Schizophrenia Spectrum and Other Psychotic Disorders

Eugene Bleuler

a Swiss psychiatrist who introduced the term “Schizophrenia”

shkizein, phren

It comes from the combination of the Greek word: ___ means split, and ___ means mind

Schizophrenia

a severe and chronic mental disorder characterized by broad spectrum of cognitive and emotional dysfunctions including: hallucinations, delusions, disorganized speech & behavior, and inappropriate emotions.

Positive symptoms

those abnormally present. Hallucinations, such as hearing voices or seeing things that do not exist, paranoia and exaggerated or distorted perceptions, beliefs and behaviors.

Negative symptoms

(those abnormally absent) A loss or a decrease in the ability to initiate plans, speak, express emotion or find pleasure

Disorganized symptoms

Confused and disordered thinking and speech, trouble with logical thinking and sometimes bizarre behavior or abnormal movements

Persecutory delusions

(i.e., belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group) are most common

Referential delusions

(i.e., belief that certain gestures, comments, environmental cues, and so forth are directed at oneself) are also common

Grandiose delusions

(i.e., when an individual believes that he or she has exceptional abilities, wealth, or fame).

Erotomanic delusions

(i.e., when an individual believes falsely that another person is in love with him or her) are also seen.

Nihilistic delusions

involve the conviction that a major catastrophe will occur

Somatic delusions

focus on preoccupations regarding health and organ function.

Auditory hallucinations

are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual's own thoughts. The hallucinations must occur in the context of a clear sensorium; those that occur while falling asleep (hypnagogic) or waking up (hypnopompic) are considered to be within the range of normal experience

Visual hallucinations

seeing things that are not there or that other people cannot see.

Tactile hallucinations

feeling things that other people don’t feel or something touching your skin that isn’t there

Olfactory hallucinations

smelling things that other people cannot smell, or not smelling the same thing that other people do smell.

Diminished emotional expression and avolition

Two negative symptoms are particularly prominent in schizophrenia:

Diminished emotional expression

includes reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normally give an emotional emphasis to speech.

Avolition

is a decrease in motivated selfinitiated purposeful activities. The individual may sit for long periods of time and show little interest in participating in work or social activities

Alogia

is manifested by diminished speech output

Anhedonia

is the decreased ability to experience pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced

Asociality

refers to the apparent lack of interest in social interactions and may be associated with avolition, but it can also be a manifestation of limited opportunities for social interactions

Disorganized thinking (formal thought disorder)

is typically inferred from the individual's speech.

Tangentiality

Answers to questions may be obliquely related or completely unrelated

Incoherence or word salad

Rarely, speech may be so severely disorganized that it is nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization

Grossly Disorganized or Abnormal Motor Behavior

may manifest itself in a variety of ways, ranging from childlike "silliness" to unpredictable agitation. Problems may be noted in any form of goal-directed behavior, leading to difficulties in performing activities of daily living

Catatonic behavior

is a marked decrease in reactivity to the environment. This ranges from resistance to instructions {negativism); to maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verbal and motor responses {mutism and stupor). It can also include purposeless and excessive motor activity without obvious cause {catatonic excitement

at least 6 months

Continuous signs of the disturbance persist for ______ months. This _-month period must include at least 1 month of symptoms

Delusional Disorder

Major feature: a persistent belief that is contrary to reality, in the absences of other characteristics of schizophrenia.

1 month or longer

Delusional Disorder: Criterion A: The presence of one (or more) delusions with a duration of ______

Brief Psychotic Disorder

Characterized by one or more positive symptoms, or disorganized speech or behavior. (No negative symptoms)

at least 1 day but less than one month

Criterion B in Brief Psychotic Disorder: Duration of an episode of the disturbance is at __________, with eventual full return to premorbid level of functioning

Schizophreniform Disorder

Experience the symptoms of schizophrenia and usually resume to normal lives

at least 1 month but less than 6 months

Criterion B: Schizophreniform Disorder - An episode of the disorder lasts _______. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”

Schizoaffective Disorder

Historically, people who had symptoms of schizophrenia and who exhibited the characteristics of mood disorders were lumped in the category of schizophrenia.

2 or more weeks

Delusions or hallucinations for_____ in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness

Substance/Medication-Induced Psychotic Disorder

• Presence delusion or hallucination or both.

• Symptoms developed during or soon after intoxication, medication, or withdrawal.

• Substance/medication produce the symptoms

Psychotic Disorder Associated with Another Medical Condition

• Prominent hallucination and delusions.

• Has evidence that the disturbance is the direct pathophysiological consequence of another medical condition.

Genetic Component, Chemical Action, Abnormalities in the Working of the Brain, Environmental Risk Factors

Causes of Schizophrenia