Schizophrenia – I

What is schizophrenia

a severe mental disorder characterized by disturbances in thought, perception, and behaviour. Symptoms may include delusions, hallucinations, and impaired functioning.

What are the 4 clusters of clinical symptoms of schizophrenia

• Positive symptoms

• negative symptoms,

• Cognitive symptoms,

• affective/mood symptoms

Explain the two main psychotic phenomena of positive schizophrenia symptoms

1. Hallucinations

2. Delusions

• Seen in acute phase of the illness

• Tend to respond well to treatment

Explain in detail hallucination phenomena of positive schizophrenia symptoms

Distortion in perception

• Sensory perception in the absence of a sensory stimulus

• Can occur in any of the 5 sensory modalities – auditory, visual, somatic, olfactory and gustatory

• Most common type in psychosis: auditory hallucination

• Examples:

  • Hearing voices from outside one’s head (even when the patient is alone)

  • Talking about the patient (3rd person’s voices)

  • Talking directly to the patient (2nd person’s voices)

Explain in detail delusion phenomena of positive schizophrenia symptoms

• Distortion in thought content

• Systematic, false, fixed belief held by the patient with absolute conviction, despite evidence to the contrary

• Types: persecutory (most common in schizophrenia), reference, grandiose, erotomanic, somatic, thought insertion/withdrawal/control/broadcasting

• Examples:

  • “My neighbour is trying to poison me”

  • “My movements are being monitored by cameras, wherever I go”

  • “I am immortal”

  • “I am the richest man in the world”

What other positive symptoms refer to schizophrenia

• Disorganised thinking and speech

  • Characterised by frequent derailment or loose associations, invented words, tangential, incomprehensible speech

• Grossly disorganised behaviour

  • Range from childlike silliness to unpredictable agitation – impairs tasks of daily living

  • Catatonic motor behaviour: decrease in reactivity to environmental events, to such an extreme that patients can maintain a rigid posture and resist effort to be moved

What are the negative symptoms referring to schizophrenia

Reflect a decrease, deficit or loss of normal functions

Considered to be restricted affect, avolition, anhedonia, and asociality

• Manifestations include:

  • Social withdrawal and isolation

  • Dull or emotional blunting

  • Poverty of speech

  • Autism

▪ Seen in chronic phase of the illness

▪ Tend not to respond well to treatment

▪ Relate to long-term disability

What are the affective/mood symptoms referring to schizophrenia

• Depression

• Anxiety

To be distinguished from negative symptoms

▪ Related to suicide

▪ Treatable

What are the 7 core domains of cognition

• Working memory

• Attention/vigilance

• Reasoning and problem-solving

• Processing speed

• Visual learning and memory

• Verbal learning and memory

• Social cognition

What are the two diagnostic criteria of schizophrenia

• DSM-V

• ICD-10-CM

what are endophenotypes

Endophenotypes in schizophrenia are measurable traits that connect genetic factors to the symptoms of the disorder. They are invisible signs of the condition that can be tested and may appear in both patients and their relatives.

Examples include impaired working memory, abnormal eye movement, and reduced attention—these traits are linked to the genetic causes of schizophrenia but are not direct symptoms like hallucinations or delusions.

What are some criteria for endophenotypes

1. An endophenotype is associated with illness in the population

2. An endophenotype is heritable

3. An endophenotype is state-independent (manifest whether illness is active or in remission) but age-normed and might need to be elicited by a challenge

4. Within families, endophenotype and illness co-segregate

5. An endophenotype identified in probands is found in their unaffected relative at a higher rate than in the general population

6. An endophenotype should be a trait that can be measured reliably, and ideally is more strongly associated with the illness of interest than with other psychiatric conditions