• SCHIZOPHRENIA

• Greek words

• schizein = split

• phren = mind

• split between the emotional & cognitive aspects of the personality

• person’s mood is not congruent with his thoughts

• a mental disorder characterized by disturbances in thought, sensory perception, &

deterioration in psychosocial functioning

• char. by weak ego

• most common psychotic disorder

• most disabling

• 95%: lifetime

• 20-50%: attempts suicide

• onset: adolescence

• men have earlier onset than women (female estrogen helps to regulate dopamine)

• tends to be less severe in women; better chance at sustaining recovery from symptoms,
respond better to low dose conventional antipsychotic drugs

• common defense mechanisms:

a. regression

b. projection

c. withdrawal

d. denial

PHASES:

• Phase 1 (the schizoid personality)

- premorbid phase

- child (later develops schizophrenia) is often described as:

 > loner & indifferent to social rel’p

> limited range of emotional experience & expression

> physically clumsy

> emotionally aloof

• Phase 2 (prodromal phase)

- time when person begins to experience change personality, decline in academic functioning,
avoids social interactions, isolates self

- often occurs during mid-to-late adolescence

- person exhibits:

 difficulty in role functioning; deterioration of social rel’p

 bizarre behavior, bizarre ideas

 neglect of personal hygiene & grooming

 different affect

 changes in communication; irrational statements

 sleeping excessively/inability to sleep

 unexpected hostility

 hyperactivity/inactivity

• Phase 3 (Psychotic break)

- active phase (acute s/sx)

A. POSITIVE (hard)

(not found in normal individuals)

- respond fairly well to antipsychotic meds

 psychotic thinking (delusions, hallucinations, illusions, ideas of reference, paranoia)

 agitation, bizarre behavior, excitement, insomnia

 aggressive behavior or suicidal tendencies

 pressured speech, tangentiality, circumstantiality, clanging

B. NEGATIVE (soft)

(absence of characteristics found in normal individuals)

 Affective flattening

 Anhedonia

 Anergia

 Asocial behavior

 Attention deficit

 Avolition – decreased initiative to participate

 Alogia – poverty of speech

 Alexithymia – difficulty naming & describing emotions

* Poor hygiene & grooming

C. COGNITIVE DEFICITS

- problems with abstract thinking

• ANOSOGNOSIA

- lack of insight into one’s problem

• poor “executive functioning”

• problems w/ “working memory”

Phase 4 (Residual Impairment)

- Period of remission when s/sxs are absent, minimal, or can be controlled by the person

DIAGNOSTIC CRITERIA

• 1 or more of the following sxs for 1 month or more

delusions, hallucinations,

grossly disorganized/catatonic behavior

disorganized speech

negative symptoms
 • significant impairment in academics, interpersonal rel’p, self-care, occupational functioning

• disturbance not due to pervasive dev’l disorder, substance abuse, general medical condition,
another mental disorder

• CAUSES

• not yet fully understood

• genetic, biological, environmental, psychological factors interplay

THEORIES

1. Genetic – become active only when exposed to certain environmental conditions

2. neurochemical – excessive or deficient neurotransmitters (dopamine, serotonin, glutamate, NE,

acetylcholine)

3. neurostructural

• prefrontal cortex : smaller or develops abnormally

• less brain tissue

• neurodevelopmental (in utero)

> during pregnancy: malnutrition/viral illness

> viral (influenza) infection could trigger genetic vulnerability

• autoimmune

> body’s immune system attacks itself

> antibodies that spec attack brain of persons w/ schizo

• psychologic/experiential

> double bind communication

> “schizophrenigenic” mother (mostly not accepted anymore)

> single parents, low socioeconomic status

> left-handedness

• vitamin deficiency (folate, Vit B complex)

 • diathesis stress

> personal predisposition to develop a disorder

> biologically based & is genetically acquired

> disorder made worse by great deal of stress

• TYPES

• TYPE I schizophrenia

> acute onset of POSITIVE sxs that responds well to typical neuroleptic medication

> better prognosis

• TYPE II schizophrenia

> slow onset of NEGATIVE sxs that respond better to atypical antipsychotic medication

• SUBTYPES

• PARANOID schizophrenia

• CATATONIC schizophrenia

 psychomotor disturbance

a. Catatonic stupor

- immobile, unresponsive, w/drawn, extreme rigidity, waxy flexibility, mutism

b. Catatonic excitement

– excessive restlessness or purposeless movements

• SUBTYPES

• UNDIFFERENTIATED

• RESIDUAL

– in a state of remission; attenuated form of s/sxs

• CANDIDATES FOR SCHIZOPHRENIA?

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