This is an informative chapter about schizophrenia (symptoms and issues). None of this information in here or other chapters can be used to diagnose people. Only psychiatry professions are obligated to diagnose. Psychopathology chapters are review and summary of Textbook “David H. Barlow, V. Mark Durand (2014) Abnormal Psychology: An Integrative Approach” and lecture notes.

Schizophrenia - Symptoms and Issues

Schizophrenia is a serious chronic mental disorder which affects the patient’s thoughts, feels and behaviors. Reality testing is disturbed in schizophrenia and all psychotic disorders. Unlike the public perception, schizophrenia is not split or multiple personality. Majority of people with schizophrenia are not violent or dangerous. Schizophrenia is not caused by childhood experiences, poor parenting or lack of willpower, nor are the symptoms identical for each person.

Clinical Pattern of Schizophrenia

Hallucinations:

Perceptual experiences that do not have a basis in reality. For the individual having them hallucinations appear to be real perceptions.

• Auditory hallucinations (hearing)
• Tactile hallucinations (sensations of the skin)
• Visual hallucinations (seeing)
• Olfactory hallucinations (smelling)

Delusions:

• Bizarre delusions (patently absurd).
• Non-bizarre (possible but unlikely).

• Delusions of persecution.
• Delusions of reference.
• Delusions of identity.
• Delusions of grandiosity.

In many cases, individuals with schizophrenia develop extremely elaborate delusional systems involving numerous interrelated delusions, and their hallucinations are incorporated into their delusions. Delusional beliefs in schizophrenia are more bizarre, more pervasive, more resistant to change.

Disturbed Thought Processes:

• Loosening of the associations; Thoughts are disjointed and do not make sense when put together.
• Word salad.

Cognitive Flooding / Stimulus Overload:

• Inability to screen out irrelevant internal and external stimuli.

Schizophrenic Deficit:

Cognitive symptoms of schizophrenia cause reduced intellectual functioning but not reduced intellectual level (dementia praecox). People with schizophrenia are not aware of their symptoms (no clinical insight). So, they do not seek treatment.

Diagnostic Criteria of Schizophrenia

1. Individual has two or more of the following;
   a. Delusions.
   b. Hallucinations.
   c. Disorganized speech.
   d. Grossly disorganized behavior.
   e. Flat mood, apathy.
   or one of the following;
   a. Bizarre delusions.
   b. Constant hallucinations in which voice talks constantly or two voices converse.
2. Individual shows a decline in social functioning.
3. Symptoms persist at least 6 months.
4. Other psychotic disorders and medical conditions have been ruled out.

NOTE: Different individuals may have very different sets of symptoms but still be suffering from the same disorder.

Phases of Schizophrenia

1.Prodromal phase;

Intellectual and interpersonal functioning begins to deteriorate (a few years to many years).

2.Active phase;

The symptom patterns are prominent.

3.Residual phase (burned-out phase);

A very serious deterioration of skills usually in long-term institutionalization.

Types of Schizophrenia

Paranoid schizophrenia;

Delusions of persecution, auditory hallucinations (may not have other symptoms).

Disorganized schizophrenia;

The most psychological disorganization lacking of systematic set of delusions.

Catatonic schizophrenia;

Lack of or peculiar movements (rare today).

Undifferentiated schizophrenia;

Delusions and hallucinations but not fit other types.

Residual schizophrenia;

A mild form occurs after at least one schizophrenic episode (some symptoms of schizophrenia).

Positive vs Negative Symptoms of Schizophrenia

For a better understanding and treatment;

Positive symptoms are

• Additions to normal behavior.
• Due to neural transmission.

Negative symptoms are

• Absence of normal behavior.
• Due to structural problems of the brain or low levels in the frontal lobes.

Prevalence of Schizophrenia;

• Point prevalence: 0.1 %.
• Life-time prevalence: 1.5 %

Sociocultural Factors of Schizophrenia

Age:

Early adulthood: 25-44.

Gender:

No consistent difference diagnosed earlier in males than in females.

Ethnicity:

No differences in rates between cultures.

Socioeconomic class:

Eight times higher in lower classes.

• Downward social drift.
• Bias in diagnosis.
• Bias in treatment.
• Bias in self-presentation.
• Prenatal and perinatal complications.

Other Psychotic Disorders

Brief psychotic disorder:

• One or more of the following;
  Delusions.
  Hallucinations.
  Disorganized speech.
  Grossly disorganized behavior.
• Symptoms 1 day to 1 month.

Schizophreniform disorder:

• Two or more of the following;
  Delusions.
  Hallucinations.
  Disorganized speech.
  Grossly disorganized behavior
• Symptoms 1 to 6 months.

Schizoaffective disorder:

• Major mood symptoms (depression and mania).
• Two or more of the following with mood symptoms;
  Delusions.
  Hallucinations.
  Disorganized speech.
  Grossly Disorganized behavior.
• Delusions and hallucinations sometimes occur in the absence of mood symptoms.

Shared psychotic disorder:

A delusion as a consequence of a close relationship with another individual that has a delusion.

Delusional disorder:

• One or more non-bizarre delusions.
• No hallucinations, disorganized speech, grossly disorganized behavior.
• Apart from the effects of delusions, functioning is not impaired.

Table of Contents

1.Introduction and Historical Issues
Normality and Abnormality in Clinical Psychopathology
2.Diagnostic Systems and Techniques
Interviews, Observations and Tests
3.Anxiety Disorders I
Symptoms of Anxiety, Phobic Disorders, Generalized Anxiety Disorders, Panic Disorder
4.Anxiety Disorders II
Obsessive-Compulsive Disorders, Post-Traumatic and Acute Stress Disorders.
5.Mood Disorders I
Major Depressive Disorder and Dysthymia.
6.Mood Disorders II
Bipolar Disorder and Cyclothymic Disorder.
7.Schizophrenia I
Symptoms and Issues.
8.Schizophrenia II
Explanations and Treatments.
9.Disruptive Behavior Disorders-I
Attention Deficit/Hyperactivity Disorder.
10.Disruptive Behavior Disorders-II
Conduct Disorder and Oppositional Defiant Disorder.
11.Pervasive Development Disorders
Autistic Disorder, Asberger`s and other Developmental Disorders.
12.Elimination Disorders and Tic Disorder.
13.Mental Retardation.
14.Cognitive Disorders
Amnesia Disorders, Dementia Disorders, Delirium Disorders.
15.Suicide.
16.Substance-related disorders.
17.Sexual Dysfunctions.