Disorders

  1. Language Matters

    • Use person-first language (e.g., "a person with schizophrenia" rather than "a schizophrenic").

    • Avoid stigmatizing terms; mental health conditions do not define a person.

  2. What is a Psychological Disorder?

    • A clinically significant disturbance in cognition, emotion regulation, or behavior.

    • Must cause distress, dysfunction, or danger (not just deviance or cultural differences).

  3. Abnormality vs. Uniqueness

    • Being atypical (e.g., genius, cultural differences) does not mean having a disorder.

    • Disorders involve impairment in daily functioning.

  4. Mental Health Professionals

    • Psychologists (Ph.D./Psy.D.): Therapy, assessment, research.

    • Social Workers (MSW/LICSW): Therapy, case management.

    • Psychiatrists (M.D.): Can prescribe medication.

  5. DSM-5 (Diagnostic & Statistical Manual)

    • Standard classification system for mental disorders.

    • Provides common language for diagnosis and research.

    • Critiques: Overpathologizing normal behavior, comorbidity issues, lack of transparency.

  6. Dimensional vs. Categorical Models

    • Categorical (DSM-5): Disorders as distinct categories.

    • Dimensional: Views disorders on a continuum (e.g., anxiety severity).

  7. Warning Signs of Mental Health Concerns

    • Changes in mood, sleep, appetite, concentration, withdrawal, or thoughts of self-harm.

Schizophrenia: Symptoms, Diagnosis, Causes, & Treatment

Diagnosis Criteria (DSM-5)

To be diagnosed with schizophrenia, a person must exhibit:
✅ Two or more of the following symptoms for ≥1 month (at least one must be from the first three):

  1. Delusions (fixed false beliefs)

  2. Hallucinations (false sensory experiences, often auditory)

  3. Disorganized speech (incoherent, tangential)

  4. Disorganized or catatonic behavior (odd movements, lack of response)

  5. Negative symptoms (lack of motivation, emotional expression, speech)

✅ Functional impairment in work, relationships, or self-care.
✅ Symptoms persist for ≥6 months (including prodromal/residual phases).
✅ Rule out other causes (e.g., bipolar disorder, substance use).

Symptoms of Schizophrenia

Positive Symptoms (Added Abnormalities)

  • Delusions (e.g., paranoia, grandiosity)

  • Hallucinations (hearing voices, seeing things)

  • Disorganized speech (word salad, loose associations)

  • Disorganized behavior (inappropriate actions, catatonia)

Negative Symptoms (Absence of Normal Behavior)

  • Avolition (lack of motivation)

  • Alogia (reduced speech)

  • Anhedonia (inability to feel pleasure)

  • Affective flattening (reduced emotional expression)

Review Questions

  1. Which is a negative symptom?
    → Answer: (2) Victor says very few words all day (alogia).

  2. How long must symptoms last for a schizophrenia diagnosis?
    → Answer: (4) 6 months.

Facts & Statistics

  • Prevalence: ~1% of the population.

  • Onset:

    • Males: Late teens–early 20s.

    • Females: Mid-20s–early 30s (better prognosis).

  • Prognosis:

    • Chronic, often lifelong impairment.

    • High suicide risk (~5-10%).

    • Early treatment improves outcomes.

Causes of Schizophrenia

Biological Factors

  • Genetics:

    • 48% risk if identical twin has it.

    • 17% risk if fraternal twin has it.

  • Brain Abnormalities:

    • Enlarged ventricles, reduced gray matter.

    • Hypofrontality (underactive frontal lobes → negative symptoms).

  • Neurotransmitters:

    • Dopamine hypothesis (excess dopamine → positive symptoms).

    • Glutamate, serotonin may also play a role.

Environmental Triggers

  • Prenatal: Infections (flu), malnutrition, birth complications.

  • Stress & Trauma: May trigger onset in genetically vulnerable individuals.

  • Cannabis Use: Linked to earlier onset and increased psychosis risk.

Treatment

1. Medication (Antipsychotics)

  • First-generation (typical): Block dopamine (e.g., haloperidol) → reduces positive symptoms.

  • Second-generation (atypical): Target dopamine & serotonin (e.g., risperidone, clozapine) → fewer side effects.

  • Side Effects: Weight gain, tremors, sedation.

2. Psychosocial Therapies

  • Cognitive Behavioral Therapy (CBT) for psychosis.

  • Social Skills Training (improving communication).

  • Family Therapy (reducing stress at home).

  • Supported Employment/Education (helping with daily functioning).

3. Early Intervention Improves Outcomes

  • Prodromal Phase Warning Signs: Social withdrawal, odd beliefs, mood swings.

  • Catching symptoms early can delay or reduce severity.

Prognosis

  • No cure, but symptoms can be managed.

  • Positive symptoms often decrease with age.

  • Negative symptoms are harder to treat.

  • Lifelong support is often needed.