CHAPTER 13: SCHIZOPHRENIA
SPECTRUM AND OTHER
PSYCHOTIC DISORDERS
Psychosis – gross departure from reality,
which includes hallucinations and
delusions
Schizophrenia
- Pervasive type of psychosis
characterized by disturbed thought,
emotion, behavior
- Comes from the combination of the
Greek words for split (skhizein) and
mind (phren)
- A startling disorder characterized by
a broad spectrum of cognitive and
emotional dysfunctions, including
delusions and hallucinations,
disorganized speech and behavior,
and inappropriate emotions
- Disrupts a person’s perception,
thought, speech, and movement
- Onset: adolescence
- Demence (loss of mind)
- Precoce (early premature)
- Catatonia – alternating immobility
and excited agitation
- Hebephrenia – silly and immature
emotionality
- Paranoia – delusions of grandeur
or persecution
Historical Background
● Emil Kraeplin – used the term
dementia praecox to describe
schizophrenic syndrome
● Early subtypes – catatonia,
herniarenia and paranoia
● Eugen Bleuler – introduced the term
schizophrenia – splitting of the mind
Identifying Symptoms
- Schizophrenia is a number of
behaviors or symptoms that aren’t
necessarily shared by all people who
are given the diagnosis
Clinical Description, Symptoms, and
Subtypes
Psychotic behavior – Used to characterize
many unusual behaviors, although in tis
strictest sense it usually involves delusions
(irrational beliefs) and/or hallucinations
(sensory experiences in the absence of
external events)
- May refer to only hallucinations or
delusions or the unusual behavior
Schizophrenia – involves psychotic behavior
Positive symptoms – symptoms
around distorted reality; disturbing
experiences of delusions and
hallucinations (50-70% of
schizophrenic individual have
hallucinations, delusions or both)
Active manifestations of abnormal
behavior
Distortion or exaggerations of
normal behavior
● Delusions
- Gross misrepresentations of reality
- Disorder of thought content
- Basic characteristics of madness
- Common delusions
⮚ others are out to get them
(delusions of persecution)
⮚ belief of having to end something
for the sake of everybody;
mistaken belief that the person is
famous or powerful (delusions of
grandeur)
 ⮚ when a person believes that
he/she knows has been replaced
by a double (Capgras syndrome)
⮚ when a person believe he is dead
(cotard’s syndrome)
● Theories
⮚ Motivational view of delusions
– beliefs as attempts to deal with
and relive anxiety and stress such
as developing stories around
some issues to make sense out of
uncontrollable anxieties in the
world
⮚ Deficit view of delusion
- Beliefs as resulting from brain
dysfunction that creates these
disordered cognitions or perceptions
● s
- Experience of a sensory events
without any input form the
surrounding environment
- Can involve all senses
- Most common: auditory
● Findings from SPECT
Studies
- Neuroimaging shows that the part of
the brain most active during auditory
hallucinations is Broca’s area
(involved in speech production not
comprehension)
Negative symptoms – deficits in normal
behavior in such areas as speech, blunted
affect (lack of emotional reactivity) and
motivation
- Absence of normal behavior
⮚ Avolition/apathy – inability to
initiate and persist in
activities/apathy
⮚ Alogia – relative absence of
speech
⮚ Anhedonia – presumed lack of
pleasure; indifference
⮚ Affective flattening – little
expressed emotion
⮚ Asociality – lack of interest in
social interactions; social
withdrawal
-
Disorganized motivation – includes
rambling speech, erratic behavior, and
inappropriate affect (ex. Smiling when
you are upset)
- Confused or abnormal speech,
behavior, and emotion
- Nature of disorganized speech
⮚ Cognitive slippage – illogical
and incoherent speech
⮚ Tangentiality – going off on a
tangent
⮚ Loose associations – conversion
in unrelated directions
- Nature of disorganized affect –
inappropriate emotional behavior
- Nature of disorganized behavior –
includes variety of unusual behaviors
- Catatonia – a psychotic spectrum
disorder in its own right, or when
occurring in the presence of
schizophrenia
Note: diagnosis of schizophrenia
requires that 2 or more positive,
negative, and/or disorganized
symptoms be present for at least 1
month, with at least one of these
symptoms including delusions,
hallucinations, or disorganized
speech
SEVERITY SCALE
0 – symptoms not present
1 – indicating equivocal evidence
(not sure)
2 – present but mild symptoms
3 – present and moderate
symptoms
 4 – present and severe psychotic features have been ruled out
because 1. No major depressive or manic
episodes have occurred concurrently
DIAGNOSTIC CRITERIA
with the active-phase symptoms; 2. If
A. 2 or more of the following, each mood episodes have occurred during
present for at least 1 month active-phase symptoms they have been
1. Delusions present for a minority of the total
2. Hallucinations duration of the active and residual
3. Disorganized speech (frequent periods of the illness
derailment or incoherence)
E. The disturbance is not attributable to
4. Grossly disorganized or catatonic
the physiological effects of a
behavior
substance (drug abuse, medication)
5. Negative symptoms (diminished
or another medical condition
emotional expression or
F. If there is a history of autistic
avolition)
spectrum disorder or a
B. For a significant portion of the time
communication disorder of
since the onset of the disturbance,
childhood onset, the additional
level of functioning in one or more
diagnosis of schizophrenia is made
major relations, or self-care, is
only if prominent delusions or
markedly below the level achieved
hallucinations, in addition to the
prior to the onset (or when the
other required symptoms of
onset is in childhood or adolescence,
schizophrenia, are also present for at
there is failure to achieve expected
least 1-month 9or less if successfully
level of interpersonal, academic, or
treated)
occupational functioning
C. Continuous signs of the Other Psychotic Disorders
disturbarnace persist for at least 6
● Schizophreniform disorder
months. This 6-month period must
- Psychotic symptoms lasting between
include at least 1 month of symptoms
-6 months (6 months =
( or less if successfully treated) that
schizophrenia)
meet Criterion A (active-phase
- Associated with relatively good
symptoms) and may include periods
functioning
of prodromal or residual symptoms.
