Historical Perspective
Early signs of schizophrenia: people wer reporting lunacy and auditory hallucinations or “hearing voices”
Postive Symptoms
Abnormal additions to mental life. Includes more obvious sings of psychosis: delusions, hallucinations, thought and speech disorder, grossly disorganized or catatonic behaviour
Negative Symptoms
Refers to the absences or loss of typical behaviours and experiences. May take form of sparse speech and language, social withdrawal, and avolition (apathy and loss of motivation).
Anhedonia (an inability to feel pleasure, as well as lack of emotional responsiveness) and diminished attention and concentration are also considered negative symptoms
Hallucinations
False perceptions occurring the absence of any relevant stimulus. Occur while a person is awake and conscious. People will hear see, sell or feel things that are not really present. Auditory hallucinations are the most common form my patients with schizophrenia
Voices; Delusions Persecutory/Paranoid; Referential; Somatic; Religious; Delusions of Granduer
Voices (Hallucination)
Perceived as distinct from the patient’s own thoughts and may include instructions to perform actions involving self harm/danger. May tell patient to stop fulfilling their responsibilities. May be insulting or complementary. Inability to discriminate between internal and external sources of information
Delusions (Hallucinatons)
False beliefs that are strongly held, even in the face of solid contradictory evidence
Persecutroy/Paranoid
False and implausible beliefs that focus on being followed, chased, harassed, or threatened by other people or unseen forces (“strangers on the street are undercover agents following me”).
May stem from individuals who make interpretations too quickly
Referential (Hallucinations)
The belief that common, meaningless occurrences have significant personal relevance (advertisement on a magazine is my sign to eat this cereal)
Somatic (Hallucinatons)
Beliefs related to the patient’s body (patients who were convinced that their inner organs had turned to dust or that they had a special “nerve” of laughter in their stomachs that was the origin of all humour in the world)
Religious (Hallucinations)
Belief that biblical or other religious passages or stories offer the way to destroy or to save the world (someone may believe they are living out a biblical prophecy)
Delusions of Grandeur (Hallucinations)
False and implausible beliefs that focus on the possession of special powers, divinity, or fame (patient who believed that all the world’s armies were under his personal command)
Disorganized Speech and Thought Disorder
Unusual sounding, nonsensical speech often signifies the existence of a formal thought disorder.
Loosening of associations and logical connections between ideas occurs and the thought disordered patient shifts quickly from one topic to another. Answers to questions are “tangential” or hardly related to the original point being made.
Ask a patient to explain a proverb or saying - thought disorder reveals itself in the structure of spoken or written language.
Least common positive symptom
Negative and Emotional Symptoms
Deficits and losses in normal functioning including avolition and restricted affect.
May have diminished emotional expression - fail to convey feeling in face, tone of voice, or body language
Anhedonia
Negative symptoms can also be seen in deterioration of academic or occupation proficiency that is usually observed, perhaps due to weakening in cognitive efficacy
Avolition
Inability to initiate and persevere in activities
Catatonic Behaviour
The other end of the motor spectrum. Significant reduction in responsiveness to the environment wherein patients assume unusual and rigid postures and resist efforts to change their position.
May engage in random undue motor activity or exhibit waxy flexibility (a state wherein a person’s limbs and posture can be “molded” into different positions)
Anhedonia
Lack of interest, enjoyment or pleasure from life’s activities
Grossly Disorganized Behaviour
Reflects difficulty with goal directed behaviour. Often manifests itself in unpredictable movements; problems performing daily activities, such as dressing or preserving personal hygiene and inappropriate sexual behaviour
DSM Criteria - Schizophrenia
a) Two (or more) of the following each present for a significant portion of time durin ga 1 month period (or less if successfully treated). At least one must be 1,2,3
1) Delusions
2) Hallucinations
3) Disorganized Speech (frequent derailment or incoherence)
4) Grossly disorganized or catatonic behaviour
5) Negative symptoms (diminished emotional expression or avolition)
b) For a significant portion of the time since onset of the disturbance, level of functioning (work, interpersonal relations, or self care) is markedly below normal.
c) Continuous signs of the disturbance persist of at least 6 months. 6 month period must include at least 1 month of symptoms
d) Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out
Markers and Endophenotypes for Schizophrenia
Marker is any physical, psychological, or biological characteristic or trait
Vulnerability Marker; Cognitive Marker; Eye Tracking
Vulnerability Marker
Sign or trait of the disorder that occurs before a person actually succumbs to the disorder. Reflects inherent predisposition to develop the disorder. Allows for identification of people at risk for becoming ill, even though they may be healthy when the marker is first observed
Cognitive Marker
Impairment on the continuous performance test (CPT) has been studied as a cognitive marker. Impairment reflects deficits in attention and inability to keep a rule in mind
Etiology
Genetic liability influences both the risk of schizophrenia and likelihood of living in impoverished neighbourhoods. People with disorder are more likely to live in deprived neighbourhoods.
Complex psychiatric conditions are seen as outcome of inherited, biologically based vulnerabilities that interact with maturation and development with environmental factors
Assumption that vulnerability or diathesis, and disorder prompting events, or stress are both required
Eye Tracking Records
Reveals more deviations from the stimulus path, and thus more errors, when compared to a healthy comparison group
Meehl’s Theory (Etiology)
Proposes biological diathesis termed “hypokrisia”. Occurs throughout the brain making nerve cells abnormally reactive to incoming stimulation - a single gene inherited from either parent causes this diathesis
