Schizophrenia

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 Schizophrenia.....

• Schizophrenia is a chronic and disabling brain disorder that

affect peoples thought, perception, emotion, interpersonal
relation ship and behavior, that result in general disruption
and decline in one’s ability to function normally.

• People with schizophrenia do not think logically, perceive

the world accurately, or behave in a way that permits
normal everyday life and work.
 Schizophrenia.....

 People with schizophrenia are out of touch with reality,

 People with schizophrenia often suffer from

hallucinations - false sensory perceptions

 They also frequently have delusions - false beliefs about

reality
 The Clinical Picture in Schizophrenia

• Positive-syndrome: behaviors added to normal

range
• Negative-syndrome: loss or reduction of normal
behavior
•
• Positive Syndrome • Negative Syndrome
– Hallucinations – Emotional Flattening
– Delusions – Poverty of Speech
– Asociality
– Bizarre Behavior
– Apathy/ lack of interest/
– Sudden Onset – Sig. Cog Impairment
•
 Typical symptoms of schizophrenia
1. Hallucinations
o Hallucinations are perceptions that have no basis in external
reality, but which are nevertheless perceived as coming from an
external source.

o Hallucinations are sensory experiences that occur within the

absence of an actual stimulus.

o For example, a person having an auditory hallucination may hear

their mother yelling at them when their mother isn’t around. Or
someone having a visual hallucination may see something, like a
person in front of them, who isn’t actually there.
 Typical symptoms of schizophrenia …

• The person may hear voices discussing them or

commenting upon their thoughts and actions, often in a
insulting or abusive manner.
• Unsurprisingly, the sudden onset of hallucinations is
often associated with great fear and anxiety, although
sometimes patients find the voices they hear helpful or
even comforting.
• Some patients, for example, converse with, or
shout back at their voices, while others may sit as if
they are listening to them.
 Examples of hallucination
• Hear voices. This is called "auditory hallucination." You
may sense that the sounds are coming from inside or
outside your mind. You might hear the voices talking to
each other or feel like they're telling you to do something.

• See things. This is also known as a "visual hallucination."

For example, you might see insects crawling on your hand
or on the face of someone you know. Sometimes they look
like flashes of light.
 Examples of hallucination

• Smell things. The technical name for this is "olfactory hallucination."

You may think the odor is coming from something around you, or that
it's coming from your own body.

• Taste things. These are called "gustatory hallucinations." You may

feel that something you eat or drink has an odd taste.

• Feel things. "tactile hallucination." It might seem to you that you're

being tickled even when no one else is around, or you may have a
sense that insects are crawling on or under your skin.

 Most common is Auditory hallucination followed by Visual

 Typical symptoms of schizophrenia…

2.Delusion

Delusions are fixed, false beliefs, not shared by others from the
same cultural or educational background.

These are false beliefs that are not based in reality.

For example, you think that you're being harmed or harassed;

certain gestures or comments are directed at you; you have
exceptional ability or fame; another person is in love with you; or
a major catastrophe is about to occur.

some of delusional thoughts are listed below.

 Typical symptoms of schizophrenia…

• Erotomanic: Someone with this type of delusional disorder believes

that another person, often someone important or famous, is in love
with him or her.

• Persecutory delusion. This is the most common form of

delusional disorder.
• The affected person fears they are being followed, scrutinized,
poisoned, or harassed by other individuals or an organization.
• As a result, the sufferer may react violently against the
persecution and/or turn to the law and other government
agencies for support.
 Typical symptoms of schizophrenia…

• Delusional jealousy. This usually develops due to a fear that a

spouse or partner is being unfaithful.
• These doubts may be unfounded and can cause severe damage
to the relationship.
• The sufferer usually goes to great lengths to try and find evidence
of their partner’s alleged “affairs” and may also resort to a third
party such as a private detective to find such evidence.
• Studies have shown that this form of delusion is more common in
men than in women. It is sometimes called morbid jealousy or
pathological jealousy.
 Typical symptoms of schizophrenia ….
Patients with schizophrenia often experience interference
with their thoughts, which they may again attribute to an
external force.

