Phases of

Schizophrenia
Mary Rose G. Hibo
MP-IP

 Prodromal Phase
Active or Acute Phase
Residual Phase

Sandy used to be social

and have lots of friends, but lately
all she does is hang out in her
room alone. She doesnt want to
do the things that she used to do,
and she doesn't seem to get upset
or feel happy. In fact, her family
notices that she seems almost
robotic because she just doesnt
show emotion. Her grades have
fallen, and she seems to be
clumsier than usual, too.
Does Sandys doctor diagnose
her with schizophrenia?

Prodromal phase
Most of the symptoms that show up in this phase are
non-psychotic symptoms.
They begin to isolate themselves. They might lose
interest in activities and people that they liked before.
They also often display less emotion or sometimes
inappropriate emotion. Sometimes, people who
seemed smart before don't have the same
intellectual capabilities. Motor deficiencies also might
show up, mostly in the form of people being clumsy.
It can last anywhere from weeks to months. In some
people, the symptoms of the prodromal phase even
show up in early childhood, even though they do not
move into the active phase until their 20s.

 Prodromal Phase
Active or Acute Phase
Residual Phase

As Sandy moves from the

prodromal phase into the active
phase, her family notices that she
begins to talk to someone who isn't
there. Sandy is hallucinating a woman,
Rose, who is a mother figure to Sandy.
Sandy listens to Rose and has long
conversations with her. Among other
things, Rose tells Sandy that her
family is trying to kill her. Sandy
comes to believe this, and even
though there's lots of evidence that it
isn't true, her delusion persists.

Active phase or acute phase

Symptoms of Schizophrenia are in full
bloom,
psychotic
symptoms
become
obvious. Patients suffer from hallucinations
and delusions and might have disordered
thinking or serious motor dysfunction.
Often treated with medication and therapy.
If the symptoms become bad enough,
hospitalization might be required.
The first active phase of schizophrenia
usually happens in the late teens or
sometime in the 20s. Some patients only
have one active phase in their life, but more

 Prodromal Phase
Active or Acute Phase
Residual Phase

Sandy longer experience

hallucinations.
But
she
still
doesn't
experience
strong
emotions,
and
even
though she realizes that
her family is not trying to
kill her, she still thinks
that they don't like her.

Residual Phase
The symptoms aren't as obvious, but
the disorder is still there.
It is important that they continue
with their treatment in order to try
to lessen or avoid another active
phase. Unfortunately, many patients
in the residual phase have a
tendency to stop their treatment.

Schizot
ypal
(Person
ality)
Disorde
r
(f22)

Schizotypal (Personality) Disorde

A disorder characterized by eccentric behavior and
anomalies of thinking and affect which resemble those
seen in schizophrenia, though no definite and
characteristic schizophrenic anomalies have occurred at
any stage. There is no dominant or typical disturbance,
but any of the following may be present:
(A) Inappropriate or constricted affect (the individual
appears cold and aloof);
(B) Behavior or appearance that is odd, eccentric, or
peculiar;
(C) Poor rapport with others and a tendency to social
withdrawal;
(D) Odd beliefs or magical thinking that influences
behavior and is inconsistent with subcultural norms (e.g.,

(E) Suspiciousness or paranoid ideas;

(F) Obsessive ruminations without inner resistance, often
with dysmorphophobic, sexual or aggressive contents;
(G) Unusual perceptual experiences including somatosensory
(bodily) or other illusions, depersonalization or derealization;
(H) Vague, circumstantial, metaphorical, overelaborate, or
stereotyped thinking, manifested by odd speech or in other
ways, without gross incoherence;
(I) Occasional transient quasi-psychotic episodes with intense
illusions, auditory or other hallucinations, and delusion-like
ideas, usually occurring without external provocation.
(J) Excessive social anxiety that does not diminish with
familiarity and tends to be associated with paranoid fears
rather than negative judgments about self.

Diagnostic Guidelines
This diagnostic rubric is not recommended for general
use because it is not clearly demarcated either from
simple schizophrenia of from schizoid or paranoid
personality disorders.
If the term is used, three or four of the typical features
listed above should have been present, continuously
or episodically, for at least 2 years. The individual
must never have met criteria for schizophrenia itself.
A history of schizophrenia in a first-degree relative
gives additional weight to the diagnosis but not a
prerequisite.

Schizophreni
form
Disorder
295.40 (f20.81)

Diagnostic Criteria
A. Two (or more) of the following, each present
for a significant portion of time during a 1-month
period (or less if successfully treated). At least
one of these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent
derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished
emotional expression or avolition).

B. An episode of the disorder lasts at least 1 month

but less than 6 months. When the diagnosis must be
made without waiting for recovery, it should be
qualified as provisional.
C. Schizoaffective disorder and depressive or bipolar
disorder with psychotic features have been ruled out
because either
1 ) no major depressive or manic episodes have
occurred
concurrently
with
the
active-phase
symptoms, or
2) if mood episodes have occurred during activephase symptoms, they have been present for a
minority of the total duration of the active and
residual periods of the illness.

