Schizophrenia

Schizophrenia onset

Source: CIHI
(2001)
Schizophrenia General Characteristics

Usually develops early in adult life – 15 – 45

Women tend to develop it 5-10 yrs later than men
Childhood schizophrenia is rare
Episodic – psychotic episodes alternate with
normal functioning
 Chronic onset

Begins with a period when your mood

alters noticeably to those who know you
Followed by a psychotic episode of 1-6
mths (can be up to a year)
The inter episode functioning varies
between individuals
 Acute onset

Sudden appearance of hallucinations or other

obvious signs
Individual shows disturbed behaviour within days
 Schizophrenia prognosis

‘Rule of the thirds’ (rule of thumb):

 1/3 recover more or less completely
 1/3 episodic impairment
 1/3 chronic decline

Confirmed in US & UK (Stevens, 1978)

With treatment about 60% of patients manage
a relatively normal life
Prognosis better in non-industrialised societies
 Schizophrenia diagnosis

At least two of the following:

 Hallucinations (us. auditory or somatic)
 Delusions (oft. linked to hallucinations)
 Disorganised speech
 Disorganised or catatonic behaviour
 Negative symptoms
 Schizophrenia diagnosis

Positive - things additional to expected behavior and

include delusions, hallucinations, agitation, and
talkativeness.
Negative - things missing from expected behavior
and include lack of motivation, social withdrawal,
flattened affect, cognitive disturbances, poor
grooming, and poor (i.e., impoverished) speech
content.
 Positive Symptoms

Delusion are a belief  Hallucination

that is clearly false  A hallucination is when you
think that you perceive
something that does not exist
in reality
 Auditory
 Visual
 Thought disorder

•Together these symptoms are called psychosis.

 Negative Symptoms

These symptoms show there is a reduction or absence of

usual mental functions and can include: lack of energy
social withdrawal lack of motivation

 A lack, or 'flattening', of emotions –

 An inability to enjoy things that you used to enjoy.
 Apathy
 Becoming increasingly uncommunicative –

The person affected may say very little, find social contact
difficult and may have difficulty getting out of bed.
 Social & occupational dysfunction
 Talk to himself  May even believe he/she is
 Gesture to themselves God
 Dress in layers in any  See things

weather  Feel people are out to get

 Fail to bathe and get a them

 Believe in all sorts of
haircut
 Gain an odd interest in
conspiracies
 Have ideas that no amount
ordinary things (like
religion) of evidence to the contrary
can dislodge
 Social & occupational dysfunction
 Be unable to work
 Stop talking or greatly
reduce conversation
 Appear lazy, unmotivated
and uninterested
 May look like he has
dementia
 Lose the ability to get and
keep friends
 Be tense

•(clockwise from top left) Mathematician

John Nash, author Jack Kerouac,
Fleetwood Mac guitarist Peter Green,
and musician Syd Barrett
 Duration

Continuous signs of disturbance for at least 6 months

 Exclusion of mood disorders

No signs of depression or elation have occurred at

the same time as the psychotic symptoms
 Exclusion of known organic disorders

Drugs
Brain disorders e.g. tumours
 Examples of Schizophrenia
 YouTube - Schizophrenia: Gerald, P
YouTube - The real story of Schizophrenia
 Gerald
x2
 http://
www.youtube.com/watch?v
YouTube - Do I Have Schizophrenia? =kvdw4b7tC-8&feature=related
 Heather
x1

 YouTube – Schizophrenia
 Jen 1
 http://
www.youtube.com/watch?v
=1XzrYyfsVYs&feature=related
 Jen 2
 Schizophrenia diagnosis

Diagnostic subtypes
 Paranoid
 Catatonic
 Disorganised
 Undifferentiated
 Residual

Type 1 - Episodic, mainly positive symptoms

Type 2 - Chronic, mainly negative symptoms
 Schizophrenia / Paranoid Type 35-40%

A. Preoccupation with one or more delusions or

frequent auditory hallucinations.
B. None of the following is prominent: disorganized
speech, disorganized or catatonic behavior, or flat or
inappropriate affect.
 Schizophrenia / Disorganised type 10%

A. All of the following are prominent:

(1) disorganized speech
(2) disorganized behavior
(3) flat or inappropriate affect
B. The criteria are not met for Catatonic Type
 Schizophrenia / Catatonic Type 10%

The clinical picture is dominated by at least two of the following:

(1) motoric immobility as evidenced by catalepsy (in-cluding waxy

flexibility) or stupor
(2) excessive motor activity (that is apparently purposeless and not
influenced by external stimuli)
(3) extreme negativism (an apparently motiveless resistance to all
instructions or maintenance of a rigid posture against attempts to be
moved) or mutism
(4) peculiarities of voluntary movement as evidenced by posturing
(voluntary assumption of inappropriate or bizarre postures),
stereotyped movements, prominent mannerisms, or prominent
grimacing
(5) echolalia or echopraxia
 Schizophrenia / Residual Type 20%

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, present in an attenuated form (e.g.,
odd beliefs, unusual perceptual experiences).
Schizophrenia / Undifferentiated Type 20%

A type in which symptoms that

meet Criterion A are present, but
the criteria are not met for the
paranoid, disorganized, or
catatonic type.
 Schizophrenia prevalence

1% lifetime risk in general population

Holds true for most geographical areas although
rates do vary
 Abnormally high in Southern Ireland, Croatia; significantly
lower rates in Italy, Spain (Torrey, 2002)
Risk factors include low SES, minority ethnicity,
urban residence
 Outline clinical characteristics of schizophrenia (6
mks)
 Explain issues of reliability and validity associated
with the classification and diagnosis of
schizophrenia (3mks +16 mks)

 Critically consider issues in classification and

diagnosis of schizophrenia (25 mks)
Outline clinical characteristics of schizophrenia (5
mks)

Symptoms – from the DSM

Demographic factors – who does it affect
Incidence & prevalence – what % people affected

Not expected to cover all these points but you do

need to refer to diagnostic criteria
 Schizophrenia occurs in 1% of the population
 It is equally common in males and females although onset is 5-10 years
earlier in males than females
The DSM IV says they should have
 2 or more of the following symptoms for at least a month –
hallucinations, delusions, disorganised speech, disorganised or
catatonic behaviour negative symptoms such as affective flattening
 Or 1 symptom if the delusions are bizarre
 Prior to onset their social/occupational functioning should be below
level
 There should be continuous signs of disturbance for at least 6 mths
 Should not be due to mood changes (depression or due to an organic
factor (brain tumour, drugs)
Catatonic
behaviour
 Social
dysfunction
Hallucinations
– hearing
voices
Affective
flattening
Delusions
Disorganised
speech