Schizophrenia Spectrum and Other Psychotic Disorders

Schizophrenia — the startling disorder characterized by a broad spectrum of cognitive and emotional
dysfunctions including delusions and hallucinations, disorganized speech and behavior, and
inappropriate emotions.

Early Figures in Schizophrenia

1. John Haslam (1809) — Published Observations on Madness and Melancholy in 1809, where he
outlined a description of the symptoms of schizophrenia.

2. Philippe Pinel (1801-1809) — A French physician who described cases of schizophrenia.

3. Benedict Morel (1852) — Physician at a French institution who used the term démence précoce (in
Latin, dementia praecox), meaning early or premature (précoce) and loss of mind (démence), to describe
schizophrenia.

Key Persons Involved in Schizophrenia

1. Emil Kraepelin — In 1899, he labeled the disorder Dementia Praecox (preconscious dementia),
because he believed that the disorder results from premature deterioration of the brain.

Distinct categories of schizophrenia under the name dementia praecox.

• Hebephrenia – silly and immature emotionality.

• Catatonia – alternating immobility and excited agitation.

• Paranoia – delusions of grandeur or persecution.

2. Paul Eugen Bleuler — Coined the term schizophrenia on April 24, 1908. He thought of it as breaking of
associative threads.

3. Margaret Mahler — Emphasized schizophrenia occurs due to distortion in reciprocal relationship

between mother and child.

Schizophrenia

GREEK words SCHIZEIN meaning “to split”, and PHREN, meaning “mind.”

• Duration of disturbance is at least 6 months.

Three Phases of Schizophrenia

1. Prodromal — present before people go into the acute phase of schizophrenia (Ex: excessive
clumsiness in children).

2. Active or Acute — characterized by hallucinations, paranoid delusions, and extremely disorganized

speech and behaviors.

3. Residual — present after they emerged from it.

Remission

1. Partial Remission — that the client partially shows disturbance or any sign of it returning.

2. Complete Remission — that the client no longer shows disturbance or any sign of it returning.

Four Causes of Schizophrenia

1. The possible genes involved in schizophrenia.

2. The chemical action of the drugs that help many people with this disorder.

3. Abnormalities in the working of the brains of people with schizophrenia.

4. Environmental risk factors that may precipitate the onset of the symptoms.

Psychotic behavior – used to characterize many unusual behaviors that usually involves delusions
(irrational beliefs) and/or hallucinations (sensory experiences in the absence of external events).

Subtypes of Schizophrenia (DSM-IV TR) CUP-DR

1. Catatonic Type — Prominent psychomotor disturbance such as catalepsy, waxy flexibility, stereotypy,
negativism, posturing, mutism, stupor, excessive motor activity, peculiar movement, echolalia &
echopraxia.

2. Undifferentiated Type — Mixed hallucinations and delusions; symptoms do not meet the criteria for
the paranoid, disorganized, or catatonic.

3. Paranoid Type— Preoccupation with one or more delusions or frequent auditory hallucinations.

4. Disorganized Type or Hebephrenia

Silly — immature emotionality; disorganized speech, disorganized behavior & flat or inappropriate affect
are all prominent; extreme social impairment.

5. Residual Type — Absence of prominent delusions, hallucinations, disorganized speech and grossly
disorganized or catatonic behavior; long term with a lot of negative type of schizophrenia.

1. Positive symptoms – generally refer to symptoms around distorted reality.

2. Negative symptoms – involves absence of insufficiency of normal behavior.

3. Disorganized symptoms – a variety of erratic behaviors that affect speech, motor behavior, and
emotional reactions (eg: smiling when upset).

A diagnosis of schizophrenia requires that two or more positive, negative, and/or disorganized symptoms
must be present for at least 6 months, with at least one of these symptoms including delusions,
hallucinations, or disorganized speech.

Type 1 Schizophrenia / Positive Symptoms (PBHAADD)

1. Bizarre Behavior — Displays unpredictable and apparently untriggered agitation – suddenly shouting,
swearing, or pacing rapidly; may be responses to hallucinations or delusions.

2. Hallucinations — A perception of something that seems real but does not really exists. The experience
of sensory events without any input from the surrounding environment.

• Auditory Hallucinations — Hearing things that aren’t there.

