Understanding Schizophrenia: Types and DSM-5 Criteria

Introduction to Schizophrenia

• Schizophrenia is a chronic and severe mental disorder affecting thoughts, feelings, and behaviors.
• Psychosis, hallucinations, delusions, and cognitive impairments characterize it.
• Schizophrenia typically manifests in late adolescence or early adulthood.
• Lifelong treatment is required.

Types of Schizophrenia

• Paranoid type involves delusions and auditory (positive) hallucinations, often persecutory or grandiose.
• Catatonic type involves very negative symptoms and severe disturbances in movement, ranging from immobility.

DSM-5 Criteria for Diagnosis

• Diagnosis requires at least two of the following symptoms during a one-month period, with some level of disturbance persisting for at least six months:
  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
  • Negative symptoms (e.g., diminished emotional expression or avolition)
• At least one symptom must be delusions, hallucinations, or disorganized speech.
• Symptoms must cause significant impairment in social, occupational, or personal functioning.
• Schizophrenia paranoid type involves an impaired social type, such as appearing dirty or using smell to keep people away as a defense mechanism.
• Premature birth, low birth weight, and lack of oxygen during birth are correlation factors.
• Males are typically diagnosed at 17/18, females at 23.
• A first psychotic break, life pressure, or initial street drug use can trigger schizophrenia.
• Prodromal signs are early symptoms or warning signs that appear before the onset of the full condition.
• Social withdrawal, decreased motivation, changes in sleep patterns, unusual thoughts or speech, and emotional blunting can be prodromal signs.
• Stress and drugs like meth (affecting dopamine) or alcohol can exacerbate signs and symptoms.

Positive Symptoms

• Hallucinations can be auditory, visual, olfactory, gustatory, or tactile.
• Delusions are false beliefs not based in reality.
• Disorganized speech includes word salad, tangentiality; the made-up word used is neologism.
• Disorganized behavior can be unpredictable or inappropriate.

Negative Symptoms (5 A's)

• Avolition: Lack of motivation.
• Alogia: Poverty of speech or thought.
• Anhedonia: Inability to experience pleasure.
• Affective Flattening / Flat affect: Diminished emotional expression.
• Asociality: Lack of interest in social interactions.
• Anergia: Lack of energy.
• Lack of self care.
• Major sleep disruptions.

Cognitive Symptoms

• Impaired executive functioning.
• Difficulty with attention and memory.
• Poor insight into illness.

Medications for Schizophrenia

• First-Generation (Typical) Antipsychotics:
  • Haloperidol (Haldol)
  • Chlorpromazine (Thorazine)
  • Fluphenazine (Prolixin)
• Second-Generation (Atypical) Antipsychotics:
  • Risperidone (Risperdal) 8mg max, may cause amenorrhea in females or gynecomastia in males.
  • Olanzapine (Zyprexa)- 40 mg, monitor DM status.
  • Quetiapine (Seroquel)- 800mg, used off-label for sleeping pill.
  • Clozapine (Clozaril) requires monitoring for agranulocytosis.
  • Aripiprazole (Abilify)- 30 mg max / IM 400ml month
• Long-Acting Injectables (LAIs):
  • Haloperidol decanoate
  • Fluphenazine decanoate
  • Risperidone (Risperdal Consta)
  • Paliperidone (Invega Sustenna, Invega Trinza)
  • Aripiprazole (Abilify Maintena)
• LAIs are used for patients who struggle with medication adherence.
• Reise Hearing is a hearing (either @ facility or court), where a judge mandates medication administration and the patient loses the right to refuse medication.
• Patients aged 18 to 30 are most likely to be noncompliant with medication, leading to psychotic breaks.
• Grave disability (GD) is the inability to care for oneself, leading to conservatorship.
  • 5352: 30 days; temporary conservatorship (GD)
  • 5350: 1 Year full conservatorship (GD)
  • 5361: 1 Year reappointment of conservator (GD)

Laboratory Tests

• Complete Blood Count (CBC): Monitors for infection or clozapine-induced agranulocytosis.