Schizophrenia refers to a dissociation in the mental abilities of an individual.

Initially, Morel coined

the term ‘demence precoce’ , followed by many researches by Kahlbaum who derived disorganised
schizophrenia. Later, Kraepelin gave detailed understanding of the disorder and coined ‘dementia
praecox’ and also differentiated it from other dementia related disorders like Alzheimer’s. Further,
Bleuler found that the symptom of loosening of association was a characteristic feature and made it
different from other psychotic disorder like dementia. Based on this he coined the term
‘schizophrenia’ meaning split mind or fragmenting of mind.

This disorder falls under the umbrella term of psychotic disorder as it distorts the perception of
reality and also interferes with one’s memory, judgement, thought, volition and mood.

Schizophrenia is marked by positive and negative symptoms. Positive symptoms are ‘additions’ to
already existing behaviours. These are not present in non-schizophrenia individuals. This includes:

1) Delusions refers to fixed, false beliefs that do not find it’s roots in reality. No amount of evidence
can alter their belief. Common types of delusions observed are:
i) Delusion of Persecution – belief of being plotted against and being followed
ii) Delusion of Grandeur- exaggerated sense of self accompanied by belief of grand traits
like power or intellect which is not true.
iii) Delusion of Reference – belief that occurrence in their surroundings have special
significance to the patient.
iv) Delusion of Control – belief that others are controlling the patient or the patient has
control over the others.
v) Delusion of Jealousy – belief that their partner or spouse is being unfaithful.
vi) Delusion of Erotomania – belief that another person is attracted or is in love with the
patient.

2) Hallucinations – perception of events in the absence of an external stimuli. Hallucinations can be

experienced in all 5 senses like-
a) Visual Hallucinations – perception of visual images without any external stimuli. Example,
seeing an animal or other patterns.
b) Auditory Hallucinations – perception of voices without stimuli. Here the voices my be talking
to them or they hear two voices talking about them. Example, hearing footsteps or door
banging.
c) olfactory Hallucinations – distorted perception of smell in the absence of stimuli. Example.,
smelling smoke.
d) Gustatory Hallucinations –experience of distortion of taste. Example metallic taste.
e) Tactile Hallucinations – perception of sensations on or under skin example, experience of a
snake crawling under the skin.
3) OTHER TYPES OF HALLUCINATIONS:
a) Reflex Hallucinations – stimulus or hallucination experienced in one sense induces
hallucination in other senses. Example, seeing someone write induce tickling in the stomach.
b) Hypnogogic Hallucinations – experienced while falling asleep at night. Person may hear, feel
or see things that are not there. Example, seeing moving patterns or shapes.
c) Hypnopompic Hallucinations – experienced while waking up in the morning. Very common
but are mostly seen among people with sleep disorders. The person may see, hear or feel
things in their absence.
 d) Functional Hallucinations – auditory stimuli triggers hallucination. Here the patient perceives
both stimuli and hallucination. Example, listening to running water(stimuli) which is
accompanied by some voices (hallucination).
e) Extra Campine Hallucinations- hearing voices beyond the sensory capacity. For example, a
person in London may claim to hear voices from America.

4) Disorganised thinking and speech – inability to make comprehendible sentences or speak

coherently due to the disorganisation of thoughts.
a) Tangentiality – complete diversion from original topic and is accompanied by excessive and
irrelevant details.
b) Circumstantiality – temporary diversion from original topic but gets back to the original idea.
c) Neologism – creating one’s own words and terminologies.
d) Derailment – sudden break in flow of thought.
e) Perseveration – continuous repetition of single thought or word.
f) Thought blocking – sudden blockage in flow of thought leading to sudden stop in talking.
g) Flight of ideas – rapid shift from one topic to another.

Negative symptoms are ‘removal’ of some characteristics from existing behaviour. These lost
characteristics mark the ‘normal’ functioning of an individual’s behaviour.

a) Alogia – poverty of speech marked only by one-word responses like yes/no.

b) Blunt effect/ Athymhoria - reduction in degree of emotion and person remains silent.
c) Flat effect – it is marked by lack of sensitivity in an individual. example, in moment of
seriousness a person may start laughing hysterically.
d) Asociality – reduction in social interest and interpersonal relations.
e) Abulia – reduced desire to be involved socially.

Psychomotor symptoms- exhibition of abnormal behaviour like waxy posturing, rigidity, mutism etc.
it majorly includes:

a) Catatonic stupor – marked by motionlessness and silence for long stretch of time.
b) Catatonia rigidity – maintain rigid upright posture for hours.
c) Catatonia posturing – exhibition of awkward and bizarre position for a long period.
d) Catalepsy – lack of responsiveness to external stimuli.
e) Waxy flexibility – bizarre posturing of limbs for long period of time.
f) Echolalia – repetition of others words.
g) Echopraxia – imitation of others actions.

