Schizophrenia and Psychotic Disorders

Introduction to Schizophrenia

• Schizophrenia is a serious, chronic, psychiatric disorder characterized by impaired reality testing, hallucinations, delusions, and limited socialization.
• It is a psychotic thought disorder where hallucinations and delusions dominate the patient's thinking, leading to confusing and bizarre behaviors.
• People with schizophrenia have a disconnection between their thoughts and feelings and between their reality and society's reality, leading to unusual and frightening behaviors.

Characteristics of Schizophrenia

• Schizophrenia is a frequent cause of long psychiatric hospitalizations.
• The suffering of patients with schizophrenia and their families can last a lifetime as this crippling condition continues.
• The first psychotic break often responds well to treatment, but the relapse rate is high, and the person may become increasingly disabled.
• Schizophrenic individuals are vulnerable to substance abuse as they self-medicate to control their symptoms.
• These patients can also be at risk for suicide, which may be manifested as voices telling the person to kill themselves or a means to end suffering.

Schizophrenia Spectrum Disorders

• DSM-5 now categorizes schizophrenia under the global title of schizophrenia spectrum disorders (2013).
• The new term of schizophrenia spectrum disorders reflects a gradient of psychopathology that a patient can experience from least to most severe.
• Disorders such as schizophreniform and schizoaffective would be the less severe forms.
• Psychoses can occur in bipolar disorder and major depression.
• Another psychotic disorder is brief psychotic disorder, which includes postpartum psychosis as well as psychosis due to substance abuse or medical conditions.

Diagnosis and Prevalence

• Schizophrenia is usually diagnosed in late adolescence or early adulthood.
• The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women.
• The prevalence of schizophrenia is estimated at about 1% of the population.
• Most clients slowly and gradually develop signs and symptoms such as social withdrawal, unusual behavior, loss of interest in school or work, and neglected hygiene.

Types of Schizophrenia

• DSM-5 eliminated the subtypes of catatonic, delusional, disorganized, undifferentiated, and residual.
• The new term of schizophrenia spectrum disorders reflects a gradient of psychopathology that a patient can experience from least to most severe.

Symptoms of Schizophrenia

• The presence of delusions, hallucinations, and/or disorganized speech for a significant portion of time during a 1-month period.
• Grossly abnormal motor behavior and/or negative symptoms.
• One or more areas of functioning, such as school, work, personal relationships, or self-care, are impaired.
• Some disturbance needs to be evident for at least 6 months.

Long-Term Course

• The intensity of psychosis tends to diminish with age.
• Many clients with long-term impairment regain some degree of social and occupational functioning.
• Over time, the disease becomes less disruptive to the person's life and easier to manage, but rarely can the client overcome the effects of many years of dysfunction.
• In later life, these clients may live independently or in a structured family-type setting and may succeed at jobs with stable expectations and a supportive work environment.

Related Disorders

• Schizoaffective disorder: diagnosed when the client is severely ill and has a mixture of psychotic and mood symptoms.
• Schizophreniform disorder: the client exhibits an acute, reactive psychosis for less than 6 months.
• Catatonia: characterized by marked psychomotor disturbance, either excessive motor activity or virtual immobility and motionlessness.
• Delusional disorder: the client has one or more non-bizarre delusions, and psychosocial functioning is not markedly impaired.

Biologic Theories

• Genetic factors: twin studies show that identical twins have a 50% risk, and fraternal twins have a 15% risk of schizophrenia.
• Neuroanatomic and neurochemical factors: people with schizophrenia have relatively less brain tissue and cerebrospinal fluid, and computed tomography scans have shown enlarged ventricles in the brain and cortical atrophy.
• Neurochemical theories: dopamine and serotonin imbalance may contribute to the development of schizophrenia.