Schizophrenia

Reference: Butcher, J. N., Hooley, J.S., & Mineka, S. (2004). Schizophrenia and Other Psychotic Disorders. Abnormal
Psychology, 12th ed. (p. 458-466). New Jersey: Pearson Education, Inc.

Clinical Symptoms

 Characterized by the presence of sever disturbances in thought, behaviour, and interpersonal

relationships

 Hallmark is a significant loss of contact with reality, often referred to as Psychosis

 Clinical Symptoms

 Delusions

 An erroneous belief that is fixed and firmly held despite clear contradictory evidence

 Involves a disturbance in the content of thought

 Common in schizophrenics, occurring in more than 90% of patients at a time

 Hallucinations

 A sensory experience that occurs in the absence of any external perceptual stimulus

 Can occur in any sensory modality

 Disorganized Speech

 External manifestation of a disorder in thought form

 Affected person fails to make sense despite seeming to conform to the semantic and
syntactic rules governing verbal communication

 Words and combinations sounds communicative but fails to get the message across

 Neologisms – completely new, made-up words sometimes appear in a patient’s speech

I have also "killed" my ex-wife in a 2.5 to 3.0 hours sex bout in Devon Pennsylvania in 1976, while two
Pitcairns were reading in my next room closet, hearing the event. Enclosed, please find my urology
report, indicating that my male genitals, specifically my penis, are within normal size and that I'm
capable or normal intercourse with any woman, signed by Dr. [name], a urologist and surgeon who
performed a circumcision on me in 1982. Conclusion: I cannot be a nincompoop in a physical sense
(unless Society would feed me chemicals for my picture in the nincompoop book).

 Disorganized and Catatonic Behaviour

 Goal-oriented activity is universally disrupted

  Impairment occurs in areas of routine daily functioning

 Catatonia involves the total absence of all movement and speech where the patient can
be in what is called a “catatonic stupor”

 A patient may also hold an unusual position for an extended period of time without any
seeming discomfort

 Schizophrenia is an episodic disorder with three distinct phases

 Prodromal phase

 Significant deterioration of social and cognitive functioning from a premorbid

level

 Withdrawal from social situations, neglect of duties and hygiene, strange

thoughts and emotions, loss of energy and initiative

 Active phase

 Markedly psychotic behaviours emerge: delusions, hallucinations, disorganized

thought patterns, odd speech, incoherence, inappropriate or restricted
emotional reactions

 Residual phase

 Symptoms similar to those in prodromal phase with the exception of emotional

blunting and particularly pronounced neglect for one’s duties

Five Subtypes of Schizophrenia

 Catatonic Schizophrenia

 Severe disturbances in psychomotor behaviour

 Patients are frequently mute and unresponsive

 Patients may assume rigid, passive, or bizarre postures

 Unifying quality of catatonics: almost completely unresponsive to their environment

 Some of these patients are highly suggestible and will automatically obey commands or
imitate the actions of others (echopraxia) or mimic their phrases (echolalia)

 May pass suddenly from extreme stupor to a state of great excitement, during which
they may seem to be under "great pressure of activity" and may become violent
  Disorganized Schizophrenia

 Patients exhibit strange, incoherent, and often silly behaviour

 Gross disturbances in thought processes versus their psychomotor processes

 Speech is characterized by loose associations, neologisms, and clanging

 Appear to be somewhat responsive to the enviroment, responses however may be

incomprehensible and unpredictable

 Usually occurs at an earlier age and has a gradual, insidious onset

 Person gradually becomes more reclusive and preoccupied with fantasies

 Paranoid Schizophrenia

 Preoccupation with elaborate delusional systems, usually relating to themes of

grandiosity, persecution, jealousy, and/or suspiciousness

 Cast of delusional systems typically involves divine or supernatural beings, important

people in the patient’s life, or images from history or the media

 Usually appear to act fairly normally, at least in the superficial level, unless they are in
the process of acting on their delusions

 Eventual clinical picture is dominated by absurd and illogical ideas and beliefs that are
often highly elaborated and organized into a coherent, though delusional, framework

 Undifferentiated Schizophrenia

 Either display prominent psychotic symptoms from more than one of the above
categories or show symptoms that do not fit easily into any of the above categories

 The “garbage can” label

 Residual Schizophrenia

 People who have suffered from at least one episode of schizophrenia but do not now
show any prominent symptoms such as hallucinations, delusions, or disorganized
speech or behavior

 Exhibit relatively mild signs of schizophrenia

 Patient’s life taken as a whole generally lacks meaning and coherence with a severe
deficit in many of the higher-order abilities

Considerations and Recommendations

 Schizophrenia constitutes a diverse class of disorders that progress through distinct phases and
manifest in a variety of ways

 Cases show great individual differences in behaviour patterns making it very difficult, if not
impossible, to predict when a patient will enter an active phase

 About 1% of the population will suffer some form of schizophrenia during their lifetimes

 Public perception is based almost exclusively on the psychotic symptoms emerging in the active
phase

 Considerations and Recommendations

 It is clear that schizophrenia has a genetic component but little is known about the causes of the
disorder

 NO CURE: treatment is primarily through the administration of antipsychotic medication with

the goal of decreasing psychotic symptoms and controlling residual symptoms to the point
where the patient can function in a more manageable and productive level

 Dosage of medication depends on the patient’s needs

 The “revolving door syndrome”: cycle of treatment and decompensation

 Considerations and Recommendations

 On the occasion that a patient does not show any residual signs following the abatement of
psychotic symptoms, he or she may be withdrawn from medication entirely, but it is possible
that the person suffers from another disorder with psychotic features

 Therapists must be wary of the possible side effects of medication, particularly a condition
known as tardive dyskensia where a person’s motor movements are impaired and shakiness is
experienced due to prolonged pharmacological treatment