schizophrenia

Schizophrenia – definition, characteristic,

types and developmental pathway

DEEPIKA-21MPS011 SEM-3
DEFINITION:
Schizophrenia is a psychotic disorder characterized by
• Hallucinations
• Delusions,
• Disturbances in thought
• Perception, and
• Behavior.
schizophrenia involves
Positive symptoms:hallucinations, delusions, formal
thought disorders
Negative symptoms:paucity of speech, anhedonia, and
lack of motivation.

• psychotic behaviors not seen in healthy people.

• The illness commonly interferes with a patient’s ability to participate in social events and to foster meaningful
relationships.

• The most common negative symptoms are diminished emotional expression and avolition (decreased initiation of
goal-directed behavior).
• HALLUCINATION- sensory perception, the sensory increases acc to age.
• PTSD disorder -hallucinations.
• DELUSION- irrational belief ,counter reality.
• Cognitive symptoms are the newest classification in schizophrenia. These symptoms are nonspecific; therefore,
they must be severe enough for another individual to notice them. Cognitive symptoms include
• disorganized speech- illogical reasoning.
• thought, and/or attention
• ultimately impairing the individual’s ability to communicate
• The primary symptoms and comorbid conditions associated with schizophrenia may ultimately lead to social and
occupational dysfunction.

• Functional consequences include an inadequate or incomplete education, which may affect the patient’s ability to
obtain and hold a stable job. Patients with schizophrenia typically cultivate few social relationships and need daily
support to manage relapses and recurring symptoms 3

 schizophrenia- DSM criteria

A. Two (or more) of the following, each present for a significant portion of time during a 1-month
period (or less if successfully treated). At least one of these must be (1), (2), or (3):
• delusions
• hallucinations
• disorganized speech (e.g., frequent derailment or incoherence)
• grossly disorganized or catatonic behavior
• Negative symptoms (i.e., diminished emotional expression or avolition).
B. Social/occupational dysfunction:
For a significant portion of the time since the onset of the disturbance, level of functioning in one or more
major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior
to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of
interpersonal, academic, or occupational functioning).

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at
least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and
may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the
disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in
an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out
because either
(1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms,
(2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the
total duration of the active and residual periods of the illness.

E. Substance/general medical condition: The disturbance is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical condition.

F. Relationship to a Pervasive Developmental Disorder: If there is a history of autism spectrum disorder or a

communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent
delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1
month (or less if successfully treated).

schizophrenia
Characteristics

• AGE OF ONSET - 2 ages- early 14 below (adolescent onset)

• PREVALENCE- rare in children -12to 15 above rise

• GENDER DIFFERENCE- MALE early onset - equal in adolescence

• COMORBIDITY- Depression,conduct disorder

• SOCIOECONOMIC STATUS-Low economic status

• DEVELOPMENTAL COURSE-Poor diagnosis child onset -3 to 27 depends on the

case,61 to 90 chronic recurring episode

• PROGNOSTIC SIGNS- Poor adjustment -12 years acute onset

 schizophrenia
TYPES

• The previous version, the DSM-4, described the following five types of schizophrenia:
• paranoid type
• disorganized type
• catatonic type
• undifferentiated type
• residual type
• The updated version, DSM-5, no longer uses these categories. The features of these types — including paranoia,
disorganized speech and behavior, and catatonia — are still features of a schizophrenia diagnosis, but experts no
longer consider them distinct subtypes.
• In 2022, the American Psychiatric Association published an updated version of the DSM-5 manual, DSM-5-TR.
However, this version does not significantly change the classification of schizophrenia.

 schizophrenia
In children
• Childhood schizophrenia is a rare form of schizophrenia, a mental health illness.
• Early onset schizophrenia starts between the ages of 13 and 18 years
• Very early onset schizophrenia starts before a person reaches 13 years of age.
• Apart from the age of onset, childhood schizophrenia is similar to adult schizophrenia. However, the symptoms can affect
children and adults differently.
• In the long term, the symptoms may be more severe in people who develop them early.
SYMPTOMS:
• psychosis
• delusions
• auditory hallucinations, in which the child hears voices
• developmental delays
• language difficulties
• difficulty coping with school work and social relationships
• trouble expressing or recognizing emotions, known as “flat affect”
(Flat affect may be noticeable during social interactions, emotional films, and cartoons. It can also affect the
ability to identify another person’s emotions by looking at their face)