CAUSES OF SCHIZOPHRENIA

There is no single cause behind schizophrenia. Many factors together are responsible for
development of schizophrenia in an individual.

Genetics – genes are considered to be one of the primary causes of schizophrenia. However, many
studies suggested that genes alone cannot inflict schizophrenia. Some twin studies show that genetic
predisposition to schizophrenia increases the possibility of an individual to develop schizophrenia
and is considered more like a vulnerability factor. An adoption study by Tienari et al. (2000),
compared children with genetic predisposition to schizophrenia when adopted in different
environments. Wahlberg, further suggested that children adopted in houses with good
communication were less likely to develop schizophrenia as compared to those with poor
communication. Thus, we can conclude that genes are vulnerability factor that co-exist with other
causes of schizophrenia.

Environment – our most immediate environment, our family plays an important role here. An
unhealthy environment in one’s family, communication deviance or chaotic and confusing
environment expression since a young age can inflict schizophrenia. The neglect, criticism and
negative emotional tends to not just triggers the disorder but may also cause relapse after recovery.
Vaughn and Leff (1976)

Factor like low socio-economic status is also important in this context. Fox(1990) in his study found a
that low socio-economic status acts as a stressor (discrimination, lack of basic amenities) etc. in most
cases the family environment is also not healthy thus increasing the possibility.

Neurological developments- the neural structure of an individual experiencing schizophrenia involves

damage to neural systems, loss of neuron density and reduction in cortical volume in frontal and
temporal lobe thus distorted perception, attention, memory etc. the longer a person suffers, the
more severe damage takes place on it’s neurons leading to neural damage and degeneration of
neurons.

Dopamine levels- episodes of schizophrenia may be marked by excessive levels of dopamine that
exhibit positive symptoms however, the dopamine system is influenced by excessive release leading
to degeneration and neuron as a result drastic reduction in dopamine level causing negative
symptoms.

Substance abuse – the intake of drugs tends to influence our biochemical balance. As a result, it
increases the risk of schizophrenia. Drugs like cannabis, amphetamines etc. may lead to psychotic
experiences and may even cause a relapse in case of already affect individual. many researches have
shown the higher vulnerability to development of schizophrenia among drug abusers.

Stressful events- one of the major triggers of schizophrenia may be due to stressful events that they
experience like loss of job, loss of a loved one, physical or sexual abuse or unhealthy and abusive
relations with family can trigger development of schizophrenia or may cause a relapse. Maternal
stress i.e., children of women who experienced traumatic or stressful events during pregnancy are
more prone to develop schizophrenia however, not much scientific evidences are available for the
same.

Pregnancy and birth complications – damage to the brain may increase chances of schizophrenia.
Researches have shown that difficulties during pregnancy like maternal stress, malnutrition, drug or
alcohol abuse or preeclampsia the risk of developing schizophrenia in the child increases. On the
other hand, if there are implications during the birth like, being born underweight, prematurity, lack
of oxygen etc. may increase the risk of schizophrenia.

TYPES OF SCHIZOPHRENIA
DISORGANISED/ HEBEPHRENIC SCHIZOPHRENIA – this type is marked by symptoms of disorganised
behaviour and thinking like flight of ideas, neologism, derailment, loose association etc. It is also
accompanied by negative symptoms like flat or blunt effect.

PARANOID SCHIZOPHRENIA- delusions and auditory hallucinations are common and most prominent
under this category accompanied by disorganised thought. This is one of the most common types of
schizophrenia. The minimum duration of 1 month for diagnosis is required.

CATATONIC SCHIZOPHRENIA – as the name suggest, psychomotor symptoms are prominent

compared to others. The patient exhibits excited catatonia- increased movement or retarded
catatonia- decreased movement which affects both posturing and speech. Most common symptoms
are: mutism, catatonia stupor, rigidity, waxy posturing etc.

RESIDUAL SCHIZOPHRENIA- it is does not prominently exhibit symptoms like delusions,

hallucinations, disorganised speech and thinking etc. here, the symptoms are in mild form. However,
negative symptoms can be observed.

UNDIFFERENTIATED SCHIZOPHRENIA – this is not characterised by specific symptoms of

schizophrenia. Even though they exhibit symptoms they can be diagnosed as some other disorder
like paranoia, social withdrawal, agitation, neglect of personal hygiene etc.