Schizophrenia Spectrum and Other Psychotic Disorder

1. Positive Symptoms
Delusions Fixed beliefs that are not amenable to change in light of conflicting evidence.
Types
Erotomanic type: believes falsely that another person is in love with him or her
Grandiose type: conviction of having some great talent or insight or having made some
important discovery.
Jealous type spouse or lover is unfaithful.
Persecutory type: conspired against, cheated, spied on, followed, poisoned or drugged,
maliciously maligned, harassed, or obstructed in the pursuit of long-term goals.
Somatic type: bodily functions or sensations.
Bizarre delusions

Delusions are deemed bizarre if they are clearly implausible and not understandable to

same-culture peers and do not derive from ordinary life experiences.

Delusions that express a loss of control over mind or body are generally considered to

be bizarre; these include:

thought withdrawal the belief that one's thoughts have been "removed" by some
outside
force thought insertion that alien thoughts have been put into one's mind (),
delusions of control or that one's body or actions are being acted on or manipulated
by some outside force
Hallucinations perception-like experiences that occur without an external stimulus.

They may occur in any sensory modality, but auditory hallucinations are the most
common in schizophrenia and related disorders.

Auditory
Hear

Voices, whether familiar or unfamiliar, that are

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Visual
See
Olfactory

Smell

Gustatory
taste
Somatic/ Tactile
Feel

perceived as distinct from the individual's own

thoughts.
Buzzing sound
Other sounds
Objects ; people
visual patterns,
lights
usually unpleasant bad odours (rubber burning,
metal)
(can be organic )
Typically an unpleasant flavour.
Epilepsy or psychotic
bugs are crawling on your skin
Internal organs are moving around.
Feel the touch of someones hands on your body.

The hallucinations must occur in the context of a clear sensorium those that occur
while falling asleep (hypnagogic) or waking up (hypnopompic) are considered to be

within the range of normal experience.

Hallucinations may be a normal part of religious experience in certain cultural contexts.

1. Negative symptoms
Diminished
emotional
expression
Affective

emotional emphasis to speech.

flattening
Avolition

Alogia,
Anhedonia

Reductions in :
the expression of emotions in the face
eye contact,
intonation of speech (prosody)
Movements of the hand, head, and face that normally give an

Show little expressed emotion, but may still feel emotion

Decrease in motivated self-initiated purposeful activities.
The individual may sit for long periods of time and show little

interest in participating in work or social activities

Diminished speech output
decreased ability to experience pleasure from positive stimuli or
a degradation in the recollection of pleasure previously

Asociality

experienced
apparent lack of interest in social interactions
may be associated with avolition,
Can also be a manifestation of limited opportunities for social
interactions

2. Disorganized symptoms
Disorganized thinking (Speech)

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Disorganized thinking (formal thought disorder) is typically inferred from the

individual's speech.
Derailment The individual may switch from one topic to another
Tangentiality Answers to questions may be obliquely related or completely unrelated
Circumstantiality include a lot of uneasy detail
incoherence or "word salad" Rarely, speech may be so severely disorganized that it

is nearly incomprehensible
The symptom must be severe enough to substantially impair effective communication.

3. Disorganized behaviour
Manifest itself in a variety of ways, ranging from childlike "silliness" to unpredictable

agitation.
Problems may be noted in any form of goal-directed behavior, leading to difficulties in
performing activities of daily living.
Catatonic behaviour
Catatonic criteria
1. Stupor
2. Cataleps
y
3. Waxy
flexibility
4. Mutism
5. Negativi
sm
6. Posturin
g
gravity).
7. Manneris
m
8. Stereoty
py
9. Agitation
,
10.
Grimacin
g.
11.Echolalia
12.Echopra
xia

no psychomotor activity; not actively relating to

environment
passive induction of a posture held against gravity
slight, even resistance to positioning by examiner
No, or very little, verbal response [exclude if known
aphasia]).
Opposition or no response to instructions or external
stimuli).
Spontaneous and active maintenance of a posture
against gravity).
odd, circumstantial caricature of normal actions
Repetitive, abnormally frequent, non-goal-directed
movements).
Agitation, not influenced by external stimuli.
Grimacing pulling of the face

mimicking anothers speech

mimicking anothers movements
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5 important symptoms in diagnosis

1. Delusions
2. Hallucinations
3. Disorganized thinking
4. Disorganized behaviour
5. Negative Symptoms
Disorder
Delusional D/O
Brief psychotic D/O ( 1 day to 1 month )

Schizophreniform (1 month to 6 months)

Schizoprenia (6 months +)
Schizoaffective D/O Psychotic symptoms +

Symptoms
1.
14
1-5
1-5
1. -5

Mood disorder
Aetiology Possible causes include:
Viral infection in a babys brain before it is born
Imbalance of certain brain chemicals
Differences in certain brain structures
Genetic component
Four factors may be at play in the development of schizophrenia:
1. Predisposing factors a basic vulnerability or predisposition for developing
schizophrenia
2. Precipitating factors thought of in terms of environmental events and physical
conditions, such as stress
3. Protective versus perpetuating factors these help to determine the outcome between
the stressors and the individuals vulnerability by altering a hypothetical illness
threshold.
Protective factors, such as coping skills and social support, raise the illness threshold
and protect the individual from further illness.
Perpetuating factors lower the illness threshold and increase the likelihood that the
person will suffer an episode of the illness.
4. Mediating mechanisms processes by which interactions between stress, vulnerability,
protective and perpetuating factors are believed to mediate in the emergence of
schizophrenic symptoms
Treatment

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