Schizophrenia
Nick Gruberg
Nature of Schizophrenia and Psychosis: An Overview! n
Schizophrenia vs. Psychosis! n
Psychosis – Cluster of disorders; hallucinations and/ or loss of contact with reality!
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Schizophrenia – A type of psychosis!
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Affects 1 in 100 persons, $65 Billion annually!
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Historical Background! n
Emil Kraeplin – 1896; Used the term dementia praecox, focused on onset and outcomes!
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Eugene Bleuler – 1911 he introduced the term schizophrenia or splitting of the mind !
Prevalence of Schizophrenia! n
Prevalence of 1% worldwide! n n n n
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2 × Alzheimer’s! 5 × Multiple Sclerosis! 6 × Insulin-dependent (Type I) Diabetes! 60 × Muscular Dystrophy!
Schizophrenia Is Generally Chronic! n
Moderate-to-severe lifelong impairment!
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Life expectancy is slightly less than average!
Equal Gender Distribution! n
Women - better long-term prognosis!
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Onset differs between men and women!
Gender differences in onset of schizophrenia in a sample of 470 patients
Howard et al., 1993
Diagnosis: DSM IV! n
Symptoms (2 or more):! n n n n n
Delusions (content)! Hallucinations! Disorganized speech (form)! Disorganized or catatonic behavior! Negative symptoms (flat affect etc.)!
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Social / Occupational Dysfunction!
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Duration: 6-months (1 month of symptoms)!
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Not caused by substances!
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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/ Incoherent hallucinations Content)
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! Active manifestations of abnormal behavior or distortions of normal behavior! n Delusions - 90%! n
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!
Some major language areas of the cerebral cortex
The Negative Symptom Cluster ! n
Absence or insufficiency of normal behavior!
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Spectrum of Negative Symptoms ! n
Avolition (or apathy) – Inability to initiate and persist in activities!
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Alogia – A relative absence of speech !
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Anhedonia – Inability to experience pleasure or engage in pleasurable activities!
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Flat affect – Show little expressed emotion, but may still feel emotion !
Disorganized Symptoms:! 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.! n
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)!
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Behavior ! n Disruption n Decline
in goal directed behavior!
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/ Incoherent hallucinations Content)
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
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Paranoid Type! n
Intact cognitive skills and affect, and do not show disorganized behavior!
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Hallucinations and delusions thematic (e.g., grandeur or persecution)!
Disorganized Type! n
Marked disruptions in speech, behavior, affect!
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Fragmented hallucinations and delusions!
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Develops early, tends to be chronic, lacks periods of remissions!
Subtypes (cont.)! n
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Catatonic Type! n
Unusual motor responses and odd mannerisms (e.g., echolalia, echopraxia)!
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? Need for consistency!
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Tends to be severe and quite rare!
Undifferentiated Type! n
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Symptoms, but don t meet criteria for another type!
Residual Type! n
One past episode of schizophrenia!
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Continue to display less extreme residual symptoms (e.g., odd beliefs)!
Problems with Diagnosis! “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] n
Heterogeneity of symptoms! n Symptoms
change as the disorder develops! n Schizophrenics ‘slip back into reality’!
Treatment response varies! n Is it a unitary disorder?! n Is it distinct from normal experience?! n
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
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Brief Psychotic Disorder! n
One or more positive symptoms of schizophrenia!
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Usually precipitated by extreme stress or trauma!
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Lasts < 1 month!
Shared Psychotic Disorder! n
Delusions from one person manifest in another person!
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Little is known about this condition!
Schizotypal Personality Disorder! n
May reflect a less severe form of schizophrenia!