Thought insertion, the individual has the sense that

thoughts or ideas are, somehow, being planted in their mind.

thought withdrawal experience their thoughts being

abruptly taken (snatched) from their minds
Thought broadcasting is the experience that thoughts are
radiating out from their mind and can be ‘picked up’ by other
people. E.g. thoughts are being broadcasted on TV, radio....
 Typical symptoms of schizophrenia…
Delusions of grandeur – Belief that you are a famous or important
figure, such as Jesus Christ or Napoleon. Alternately, delusions of
grandeur may involve the belief that you have unusual powers,
such as the ability to fly

a religious delusion (people often believe that their unique

interpretation of religious text give them the means to save or destroy the

world) are also frequent.

Delusions of reference – A neutral environmental event is

believed to have a special and personal meaning. For example, you
might believe a billboard or a person on TV is sending a message
meant specifically for you
 Typical symptoms of schizophrenia…

3. Disorganized speech
• Verbal communication problems, bizarre behavior and thinking
disturbance .
• disorganized speech, involves the tendency of some patients to
say things that don’t make sense.
• Effective communication can be impaired, and answers to
questions may be partially or completely unrelated.
• Signs of disorganized speech include making irrelevant responses
to questions, expressing disconnected ideas, and using words in
odd ways.
 Typical symptoms of schizophrenia…
• Common features of disorganized speech in schizophrenia include:

• Clang association : nonsense sequence of like sounding words

E.g: Shout me, shout, shoot, shoe me, shoe! Shout, shoee....

How are you? “Well, hell, it’s well to tell”

• How’s the weather? “So hot, you know it runs on a cot, boat”
• Shifting topics too abruptly, called loose associations or derailment
• Tangentiality; Replying to a question with totally irrelevant response,
• Circumstantiality; excessively indirect speech and including irrelevant
details to answer questions.

• Word salad: A seemingly random collection of disorganized words

 Typical symptoms of schizophrenia…
• perseveration. Persistently repeating the same word or phrase over
and over again

• loose of speech:

Example

Clinician: where are you from?

• Client: my name is gebeyehu, but i would like to be a merchant my

fathers name is.......

• Neologisms : made up their own words that others can’t understand

e.G. “Head vise” for “headache”

• Echolalia : they mimic what they just heard

 Typical symptoms of schizophrenia…

4. Grossly disorganized behavior

This may show in a number of ways, from childlike silliness to

unpredictable agitation.

Behavior isn't focused on a goal, so it's hard to do tasks. Behavior

can include resistance to instructions, inappropriate or bizarre

posture, a complete lack of response, or useless and excessive

movement.

It is exemplified by patients who lined hat with tin foil to keep

government agent from stealing his thought via special laser ray .
 …
Typical symptoms of schizophrenia

the man who is urinating in the corner, because he said, toilets

contained the holy water.

Inappropriate emotional reactions constitute another form of

disorganized behavior.

• The individual may begin to giggle when discussing the death

of parent. ( inappropriate affect)

Some people react in a “silly” manner to all situations.

Often these behavior are combined with severe agitations and

poor impulse control that the person has difficulty in carrying
out daily self maintenance functioning such as eating and
washing
 Typical symptoms of schizophrenia…
5. Catatonia
• Refers to marked muscular rigidity and immobility

• Patients may exhibit an immobility or resistance to any attempt to

change how they appear.

• They may maintain a posture in which someone places them,

sometimes for extended periods of time.

• catatonia stupor is a marked decrease in the persons reaction to

his or her environment ,sometimes reaching a level of complete
unawareness/complete mutism/.

• Catatonic rigidity describes the behavior of schizophrenia which

maintains rigid ,bizarre posture and who resist effort to be moved.
 Typical symptoms of schizophrenia…
∆ Echoproxia :in which a person imitates some one’s
movement.

∆ waxy flexibility (maintenance of limbs and body in externally

imposed positions.

