Chapter Three

Schizophrenia and
Other Psychotic
Disorder
Schizophrenia spectrum and other psychotic
disorders
Defined by abnormalities in one or more of the
following five domains: delusions, hallucinations,
disorganized thinking (speech), grossly disorganized or
abnormal motor behavior (including catatonia), and
.negative symptoms
Substance/medication- induced psychotic disorder
The psychotic symptoms are judged to be a
physiological consequence of a drug of abuse, a
medication, or toxin exposure and cease after
.removal of the agent
Psychotic disorder due to another medical condition
The psychotic symptoms are judged to be a direct
physiological consequence of another medical
.condition
■ Etiology
Still uncertain. results from a combination of influences that
include biological, psychological, and environmental factors.
1. Biological Influences
● Genetics:
Twin Studies :Modern twin studies have concluded that
almost all traits are in part influenced by genetic differences
● Biochemical Influences
a) The Dopamine Hypothesis (excess of dopamine)
b) Other Biochemical Hypotheses
 The Dopamine Hypothesis
• The dopamine hypothesis of schizophrenia or the
dopamine hypothesis of psychosis is a theory that
argues that the unusual behavior and experiences
associated with schizophrenia (sometimes extended
to psychosis in general) can be fully or largely
explained by changes in dopamine function in the
brain
● Physiological Influences
a) Viral Infection (as influenza, especially during childhood)
b) Anatomical Abnormalities (Structural brain
abnormalities)
c) Histological Changes (Cerebral changes)
d) Physical Conditions
Some studies have reported a link between schizophrenia
and epilepsy, Huntington’s disease, birth trauma, head
injury in adulthood, alcohol abuse, cerebral tumor,
cerebrovascular accidents, SLE, myxedema, parkinsonism,
and Wilson’s disease.
•
Huntington's disease (HD):
is a fatal genetic disorder that causes the progressive breakdown
of nerve cells in the brain. It deteriorates a person's physical and
mental abilities usually during their prime working years and has
no cure
• Wilson’s disease:
• Wilson's disease is a genetic disorder in which
excess copper builds up in the body. Symptoms are typically
related to the brain and liver. Liver-related symptoms
include vomiting, weakness, fluid build up in the
abdomen, swelling of the legs, yellowish
skin and itchiness. Brain-related symptoms include tremors,
muscle stiffness, trouble speaking, personality changes, anxiety
2. Psychological Influences
(poor parent–child relationships and dysfunctional
family systems)
3. Environmental Influences
● Sociocultural Factors (low socioeconomic classes)
4. Stressful Life Events
■ Key features that define the psychotic disorders
Positive or hard symptoms:
1. Delusions
Persecutory delusions are most common, referential delusions
are also common.
2. Hallucinations
Auditory hallucinations are the most common in
schizophrenia and related disorders. The second most
common type is visual hallucinations, while other
hallucinations may be rare.
3. Disorganized Thinking and Speech
Such as loose associations or tangentiality. Rarely,
speech may be so severely disorganized that it is
nearly (incoherence or "word salad").
4. Grossly Disorganized or Abnormal motor
Behavior (including Catatonia)
Ranging from childlike "silliness" to unpredictable
agitation that leading to difficulties in performing
activities of daily living.
Catatonic behavior ranges from (negativism);
to maintaining a rigid, inappropriate or
bizarre posture; to (mutism) and (stupor). It
can also include (catatonic excitement). Other
features are repeated stereotyped movements,
staring, grimacing, and echolalia.
Negative or Soft Symptoms
1. Diminished emotional expression, it may
include variety of symptoms as feelings of
indifference toward people, activities, and
events (Apathy), blunted or flat affect (more
common).
2. Avolition is a decrease in motivated self-
initiated purposeful activities (more
common).
3. Alogia
Manifested by diminished speech.
4. Anhedonia
The decreased ability to experience pleasure from
positive stimuli or a degradation in the recollection
of pleasure previously experienced.
