Schizophrenia

  1. Symptoms: changes in the way a person thinks, feels, and relates to other people and the outside environment; no single symptom or specific set of symptoms is a characteristic of schizophrenic patient; problems with their own subjective satisfaction and their ability to complete an education, hold a job, and develop social relationships with other people; about 10% of schizophrenic patients commit suicide; first episode is usually between the ages of 15 and 35, and rarely after 55; fluctuate in severity over time
    1. Prodromal phase: obvious deterioration in role functioning as a student, employee, or homemaker; peculiar behavior, unusual perceptual experiences, outbursts of anger, increased tension, and restlessness; social withdraw, indecisiveness, and lack of will power
    2. Active phase: hallucinations, delusions, and disorganized speech
    3. Residual phase: dramatic symptoms have improved; impoverished expression of emotions
    4. Positive symptoms: hallucinations (sensory experiences that are not caused by actual external stimuli), delusional beliefs (false beliefs based on incorrect inferences about reality)
    5. Negative symptoms: flattening or restrictions of the person’s nonverbal display of emotions (diminished emotional expression/blunted affect); fail to exhibit signs of emotions or feeling; neither happy nor sad; appear to be completely indifferent to their surroundings; voices lack the typical fluctuations in volume and pitch; events in the environment hold little consequence; lack of concern for themselves and for others; anhedonia (inability to experience pleasure); loss of interest in recreational activities and social relationships; unable to experience pleasure from physical sensations (such as taste and touch); malfunction of interpersonal relationships; social withdraw; indecisiveness, ambivalence, and loss of willpower (avolition); algoia (speech disturbance)
    6. Disorganization: thinking disturbances; disorganized speech; making irrelevant responses to questions, expressing disconnected ideas, using words in peculiar ways; shifting topics too abruptly (loose association/derailment); responding to a questions with an irrelevant response (tangetiality); persistently repeating the sae word or phrase over and over again (preservation); catatonic behavior (obvious reduction in reactivity to external stimuli); exhibit reduced or awkward spontaneous movements; unusual postures or remain in a rigid standing or sitting positions for long periods of time; resist attempts to alter position; stuperous state (generally reduced responsiveness); inappropriate affect (incongruity and lack of adaptability in emotional expression)
  2. Diagnosis: subtypes: 3 types: paranoid, disorganized, catatonic, and undifferentiated
    1. 2 (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least 1 of these must be the first three below
      1. Delusions
      2. Hallucinations
      3. Disorganized speech
      4. Grossly disorganized or catatonic behavior
      5. Negative symptoms
    2. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to onset
    3. Continuous signs of disturbance persist for at least 6-month. This 6-month period must include at least 1-month of symptoms that meet criterion A and may include periods of prodromal or residual symptoms.  During these prodromal or residual, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form
    4. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of illness
    5. The disturbance is not attributable to the physiological effects of a substance or another medical condition
    6. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1-month.
  3. Course and Outcome: deteriorating course of the condition; many patients improve in terms of symptoms; evidence indicates that different dimensions of outcomes (social adjustment, occupational functioning, and symptoms severity are only loosely correlated)
  4. Frequency of Disorder: approximately 1% of people in the US have schizophrenia or other psychotic disorders; men are 30 to 40% more likely to develop schizophrenia than women; men exhibit overt symptoms younger by 4 or 5 years and exhibit more negative symptoms; rates of schizophrenia vary from country to country
  5. Etiology:
    1. Biological Factors: genetics, pregnancy and birth complications (diseases/infections, extended labor, forceps delivery, breech delivery, umbilical cord wrapped around the baby’s neck, dietary factors such as malnutrition), viral infections, neuropathology reflecting the increased and decreased use of different areas of the brain, chemicals in the brain
    2. Social Factors: nutritional variables, stressful life events, social class (amount of hardships, harmful events), immigrants have higher rates of schizophrenia
    3. Psychological Factors: family interactions can have effect on the course of schizophrenia
  6. Treatment(s):
    1. Antipsychotic medications: classical/traditional antipsychotics such as chlorpromazine (Thorazine); atypical antipsychotics such as risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel); other medications have been used over the years
    2. Psychosocial Treatment: Family orientated after care, social skills training, cognitive therapy, assertive community treatment, institutional programs
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