• Visual Hallucinations — Seeing things that aren’t there.

• Single Photon Emission Computed Tomography (SPECT) — used to study the cerebral blood flow of
men with schizophrenia also had auditory hallucinations.

3. Ambivalence — Contrasting feelings toward the same person at the same time.

4. Abnormal Thought Forms — Trouble organizing their daily routines of bathing, dressing properly, and
eating regularly. They may engage in socially unacceptable behavior, such as public masturbation. Many
are disheveled and dirty, sometimes wearing few clothes on a cold day or heavy clothes on a very hot
day.

5. Delusion — is seen by society as misrepresentation of reality. It is also called “disorder of thought” or

the basic characteristics of madness.
• Delusion of Grandeur — A mistaken belief that the person is famous or powerful, a belief that a person
has exceptional abilities.

• Delusion of Persecution — A belief that one is going to be harmed or harassed by an individual or

group.

• Referential Delusion — A belief that certain gestures, comments, environmental cues are directed to
oneself.

• Erotomanic Delusion — An individual believe falsely that another person is in love with him or her.

• Nihilistic Delusion — It involves the conviction that a major catastrophe will occur.

• Somatic Delusion — It is focused on preoccupations regarding health and organ function.

• Delusion of Control — A belief that another person, group of people, or external force controls one's
general thoughts, feelings, impulses, or behavior.

• Delusion of Religion — Believing that one is communicating directly with a higher being and is being
listened to from up above.

• Delusion of Jealousy — Delusions that the individual’s partner is unfaithful.

• Mixed Delusions — Delusions characteristic of more than one of the above types but no one theme
predominates.

TWO THEMES

a. Motivational view of Delusions — Would look at these beliefs as attempts to deal with and relieve
anxiety and stress.

b. Deficit view of delusions — Sees these beliefs as a result from brain dysfunction that creates these
disordered cognitions or perceptions.

Type 2 Schizophrenia / Negative Symptoms (NAAAAAAA)

1. Alogia — A (“without”) and logos (“words”). Refers to the relative absence of speech. A person with
alogia may respond to questions with brief replies that have little content and may appear uninterested
in the conversation.

2. Affective Flattening — It shows a relatively immobile and unresponsive facial expressions, often
accompanied by poor eye contact and little body language or movement. Howard Berenbaum and
Thomas Oltmanns compared people with schizophrenia who had flat affect with those who did not.
3. Anhedonia — A (“without”) and the word hedonic (“pertaining to pleasure”). It is the presumed lack
of pleasure experienced by some people with schizophrenia. It signals an indifference to activities that
would typically be considered pleasurable such as eating, social interactions and sexual relations.

4. Attention Impairment— Difficulty in focusing and maintaining attention. Deficits in the working
memory (ability to hold information and manipulate it). Difficulty in keeping in touch with reality.

5. Avolition or Apathy — Loss of motivation. A-“without,” and volition - “an act of willing, choosing, or
deciding,” It is the inability to initiate and persist in activities.

6. Asocial Behavior — Lack of interest in social interaction.

7. Anergia — Abnormal lack of energy.

Disorganized Symptoms — A variety of erratic behaviors that affect speech, motor behavior, and
emotional reactions.

1. Disorganized Speech — They jump from topic to topic, and at other times they talk illogically.

2. Disorganized Behavior — They exhibit bizarre behaviors such as hoarding objects or acting in unusual
ways in public.

3. Inappropriate Affect — Display laughing or crying at improper times.

1. Psychosis — A break from reality. Often involves difficulties interacting with and perceiving the real
world. Split between thoughts and emotions.

2. Delusional Disorder — Delusions of at least 1 month’s duration. Functioning is not markedly impaired
and behavior not obviously odd or bizarre.

3. Shared Psychotic Disorder — A delusion develops in an individual in the context of a close relationship
with another person(s), who has an already-established delusion. (husband and wife, parent and child,
siblings, etc.).

4. Brief Psychotic Disorder — Duration of an episode of the disturbance is at least 1 day but less than 1
month with eventual full return to the premorbid level of functioning. Conflicting evidence about the
biological or the psychosocial influences. Later age of onset: Between 35 – 55. Female > Male.

