Understanding Schizophrenia

Schizophrenia Overview

• Schizophrenia, previously known as Psychosis, involves a significant detachment from reality.
• It is a complex syndrome with devastating effects on the individual and their family.
• It disrupts perception, thought, speech, and movement, affecting almost all aspects of daily functioning.
• People are likely to be stigmatized and discriminated against.
• Full recovery has a low success rate of 1 in 7 patients.
• The annual cost of schizophrenia in the United States is estimated to exceed $60 billion.

Early Figures in Diagnosing Schizophrenia

• John Haslam (1764–1844) published "Observations on Madness and Melancholy", detailing symptoms, including delusions, typical of schizophrenia.
• Philippe Pinel (1745–1826) was a French physician who described cases of schizophrenia.
• Benedict Morel (1809–1873) used the French term "démence précoce" (early loss of mind) due to the disorder's onset often occurring during adolescence.
• Emil Kraepelin (1856–1926), a German psychiatrist, described dementia praecox, where patients become suspicious, see poison, and feel persecuted.
• Kraepelin combined symptoms of insanity, including catatonia, hebephrenia, and paranoia.
• He also distinguished dementia praecox from manic-depressive illness (bipolar disorder).
• Eugen Bleuler (1857–1939) coined the term "schizophrenia" (from Greek "schizo," meaning "split," and "phren," meaning "mind").
• Bleuler believed it was characterized by thought disorganization, lack of coherence between thought and emotion, and inward orientation.

Schizophrenia Spectrum Disorder

• The Schizophrenia spectrum includes schizophrenia, schizophreniform, schizoaffective, delusional, and brief psychotic disorders.
• Schizotypal personality disorder is included under this category.

Symptoms of Schizophrenia

• Symptoms split into three groups, positive, negative, and disorganized.

Positive Symptoms

• Reflect an excess or distortion of normal behaviour and experience.
• Delusions - disorder of thought content, a belief that would be seen my most members of society as a misrepresentation of reality.
• Hallucinations - a sensory experience (auditory, visual, olfactory, tactile, or gustatory) that seems real but occurs without external stimulus.
• Delusions of Grandeur include a mistaken belief that the person is famous or powerful. Delusions of Persecution include a belief that others are "out to get them".

Negative Symptoms

• Indicate the absence or insufficiency of normal behavior.
• Avolition - Showing little interest to perform any function
• Alogia - Relative absence of speech
• Anhedonia - Presumed lack of pleasure
• Asociality - Lack of interest in social interactions
• Affective Flattening - Do not show emotions

Disorganized Symptoms

• Involve a variety of erratic behaviors affecting speech, motor behavior, and emotional reactions.
• Disorganized Speech - Is the external manifestation of a disorder in thought form
• Disorganized Behaviour - Is any behaviour that is usually viewed as unusual
• Catatonia - Involves motor dysfunctions ranging from wild agitation to immobility.

Historic Schizophrenia Subtypes

• Paranoid Schizophrenia: Characterized by absurd and illogical beliefs organized into a coherent, delusional framework.
• Disorganized Schizophrenia: Characterized by disorganized behavior.

Schizoaffective Disorder

• People experiencing this disorder experience symptoms of schizophrenia for a few months only
• DSM -5 criteria include mood disorder, delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.

Schizophreniform Disorder

• Schizophrenia-like psychoses that last at least a month but less than 6 months.
• The symptoms sometimes disappear with successful treatment.
• DSM -5 diagnostic criteria include psychotic symptoms within 4 weeks of a change in behaviour and confusion at the height of the episode.

Delusional Disorder

• Includes persistent beliefs contrary to reality, without other schizophrenia characteristics.
• Individuals tend not to have flat affect, anhedonia, or other negative symptoms.
• May become socially isolated due to suspiciousness. It can include long-standing delusions.
• Delusional disorder subtypes recognised by the DSM-5 are:
  • Erotomanic: Irrational belief of being loved by another person.
  • Grandiose: Inflated worth, power, knowledge, or special relationships.
  • Jealous: Believing a sexual partner is unfaithful.
  • Persecutory: Believing oneself is malevolently treated.
  • Somatic: Feeling afflicted by a physical defect or medical condition.

Substance-Induced Psychotic Disorder

• Other disorders that cause delusions should be ruled out.
• DSM -5 criterion A includes the presence of delusions and/or hallucinations.
• There should be evidence of the symptoms in Criterion A developing during, or soon after, substance intoxication.

Psychotic Disorder Associated with Another Medical Condition

• DSM -5 criterion A states that there should be prominent hallucinations or delusions.
• The disturbance is the direct consequence of another medical condition.

Brief Psychotic Disorder

• Involves the sudden onset of psychotic symptoms or disorganized speech.
• Characterized by one or more positive symptoms, with the episode lasting only a matter of days and no more than 1 month.
• Patients return to their former level of functioning and may never have another episode.

Attenuated Psychosis Syndrome

• Some individuals who develop psychotic symptoms but do not meet the full criteria for schizophrenia.
• These individuals may be good candidates for early intervention.
• DSM-5 proposes attenuated psychosis syndrome for further study.

Schizotypal Personality Disorder

• It is a related psychotic disorder, with characteristics similar to schizophrenia but less severe.
• May be genetically related as part of a "schizophrenia spectrum".