Schizophrenia

SchizophreniaA. Two or more of the following, each

present for a significant portion of the time during a 1-month period**

1. Delusions2. Hallucinations3. Disorganized speech4. Grossly disorganized or catatonic behavior5. Negative symptoms

Schizophrenia**Exception to the 2+ symptom requirement:

only 1 psychotic symptom required if:1. Delusion is bizarreOR2. Hallucination consists of either:a. voice keeps up a running commentary on the person’s thoughts or behaviorORb. two or more voices conversing with each other

SchizophreniaB. Impairment in functioningC. Signs of the disturbance for at least 6

months, that includes at least 1 month of symptoms described by Criterion A

D. Symptoms are not better accounted for Schizoaffective Disorder or Mood Disorder with Psychotic Features

E. Not due to a GMC or substanceF. If there is a developmental disorder

present, there are prominent delusions or hallucinations present for at least one month

Delusions (Positive Symptom) Fixed, false beliefs Types

Bizarre –delusion that is very strange and completely implausible for the person's culture; an example of a bizarre delusion would be that aliens have removed the affected person's brain vs. the non-bizzare delusion that you’re under police surveillance

Thought insertion –thoughts are being inserted into his or her mind from some outside force, person, or group of people, and these thoughts are not recognized as the person's own thoughts

Thought withdrawal – Thought broadcast – Reference – believes that insignificant remarks, events,

or objects in one's environment have personal meaning or significance

Delusions (positive symptom) Types, continued

Control –another person, group of people, or external force controls one's thoughts, feelings, impulses, or behavior.

Somatic – Usually the false belief is that the body is somehow diseased, abnormal, or changed. An example of a somatic delusion would be a person who believes that his or her body is infested with parasites.

Nihilistic – Belief that something is about the to end. You or the world

Grandiose –An individual exaggerates his or her sense of self-importance and is convinced that he or she has special powers, talents, or abilities. Sometimes, the individual may actually believe that he or she is a famous person (for example, a rock star or Christ). More commonly, a person with this delusion believes he or she has accomplished some great achievement for which they have not received sufficient recognition.

Religious –Any delusion with a religious or spiritual content. Persecutory –These are the most common type of delusions

and involve the theme of being followed, harassed, cheated, poisoned or drugged, conspired against, spied on, attacked, or obstructed in the pursuit of goals.

Hallucinations (Positive Symptom) False sense perception Types

Auditory –

Tactile –

Visual –

Olfactory/Gustatory –

Somatic –

Disorganized Speech (Positive Symptom) Speech that is hard to understand or follow,

impairs communication Types

Loose associations –

Incoherence –

Frequent derailment –

Disorganized Speech:Geometric Analogy

Q A A

A

A

Q

Q

Q

Normal: goal directed and linear Tangential

Loosening of Associations

Incoherence

AQ

Circumlocution

Grossly Disorganized or Catatonic Behavior (Positive Symptom) Grossly Disorganized Behavior

Unusual behavior in which the individual acts any number of ways from silly and childlike to angry and aggressive.

Grossly Disorganized or Catatonic Behavior (Positive Symptom) Catatonic Behavior

Negative Affect (Negative Symptom) Flat affect No emotional expression in speech Restricted fluency of thought and speech

Schizophrenia: Course

Group 330% have repeated episodes of illness with some impairment between episodes

Group 225% have repeated episodes of illness with no impairment between episodes

Group 115% have only a single episode of illness with no subsequent impairment

Group 430% have repeated episodes of illness with gradually declining impairment between episodes

Subtypes of Schizophrenia Paranoid Disorganized Catatonic Undifferentiated Residual

Catatonic

Paranoid Schizophrenia Preoccupation with one or more

delusions or auditory hallucinations (usually persecutory, grandiose, or both)

None of the following is prominent: Disorganized speech, Disorganized behavior Catatonic behavior Flat/inappropriate affect

Disorganized Schizophrenia All of the following are prominent

Disorganized speech Disorganized behavior Flat/Inappropriate affect

There is no catatonic behavior

Catatonic Schizophrenia A type of Schizophrenia in which the

clinical picture is dominated by at least 2 or more catatonic behaviors Motoric immobility as evidenced by stupor,

catalepsy, or waxy flexibility Excessive motor activity that is apparently

purposeless and not influenced by external stimuli

Extreme negativism or mutism Peculiarities of movement (posturing,

stereotyped movements, prominent mannerisms, or prominent grimacing

Repeating whatever is said or done

Undifferentiated Schizophrenia Characterized by symptoms which do not

fit the paranoid, disorganized, or catatonic subtypes

Vague, “catch-all” category