Schizophrenia DSM-5 Quiz

Schizophrenia

• Schizophrenia is a chronic, disabling brain disorder affecting approximately 1% of Americans.
• It's characterized by a loss of contact with reality, significantly impaired perception and response to the environment, and impaired functioning.
• Symptoms include hallucinations (false sensory perceptions) and/or delusions (false beliefs), often leading to erratic behavior.
• There is no cure, but treatment can manage serious symptoms.
• The DSM-5 defines schizophrenia as a severe, chronic, and potentially disabling thought disorder, characterized by deteriorated personal, social, and occupational functioning due to unusual perceptions, disturbed thought processes, unusual emotions, and motor abilities.
• Remission and relapse are typical throughout the lifespan.

Psychosis

• Psychosis is a state marked by a loss of contact with reality, where the ability to perceive and respond to the environment is significantly impaired.
• Psychosis can manifest as hallucinations (false sensory perceptions), and/or delusions (false beliefs).
• Psychosis can be substance-induced or caused by brain injury.
• Most psychoses are in the form of schizophrenia.

DSM-5 Criteria for Schizophrenia

• A. Two (or more) of the following, present for a significant portion of a one-month period; at least one must be (1), (2), or (3) :
  • Delusions
  • Hallucinations
  • Disorganized speech
  • Catatonic behavior
  • Negative symptoms (diminished emotional expression)
• B. For a significant time since the disturbance began, functioning in one or more major areas (e.g., work, relationships, self-care) is markedly below previous levels.
• C. Continuous signs of the disorder persist for at least six months, including at least one month of symptoms meeting Criterion A (active-phase symptoms). Disorders like schizoaffective and mood disorders with psychotic features must be ruled out.
• D. The disturbance is not attributable to effects of a substance or another medical condition.
• E. If a history of autism spectrum disorder or a childhood communication disorder exists, additional schizophrenia diagnosis is made only if prominent delusions or hallucinations—in addition to other required schizophrenia symptoms—are present for at least one month (or less if successfully treated).

Symptoms of Schizophrenia

• Positive symptoms: Disorders of commission (things patients do or think). Includes hallucinations, delusions, and disorganized behavior.
  • Hallucinations: Sensory perceptions occurring in the absence of external stimuli; commonly auditory, but can involve any sense.
  • Delusions: Beliefs with no basis in fact; faulty interpretations of reality. Examples include delusions of reference, persecution, grandeur, and control.
  • Bizarre or disorganized behavior: Includes loose associations (derailment), neologisms (made-up words), perseveration (repetition of words/statements), and clang (rhyming).
• Negative symptoms: Disorders of omission (things patients do not do). Includes lack of speech, flat affect, anhedonia (inability to experience pleasure), asociality, avolition (lack of motivation), and apathy.
  • Poverty of speech (alogia): Long lapses before answering questions, or reduction in speech quantity/content.
  • Blunted and flat affect: Show less emotion than most people; lack of eye contact, expressionless face.
  • Anhedonia: Loss of pleasure or enjoyment. Loss of volition (motivation, directedness).
  • Social withdrawal (asociality): Withdraw from social environment; breakdown of social skills.
• Cognitive symptoms: Deficits in attention, working memory, verbal learning, memory, and executive functions.

Onset and Prevalence

• Symptoms typically become apparent between ages 18 and 35; onset before adolescence is rare.
• The peak age of onset for the first psychotic episode is between 20 and 25 for males and 26 and up for females.
• Onset can be abrupt, happening virtually overnight.
• Schizophrenia prevalence is about one percent of the general population.

Risk Factors

• Birth month has been correlated with schizophrenia, particularly late winter/early spring (possible link to flu season).
• Higher incidence in urban areas and some minority ethnic groups.
• Other genetic and environmental factors potentially linked, including pregnancy/labor complications with hypoxia, older fathers, stress, infection, malnutrition, and maternal diabetes (exact causal links remain inconclusive).

Causes

• Schizophrenia is a result of a combination of genetic predisposition and environmental, social, and psychological factors.
• Neurodevelopmental abnormalities and target features play a role, often leading to brain dysfunction and imbalanced brain chemicals.

Subtypes of Schizophrenia

• Paranoid type
• Disorganized type
• Catatonic type
• Undifferentiated type
• Residual type

Clinical Features

• Mental status examination: Includes observation of appearance, behavior, mood, feelings, and affect; presence of perceptual disturbances and thought content/form. Cognitive functioning, insight, and judgment are also assessed.

Treatments

• Biological therapies (medication).
• Psychosocial therapies (social skills training, family-oriented therapies, group/individual therapy, assertive community treatment (ACT), cognitive behavioral therapy (CPT)).

Additional Notes

• Physical inactivity and poor cardiorespiratory fitness can be correlated to brain volume reductions.
• A Beautiful Mind Evaluation video available online.
• Case study presenting a 27-year-old male with schizophrenia, experiencing a decline in behavior (specifically, immobility and strange posture) and reduced insight into illness.