- Most patients resume normal lives
During these prodromal or residual
- Lifetime prevalence: approximately
periods, the signs of the disturbance
0.2 %
may be manifested by only negative
● Schizoaffective disorder
symptoms or by two or more
- Symptoms of schizophrenia +
symptoms listed in Criterion A
additional experience of a major
present in an attenuated form (odd
manic episode
beliefs, unusual perceptual
- Psychotic symptoms must also occur
experience)
outside the mood disturbance
D. Schizoaffective disorder and
depressive or bipolar disorder with
 - Prognosis is similar for people with
schizophrenia
- Do not tend to get worried on their
own
● Delusional Disorder
- Delusions – contrary to reality
⮚ Lack of other positive and
negative symptoms
⮚ Types of delusions includes:
erotomanic – irrational belief
that one is loved by another
person, usually of higher status;
grandiose – involves believing
in one’s inflated worth, power,
knowledge, etc.; jealous –
believes the sexual partner is
unfaithful; persecutory –
involves believing oneself is
being malevolently treated in
some way; somatic – person
feels afflicted by physical defect
or general medical condition
⮚ Delusional
- Rarel affects 20-60 individual per
100,000
- Later age of onset, between ages
35-55
- Somewhat common in women
- 55% if patients with this hisorder are
female
CONCEPT CHECKS
13.1
1. Jane has spent the past half hour
staring in the mirror. As you
approach her, she turns away and
giggles. When you ask what she’s
laughing at, she answers, but you’re
having difficulty understanding what
she says. Disorganized
2. Drew has experienced hallucinations
and bizarre delusions for the past
four months. Schizophreniform
disorder
3. Greg’s cognitive skills and affect are
relatively intact. He, however, often
has delusions and hallucinations that
convince him enemies are out to
persecute him. Delusional disorder
4. Alice usually holds an unusual
posture and is sometimes seen
grimacing. catatonic
5. Cameron has started to hear voices,
and this is very disturbing to him. He
told his parents and recognized that
he needs to see a mental health
professional for help. Attenuated
psychosis syndrome
6. Lately Dom has become more isolated
because he believes his coworkers are
conspiring to get him fired. He becomes
agitated whenever he sees a group of
employees talking and laughing, because he
believes that they are plotting against him.
Delusional disorder
7. Natalie reveals to her therapist that she
hears numerous voices talking to her and
giving her orders. Her doctor has just sent
her to this therapist for what he believes to
be a major depressive episode. She had
begun to sleep all the time and contemplated
suicide often. Schizoaffective disorder
8. Shawn’s schizophrenic symptoms
disappeared afer about 4 months and he
returned to his normal life, what diagnosis
might he have received? Schizophreniform
disorder
9. Elias believes the government is out to get
him. He thinks agents follow him daily,
monitor his calls, and read his mail. His 2. In _________, clinicians attempt to
roommate Cedric tried to convince him reteach such behaviors as basic
otherwise. Afer a year of this, however, conversation, assertiveness, and relationship
Cedric began to believe Elias was correct building to people with schizophrenia social
and the government was out to get him, too. skills training
Shared psychotic disorder
3. Aside from social skills training, two
13. 2 psychosocial treatments for schizophrenia,
_________ (teaching family members to be
1. The greatest risk of having
supportive) and _________ (teaching
schizophrenia is in those who have
meaningful jobs), may be helpful. Family
a(n) __________ or __________
intervention; vocational rehabilitation
with schizophrenia. Any relative
with schizophrenia will make your 4. Recent studies sometimes indicate that
chances of developing the disorder the relationship of the neurotransmitters
__________ than those of the _________ and _________ may explain
general population. Severity; dopamine; serotoninsome positive
general symptoms of schizophrenia.
2. Raised in a home other than that of
5. Because antipsychotic medications may
their biological parents, adopted
cause serious side effects, some patients stop
children of parents with
taking them. One serious side effect is called
schizophrenia have a(n) __________
_________, which may include
chance of having the disorder
Parkinsonian symptoms. Extrapyramidal
themselves. Children of people with
symptoms
schizophrenia adopted into families
without schizophrenia have a 6. Difficult cases of schizophrenia seem to
__________ than-average chance of improve with a serotonin and dopamine
having schizophrenia. Higher and antagonist called olanzapine
lower
3. the likelihood of a child’s having
schizophrenia is influenced by the
__________ of the parent’s disorder.
One may inherit a predisposition for
__________ schizophrenia that is the
same or different from that of the
parent. Severity, general
Concept Check 13.3
1. Setting up an elaborate _________ in
which patients are fined for disruptive or
inappropriate behavior and rewarded for
appropriate behavior is beneficial in
hospitals. Token economy