Schizophrenia

INTRODUCTION — Schizophrenia is a psychiatric disorder involving chronic or recurrent
psychosis. It is commonly associated with impairments in social and occupational functioning. It

is among the most disabling and economically catastrophic medical disorders, ranked by the
World Health Organization as one of the top ten illnesses contributing to the global burden of
disease.
Characteristics of schizophrenia typically include positive symptoms such as hallucinations or

delusions, disorganized speech, negative symptoms such as a flat affect or poverty of speech, and
impairments in cognition including attention, memory and executive functions. A diagnosis of
schizophrenia is based on the presence of such symptoms, coupled with social or occupational
dysfunction for at least six months, in the absence of another diagnosis that would better account
for the presentation.
CLINICAL MANIFESTATIONS — People with schizophrenia generally present with several

areas of distinct psychopathology, as defined by DSM-IV-TR diagnostic criteria:
 Positive symptoms
 Negative symptoms
 Cognitive impairment
 Mood symptoms
 Anxiety
Positive symptoms — Positive symptoms represent an exaggeration of normal processes. This

group of symptoms includes the reality distortion symptoms of hallucinations and delusions as
well as disorganized thoughts and behavior.
Hallucinations — Hallucinations are defined as the perception of a sensory process in the

absence of an external source. They can be auditory, visual, somatic, olfactory, or
gustatory.
 Auditory hallucinations are the most common form of hallucination, between 40%-
80% in people with schizophrenia. Although auditory hallucinations are frequently
voices, they can take the form of other sounds such as music, body noises, or
machinery.
 Some people with schizophrenia describe the sounds as coming from inside their
head, whereas others can point to a specific external location from which they
emanate.
 Auditory hallucinations are often the most responsive symptom to antipsychotic
medication.
 Visual hallucinations are often unformed, such as glowing orbs or flashes of color.
However, some people with schizophrenia describe fully formed human figures,
faces, or body parts.
 Somatic hallucinations can include feelings of being touched, of sexual intercourse,
or of pain.
 Olfactory and gustatory hallucinations, patients will report a strange taste or smell.
Delusions — Delusions, defined as a fixed, false belief, are present in approximately 80%
of people with schizophrenia. Because insight into their illness may be impaired, people with
schizophrenia often have delusional explanations for their hallucinations.
Delusions are broadly categorized as bizarre or non-bizarre.
 Bizarre delusions are clearly implausible; they have no possibility of being true. Their
content is not understandable. Basic concepts may be described in an unusual way,
how the person experiences time, space, the self.
 Ex:
 a patient’s belief that aliens have cloned the patient a perfect body, but he must find
a way to take off his head so that his spirit can flow into the new body.
 A non-bizarre delusion is one that while not true is understandable and has the
possibility of being true.
Ex:
An example is that the IRS is after the patient for not paying taxes.
The content of delusions can often be categorized:
 Grandiose delusions: form around the belief that the person has some special
significance or power.
 Paranoid delusions: are clinically important because they may prevent the individual
from cooperating with evaluation or treatment, and because they may increase the
likelihood of problems like homelessness as the person goes “off the grid”.
 Nihilistic delusions: are uncommon, bizarre beliefs that one is dead or one’s body is
breaking down or that one does not exist.
 Erotomanic delusions: the person erroneously believes that he/she has a special
relationship with someone. These delusions can lead to legal problems such as
restraining orders.

Schizophrenia

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Schizophrenia

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INTRODUCTION — Schizophrenia is a psychiatric disorder involving chronic or recurrent

psychosis. It is commonly associated with impairments in social and occupational functioning. It

Characteristics of schizophrenia typically include positive symptoms such as hallucinations or

CLINICAL MANIFESTATIONS — People with schizophrenia generally present with several

Positive symptoms — Positive symptoms represent an exaggeration of normal processes. This

Hallucinations — Hallucinations are defined as the perception of a sensory process in the

The content of delusions can often be categorized:

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