5. Asociality
Refers to the apparent lack of interest in social
interactions.
Schizophrenia ■
Diagnostic Criteria
A. Two (or more) of the following symptoms that lasts
for 6 months at least, at least one of these must be (1 ),
:(2), or (3)
.Delusions .1
.Hallucinations .2
Disorganized speech .3
.Grossly disorganized or catatonic behavior .4
Negative symptoms .5
B. Decreased level of interpersonal, academic, or
occupational functioning
D. The disturbance is Not due to other
psychological condition, or to the physiological
effects of a substance (e.g., a drug of abuse, a
.medication) or another medical condition
■ Delusional Disorder:
Diagnostic Criteria
A. The presence of one (or more) delusions with a
.duration of 1 month or longer
B. Functioning is not markedly impaired, and behavior
.is not obviously bizarre or odd
C. The disturbance is not attributable to the
physiological effects of a substance or another medical
condition and is not better explained by another mental
.disorder
:Specify if
With bizarre content
Delusions are deemed bizarre if they are
clearly implausible, not understandable, and not
derived from ordinary life experiences (e.g., an
individual’s belief that a stranger has removed his
or her internal organs and replaced them with
someone else’s organs without leaving any wounds
.or scars)
Brief Psychotic Disorder ■
Diagnostic Criteria
A. Presence of delusions, hallucinations or
disorganized speech at least, also individual may has
.grossly disorganized or catatonic behavior
.B. Duration is at least 1 day but less than 1 month
C. The disturbance is Not due to other psychological
condition, or to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or
.another medical condition
 Schizophreniform Disorder ■
Characterized by a symptomatic presentation
equivalent to that of schizophrenia except for
its duration (last at least 1month but less than
6 months) and the absence of a requirement
.for a decline in functioning
Schizoaffective Disorder ■
Characterized by a mood episode and the
active-phase symptoms of schizophrenia occur
together and were preceded or are followed by
at least 2 weeks of delusions or hallucinations
without prominent mood symptoms (major
.depressive or manic)
Catatonic Disorder ■
Catatonia can occur in several disorders, including
neurodevelopmental, psychotic, bipolar, depressive,
and other mental disorders. It also includes the
diagnosis catatonia associated with another mental
disorder (catatonia specifier), catatonic disorder
due to another medical condition, and unspecified
.catatonia
Diagnostic criteria
The clinical picture is dominated by three (or more) of the
:following symptoms
Stupor (i.e., no psychomotor activity; not actively relating to .1
.environment)
Catalepsy (i.e., passive induction of a posture held against .2
.gravity)
Waxy flexibility (i.e., slight, even resistance to positioning by .3
.examiner)
.Mutism (i.e., no, or very little, verbal response) .4
Negativism (i.e., opposition or no response to instructions or .5
.external stimuli)
Posturing (i.e., spontaneous and active maintenance of .6
.a posture against gravity)
Mannerism (i.e., odd, circumstantial caricature of .7
.normal actions)
Stereotypy (i.e., repetitive, abnormally frequent, non- .8
.goal-directed movements)
.Agitation, not influenced by external stimuli .9
.Grimacing .10
.Echolalia (i.e., imitating another’s speech) .11
.Echopraxia (i.e., imitating another’s movements) .12
Treatment ■
Psychopharmacology
The primary medical treatment for schizophrenia
is psychopharmacology. In the past, electroconvulsive
therapy, insulin shock therapy, and psychosurgery
were used, but in 1952, other treatment modalities
have become all but obsolete. Antipsychotic
medications, also known as neuroleptics, they do not
cure schizophrenia; rather, they are used to manage
the symptoms of the disease.
Two antipsychotics are available in depot injection
forms for maintenance therapy. The effects of the
medications last 2 to 4 weeks, while the duration
ranks from 1 to 4 weeks, eliminating the need for
daily oral antipsychotic medication.
Psychosocial Treatment
Individual and group therapies, family therapy,
family education, and social skills training can be
instituted for clients in both inpatient and community
settings.