Chapter 8

Schizophrenia Spectrum
and Other Psychotic
Disorders
 Announcements

 Quizzes for Chapter 8 and 9 are due before Friday

(3/31/23) by 11:59pm

 Midterm raw scores (out of 68) are posted on Husky

CT (add 7 to that score)

 Midterm letter grades are now posted on Student

Admin system

 Emilie will be guest lecturing on 3/30/23

 The Final Exam is on Wednesday (5/3/23) from 6:00-

8:00pm
 Brief History of Schizophrenia

 Emil Kraepelin: Dementia praecox

 Eugen Bleuler: Schizophrenia
 Four A’s:
Associations
Affect
Autism
Ambivalence
 Kurt Schneider: Early DSM (1950’s)
 Psychosis

 Inability to differentiate between what is real and

what is unreal
 Psychotic symptoms divided into two groups:
positive and negative
 Positive symptoms: delusions, hallucinations,
disorganized speech, disorganized behavior
 Negative symptoms: lack of expected or normal
emotions, behaviors, and motivations
 Delusions

 Disturbances in inferential thinking that

involve firmly held beliefs that are untrue.

 Persecutory, Grandiose, Somatic, Religious,

Nihilistic

 Delusions of Reference
TABLE 1Types
TABLE 1 Types of Delusions
of Delusions
These are some types of delusions that are often woven together in a complex and frightening
system of beliefs.
Type of Delusion Definition Example
Persecutory False belief that oneself or one's loved ones are Belief that the CIA, FBI, and local police
delusion being persecuted, watched, or conspired are conspiring to catch you in a sting
against by others operation
Delusion of Belief that everyday events, objects, or other Belief that a newscaster is reporting on
reference people have an unusual personal significance your movements or that a random
manhole cover was put there so you
could see it
Grandiose False belief that one has great power, Belief that you are Martin Luther King,
delusion knowledge, or talent or that one is a famous Jr., reincarnated
and powerful person
Delusion of being Belief that one's thoughts, feelings, or behaviors Belief that an alien has taken over your
controlled are being imposed or controlled by an external body and is controlling your behavior
force
Thought Belief that one's thoughts are being broadcast Belief that your thoughts are being
broadcasting from one's mind for others to hear transmitted via the Internet against your
will
Thought insertion Belief that another person or object is inserting Belief that your spouse is inserting
thoughts into one's mind blasphemous thoughts into your mind
Thought withdrawal Belief that thoughts are being removed from Belief that your roommate is stealing all
one's mind by another person or by an object your thoughts while you sleep
Delusion of guilt or False belief that one has committed a terrible Belief that you have killed someone or
sin act or is responsible for a terrible event that you are responsible for a disaster
(e.g., flood)
Somatic delusion False belief that one's appearance or part of Belief that your intestines have been
one's body is diseased or altered replaced by snakes
 Hallucinations

 Perceptions experienced without an external

stimulus to the sense organs that have
qualities similar to true perceptions.

 Auditory, Visual, Gustatory, Olfactory, Tactile

 Positive Symptoms (continued)

 Formal thought disorder: Schizophrenia involves

significant problems with thinking
 Loose associations or derailment: Tendency to slip from
one topic to an unrelated topic with little coherent
transition
 Disorganized behavior: Unpredictable and
apparently untriggered agitation—shouting,
swearing, pacing
 Catatonia: Disorganized behavior that reflects
unresponsiveness to the environment
 Waxy flexibility
 Examples of Derailment

"The next day when I'd be going out you know, I took
control, like uh, I put bleach on my hair in
California.”

"I think someone's infiltrated my copies of the cases.

We've got to case the joint. I don't believe in joints,
but they do hold your body together.”

"The salad was green as I left the front porch

yesterday. My uncle is a nice person and dogs like
to swim in rivers when the sky is very cloudy."
 Negative Symptoms

 Certain behaviors, emotions, and motivations one

would expect to see are absent in the person
affected by schizophrenia
 Restricted affect: Severe reduction in or absence
of emotional expression
 Avolition/asociality: Inability to initiate or
persist at common, goal-directed activities
 Cognitive deficits: Deficits in basic cognitive
processes, including attention, memory, and
processing speed
 DSM-5 Criterion A:
Active Phase
A. Two (or more) of the following, each present
for a significant portion of time during a 1-
month period:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
 Must have 1, 2 or 3.
 DSM-5 Criteria B and C

B. For a significant portion of the time since the onset

of the disturbance, level of functioning in one or
more major areas, such as work, interpersonal
relations, or self-care, is markedly below the level
achieved prior to the onset.

C. Continuous signs of the disturbance persist for at

least 6 months. This 6-month period must include
at least 1 month of symptoms meeting Criterion A.
 Other Psychotic Disorders

 Schizoaffective disorder
 Mix of schizophrenia and a mood disorder

 Schizophreniform disorder (1 month to 6

months)
 Symptoms of schizophrenia present for less than 6
months
 Brief psychotic disorder (< 1 month)
 Sudden onset of delusions, hallucinations, disorganized
speech, and/or disorganized behavior lasting for up to a
month
 Schizotypal personality disorder
 DSM-5: Delusional Disorder

 The presence of one or more delusions with a duration

of 1 month or longer, but Criterion A for Schizophrenia
has never been met.
 Subtypes:
 Erotomanic
 Grandiose
 Jealous
 Persecutory
 Somatic
 Epidemiology of Schizophrenia

 Lifetime prevalence is around 1%

 Equal number of males and females, but
females have better long-term outcome
 Age of onset: males (late teens), females
(late 20’s)
 Chronic, debilitating condition with a poor
long-term outcome
 Three Phases of Schizophrenia

 Prodromal phase: beginning of deterioration;

mild symptoms

 Active (acute) phase: symptoms become

apparent

 Residual phase: a return to prodromal-like

levels
 Prognosis

 Overall poor prognosis even with treatment

 One of the most severe and debilitating mental
illnesses
 Rehospitalization rates between 50 and 80
percent
 5–10 percent die by suicide
 Some may reach some stabilization between
5 and 10 years after first psychotic episode
 High rate of medical problems
 Factors Affecting Prognosis

 Sex and age

 Females develop the disorder later, display
milder symptoms, and have a more favorable
course than males
 Functioning in some may improve with age
 Sociocultural factors
 Socioeconomic status (SES)