Schizophrenia Spectrum and Psychotic Disorders Overview

Schizophrenia

A severe and chronic mental disorder characterized by disturbances in thought, perception, and behavior, including delusions, hallucinations, and disorganized speech.

Psychosis

A loss of contact with reality that may include delusions and hallucinations.

Delusions

Fixed, false beliefs not grounded in reality or cultural norms.

Hallucinations

Perceptions without external stimuli, most commonly auditory.

Disorganized Thinking

Speech that is tangential, incoherent, or illogical.

Grossly Disorganized Behavior

Unpredictable agitation or childlike silliness.

Negative Symptoms

Symptoms such as diminished emotional expression, avolition, or alogia.

Alogia

Poverty of speech reflecting decreased thought productivity.

Anhedonia

Reduced ability to experience pleasure.

Asociality

Lack of interest in social interactions.

Affective Flattening

Limited range of emotional expression.

Catatonia

Marked decrease in reactivity to environment, which may include stupor or excessive motor activity.

Anosognosia

Lack of insight into one's illness.

Schizoaffective Disorder

A mood disorder concurrent with schizophrenia symptoms and psychosis lasting 2+ weeks without mood symptoms.

Brief Psychotic Disorder

Sudden onset of psychotic symptoms lasting more than a day but less than a month.

Delusional Disorder

Presence of one or more delusions for at least one month without other major schizophrenia symptoms.

Schizophreniform Disorder

Same symptoms as schizophrenia, but duration is less than 6 months.

Substance/Medication-Induced Psychotic Disorder

Psychotic symptoms caused by intoxication, withdrawal, or exposure to a substance.

Schizotypal Personality Disorder

Characterized by social deficits and perceptual distortions, often considered part of the schizophrenia spectrum.

Etiology of Schizophrenia

Includes genetic predisposition, neurotransmitter abnormalities, and structural brain differences.

Dopamine Hypothesis

Theory that schizophrenia symptoms are related to overactivity of dopamine in certain brain areas.

Glutamate Hypothesis

Impaired glutamate activity may contribute to symptoms.

Neuroanatomy in Schizophrenia

Includes enlarged ventricles and reduced gray matter in prefrontal and temporal areas.

Onset of Schizophrenia

Typically occurs in late teens to early 30s, often earlier in males.

Premorbid Phase

Stage before illness with subtle social and cognitive deficits.

Prodromal Phase

Gradual appearance of symptoms prior to acute episode.

Active Phase

Period during which characteristic symptoms are present.

Residual Phase

Symptoms decrease but functional impairments remain.

Positive Symptoms

Excesses or distortions such as hallucinations or delusions.

DSM-5 Criteria for Schizophrenia

Two or more symptoms for at least 1 month, including delusions, hallucinations, or disorganized speech; continuous signs for 6 months.

Functional Impact of Schizophrenia

Disruption in self-care, relationships, work, and independent living.

Cognitive Impairments

Affect attention, memory, and executive functioning.

Social Cognition Deficits

Difficulty recognizing emotions, sarcasm, and social cues.

Typical Antipsychotics

Older medications (e.g., haloperidol) that block dopamine receptors.

Atypical Antipsychotics

Newer medications (e.g., risperidone) affecting multiple neurotransmitters.

Side Effects of Antipsychotics

May include weight gain, sedation, extrapyramidal symptoms.

Tardive Dyskinesia

Involuntary movements caused by long-term antipsychotic use.

Psychosocial Treatment

Includes CBT, social skills training, supported employment.

Cognitive Remediation

Therapies targeting cognitive deficits.

Assertive Community Treatment

Team-based, intensive support in the community.

Family Psychoeducation

Involves educating family members to support recovery.

Supported Employment

Helping individuals with schizophrenia obtain and maintain work.

Recovery Model

Focus on empowerment, self-direction, and quality of life.

Comorbid Conditions

Commonly includes substance abuse, depression, and anxiety.

Hospitalization

Often required during acute episodes for stabilization.

Relapse Prevention

Involves medication adherence and psychosocial support.

Stigma

Negative societal attitudes affecting diagnosis and treatment.

Early Intervention

Reduces long-term disability through early treatment.

Long-Term Prognosis

Variable; some recover fully, others experience chronic symptoms.

Suicide Risk

High in individuals with schizophrenia, especially young males.