Specify if:
- with good prognostic features: presence of
at least two of the following features:
1. onset of prominent psychotic symptoms within 4
weeks of the first noticeable change in usual behavior
or functioning;
2. confusion or perplexity:
3. good premorbid social and occupational
functioning; and
4. absence of blunted or flat affect.
- without good prognostic features: if two or
more of the above features have not been present.
- with catatonia (refer to the criteria for catatonia
associated with another mental disorder).
Coding note: use additional code 293.89 (F06.1)

Specify
current
severity:
Severity is rated by a quantitative
assessment of the primary symptoms of
psychosis,
including
delusions,
hallucinations,
disorganized
speech,
abnormal
psychomotor
behavior,
and
negative
symptoms.
Each
of
these
symptoms may be rated for its current
severity (most severe in the last 7 days) on
a 5-point scale ranging from 0 (not present)
to
4
(present
and
severe)

Diagnostic Features
The diagnosis of schizophreniform disorder is made under
two conditions.:
1) when an episode of illness lasts between 1 and 6 months
and the individual has already recovered, and
-

2) when an individual is symptomatic for less than the 6

months' duration required for the diagnosis of schizophrenia
but has not yet recovered.
In this case, the diagnosis should be noted as
"schizophreniform disorder (provisional)" because it is
uncertain if the individual will recover from the disturbance
within the 6-month period. If the disturbance persists beyond
6 months, the diagnosis should be changed to schizophrenia.

Diagnostic Features
- Lack of a criterion requiring impaired social

and occupational functioning. While such

impairments may potentially be present, they
are not necessary for a diagnosis of
schizophreniform disorder
- Assessment of cognition, depression, and
mania symptom domains is vital for making
critically important distinctions between the
various schizophrenia spectrum and other
psychotic disorders.

Prevalence
Schizophrenia is the top brain disorder affecting mentally ill Filipinos who seek consultation and
treatment in hospitals in the country, according to a study released on Friday, June 8, 2015.
The study was based on records culled from the new Philippine Health Information System on
mental health (PHIS-MH), comprising information from 2,562 patients who consulted 14 participating
public and private hospitals from May 8, 2014, to May 6, 2015.
The PHIS-MH is the countrys first database that aims to gauge the mental health of Filipinos today.
A joint initiative of the University of the Philippines Manila National InstituteInstitute of Clinical
Epidemiology, Department of Health, Foundation for Advancement of Clinical Epidemiology and
Philippine Psychiatric Association, the system was developed to address the lack of a database and
to improve individual case support and monitoring of mental health across the country.
Showing initial findings, Dr. Amarillo, reported that over 11,000 information sheets were distributed
to the 14 participating facilities. Of these, 80 percent were collected.
Of the 9,066 patient records collected, 4,122 were encoded and of this number 2,562 were uploaded
into the system. Elaborating on key findings, Dr. Tomas Bautista said that of the more than 2,500
patients who consulted the participating health facilities, 42 percent were living with schizophrenia,
a type of psychotic disorder that can be disabling when left untreated. Majority of them were men
aged 20 to 44.
Many of them are male because they are more aggressive, especially if they are floridly psychotic,

Prevalence
He said their families were more watchful of mentally ill male patients because of their tendency to be
violent, thus, they were brought more often for consultation or admission to a hospital.
The female presentation [of the disorder] is not as violent or aggressive as their male counterpart,
he added.
Bautista said that from the initial figures gathered from the database, it could be estimated that about
one percent of the countrys total population, or roughly about one million, are suffering from the
disorder, which is usually caused by chemical imbalance in the brain.
Sufferers usually have hallucinations or delusions and show extremely abnormal motor behavior. They
also often hear voices or see things. These experiences trigger anxiety and withdrawal.
According to the World Health Organization (WHO), roughly one in 250 people globally suffer from
schizophrenia. It appears in men in their late teens and early 20s and 10 years later in women.
The study also showed that only 22 percent of the patients on record were covered by the state-owned
Philippine Health Insurance Corp. either as members (13 percent) or dependents (nine percent).
Read more:
http://newsinfo.inquirer.net/696823/schizophrenia-top-mental-disorder-afflicting-filipinos-who-seek-hel
p-says-study#ixzz4J7rqdsUr

Development
and
Course
The development of schizophreniform disorder
is similar to that of schizophrenia. About onethird of individuals with an initial diagnosis of
schizophreniform
disorder
(provisional)
recover within the 6-month period and
schizophreniform disorder is their final
diagnosis.
The majority of the remaining two-thirds of
individuals will eventually receive a diagnosis
of schizophrenia or schizoaffective disorder.