Nature of Schizophrenia and Psychosis: An Overview!
n Schizophrenia vs. Psychosis!n Psychosis – Cluster of disorders; hallucinations and/
or loss of contact with reality!n Schizophrenia – A type of psychosis!
n Affects 1 in 100 persons, $65 Billion annually!n Historical Background!
n Emil Kraeplin – 1896; Used the term dementia praecox, focused on onset and outcomes!
n Eugene Bleuler – 1911 he introduced the term “schizophrenia” or “splitting of the mind” !
Prevalence of Schizophrenia!n Prevalence of 1% worldwide!
n 2 × Alzheimer’s!n 5 × Multiple Sclerosis!n 6 × Insulin-dependent (Type I) Diabetes!n 60 × Muscular Dystrophy!
n Schizophrenia Is Generally Chronic!n Moderate-to-severe lifelong impairment!n Life expectancy is slightly less than average!
n Equal Gender Distribution!n Women - better long-term prognosis!n Onset differs between men and women!
Diagnosis: DSM IV!n Symptoms (2 or more):!
n Delusions (content)!n Hallucinations!n Disorganized speech (form)!n Disorganized or catatonic behavior!n Negative symptoms (flat affect etc.)!
n Social / Occupational Dysfunction!
n Duration: 6-months (1 month of symptoms)!
n Not caused by substances!
n Not Schizoaffective/Mood Disorder!
Symptoms of Schizophrenia!Positive (Type 1)
Negative (Type II)
Disorganized
Thematic Delusions Avolition (apathy) Grossly Bizarre Behavior
Thematic Hallucinations Alogia (Poverty of Speech/Content)
Incoherent hallucinations or delusions
Bizarre Behavior Anhedonia Disorganized Affect
“Good” intellect Flat Affect Disorganized Speech
Asociality
Better Prognosis Poor Prognosis Poor Prognosis
Lenzenweger, Dworkin & Wethington (1991)
The “Positive” Symptoms!n Active manifestations of abnormal
behavior or distortions of normal behavior!
n Delusions - 90%!n Somatic: “Snake living inside my
abdomen” !n Grandeur: “Chosen by God”!n Persecution: “ ‘They’ are monitoring
me”!n Manifestations: Thought broadcasting,
ideas of reference, thought withdrawal!
The “Positive” Symptom Cluster !
n Hallucinations!n Sensory events without environmental
input!n Auditory are the most common (can be
any sensory modality)!n Speech vs. auditory processing studies!
The “Negative” Symptom Cluster !
n Absence or insufficiency of normal behavior!n Spectrum of Negative Symptoms !
n Avolition (or apathy) – Inability to initiate and persist in activities!
n Alogia – A relative absence of speech !
n Anhedonia – Inability to experience pleasure or engage in pleasurable activities!
n Flat affect – Show little expressed emotion, but may still feel emotion !
“Disorganized” Symptoms:!
n Severe and excess disruptions in:!n Speech !Therapist: I was sorry to hear that your uncle Bill
died a few years ago. How are you feeling about him these days?”!
David: Yes, he died. He was sick, and now he’s gone. He likes to fish with me, down at the river. He’s going to take me hunting. I have guns. I can shoot you and you’d be dead in a minute.!
“Disorganized” Symptoms"Speech!
n Cognitive slippage – Illogical and incoherent speech!
n Tangentiality – “Going off on a tangent” and not answering a question directly !
n Loose associations or derailment – Taking conversation in unrelated directions!
n ??!
“Disorganized” Symptoms!n Affect!
n Inappropriate affect (e.g., crying when one should be laughing)!
n Behavior !n Disruption in goal directed behavior!n Decline in routine daily functioning!n Catatonia – Spectrum from wild agitation,
waxy flexibility, to complete immobility !
Symptoms of Schizophrenia!Positive (Type 1)
Negative (Type II)
Disorganized
Thematic Delusions Avolition (apathy) Grossly Bizarre Behavior
Thematic Hallucinations Alogia (Poverty of Speech/Content)
Incoherent hallucinations or delusions
Bizarre Behavior Anhedonia Disorganized Affect
“Good” intellect Flat Affect Disorganized Speech
Asociality
Better Prognosis Poor Prognosis Poor Prognosis
Lenzenweger, Dworkin & Wethington (1991)
Subtypes of Schizophrenia!n Paranoid Type!
n Intact cognitive skills and affect, and do not show disorganized behavior!
n Hallucinations and delusions thematic (e.g., grandeur or persecution)!
n Disorganized Type!n Marked disruptions in speech, behavior, affect!n Fragmented hallucinations and delusions!n Develops early, tends to be chronic, lacks periods of
remissions!
Subtypes (cont.)!n Catatonic Type!
n Unusual motor responses and odd mannerisms (e.g., echolalia, echopraxia)!
n ? Need for consistency!n Tends to be severe and quite rare!
n Undifferentiated Type!n Symptoms, but don’t meet criteria for another type!
n Residual Type!n One past episode of schizophrenia!n Continue to display less extreme residual symptoms
(e.g., odd beliefs)!
Problems with Diagnosis!
n Heterogeneity of symptoms!n Symptoms change as the disorder develops!n Schizophrenics ‘slip back into reality’!
n Treatment response varies!n Is it a unitary disorder?!n Is it distinct from normal experience?!
“Schizophrenia appears to be a disorder with no particular symptoms, no particular course, no particular outcome and which responds to no
particular treatment” [Bentall, 1990]
Other Psychotic Disorders!n Schizophreniform Disorder!
n Schizophrenic symptoms for less than 6 months!
n Associated with good premorbid functioning; most resume normal lives!
n Schizoaffective Disorder!n Symptoms of schizophrenia and a mood
disorder!n 10-year outcome better than Schizophrenia
(Harrow et al., 2000)!
Other Psychotic Disorders!n Delusional Disorder!
n Delusions without other major schizophrenia symptoms!
n May show other negative symptoms!n Type of delusions include erotomanic,
grandiose, jealous, persecutory, and somatic!n This condition is extremely rare!
Additional Disorders with Psychotic Features!
n Brief Psychotic Disorder!n One or more positive symptoms of schizophrenia!n Usually precipitated by extreme stress or trauma!n Lasts < 1 month!
n Shared Psychotic Disorder!n Delusions from one person manifest in another
person!n Little is known about this condition!
n Schizotypal Personality Disorder!n May reflect a less severe form of schizophrenia!