SCHIZOPHRENIA

What is psychosis?
Disorder where the client:
 Does not perceive reality as it is
 Experiences changes in behaviour, mood and
thinking patterns
 Unable to function as they usually do – decline
in functioning
 Symptoms of psychosis
Broadly the symptoms are of two types:
 Positive symptoms: when there are symptoms
added to normal functioning – like hearing
voices & seeing things that are not there,
aggression, suspiciousness
 Negative symptoms: when there is a decrease
in things the client usually does – like lack in
energy levels, lack of/absent motivation,
decreased interaction with people, & inability
to feel & express feelings
 Early signs of development
of psychoses
 Mood changes – being anxious, low, irritable
 Decreased attention & concentration
 Decreased performance at work and
studies
 Not feeling like talking to people
 Person remaining confused – they find it
difficult to figure out what is happening
to them – but know they are not feeling
ok
 Remaining preoccupied
 Disturbed sleep

 Disturbed appetite
 What are hallucinations?

 When a client - hears, sees, or senses

something that is not actually there
 Auditory hallucinations
 Even when there is nobody there, it appears
that client is talking to themselves/someone
 They may be hearing voices which tell them to
do something
 Or voices that comment on things they are
doing
 Or voices that may even threaten or abuse
them
Auditory hallucinations contd…
 Clients talk to these voices as if they are
real
 They get distressed because they
cannot make these voices stop
 They feel distressed because they don’t
want to do what the voice may ask
them to do
 Visual hallucinations

 The client may see things that are not there –

they are not visible to us – but for the client
these images are as real as everything else

 For eg some clients may say that they saw a

person who was not there, images of gods,
scary images etc
 Somatic hallucinations
Here the client may experience sensations like:

 feeling ants/insects are crawling over their skin

 feel as if there is something moving inside their

body
Somatic hallucination contd…

 feel pin pricks all over

 these feelings cause distress as these

sensations may be continuous, client is unable
to stop them and it distracts them
continuously
 Delusions
 These are wrong/false beliefs that the client
holds very strongly and believes what they
think is true
 They feel convinced that their belief is right
 Even if the family tells them it is false, the
clients do not believe them
 Get angry if challenged
 She is
People are cheating on
talking about me…
me…

People will kill

me…harm I am the
me.. chosen one,
special one
 Delusions of persecution
The client believes that:
 people are against them
 people are trying to harm them
 People are following them
 People are spying on them
 People want to harm them by mixing
something in their food or water
 Delusions of reference
The client believes that:
 People are talking about them
 When they go anywhere they feel people are
laughing at them or mocking them
 They feel that whatever is being talked about –
at times on radio or TV is about them or meant
for them
 They may feel anxious or get into fights with
the people because of this
 Delusions of grandeur
 The client believes that:
 They have higher/ superhuman powers
 They have been nominated by God/ they can
talk to God
 They can do exceptional things
 Delusions of infidelity
 The client believes/suspects that their partner/
spouse is having an affair with somebody
 They may check spouse’s phone, follow them,
repeatedly question them about the person
they suspect
 At times, even though they don’t know who
the other person is they still believe their
spouse is having an affair
 Aggression

 May be mild (annoyed, irritable) or severe

(verbal abuse, harming self and/or others,
breaking things)
 Person may get angry at small/ trivial things
 May get angry without any reason & its hard
for the family to understand why the person
got angry
 Sometimes the anger may happen when their
false fixed beliefs are challenged by people
 Speech & thought symptoms
Problems in speech may also be present, like:
 Client, may say something completely irrelevant
to the question asked

 Family members may find it difficult to figure

out what client is saying (incomprehensible)

 When asked a question – talks about

something but does not answer the question
 Speech & thought symptoms contd…

 Client may keep repeating one word over & over

 May rhyme while talking such that it does not
make sense (I never have trouble sleeping. I
never have trouble peeping).
 May use a new & inappropriate word for an
object (eg. May call a ball a plate etc)
 May use words that don’t belong to that
language
 Speech & thought symptoms contd…

 Sometimes a client may suddenly stop talking

mid-sentence – then they cant remember what
they were talking about as they feel their mind
has suddenly gone blank

 While talking, they keep shifting from one topic

to other such that what they say does not
communicate any meaning
 Additional thought symptoms
 Decreased attention and concentration
 They become forgetful
 May perform poorly in work/studies
 Feel confused if many things are said or tasks
are given at the same time
 Feel confused & cant make decisions
 Even if make decisions, they are inappropriate
 Cant judge situations appropriately
 Catatonic/ movement symptoms
 The client may almost become like a statue
 They may keep sitting in one position for hours
 If they are standing, they may keep standing
for hours without moving & feeling tired
 If the family talks to them its as if they cant
hear & they don’t respond
 If family tries to shake/move them, they cant –
they maintain the position they are in
 NEGATIVE SYMPTOMS
 Speak extremely less despite repeated attempts
to make them talk
 Take a lot of time to respond or react
 Do things slowly/ take lot of time to do it
 Isolate themselves from people
 Don’t get affected by good or bad things
happening in their or family members lives –
become detached or indifferent
 Don’t display any feelings in either words or
gestures
 Negative symptoms contd…

 Complete lack of motivation – there is a lack of

initiative for at times the smallest of tasks at
home & work; the person has to be pushed
into doing things, the instructions may have to
be repeated several times - It may give the
family members that the client has become lazy
– but this is not so
 Loose interest in everything
 Become inattentive
 Cant decide – may wait for instructions
 Other behavioural changes
 Not taking care of their basic hygiene
 Collecting and accumulating things even when
they don’t need it and completely clutter their
room
 Leaving home and going away for hours or days
without informing anyone or without any reason
 Increased smoking
EPIDEMIOLOGY
 EPIDEMIOLOGY
• Incidence (how common is it) – 1%
• Found in all societies, all geographical regions,
and incidence rates worldwide are about equal.
• +ve Sx usually start during late adolescence
and early adulthood (though gender differences
exist)
• Males - onset of positive symptoms-17 to 27 yrs
• Females – onset - between 17 to 37 yrs of age