Schizophrenia and Psychotic Disorders

• Functional Psychosis


  Mental disorder causing psychotic symptoms (e.g., Schizophrenia, Mood disorders)
• Non-Functional Psychosis


  Psychosis caused by organic brain disorders, substance abuse, or medical conditions
• Positive Psychotic Symptoms


  • Delusions
  • Hallucinations
  • Formal Thought Disorder
  • Chaotic Behavior
• Negative Psychotic Symptoms


  • Social Withdrawal
  • Lack of Drive (Avolition)
  • Anhedonia
  • Flattening of Affect
• Cognitive Symptoms appear later in the course of psychosis, including disorganization
• Affective Symptoms are emotional disturbances, often accompanying other symptoms
• Schizophrenia Spectrum and Other Psychotic Disorders in DSM-5

  • Schizotypal (Personality) Disorder
  • Delusional Disorder
  • Brief Psychotic Disorder
  • Schizophreniform Disorder
  • Schizophrenia
  • Schizoaffective Disorder
  • Substance/Medication-Induced Psychotic Disorder
  • Psychotic Disorder Due to Another Medical Condition
• Schizophrenia


  • At least 2 of 5 symptoms for at least one month, with at least one of three core symptoms: delusions, hallucinations, disorganized speech
• Schizophreniform Disorder


  • Same criteria as schizophrenia, but duration is between 1 and 6 months
• Schizoaffective Disorder


  • Continuous episode meeting criteria for both mood disorder (longest part) and schizophrenia, with delusions or hallucinations present without prominent mood disorder symptoms during the same period
• Delusional Disorder


  • Delusion lasting for at least one month, no previous meeting of criteria for schizophrenia, no significant functional impairment or odd/bizarre behavior
• Types of Delusional Disorder

  • Erotomanic type
  • Grandiose type
  • Jealous type
  • Persecutory type
  • Somatic type
  • Bizarre type
  • Mixed type
  • Unspecified type
• Brief Psychotic Disorder


  • One or more symptoms (delusions, hallucinations, chaotic speech, chaotic/catatonic behavior), duration less than one month, with full return to previous functioning
• Other Schizophrenia Spectrum and Other Psychotic Disorders


  • Persistent Auditory Hallucinations
  • Delusions with Significant Overlapping Mood Episodes
  • Attenuated Psychosis Syndrome
  • Delusional Symptoms in Partner of Individual with Delusional Disorder
• Catatonia


  • Three or more symptoms of: Catalepsy, Waxy flexibility, Stupor, Agitation, Mutism, Negativism, Posturing, Mannerisms, Stereotypies, Grimacing, Echolalia, Echopraxia
• Types of Catatonia


  • Catatonic disorder due to a general medical condition
  • Catatonia specifier for other psychotic disorders
  • Catatonia specifier for mood disorders
  • Unspecified catatonia
• Lifetime Risk of Schizophrenia is 0.7% to 1%
• Men are slightly more likely than women to develop schizophrenia (M:V ≥ 1:1)
• Mean age of onset is 15-25 for men, 25-35 for women, with 90% of cases occurring between 15 and 55 years
• Men are more likely to experience negative symptoms and have a worse prognosis in schizophrenia
• There is a higher rate of schizophrenia births in winter months
• The concordance rate is 50% in monozygotic twins and 10-15% in first-degree relatives for schizophrenia
• Older fathers are at higher risk of having a child with schizophrenia
• Rates of schizophrenia are higher in urban areas
• People with schizophrenia have lower fertility rates
• 80% of people with schizophrenia may have somatic health issues
• 50% of people with schizophrenia attempt suicide, and 10-15% die by suicide within 20 years
• Risk factors for suicide in schizophrenia include depression and younger age
• People with schizophrenia have high rates of nicotine, alcohol, cannabis, and cocaine use
• Socioeconomic Factors in Schizophrenia

  • Downward Drift Hypothesis
  • Social Causation Hypothesis
  • 30-60% of homeless people have schizophrenia
  • High socioeconomic costs due to unemployment
• Stress-Diathesis Model of Schizophrenia Etiology

  • Combination of genetic predisposition (diathesis) and environmental stressors
• Biological Factors in Schizophrenia Etiology

  • Brain Structure and Function
  • Neurotransmitters
  • Brain Imaging
  • Eye Movements
  • Immunology/Endocrinology
• Psychosocial Theories of Schizophrenia Etiology

  • Psychoanalytic Ideas
  • Expressed Emotion (EE)
  • Double Bind
  • Social Theories
  • Life Events
• Neurocognitive Deficits in Schizophrenia

  • Attention, concentration, working memory, executive functions, social cognition
• Neurocognitive deficits contribute to social dysfunction in schizophrenia
• Early Sensory Processing Deficits in Schizophrenia

  • Preconscious Perceptual Processes
  • Multisensory Integration
  • Unisensory Deficits
• Cognitive deficits are the best predictor of social dysfunction in schizophrenia, not positive or negative symptoms
• 73% of the stable schizophrenia population have cognitive deficits, while 25-40% have delusions/hallucinations
• Schizophrenia Treatments


  • Antipsychotics
  • Hospitalization
  • Psychoeducation
  • Case Management
  • Group Therapy
  • Rehabilitation
  • Cognitive Therapy