SCHIZOPHRE

NIA
REPORTED BY:
Francis Von Saulo
Ronaly Capunitan
Jan Michael Armogenia
OUTLINE:
• Schizophrenia
• Types of Schizophrenia
• Psychotic Disorders in the DSM-IV
• Symptoms, Diagnosis and Prognosis
- Positive Symptoms
- Negative Symptoms
- Other features of Schizophrenia
• Extraordinary people: JOHN NASH, “A
Beautiful mind”
• Biological Theories
- Genetic Contributors to
Schizophrenia
- Structural Brain Abnormalities
- Neurotransmitter
• Psychosocial Perspectives
- Family Interactions and
Schizophrenia
• Treatments Stress and Schizophrenia
- Biological Treatments: Drug Therapy
 CHAPTER OVERVIEW
TAKING PSYCHOLOGY PERSONALLY
• Helping families cope with schizophrenia
EXTRAORDINARY PEOPLE
• John Nash, A Beautiful Mind
BIOLOGICAL THEORIES
• There is strong evidence that schizophrenia is
transmitted genetically. People with
schizophrenia show abnormalities in the
prefrontal cortex and ventricles of the brain. A
number of prenatal difficulties and obstetrical
problems at birth are implicated in the
 development of schizophrenia, including
prenatal hypoxia and exposure to the influenza
virus during the second trimester of gestation.
Imbalances in the neurotransmitter dopamine,
serotonin, glutamate, and GABA are also
implicated in schizophrenia.
PSYCHOSOCIAL PERSPECTIVE
• Early psychodynamic theorists suggested that
schizophrenia results from overwhelmingly
negative experiences in early childhood
between a child and his or her primary
caregivers. More recent theories have focused
on aspects of family life that may increase stress
and relapse in schizophrenia . A variety of
stressors may worsen the course of
schizophrenia . Behavioral theories suggest
that the symptoms of schizophrenia can
develop through operant conditioning. Cognitive
theories accept that there is a biological
vulnerability to schizophrenia but see many
symptoms as attempts to understand and cope
with basic perceptual and attentional problems.
TREATMENTS
• Drugs called neuroleptics have proven useful
in the treatment of schizophrenia. They have
significant neurological side effects. New drugs
known as atypical antipsychotics appear to be
effective without inducing as many side effects
as previous drugs. Psychosocial therapies
focus on teaching communication and living
skills and reducing isolation in people with
schizophrenia.
 SCHIZOPHRENIA
 disorder consisting of unreal or disorganized
thoughts, and perceptions as well as verbal,
cognitive and behavioral deficits.
 the most common of the psychotic disorders
(or a group of disorders) marked by severely
impaired thinking, emotions, and behaviors,
described in Axis I of the DSM-IV-TR, includes
several subtypes, each having a distinctive set
of symptoms.
 Description of Schizophrenia
The course of schizophrenia in adults can be
divided into three phases or stages. In the acute phase,
the patient has an overt loss of contact with reality
(psychotic episode) that requires intervention and
treatment. In the second or stabilization phase, the
initial psychotic symptoms have been brought under
control but the patient is at risk for relapse if treatment
is interrupted. In the third or maintenance phase, the
patient is relatively stable and can be kept indefinitely
on antipsychotic medications. Even in the maintenance
phase, however, relapses are not unusual and patients
do not always return to full functioning.
 The term schizophrenia comes from two
Greek words that mean "split mind." It was observed
around 1908, by a Swiss doctor named Eugen Bleuler, to
describe the splitting apart of mental functions that he
regarded as the central characteristic of schizophrenia.
Recently, some psychotherapists have begun
to use a classification of schizophrenia based on two main
types. People with Type I, or positive schizophrenia, have
a rapid (acute) onset of symptoms and tend to respond
well to drugs. They also tend to suffer more from the
"positive" symptoms, such as delusions and hallucinations.
People with Type II, or negative schizophrenia, are usually
described as poorly adjusted before their schizophrenia
slowly overtakes them. They have predominantly
"negative" symptoms, such as withdrawal from others and
a slowing of mental and physical reactions (psychomotor
retardation).
 POSITIVE SYMPTOMS OF
SCHIZOPHRENIA
The positive symptoms of schizophrenia represent the
presence of unusual perceptions, thoughts, or behaviors.
SYMPTOMS DEFINITION AND EXAMPLE
Delusions Beliefs with little grounding in reality( e.g., beliefs
that you are being persecuted or that you are the
Hallucinations Messiah)
Unreal perceptual or sensory experiences ( e.g.,
Disorganized hearing, seeing, and feeling things that are not
thought and speech there)
Grossly disorganized pattern of speech ( e.g.,
Disorganized or complete incoherence, linking together of words
catatonic behavior based on sounds instead of meaning)
Behavior that is highly unpredictable, is bizarre,
and/or shows a complete lack of responsiveness to
the outside world (e.g., complete motionlessness
for long periods; sudden, untriggered outburst)
 NEGATIVE SYMPTOMS OF
SCHIZOPHRENIA
The negative symptoms of schizophrenia represent the
absence of usual emotional and behavioral response.
Symptoms Description Examples
Affective Severe reduction or No facial expressions in
flattening complete absence of response to emotionally
(blunted affect) affective( emotional) charged stimuli; no
responses to the emotional expression in
environment. voice.
Alogia Severe reduction or Complete mutism for
complete absence of weeks.
speech.
Avolition Inability to persist at Inability to get dressed,
common, goal oriented brush teeth, eat
tasks. breakfast in morning.
Sample Illustrations/Photos of
Schizophrenics
Sample Illustrations/Photos of
Schizophrenics
 OTHER FEATURES OF
SCHIZOPHRENIA
INAPPROPRIATE AFFECT
• Instead of showing flattened, or blunted, affect, the person with
schizophrenia may show inappropriate affect, laughing at sad
things and crying at happy things. This may happen because he
or she is thinking about the responding to something other than
what is going on in the environment.
• Inappropriate displays of affect may also occur because the
brain processes that match stimuli with the proper emotions and
emotional responses to those stimuli are not working properly,
so that unhappy stimuli trigger sadness.
• Whatever the cause, inappropriate affect is one of the most
striking symptoms in schizophrenia. Often, the person will
switch from one extreme emotional expression to another for
no apparent reason.
ANHEDONIA
• Recall that many people who display flattened, or
blunted, affect are actually experiencing emotions,
although they are not showing them. Some people with
schizophrenia, however, experience severe anhedonia,
similar to the anhedonia that characterizes depression.
They lose the ability to experience emotion, and no
matter what happens, they do not feel happy or sad.
This emotional void itself can be very aversive.
IMPAIRED SOCIAL SKILLS
• Not surprisingly, the symptoms of schizophrenia make it
difficult to have normal interactions with other people.
People with schizophrenia show a wide range of
impaired social skills, including difficulty in holding
conversations in maintaining relationships and in holding
a job.
Pictures of other features of Schizophrenia
 DIAGNOSTIC CRITERIA FOR
SCHIZOPHRENIA
The DSM-IV criteria for schizophrenia require the presence of
severe symptoms for at least one month and the presence of
some symptoms for at least six months.
A. Core symptoms: two or more of the following present for at
least a one-month period:
1.) Delusions
2.) Hallucinations
3.) Disorganized speech
4.) Grossly disorganized or catatonic behavior
5.) Negative symptoms
B. Social/ occupational functioning: significant impairment in
work, academic performance, interpersonal relationships,
and/ or self-care.
C. Duration: continuous signs of the disturbance for at least six
months; at least one month of this period must include
symptoms that meet Criterion A above.

