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SCHIZOPHRENIA & OTHER PSYCHOTIC DISORDERS

JACK L. BODDEN, PH.D.

Schizophrenia and other psychotic disorders are characterized by disturbances in thinking and perceptions of reality. While persons suffering from these disorders may also exhibit disturbances of emotion and behavior what distinguishes them from other disorders we have studied is that thinking and perception are severely affected. Sometimes these disorders are referred to as thought disorders.

One of the earliest clinical descriptions of schizophrenia was given by Emil Kraepelin (1896) who referred to the disorder as Dementia Praecox, because he saw it as a form of early or premature dementia (mental deterioration). The term schizophrenia was introduced a few years later (early 1900s) by Eugen Bleuler. Schizophrenia literally means split mind. Sometimes people think this refers to a splitting of personality (as in DID), but that is not correct. Rather, Bleuler was referring to a split between thoughts and emotion or between the intellect and external reality.

The term psychosis refers to a significant disturbance in thought and perception such that the individual looses contact with external reality.
People experiencing a psychotic disorder (including schizophrenia) may report hallucinations or delusional beliefs (e.g., grandiose or paranoid delusions), and may exhibit personality changes and disorganized thinking. This is often accompanied by lack of insight into the unusual or bizarre nature of their behavior, as well as difficulty with social interaction and impairment in carrying out the activities of daily living.

THE CLINICAL PICTURE IN SCHIZOPHRENIA

HALLUCINATIONS & DELUSIONS


Hallucination a false sensory experience, one not based in reality (e.g. hearing a voice that no one else can hear or seeing a vision). There is no external referent or stimulus. Auditory hallucinations are the most common form.
Illusion is a misinterpretation of a real, external stimulus (e.g. hearing the wind and thinking it is someone whispering).

Delusion an erroneous, fixed belief which is held despite clear contradictory evidence. A delusion represents a disturbance in thought content. Delusions may be of different types (e.g. paranoid, grandiose, persecutory, thought insertion or broadcasting).

DISORGANIZED AND CATATONIC BEHAVIOR

Disorganized behavior is just that. Person shows inability to plan and carry out problem solving and self care behavior. Judgment is poor, and behavior is inappropriate (wearing an overcoat when it is hot). Personal hygiene and diet suffer.
Catatonic Behavior impairment in motor function or even an absence of motion. Behavior may seem waxy or frozen, often in odd postures. Behavior may range from stuporous to excited.

POSITIVE AND NEGATIVE SYMPTOMS


Positive Symptoms reflect an excess or distortion in a persons normal repertoire of behavior & experience (e.g. hallucinations & delusions). Negative Symptoms represent a deficit of behaviors that are normally present (e.g. lack of of flat, blunted emotion, minimal speech, apathy)
Both positive & negative sx can be seen in the same patient. Medication tends to knock out the positive sx.

TYPES OF SCHIZOPHRENIA
PARANOID DISORGANIZED CATATONIC UNDIFFERENTIATED RESIDUAL

SUBTYPES ARE DEFINED BY THE PARTICULAR SYMPTOMATOLOGY EXHIBITED AT TIME OF EVALUATION.

PARANOID SCHIZOPHRENIA
Preoccupation with one or more delusions or frequent auditory hallucinations.
No evidence of marked disorganized speech, disorganized or catatonic behavior, flat or inappropriate affect. Paranoid schizophrenics show a history of suspiciousness, and mistrust. Delusions are often persecutory or grandiose. Paranoid types have the best prognosis.

DISORGANIZED SCHIZOPHRENIA

Disorganized speech
Disorganized behavior Flat or inappropriate affect No evidence of catatonia Worst prognosis

CATATONIC SCHIZOPHRENIA
Immobile body or stupor Excessive, purposeless motor activity that is unrelated to outside stimuli Extreme negativism or mutism Assumption of bizarre postures or stereotyped movements/mannerisms Echolalia or echopraxia