Schizophrenia

Schizophrenia

• Major disturbances in thought, emotion, and behavior

  • Disordered thinking

    • Ideas not logically related

    • Faulty perception and attention

  • Lack of emotional expressiveness

    • Inappropr\iate or flat emotions

  • Disturbances in movement or behavior

    • Disheveled appearance

  • Can disrupt interpersonal relationships, diminish capacity to work to live independently

  • Significantly increased rate of suicde and death

The symptoms of schizophrenia

• Characteristic symptoms include:

  • Disturbacnes in which normal functions are distorted or exaggerated(positive symptoms)

    • Hallucinations

    • Thought disorder(content)

    • Bizarre or disorganized behavior)

    • Thought disorder(form)

  • Disturacnes in which normal functions are diminished or absent(negativr symptoms)

    • Anhedonia

    • Alogia

    • Affect

    • Avolition

    • Attentional impairment

Positive symptoms:behavioral excesses and distortions

• Delusions

  • Firmly held beliefs

  • Contrary to reality

  • Resistant to disconfirming

  • Evidence

• Types of delusions

  • Persecutory delusions

    • “The CIA planted a listening device in my head”

    • 65% have these

  • Thought insertion

  • Thought broadcasting

  • Outside control

  • Grandiose delusions

  • Ideas of reference

• Hallucinations

  • Sensory experiences in the absence of sensory stimulation

• Types of hallucinations:

  • Auditory

    • 74% have this symptom

  • Visual 

  • Hearing voices

    • Increased levels nof activity in Broca’s area during hallucinations

Disorganzied symptoms

• Disordganzied speech(formal thought disorder)

  • Incoherence

    • Inability to organize ideas

  • Loose associations(derailment)

    • Rambles, difficulty sticking to one topic

• Disorganzied behavior

  • Odd or peculiar behavior

    • Sillness, agitation, unusual dress

      • Eg, weaning several heavy coats in hot weather

Negative symptoms: behavioral deficits

• Avoilitions 

  • Lack of interest;apathy

• Asocialtity

  • Inability to form close personal relationships

• Anhedonia

  • Inability to experience pleasure

• Blunted affect

  • Exhibits little or no affect in face or voice

• Alogia 

  • Reduction in speech

Movement symptoms

• Catatonia

  • Motor abnormalities 

  • Repetitive, complex gestures

    • Usually of the fingers or hands

 Excitable, wild flailing of limbs

Catatonic immobility

• Maintain unusual posture for long periods of time

  • Stand on one leg

Waxy flexibility

• Limbs can be manipulated and posed by another person

Schizophrenia

• Lifetime prevalence~1%

• Affects men slightly more often than women

• Onset typically late adolescence or early adulthood

  • Men diagnosed at a slightly earlier age

schizophrenia:DSM-5-TR criteria in a nutshell

• Two or more of the following symptoms for at least 1 month; one symptoms should be 1, 2, or 3:

• (1) delusions

• (2) hallucinations 

• (3) disorganzied speech

• (4) disorganized (catatonic) behavior 

• (5) negative symptoms(diminished motivation or emnotional expression)

• Functioning in work, relationships, or self-care has decline since onset

• Signs of disorder for at least 6 months;if during a prodromal or residual phase, negative symptoms or two or more of symptoms

How do we recognize schizophrenia

• Characteristic symptoms include:

  • Disturbances in which normal functions are distorted or exaggerated(positive symptoms)

    • Hallucinations

    • Thought disorder (content)

    • Bizarre or disorganied behavioer

    • Thought disorder (form)

  • Disturbances in which normal functions are diminished or absent(“negative” symptoms)

    • Anhedonia 

    • Alogia

    • Affect

    • Avoilition

    • Attentional impairment

Diagnostic overview of schizophrenia:

• At least two of the following categories of symptoms from the table elow. At least one must be delusions, hallucinations, or disorganized speech

  • Delisions

  • Hallucinations

  • Disorganized thought ands speech

  • Disorganized behavior

  • Negative symptoms

• Impact: symptoms must exvceed culutral and contextual norms. Symptoms are related to clinically significant distress or create impairment in important areas of life such as with friends and family or at work or school