In 1883, Kraepelin labeled the disorder dementia

praecox (precocious dementia), because he believed that
the disorder results from premature deterioration of the brain.
He viewed the disorder as progressive, irreversible, and
chronic. Kraepelin’s definition of this disorder was a narrow
one, which resulted in only a small percentage of people
receiving this diagnosis.

Prodromal symptoms are present before people

go into the acute phase of schizophrenia, and residual
symptoms are present after they come out the acute phase.
 DIAGNOSTIC CRITERIA FOR
SCHIZOAFFECTIVE DISORDER
The major distinction between schizoaffective disorder and
schizophrenia is the presence of severe mood symptoms in
schizoaffective disorder.
A. An uninterrupted period of illness during which, at same time,
there is either a major depressive episode, a manic episode, or
a mixed episode concurrent with symptoms that meet criterion
A for schizophrenia.
B. During the same period of illness, there have been delusions
or hallucinations for at least two weeks in the absence of
prominent mood symptoms.
C. Symptoms that meet criteria for a mood episode are present
for a substantial portion of the total duration of the active and
residual periods of the illness.
 TYPES OF SCHIZOPHRENIA
The DSM-IV recognizes five subtypes of schizophrenia.
TYPE MAJOR FEATURES
Paranoid schizophrenia Delusions and Hallucinations with themes of
persecution and gradiosity.
Disorganized Incoherence in cognition, speech, and
schizophrenia behavior and flat or inappropriate affect.
Catatonic schizophrenia Nearly total unresponsiveness to the
environment, as well as motor and verbal
abnormalities.
Undifferentiated Diagnosed when a person experiences
schizophrenia schizophrenic symptoms but does not meet
the criteria for paranoid, disorganized,
catatonic schizophrenia.
Residual schizophrenia History of at least one episode of acute
positive symptoms but currently no
prominent positive symptoms.
 Paranoid Schizophrenia
• It is the best known and most researched type
of Schizophrenia.
• P. Schizophrenics (P.S.) have prominent
delusions & hallucinations that involve themes
of persecution and grandiosity.
• P.S. do not show disorganized speech or
behavior unlike in other types of schiz.
• P.S. are lucid and articulate, highly resistant to
any arguments against their delusions, act
arrogantly as if they were superior to others or
may remain aloof and suspicious.
 Paranoid Schizophrenia
• Prognosis for P.S. – better than the other types.
• Likely to live independently, hold down a job,
show better cognitive and social functioning.
• Onset of P. Schizophrenia tend to occur later in
life than does the onset of other types of Schiz.,
and episodes of psychosis are often triggered
by stress.
• P. Schizophrenia is considered a milder less
insidious form of Schiz.
Disorganized
• Disorganized Schizophrenics (D.S.) do not
have well-formed delusions or hallucinations
but their thoughts and behaviors are severely
disorganized, prone to odd stereotyped
behaviors (frequent grimacing or mannerisms
such as flapping of hands), they do not bathe,
dress, or eat if left on their own.
• Emotional experiences and expressions are
disturbed, may not show any emotional
reactions to anything, unusual or inappropriate
emotional reactions to events.
Schizophrenia
 Schizophrenia
• D. Schizophrenia tends to have an early
onset and a continuous course, w/c is
often unresponsive to treatment. D.S.
are among the most disabled by the
disorder.