∆ Catatonic excitement: seemingly purposeless, unspecified and

excessive motor activity or general agitation of speech and
behavior, often following a period of catatonic rigidity or
stupor

E.G. Rocking back and forth for hours

Rubbing their hands together for hours in the same fashion

catatonic posturing
 Negative Symptoms of Schizophrenia
1. Apathy. The person may have a lack of interest in activities that
previously were important to them such as their work or studies or
recreational activities such as sports.

• They may also stop looking after themselves properly and their
personal hygiene and appearance may suffer noticeably.

• They may be reluctant to leave the house or even their bedroom and
may lie in bed for the larger part of the day

2. Absent, blunted or incongruous emotional responses.

• People with schizophrenia experiencing negative symptoms may

appear to display no reaction to good or bad news or to react
inappropriately for instance laughing at sad news or appearing to
become unhappy when hearing good news.
 Negative Symptoms of Schizophrenia..
3. reductions in speech /Alogia/

• People with negative symptoms of schizophrenia may appear to have little

interest in conversation and may give only very brief responses to questions.
Their speech may be disrupted or there may be long pauses in the flow of
their speech or in responding to conversation (known as poverty of speech).

• The ability to make small talk is often completely lost and this loss of vital
communication skills can impact seriously on the person’s ability to take part
in social activities or find employment

4. Social withdrawal /avolition /

• The person may avoid social contact and may prefer to spend the larger part
of the day and night by themselves. There is a general lack of will to interact
with the world around them.
 Negative Symptoms of Schizophrenia..
5. Impaired attention.

• There may be an obvious difficulty in concentrating during conversation

and an inability to concentrate on even simple tasks.
6. Anhedonia.
• This describes an inability to experience pleasure. People with
schizophrenia who experience this often describe life as being grey or
empty, devoid of the normal emotional ups and downs that we all take for
granted
7. Sexual problems.
• There may be a significant reduction or total absence of libido (sex drive),
men may experience problems in achieving erections and both men and
women may have problems achieving an orgasm (anorgasmia).
 Negative Symptoms of Schizophrenia..
8. Lethargy

• People with schizophrenia experiencing negative symptoms

will often have a profound lack of energy and find it difficult
to do any more than light activity. This may lead to them

spending a large part of the day in bed or watching television.

 Diagnosis Criteria for schizophrenia
A. Presence of at least two or more the following characteristic
symptoms in the active phase for at least 1 month (unless the
symptoms are successfully treated).
1. Delusions.
2. Hallucinations.
3. Disorganized speech
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms.
B. Social/occupational dysfunction
C. Duration: Continuous signs of the disturbance persist for at least 6
months.
D. Schizoaffective and mood disorders exclusion:
E. Substance/general medical condition exclusion
 Subtypes of schizophrenia
DSM-IV recognizes five subtypes of schizophrenia, defined primarily
by predominant symptomatology as the time of assessment.

1.Disorganized Schizophrenia

# The most severe

• In this, disorganized speech and behavior, and flat or inappropriate

mood are the dominant features.

• It is also characterized by inappropriate laughter and giggling

silliness, incoherent speech, infantile behavior, strange and
sometimes rude behavior.
 Subtypes of schizophrenia
DSM-IV-TR diagnostic criteria for Disorganized
schizophrenia

A. all of the following are prominent

1.Disorganized speech

2. Disorganized behavior

3. Flat or inappropriate affect

B. the criterion are not met for catatonic type

 Subtypes .…
2. Paranoid schizophrenia
 the commonest type of schizophrenia
 Auditory hallucinations may support these delusional beliefs.
 Disturbances of mood and speech, and catatonic symptoms,

are not prominent.

 The key to diagnosis is the presence of prominent delusions.

 Delusions of persecution are most common ,grandiose

delusions, in which they have an exaggerated sense of their
own importance, power, knowledge or Identity.
 Subtypes .…
delusional jealousy, the unsubstantial belief that their sexual
partner is unfaithful Vivid auditory hallucinations may
accompany the delusions.

ideas of reference; they incorporate unimportant events with

a delusional framework and read personal significance into
the trivial activities of others

• They are restless, argumentative, angry, and sometimes

violent.
• They are also more alert and verbal than patients with
other types of schizophrenia.
• Their language, although filled with references to
delusions,
 Subtypes .…
DSM-IV-TR diagnostic criteria for paranoid schizophrenia

A. Preoccupation with one or more delusions or frequent

auditory hallucinations.

