Ricky was staying with his father for a few weeks on a visit.

During the first week, things had

gone pretty well, but Ricky forgot to take his medication for a few days. His father knew
Ricky wasn’t sleeping well at night, and he could hear Ricky talking to himself in the next
room. One day while his father was at work, Ricky began to hear some voices outside the
apartment. The voices grew louder, saying, “You’re no good; you can’t do anything right.
You can’t take care of yourself or protect your dad. We’re going to get you both.” Ricky
grew more frightened and went to the closet where his dad kept his tools. He grabbed a
hammer and ran outside. When his father came home from work early, Ricky wasn’t in the
apartment, though his coat and wallet were still there. Ricky’s father called a neighbor, and they
drove around the apartment complex looking for Ricky. They finally found him crouched
behind some bushes. Although it was 45F (7C), he was wearing only a t-shirt and shorts
and no shoes. Ricky’s neighbor called emergency services. Meanwhile, Ricky’s father tried to
coax Ricky into the car, But Ricky wouldn’t come. The voices had grown louder, and Ricky was
convinced that the devil had kidnapped his father and was coming for him too. He saw
someone else in the car with his dad. The voices said they would crash the car if he got in.
They were laughing at him! He couldn’t get into the car; it was a trap. His dad had tried his
best, nut he was trapped too. The voices told Ricky to use the hammer and to destroy the car to
kill the devil. He began to swing the hammer into the windshield, but someone held him
back. The emergency services staff arrived and spoke quietly and firmly as they removed the
hammer from Ricky’s hands. They told Ricky they were taking him to the hospital where he and
his father would be safe. They gently put him on a stretcher with restraints, and his father rode
in the emergency van with him to the hospital.

S/SX

Positive or Hard Symptoms Negative or Soft Symptoms

Content of Thought Affect
Delusion Inappropriate affect
Religiosity Bland or flat affect
Paranoia Apathy
Magical Thinking
Form of Thought Volition
Associative looseness Inability to initiate goal-directed activity
Neologisms Emotional ambivalence
Concrete thinking Deteriorated appearance
Clang Associations
Word Salad
Circumstantiality
Mutism
Perseveration
Perception Interpersonal Functioning and Relationship to
Hallucinations the External World
Illusions Impaired Social Interaction
Social Isolation
Sense of Self Psychomotor Behavior
Echolalia Anergia
Echopraxia Waxy Flexibility
 Identification and Imitation Posturing
Depersonalization Pacing ang Rocking
Associated Features
Anhedonia
Regression

DIAGNOSIS:

The DSM-5 criteria for schizophrenia are as follows:

I. Two (or more) of the following, must manifest for a significant amount of time over a one-
month period (or less if successfully treated). At least of these must be (1),(2),(3):

1. Delusions
2. Hallucinations
3. Disorganized Speech (frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (i.e., diminished emotional expression or avolition).

II. For a large percentage of the period since the commencement of the disturbance, the level of
functioning in one or more main areas, such as employment, interpersonal relationships, or self-
care, has been much lower than the level obtained before to the onset.

III. For at least 6 months, there are persistent evidence of the disruption. This 6-month period must
contain at least one month of symptoms that match Criterion A (i.e., active-phase symptoms)
and may include periods of prodromal or residual symptoms.

IV. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition.

V. If there is a history of autistic spectrum disease or a communication impairment of childhood

development, the additional diagnosis of schizophrenia is established only if prominent
delusions or hallucinations are present for at least 1 month in addition to the other essential
symptoms of schizophrenia.

PROGNOSIS:

 Outcomes in schizophrenia are difficult to predict, but a complete return to full premorbid
functioning is not common.
 several factors have been associated with a more positive outcome. These factors include good
premorbid functioning, later age at onset, female gender, abrupt onset of symptoms with
obvious precipitating factor (as opposed to gradual insidious onset of symptoms), associated
mood disturbance, rapid resolution of active-phase symptoms, minimal residual symptoms,
absence of structural brain abnormalities, normal neurological functioning, and no family history
of schizophrenia (Black & Andreasen, 2011; Puri & Treasaden, 2011; Sadock & Sadock, 2007).