5. Schizophreniform Disorder — An episode of the disorder (including the prodromal, active and residual
phases) lasts at least 1 month but less than 6 months. Do not require impaired social and occupational
functioning. Associated with good premorbid functioning. Most resume normal lives.
Personality Disorders

Personality — A pattern of relatively permanent traits and unique characteristics that give both
consistency and individuality to a person’s behavior.

Personality Disorder — A personality disorder is a persistent pattern of emotions, cognitions and

behavior that results in enduring emotional distress form the person affected and/or for others and may
cause difficulties with work and relationship (American Psychiatric Association, 2013).

• Pervades every aspect of a person’s life; common and chronic.

• Ego-syntonic; Far more likely to refuse psychiatric help.

• A predisposing factor for other psychiatric disorders (Ex: substance use, suicide, affective disorders,
impulse-control disorders, eating disorders, and anxiety disorders).

Origin

• Begin in childhood

Can remit but is replaced by other personality disorder.

• High comorbidity

• Poorer prognosis

Gender Differences

• MEN — Aggressive, structured, self-assertive and detached.

• WOMEN — More submissive, emotional and insecure.

Big Five
1. OPENNESS TO EXPERIENCE (imaginative, curious, and creative versus shallow and imperceptive).

2. CONSCIENTIOUSNESS (organized, thorough, and reliable versus careless, negligent, and unreliable).

3. EXTROVERSION (talkative, assertive, and active versus silent, passive, and reserved).

4. AGREEABLENESS (kind, trusting, and warm versus hostile, selfish, and mistrustful).

5. NEUROTICISM (even-tempered versus nervous, moody, and temperamental).

Five Main Psychopathology Domains

1. PSYCHOTICISM (versus Openness).

2. DISINHIBITION (versus Conscientiousness).

3. DETACHMENT (versus Extraversion).

4. ANTAGONISM (versus Agreeableness).

5. NEGATIVE EMOTIONALITY (versus Emotional Stability).

Personality Disorder are divided into three clusters:

1. Cluster A (Weird).

2. Cluster B (Wild).

3. Cluster C (Worried).

Cluster A (Weird) — are characterized by odd, eccentric thinking or behavior.

1. Paranoid Personality Disorder — is a mental disorder characterized by paranoia and a pervasive, long-
standing suspiciousness and generalized mistrust of others.

2. Schizoid Personality Disorder — They lack the desire to form interpersonal relationships and are
emotionally cold (show little emotions) in their interactions with others.

3. Schizotypal Personality Disorder — Psychoticism characterized by eccentricity, cognitive and

perceptual dysregulation, and unusual beliefs and experiences.
Cluster B (Wild) — are characterized to be manipulative, volatile, and uncaring in social relationships.
They are prone to impulsive, sometimes violent behaviors.

1. Anti-Social Personality Disorder — an ingrained pattern of behavior in which individuals

consistently disregard and violate the rights of others around them.

2. Borderline Personality Disorder — is a mental health disorder that impacts the way you think and feel
about yourself and others, causing problems functioning in everyday life. It includes a pattern of unstable
intense relationships, distorted self-image, extreme emotions and impulsiveness.

3. Histrionic Personality Disorder — characterized by a pattern of excessive attention-seeking emotions,

usually beginning in early adulthood, including inappropriately seductive behavior and an excessive need
for approval.

4. Narcissistic Personality Disorder — a long-term pattern of abnormal behavior characterized by

exaggerated feelings of self-importance, excessive need for admiration, and a lack of empathy.

Cluster C (Worried) — are characterized by anxious, fearful thinking or behavior.

1. Avoidant Personality Disorder — are marked by feelings of nervousness and fear. People with avoidant
personality disorder have poor self-esteem. They also have an intense fear of rejection and being
negatively judged by others.

2. Dependent Personality Disorder — characterized by an inability to be alone. People with DPD develop
symptoms of anxiety when they're not around others. They rely on other people for comfort,
reassurance, advice, and support.

3. Obssessive Personality Disorder — characterized by a general pattern of excessive concern with

orderliness, perfectionism, attention to details, mental and interpersonal control, and a need for control
over one's environment, which interferes with personal flexibility, openness to experience, and
efficiency, as well as interfering with relationships.