Schizophrenia

• Auditory hallucinations


  Most common type of hallucinations in schizophrenia and related disorders, usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual's own thoughts
• Hallucinations may be a normal part of religious experience in certain cultural contexts
• Delusions


  Beliefs that have no basis in reality and are not open to change despite conflicting evidence
• Types of delusions


  • Persecutory (belief that one is going to be harmed, harassed, etc. by an individual, organization, or group)
  • Referential (belief that certain gestures, comments, environmental cues, etc. are directed at oneself)
  • Grandiose (belief that one has exceptional abilities, wealth, or fame)
  • Erotomanic (belief that another person is in love with them)
• Bizarre delusion


  Belief that an outside force has removed one's internal organs and replaced them with someone else's without leaving any wounds or scars
• Non-bizarre delusion


  Belief that one is under surveillance by the police, despite a lack of convincing evidence
• The distinction between a delusion and a strongly held idea is sometimes difficult to make, and depends on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidence
• Negative symptoms of schizophrenia

  Reduction or loss of normal function, including speech poverty and avolition
• Affective flattening


  Reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact, and inability to interpret or use appropriate body language
• Avolition


  Reduction, difficulty, or inability to initiate and persist in goal-directed behaviour, often mistaken for apparent disinterest, such as no longer being interested in going out, meeting friends, or activities one used to enjoy
• Hallucinations


  Perceptions in the absence of external stimuli; can occur in any sensory modality
• Religious experience


  An experience related to a person's religious or spiritual beliefs; can include things like having a sense of divine presence, seeing religious symbols or figures, or hearing voices with a religious message
• Certain cultural contexts


  Refers to cultural settings in which religious hallucinations may be more accepted or even encouraged
• Non-bizarre delusion


  A false belief that is possible in reality but not based on evidence or fact. Examples include beliefs about being persecuted or under surveillance.
• Bizarre delusion


  A false belief that is clearly implausible or impossible, such as believing that aliens have implanted a chip in your brain.
• Bizarre delusion


  A false belief that is clearly implausible or impossible, such as believing that aliens have implanted a chip in your brain or that you have the ability to control the weather.
• Non-bizarre delusion


  A false belief that is possible in reality but not based on evidence or fact, such as beliefs about being persecuted, under surveillance, or having a serious illness.
• Misinterpretations of real events


  The basis for some non-bizarre delusions, in which real events or experiences are misinterpreted or distorted.
• Hallucinations


  Perceptions that occur in the absence of external stimuli; can occur in any sensory modality
• Schizophrenia


  Characterised by delusions, hallucinations, disorganised or abnormal speech and behaviour, negative symptoms and other symptoms that cause social or occupational dysfunction
• Diagnosis of schizophrenia


  1. Symptoms must have been present for six months

  2. Must include at least one month of active symptoms

  3. Individual must exhibit at least two of the following symptoms (one of which must be either number 1, 2 or 3)
• Symptoms of schizophrenia


  • Delusions, with no basis in belief
  • Hallucinations - response to no stimulus (sensory experience with no sensory stimulus)
  • Disorganised speech (e.g., frequent derailment or incoherence)
  • Grossly disorganized or catatonic behaviour
  • Negative symptoms (ie., diminished emotional expression or avolition)
• Positive symptoms of schizophrenia

  The addition of something 'extra', eg. a behaviour or biological reaction that you didn't have before, including delusions and hallucinations
• Hallucinations


  Perception-like experiences that occur without an external stimulus, vivid and clear, with the full force and impact of normal perceptions, not under voluntary control
• DSM-I, DSM-II, DSM-I, DSM-V, DSM-VE
• DSM V - USA, ICD - Europe
• Rosenhan study


  • Useful for real life application on training staff how to behave and diagnose people in the asylum
  • Improvement in care
• Rosenhan study


  • Problematic for mental health institutions
  • Staff and real patients did not give consent to withdraw etc. (kept confidential/anonymous)
• Ethics


  Protect patient (right to withdraw) + labelling
• Symptom overlap


  Shares symptoms with other disorders
• Positive symptoms of schizophrenia


  Can look like symptoms in about 50% of manic episodes, especially those with psychotic features (these can include delusions of grandeur, hallucinations, disorganized speech, paranoia, etc.)
• Negative symptoms of schizophrenia

  Can closely resemble the symptoms of a depressive episode (these include apathy, extreme emotional withdrawal, lack of affect, low energy, social isolation, etc.)
• Common co-morbid disorders with schizophrenia

  • Dementia
  • Substance abuse
  • OCD
  • Depression
  • Heart disease
  • Diabetes
• Co-morbidity means that clinicians might find it difficult to distinguish between symptoms presented by schizophrenia and symptoms that occur from the other disorder, which means their diagnosis might not be valid
• Co-morbidity creates problems with reliability as there can be inconsistency in which disorder is diagnosed (some doctors may diagnose schizophrenia whereas others diagnose the co-morbid disorder instead)
• Co-morbidity affects clinicians' ability to successfully treat these disorders
• Estimated that comorbidity occurs in 50% of patients with schizophrenia & 47% of patients have a lifetime diagnosis of substance abuse
• 12% of schizophrenic patients also fulfilled the diagnostic criteria for OCD, and approximately 12% displayed significant OCD symptoms
• Patients diagnosed with schizophrenia also had a medical condition
• First-rank symptoms of schizophrenia

  • Auditory hallucinations (hearing thoughts spoken aloud, hearing voices referring to himself/herself, made in the third person, auditory hallucinations in the form of a commentary)
  • Thought withdrawal, insertion and interruption
  • Thought broadcasting
  • Somatic hallucinations
  • Delusional perception