B. None of the following is prominent: disorganized or catatonic

behavior, or flat or inappropriate affect.

 Subtypes .…
3.Catatonic schizophrenia
•Catatonia refers to a set of symptoms that might develop in some patients
with schizophrenia. It can include periods where the individual moves very
little and does not respond to instructions.
• The clinical picture of catatonia is dominated by at least three of the
following symptoms:
• Stupor - no psychomotor activity, no interaction with the environment
• Catalepsy - includes adopting unusual postures
• Waxy flexibility - if an examiner places the patient's arm in a position, they
will maintain this position until it is moved again
• Mutism - limited verbal responses
• Negativism - little or no response to instructions or external stimuli
 Subtypes .…
• Posturing - actively holding a posture against gravity

• Mannerism - carrying out odd, exaggerated actions

• Stereotypy - repetitive movements without an apparent

reason

• Echolalia - mimicking another person's speech

• Echopraxia - mimicking another person's movements

 Subtypes .…
DSM-IV-TR diagnostic criterion for catatonic type
1. Motoric immobility as evidenced by catalepsy (including
waxy flexibility or stupor).
2. excess motor activity (that is apparently purposeless and
not influenced by external stimuli).
3. Extreme negativism (an apparently motive less resistance
to all instructions or maintenance of rigid positive against
attempts to be moved) or mutism.
4. peculiarity of voluntary movement as evidenced by
posturing (voluntary assumption of inappropriate or bizarre
postures), stereo typed movement, prominent mannerism or
grimacing.
 Subtypes .…
4. Residual schizophrenia
 Residual schizophrenia is one of the 5 types of schizophrenia that is
characterized by a long-term history of negative symptoms (i.e.
psychomotor slowing), with very infrequent or rare occurrences
of positive symptoms.

 it is characterized by an absence of prominent delusions,

hallucinations, disorganized speech, or grossly disorganized or

catatonic behavior.

 There is continuing evidence of a disturbance, indicated by

the presence of negative symptoms
 Subtypes .…

DSM-IV-TR diagnostic criteria for Residual schizophrenia

A. Absence of prominent delusions, hallucinations, disorganized

speech, and grossly disorganized or catatonic behavior.

B. There is continuing evidence of the disturbance, as indicated

by the presence of negative symptoms or two or more

symptoms listed in criterion A for schizophrenia,

 Subtypes .…
5.Undifferentiated type of schizophrenia
 Undifferentiated schizophrenia is characterized by general
symptoms of schizophrenia that do not fit a specific
classification or diagnosis of another subtype.

 People may exhibit the traditional “positive” and “negative”

symptoms, but they may fluctuate over a period of time

 it includes schizophrenic patients who display prominent

psychotic symptoms and either meet the criteria for several
subtypes or otherwise do not meet the criteria for the
catatonic, disorganized, or paranoid .
 Subtypes .…
 It is a more general “waste-basket” category for patients
who display prominent symptoms, but who do not fall easy
in to one of the varies categories.

DSM-IV-TR diagnostic criteria for undifferentiated

schizophrenia

A. A type schizophrenia in which symptoms that meets

criterion A are present, but the criteria are not fully met for
the paranoid, disorganized, or catatonic type.
Epidemiology -schizophrenia

 Prevalence: ~3.2/1000

 Sex ratio: male-to-female = 1:1

 Marital status: unmarried (more in male)

 Socioeconomic status: low social class

 Ethnicity and race: relatively similar world-wide

 Mortality: high death rates –suicide/accidents

 Violence and criminality: 5 times increased rate

.

Prevalence of Schizophrenia in Specific Populations

Population Prevalence (%)

• General population 1

• Non-twin sibling of a schizophrenia patient 8

• Child with one parent with schizophrenia 12

• Dizygotic twin of a schizophrenia patient 12

• Child of two parents with schizophrenia 40

• Monozygotic twin of a schizophrenia patient 47