Schizophrenia Spectrum and other Psychotic Disorders

Schizotypal Disorder

Delusional Disorder

Brief Psychotic Disorder

Schizophreniform Disorder

Schizophrenia

Schizoaffective Disorder

Substance / Medication-Induced Psychotic Disorder

Psychotic Disorder Due to Another Medical Condition

Catatonia Assocaited with Another Mental Disorder

Cataonic Disorder Due to Another Medical Condition

Other Specified Schizophrenia Spectrum and Other Psychotic Disorder

Unspecified Schizophrenia Spectrum and Other Psychotic Disorder


Schizophrenic Disorders - literally "split mind" fragmented thought and emotional disturbance; break from reality.

General symptoms - trouble holding a job, irrational thought, deterioration of adaptive behaviour, distorted perception, disturbed emotion, social withdrawal, disturbed sense of self, poverty of speech, abnormal motor behaviour.

Positive Symptoms Behavioural excess (new aspects to behaviour and thought) including:

Delusions - false beliefs or irrational thought without any connection to reality.

Hallucinations - sensory perceptions in absence of external stimulus or gross distortion of perceptual input (radio). Grandiose or "wild" thoughts of importance or the bizarre including disorganised speech (word salad).

Negative Symptoms Behavioural deficits or deterioration of adaptive behaviour. E.g., 'blunted' or flattened affect (also may include inappropriate emotional responses, e.g., laugh at funeral); social withdrawal, apathy, loss of attention, poverty of speech.

 you tube - Schizophrenia

Subtypes of Schizophrenia

Parnoid type - is characterized by delusion of grandure and persecution. Commonly seen as "people are reading my thoughts" or "plotting against me" where there is a heightened sense of importance (having special information-cure for cancer-or are someone important-Jesus Christ). Gerald

Catatonic type - Extremely withdrawn (stupor) characterized by motor disturbances called "waxy flexibility" involving muscular rigidity or random motor activity. May also be hyperactive and incoherence where some alternate between these.

Disorganised type (hebephrenic) - Are characterized by emotional indifference and are frequently incoherent, exhibiting near total social withdrawal. Often involved in aimless babbling and giggling and may have delusions about body; e.g., brain is melting out of ears.

Undifferentiated - marked by idiosyncratic blends of the 3 other types.
 
 Course and outcome

Favourable prognosis when: 1) sudden onset, 2) later age onset, 3) prior work/social is good, 4) relatively healthy and supportive family.

Etiology ofSchizophrenia

1) Genetic Vulnerability: Twin studies concordance rates -MZ=48% DZ=17% 2 parents with Schizophrenia = 46% chance that child will have it. Polygenetic vulnerability. Seen across cultures .

2) Neurochemical Factors - excess Dopamine as Da reducers will lessen the symptoms, yet not consistent results.

3) Structural abnormalities in the brain (cause or effect?)
enlarged ventricles & smaller thalamus (sensory integration), left with inability to 'filter out' information and attentional focus and shifting problems.

Also demyelinization of brains (crossing circuits).

Neurodevelopmental hypothesis suggests that prenatal infection or malnutrition may increase vulnerability.

Influenza during second trimester or malnutrition has suggested pregnancy complications change brain (and other minor physical abnormalities).

4) Emotional Expression - Family dynamics where highly critical and emotionally involved families may precipitate symptoms. Recidivism for those from high EE families is 3-4 X others

5) Precipitating stress is 'needed" to bring vulnerability into disorder, can also lead to relapse.