia
- the symptoms of patients with schizophrenia involve disturbances in several major areas: thought,
perception, and attention; motor behavior; affect or emotion; and life functioning
- no essential symptom must be present for a diagnosis of schizophrenia
Positive Symptoms
positive symptoms ± in schizophrenia, behavioral excess, such as hallucinations and bizarre behavior
- positive symptoms comprise excess or distortions, such as disorganized speech, hallucinations,
and delusions
- positive symptoms define an acute episode of schizophrenia
- positive symptoms are the presence of too much of a behavior that is not apparent in most people, while
the negative symptoms are the absence of a behavior that should be evident in most people

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Disorganized Speech
disorganized speech (thought disorder) ± speech found in schizophrenics that is marked by problems
in organization of ideas and in speaking so that others can understand
- this refers to problems in organizing ideas and speaking so that a listener can understand
incoherence ± in schizophrenia, an aspect of thought disorder wherein verbal expression is marked by
disconnectedness, fragmented thoughts, and jumbled phrases
- people with schizophrenia, although they may make repeated references to central ideas or a theme,
the images and fragments of thought are not connected; LWVGLIILFXOWWRXQGHUVWDQGH[DFWO\ZKDWWKH
patient is trying to tell the interviewer
loose associations (derailment) ± in schizophrenia, an aspect of thought disorder wherein the patient
has difficulty sticking to one topic and drifts off on a train of associations evoked by an idea from the past
- with loose associations (derailment), the patient may be more successful in communicating with a
listener but has difficulty sticking to one topic
- evidence indicates that the speech of many patients with schizophrenia is not disorganized and that the
such as some mood disorders
delusions ± beliefs contrary to reality, firmly held in spite of evidence to the contrary, common in
paranoid disorders
- delusions, which are common beliefs contrary to reality, are common positive symptoms of
- please see page 327-328 for examples of delusions
- although delusions are found among more than half of people with schizophrenia, as with speech
- the delusions of patients with schizophrenia are often more bizarre than those of patients in other
diagnostic categories; their delusions are highly implausible
Hallucinations and Other Disorders of Perception
- patients with schizophrenia often report that the world seems somehow different or even unreal to them
hallucinations ± perceptions in any sensory modality without relevant and adequate external stimuli
- the most dramatic distortions of perception are hallucinations, sensory experiences in the absence of
any stimulation from the environmentWKHUHPRUHRIWHQDXGLWRU\WKDQYLVXDO
- some hallucinations are thought to be particularly important diagnostically because they occur more
often in patients with schizophrenia than in other psychotic patients; these types of hallucinations include:
Æ some patients of schizophrenia report hearing their own thoughts spoken by another voice
Æ some patients claim that they hear voices arguing
Æ some patients hear voices commenting on their behavior
Negative Symptoms
negative symptoms ± behavioral deficits in schizophrenia, such as flat affect and apathy
- the negative symptoms of schizophrenia consist of behavioral deficits, such as avolition, alogia,
anhedonia, flat affect, and asociality
- these symptoms tend to endure beyond an acute episode and have profound effects on the lives of

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patients with schizophrenia
- the presence of many negative symptoms is a strong predictor of a poor quality of life (eg: occupational
impairment, few friends), 2 years following hospitalization
- in addition to prognosis, there is also some evidence that negative symptoms are associated with earlier
onset brain damage (eg: enlarged ventricles) and progressive loss of cognitive skills (eg: IQ decline)
schizophrenia and those that are due to some other factor; observing patients over extended periods of
probably the only way to address this issue
avolition ± a negative symptom in schizophrenia in which the individual lacks interest and drive
- apathy or avolition refers to a lack of energy and a seeming absence of interest in or an inability
to persist in what are usually routine activities
- for example, they may have difficulty persisting at work, school, or household chores and may spend
much of their time sitting around doing nothing
alogia ± a negative symptom in schizophrenia marked by poverty of speech and of speech content
- alogia can take several forms
- in poverty of speech, the sheer amount of speech is greatly reduced
- in poverty of content of speech, the amount of discourse is adequate, but it conveys little information
and tends to be vague and repetitive
anhedonia ± a negative symptom in schizophrenia in which the individual in unable to feel pleasure
- this is an inability to experience pleasure
- it is manifested as a lack of interest in recreational activities, failure to develop close relationships with
other people, and lack of interest in sex
- patients are aware of this symptoms and report that normally pleasurable activities are not enjoyable for
Flat Affect
flat affect ± a deviation in emotional response wherein virtually no emotion is expressed whatever the
stimuli, emotional expressiveness is blunted, or a lack of expression and muscle tone is noted in the face
- in patients with this, virtually no stimulus can elicit an emotional response
- the patient may stare vacantly, the muscles of the face flaccid, the eyes lifeless; when spoken to, the
patient answers in a flat and toneless voice
experience, which may not be impoverished at all
asociality ± a negative symptom of schizophrenia marked by an inability to form close relationships and
to feel intimacy
- patients with this have few friends, poor social skills, and little interest in being with other people
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