Schizophrenia

• SCHIZOPHRENIA was coined by Eugen Bleuler – a Swiss psychiatrist
• SCHIZOPHRENIA


  It came from the Greek word meaning split personality- which means that there is a disconnection or splitting of the psychic functions
• SCHIZOPHRENIA


  • It encompasses a group of psychotic reactions that affect multiple areas of the individual’s functioning, including thinking and communicating, perceiving and interpreting reality, feeling and demonstrating emotion, and behaving in socially acceptable manner
  • It is characterized by withdrawal from reality, illogical patterns of thinking, delusions, and hallucinations, and accompanied in varying degrees by other emotional, behavioral, or intellectual disturbances
  • It is a severe mental disorder characterized by 5 “A’s”: affect, association, autism, ambivalence, auditory hallucination
  • The nodal onset for men is between 18 to 25; for women, between 25 and mid-30’s
• Characteristics of SCHIZOPHRENIA

  • Affect: a person’s mood, feeling tone or emotions
  • Association: loose or distorted
  • Autism: a thought process in which the person retreats from reality
  • Ambivalence: contradictory or opposing emotions, attitudes, ideas and desires for the same person, thing or situation
  • Auditory hallucination
• Causes of SCHIZOPHRENIA
• Genetic predisposition

  • One affected parent: 12% to 15% risk
  • Both parents affected: 35% to 39%
  • Sibling affected: 8% to 10%
  • Dizygotic twin affected: 15% at risk
  • Monozygotic twin: 50% risk
  • Distant relative: 3% to 5%
• Neuro developmental abnormalities


  • Development of minor fetal malformation during early gestation
  • Factors that can affect neurodevelopment and that may increase the risk of disease include; influenza infection (maternal) during 2nd trimester, trauma or injury at birth (hypoxia or oxygen deprivation), abuse or trauma during infancy or early childhood
• Brain structural abnormalities and chemical imbalances

  • Brain imaging techniques, MRI, positron emission tomography have shown abnormalities in the structure of the brain
  • Enlarged ventricles
  • Decreased cortical blood flow, especially in the pre-frontal cortex
  • Decreased metabolic activity in certain areas
  • Cerebral atrophy
  • Excessive production of dopamine in some areas of the brain
  • Other neurotransmitters like serotonin, nor epinephrine, glutamate and GABA play an important role in the development of schizophrenia
• Psychosocial and environmental factors

  • Developmental theorists proposed that the lack of warm, nurturing attention in the earliest life contributes to the lack of self-identity, reality misinterpretation and relationship withdrawal
  • Families who have highly expressed emotions are emotionally over involved, hostile and critical
  • Consistent association with low-socio-economic
  • Biologically vulnerable individuals who are always exposed to life’s stressors may produce symptoms of schizophrenia
• Signs and symptoms of SCHIZOPHRENIA

  • Positive symptoms: reflect the symptoms of overt psychotic or distorted behavior
  • Excess or distortion of normal functions
  • Bizarre or disorganized behavior
  • Hallucinations
  • Illusion
  • Delusions
  • Delusions of reference: everything occurring in environment has a direct significance to oneself
  • Delusion of persecution: people or institutions are plotting against or attacking him
  • Delusion of external control: one is controlled by others or outside forces
  • Somatic delusion: appearance or functioning of one’s body is altered
  • Nihilistic delusion: a belief that one is dead or the world is ending
  • Erotomanic: belief that another person, often someone important or famous, is in love with him or her
  • Grandiose: an over-inflated sense of worth, power, knowledge, or identity
  • Persecutory: belief that they (or someone close to them) are being mistreated, or that someone is spying on them or planning to harm them
• Inflated sense of worth, power, knowledge, or identity. The person might believe he or she has a great talent or has made an important discovery
• Persecutory delusional disorder: People believe they are being mistreated, spied on, or someone is planning to harm them
• Excitement and agitation
• Hostility or aggressive behavior
• Suspiciousness
• Pressured speech
• Possible suicidal tendencies
• Loose association
• Neologism: creating new words
• Word salad: words in a sentence that may seem connected but do not compose coherent thought
• Echolalia: senseless repetition of the words of another person
• Echopraxia: senseless copying of another person’s behavior or action
• Clang association: words that rhyme are put together for their sound association, without coherent thought
• Flight of ideas: continuous flow of verbalization in which the person jumps from one topic to another
• Negative symptoms reflect a diminution or loss of normal function
• Negative symptoms

  • Anergia
  • Anhedonia
  • Emotional withdrawal
  • Poor eye contact
  • Blunted affect
  • Ambivalence
  • Avolition
  • Difficulty to abstract thinking
  • Alogia
  • Dysfunctional relationship with others
• Types of Schizophrenia

  • Paranoid
  • Disorganized
  • Catatonic
  • Undifferentiated
  • Residual
• Paranoid schizophrenia is characterized by systematized delusions or auditory hallucinations; the individual may be suspicious, argumentative, hostile, and aggressive
• Disorganized schizophrenia involves disorganized speech and behaviors as well as flat or inappropriate affect
• Catatonic schizophrenia is characterized by marked psychomotor disturbances, which may involve immobility or excessive activity
• Undifferentiated schizophrenia
• Residual schizophrenia
• Other psychotic disorders

  • Schizoaffective disorder
  • Brief reactive psychosis or brief psychotic disorder
  • Schizophreniform disorder
  • Delusional disorder
  • Shared psychotic disorder (folie a deux)
• Schizoaffective disorder refers to behavior characteristic of schizophrenia in addition to those indicative of disorders of mood such as depression or elation
• Brief reactive psychosis or brief psychotic disorder involves a sudden onset of psychotic symptoms in response to severe psychosocial stressors
• Schizophreniform disorder has essential features identical to schizophrenia but with a duration of less than 6 months but more than 4 weeks
• Delusional disorder: The client has one or more non-bizarre delusions that are believable ideas
• Shared psychotic disorder (folie a deux) involves a similar delusion shared by two people