Schizophrenia and Other Psychotic Disorders
- the most severe that we will be talking about
- psychotic disorder
Introduction to Schizophrenia
- Psychotic disorder- form of psychosis, a clear break with reality- hallucinations- hearing voices and
delusions – false beliefs.
- Most severely debilitating of mental disorders
- Most patients unable to care for themselves
- 10% - 20% of homeless people
o live at home 40-60% , others are institutionalized, halfway homes
- Begins early in life (age 16-25)
- Long-term disability
- Suicide rates 8% - 10%
- 1 % of population will develop schiz, but when you stop and think about it its quite a lot.
- 2x as common as Alzheimer’s, 5x MS—we hear about all these diseases through media and publicity
and fundraisers- but schizophrenia is a serious debilitating illness.
- Cystic fibrosis (Shinerama) – (300x schizophrenia)--- its so rare
- 300,000 Canadians - 1 / 12 hospital beds
o Huge health care and social costs
o Estimated $4 billion annually in Canada
o A major worldwide health problem.
A Brief History
- Apparently rare before 1800
o Increased urbanization, industrialization?
Industrial revolution, world changing
o It seems as if it didn’t exist a couple hundred years ago and its not in literature from history
o Puzzling, we don’t know for sure if it was there all along just no one ever noticed it or wrote
Emil Kraepelin- first late 1800 to identify that schizophrenia as a unique disorder
o “Dementia praecox”*** on exam (―early onset senility‖)- name he gave to schizophrenia
o Saw it as an organic condition
o Believed prognosis is extremely poor
o Deterioration of the brain, purely biologically cause, prognosis is bad and they get worse and
o Coined the term ―schizophrenia‖ (―split mind‖)—this led to the misconception that it refers to
o Disordered thinking processes
o Biology-environment interaction
o Believed recovery is possible
o On-going debate- is purely biological disease of the brain? Or an interaction between psych. And
bio. Symptoms of Schizophrenia- not everybody will have all these symptoms/different combinations
1) Disordered Thought Process (disorganized speech)
- Processes of thinking and processes information
Incoherence really hard to understand them
―Word salad‖gibberish, words, but don’t make sense
Neologisms** exam word that a person makes up. – Cosmos blue
Loose associations word associations- jumps from one thought to another
Poverty of speech alogia- lack of words, almost mute
Perseveration person gets stuck on one line of thinking and cant shift to another thought- keep
coming back to that same topic
Thought blocking suddenly their thoughts disappear from mind.
2) Disordered Thought Content
- Content of thoughts
- A beautiful mind****- they can be talented and creative, he was really brilliant, student at Harvard he
developed schiz. And it shows the development. BUT no accurate that they portray his hallucinations as visual
Ideas of reference how they often think of things are irrelevant but very significant to them. Ex. If
an airplane is flying over her. She believes that they are spies and looking for her.
Delusions false beliefs absolutely convinced that an elaborate story is reality.
Grandeur (think they’re important)
Control (being controlled by other forces outside the skull, someone is controlling or
planting thoughts in mind)
Persecution (people are out to get them)
Somatic (false beliefs about the body, a delusion that all of their insides have rotted away
and they don’t have any organs left in their body)
Thought insertion someone can hear what you’re thinking
Thought broadcasting someone is broadcasting their thoughts
Thought withdrawal they create these delusions to account for all these strange things happening
3) Disordered Perception
- Hallucinations (most commonly auditory) hear voices, or someone talking to them or multiple voices
talking to each other.
4) Attentional Deficits
- Common, text says that it’s seen as the central deficit in schiz. It’s the core abnormality and a breakdown of
- We are constantly being bombarded with things around us and our own thoughts are consistently going out so
we need to filter out what is important and what is not.
Breakdown of selective filter- they are not able to filter out irrelevant stimuli—as a result:
Associative intrusions—loose associations can be explained by the inability to filter out the
5) Disordered Motor Activity
Disorganized behaviour- on the move, out of control, sometimes violent
Catatonic immobility – ―waxy flexibility‖. - Still, not moving, immobile, curl up in a fetal position,
or evens standing up and do posturing- stand in a pose for a long period of time
- This is just a way of control all these excessive input. So if you want to block it out by withdrawing
completely and becoming immobile. 6) Disordered Affect (Mood)
Flat or blunted affect – anhedonia a loss of pleasure, emotionally blunted- not positive or negative,
don’t get happy or sad about things
Inappropriate, silly affect person will show a lot of emotion- starts laughing when it’s supposed to
be sad. Inappropriate emotion
7) Impairment of Functioning- requirement for diagnosis
Social skills, occupational and social functioning don’t know how to relate to people. Socially
Schizoid withdrawal isolation – social withdrawal from other people.
Positive vs. Negative Symptoms- been discovered in recent years all these symptoms can be
distinguish in two broad groups
Positive symptoms- it means that they are an excess of behavior.
- Behavioral excesses or distortions
o E.g., hallucinations, delusions, disorganized speech, disorganized behavior
Respond to antipsychotic medications
- Behavioral deficits
o E.g., poverty of speech (alogia), flat affect, social withdrawal, anhedonia, lack of motivation
(avolition- lack of motivation)
o Less response to antipsychotic meds can make symptoms worse
DSM-IV Diagnosis of Schizophrenia
- Prodromal – clear deterioration of functioning- couple months, gradually becomes socially withdrawn,
weird thinking. Couple of months
- Active phase involves 2 or more symptoms: - full blown psychosis--- 6-7 months
o At least one month of an active phase.
o Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior,
o However, you can have diagnosis with Only 1 symptom if: (1) bizarre delusion, or (2) auditory
hallucination of voice keeping running commentary, or (3) two or more voices conversing
- Residual – attenuated symptoms following active phase
o Symptoms subsides, but still thinking strangely, negative symptoms, anhedonia
Non-bizarre delusions- it can be possible in reality that it could happen
Bizarre- aliens from out of space and removing your organs, could not possibly be true