Disorganized
 Catatonic Schizophrenia
• Distinct features of Catatonic Schizophrenia, the variety of
motor behaviors and ways of speaking that suggest almost
complete unresponsiveness to their environment.
• Clinically significant case of C. Schizophrenia requires two (2)
of the following:
1. Catatonic stupor (motionless for long periods of time)
2. Catatonic excitement (excessive and purposeless motor
activity)
3. Maintenance of rigid postures or being completely mute for
long periods of time
4. Odd mannerisms (grimacing and hand flapping)
5. Echolalia (senseless repetition of words just spoken by others-
Maina bird is a sample of this, jejejejeje :] )
6. Echopraxia (repetitive imitation of the movements of another
person)
 Undifferentiated Schizophrenia
• Undifferentiated Schizophrenics (U.S.) have
symptoms that meet the criteria for
schizophrenia (delusions, hallucinations,
disorganized speech, disorganized behavior,
negative symptoms) but do not meet the criteria
for paranoid, disorganized, or catatonic Schiz.
• Tend to have an onset relatively early in life and
to be chronic and difficult to treat.
• Have had at least one acute episode of acute
positive symptoms of Schiz. But do not
currently have prominent positive symptoms of
Schiz.
• Residual Schizophrenics (R.S.) continue to
have signs of the disorder, however, including
the negative symptoms and mild versions of the
positive symptoms.
• R.S. may have these residual symptoms
chronically for several years.

Residual Schizophrenia
 Prognosis - Schizophrenia
• Schizophrenia “S” - is more chronic and
debilitating that most other mental disorders.
Life expectancy of schizophrenics is 10 years
shorter than that without “S”.
• Schizophrenics suffer from infectious and
circulatory diseases at a higher rate.
• As many as 10% of schizophrenics commit
suicide.
 Age and Gender Factors
• The “S” most stabilize w/in 5-10 years of its first
episode, and the number of re-hospitalization
decline as the person grows older. Example:
John Nash
• Women with “S” have a more favorable course
of the disorder than do men. Women are
hospitalized less often and for brief periods of
time. They show milder negative symptoms and
they have better social adjustment when they
are not psychotic.
 Socio-cultural Factors
• “S” tends to have a more benign course in
developing countries than in developed
countries. The social environments of
schizophrenics in developing countries may
facilitate adaptation.
• Social factors likely contribute to the gender
differences in the course of schizophrenia.
 Biological Theories of “S”
Theory Description

Genetic theories Disordered genes cause “S”, or at least a vulnerability to “S”.

Structural brain Enlarged ventricles may indicate deterioration of a number of

abnormalities brain areas, leading to cognitive and emotional deficits. Reduced
volume and neuron density in the frontal cortex and the temporal
and limbic areas causes widespread cognitive and emotional
deficits.

Birth complications Delivery complications, particularly those causing loss of oxygen,

might damage the brain.

Prenatal viral Exposure to viruses during prenatal period might damage the
exposure brain.

Neurotransmitter Imbalances in levels of or receptors for dopamine cause

theories symptoms; serotonin, GABA, and glutamate may also play roles.
 Psychosocial Perspective
Perspective Description
Psychodynamic Overwhelming rejection by an infant’s caregiver causes the child to
theory lose ability to distinguish reality from unreality.
Communication Oddities in communication by a caregiver to a child at risk for
patterns schizophrenia impair the development of the child’s ability to
communicate with others and increase stress.
Expressed Families that are over-involved with and hostile toward their member
emotion w/ schizophrenia increase stress, w/c leads to relapse.
Social drift and Schizophrenia impairs functioning, leading an individual to lose
urban birth social status,; also, people born into poor urban setting are at
increased risk for the prenatal diseases and injuries that may
contribute to schizophrenia.
Stress and A variety of stressful events increase risk of relapse.
relapse
Behavioral Schizophrenics attend to irrelevant stimuli in the environment and do
theories not know socially acceptable responses to others.
Cognitive theories The symptoms of “S” arise from an individual’s responses to strange
perceptual experiences.
 Treatments
Biological treatments:
• Drug Therapy (Antipsychotic drugs)
• Insulin coma therapy
• Electroconvulsive therapy (ECT)
Psychological and Social treatments:
• Behavioral, Cognitive, and Social Interventions
• Family Therapy