The American Academy of Child & Adolescent • neglects their personal grooming
Psychiatry (AACAP) note that changes may slowly
occur over time. Children who previously made The child may not always be aware that their experiences
friends easily or did well at school may start to find are different than those of other people.
these things challenging.
• Childhood schizophrenia is much less common than
The AACAP add that parents and caregivers may notice adult schizophrenia.
that their child: • Around 0.04% of people experience schizophrenia as
children, while some 0.25%–0.64% of adults in the
• has unusual behavior or speech United States experience the disorder.
• has unusual or bizarre thoughts and ideas • That said, as researchers learn more about
• confuses television and dreams with reality schizophrenia in children, and discover better ways to
• seems confused in their thinking identify it, childhood-onset schizophrenia may become
• experiences severe mood changes more common
• shows changes in their personality
• believes that someone is after them or talking about
them (paranoia)
• appears anxious and fearful
• has difficulty relating to peers and maintaining
friendships
• becomes withdrawn and increasingly isolated

Early signs of schizophrenia can be very difficult to detect in children and adolescents, because symptoms often overlap with adolescent
changes in behavior and other more common childhood conditions.
Symptoms of schizophrenia may also be different in children and adolescents than in adults, and they may develop or worsen
gradually over time.

Early signs of schizophrenia in children and adolescents include:

• changing friends or having trouble keeping them
• increase in unusual ideas and thoughts
• hallucinations (seeing, smelling, hearing, or feeling things that are not real)
• odd speech or behavior
• confusing things from television and dreams from reality
• personality changes
• confused thinking
• severe fearfulness and anxiety
• trouble relating to peers
• reduced self-care and hygiene
• increased isolation or social withdrawal
• paranoia (thinking that people are discussing them or out to get them)
• attention problems
• drop in academic performance and grades
• irritability or extreme moodiness
• problems sleeping

 schizophrenia
developmental pathway

• Individual with schizophrenia showed developmental impairment.

• Severe cases - hospitalisation required
• Parental hostility
• Locating cues - mother is schizophrenic ,IQ
• Schizophrenic mom and criminal dad impact child
• Obstetric complications were found to increase the risk of psychosis with poorer motor development, poor receptive
language and lower IQ.

• DRUG USE: It may be the factor in the trend towards a lower age of onset of schizophrenia
• SOCIAL STRESS: The range of social and psychological factors, such as stressful life events, ethnicity and childhood
trauma are associated with schizophrenia social isolation are positively correlated.
Pathways to schizophrenia: the impact of environmental factors
DOI : 10.1017/S1461145704004122

• Childhood physical abuse has been shown to be associated with later violent behaviour in general population (Elbogen
and Johnson, 2009), patient (Hoptman et al., 1999; Witt et al., 2013) and prisoner (Sarchiapone et al., 2009) samples.
However, less is known about the influence of other forms of childhood trauma on the risk of violence in people with
schizophrenia.
• Childhood adversity is strongly associated with an increased risk for psychosis and could have a significant aetiological
role (Varese et al., 2012). For example, a prospective study in adolescents showed that childhood trauma was strongly
predictive of new psychotic experiences and that stopping the trauma stopped the psychotic experiences (Kelleher et al.,
2013).
• There is also evidence that childhood abuse and number of later life events combine synergistically to increase the odds
of psychotic experiences beyond the effects of each risk factor alone (Morgan et al., 2014). childhood adversity might
interact with CD to contribute towards the increased risk of violence in schizophrenia.
Oakley, C., et al., Childhood adversity and conduct disorder: A developmental pathway to violence in schizophrenia, Schizophr. Res.
(2016), http://dx.doi.org/10.1016/j.schres.2016.01.047

• The negative symptoms include behavioural deficient, social withdrawal, affective flattening,avolition and anhedonia the
patients who showed the symptoms during adults were characterized by greater social withdrawal and passivity in
childhood.

Childhood adversity is a broad term that refers to a wide range of circumstances or events that pose a serious
threat to a child's physical or psychological well-being.
•
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Findings - developmental studies

Prenatal period - infancy

• Influenza in pregnancy - schizophrenic

• Mom is schizophrenic - birth complications

• Intrapersonal context - sensory and motor problems ,deviating speech ,loss

in gross motor difficulties ,gait

• Passivity -unresposive to external stimuli (babbling and slowness)

• Interpersonal context - separation from caregiver

Findings - developmental studies
Toddler to middle childhood

• Intrapersonal context - low speech, motor coordination, low energy, delayed

speech, psychological disturbance

• School -ability to repeat forward and backward

• Boys -7to 11 preschizophenic - more disturbed

• Girls after 11

• Social withdrawal, affective flatting, poverty of speech

• Excitability,aggression,distrubing Behr

• Reading and arithmetic lagging.

Findings - developmental studies
Adolescence

• Intrapersonal context -Deficits in attention

• Boya ang girls normal onset rapid growth

• No connection with puberty

• Interpersonal context- no differences