1. The document discusses schizophrenia and other psychotic disorders, providing definitions and historical context. It describes Emil Kraepelin's distinction between dementia praecox and manic-depressive psychoses, and Eugen Bleuler coining the term "schizophrenia". 2. Key symptoms of schizophrenia are discussed in detail, including hallucinations, delusions, thought disorders, and emotional flattening. Diagnosis is based on psychiatric history and examination, as there is no medical test. 3. The course of schizophrenia is usually chronic, with residual symptoms that can persist throughout life and impair social functioning. Etiology includes genetic and environmental factors.

1. Lecture 5
Schizophrenia
Other psychotic disorders and schizophrenic spectrum
Part 1
1- Schizophrenia
2- Schizophrenoform disorder
3- Schizoaffectivedisorder
4- Brief psychotic disorder , cycloid psychosis and other acute
psychosis
5- Delusional disorder ( paranoia )
6- Shared Psychotic Disorder
7- Drug induced psychosis
8- Psychosis due to general medical factors
9- Schizoid personality disorder
10- Schizotypal personality disorder
11- Paranoid personality disorder
12- Specific psychosisand other culturally modified psychosis
Schizophrenia
1- Definition
2- The history of the concept
a- Pre- Emil Kraepelin
b- Emil Kraepelin
c- Eugen Bleuler
d- Kurt Schneider
e- Positive vas negative schizophrenia ( Crow . N. andreason )
f- Recent diagnostic criteria DSM4r , ICD10
3- Clinical features
4- Diagnosis
5- Course and prognosis
6- Etiology

2. Definition :Schizophrenia is a psychotic illness that, in its active phase,
includes delusions, hallucinations, and disruption of thinking, feeling,
and many other mental functions , the disorder is always severeand is
usually long lasting ( with a chronic course) which may persists
throughoutlife leaving profoundly disruptive residualpsychiatric
symptoms and impaired social functioning , the diagnosis of
schizophrenia is based entirely on the psychiatric history and mental
status examination. There is no laboratory test for schizophrenia.
History of the concept: In the 18th century, Philippe Pinel, a prominent
French physician, was one in a growing list of predecessors who believed
that mental illness was a diseaseof the central nervous system and one
that could be caused by hereditary or environmental factors (this was
the firstrevolutionary and firstscientific step in psychiatry)
A Model of Mental treatment before Philippe Pinel
An illness like schizophrenia has been variously described over the years.
Falvet in 1851 described the paranoid feature called it Folie circulaire, Hecker
in 1871 described Hebephrenia, Kahlbaum in 1874 described Catatonia (a
movement disorder) and Paranoia ( recently called delusional disorder)
Emil Kraepelin(1856–1926)

3. Emil Kraepelin (1856–1926) wasa German psychiatristwho devoted his
life’s work to the task of describing and characterizing the symptoms his
patients manifested. Fromthese observations, heconcluded that not all
mental patients suffered from the same disease. He was the firstto
distinguish manic-depressivepsychosesfrom other chronic psychotic
illnesses, kraepelin used the term démence précoce (“dementia
praecox.”) used before by( Augustin Morel) in 1850 , Morel used this
term to describea previously normalyoung boy who suddenly
manifested symptoms of mental deterioration , but kraepelin in his
concept of (“dementia praecox.”) connected 3 situations had been
good described before, hebephrenic, catatonic, and paranoid and
categorized them in one nosology called dementia praecox.
Emil Kraepelincriteriafor his dementiapraecox
1- Disturbanceattention and comprehension
2- Hallucinations , especially auditory ( voices )
3- Audible thoughts
4- Experience of influenced thought
5- Disturbanceof the flow of thought
6- Impairmentof cognitive function and judgment
7- Affective flattening
8- Appearanceof morbid behavior ( reduced drive , automatic
obedience , echolalia , echopraxia , acting out , catatonic

4. stereotypes and negativism , autism , disturbanceof verbal
expression )
Eugen Bleuler (1857–1939).
Eugen Bleuler was a Swiss psychiatristwho is known, among other
things, for coining the term schizophrenia. In 1911, EugeBleuler
published his monograph entitled Dement Praecox, or the Group of
Schizophrenias, and argued the dementia praecox was not a single
disease, was not associated with intellectual decline ( dementia ) , and
had its fundamental basis disorders of affectivity, ambivalence , autism,
attention and will. Other symptoms such delusions, hallucinations,
abnormalbehavior and catatonia wereconceptualized as secondary
(accessory symptoms) , and except the three types registered by Emil
Kraepelin (, hebephrenic, catatonic, and paranoid ) he added a new
type called it simple schizophrenia ( according his criteria simple
schizophrenia was the mostnuclear type of schizophrenia )
Eugen Bleuler criteria for his schizophrenia
1- Basic or fundamental disturbance( the 4 and sometimes 6 A)
 Association loss
 Affective flattening
 Ambivalence

5.  Apathy
 Abolia
 Autism
2- Accessory symptoms
 Disorders of perception ( hallucinations )
 Delusions
 Certain memory disturbance
 Modification of personality
 Changes of speech and writing
 Somatic symptoms
 Catatonic symptoms
 Acute syndromes ( such as melancholic , manic , catatonic ,
and other states )
Kurt Schneider (1887–1967)
Kurt Schneider probably contributed to our current diagnostic
classifications morethan any other person. Schneider studied both
Kraepelin’s and Bleuler’s ideas during his psychiatric training in
Germany , In 1959 helisted the 'firstrank features' of schizophrenia.
One of these symptoms, in the absence of organic disease, or persistent
affective disorder, or drug intoxication, was sufficientfor a diagnosis of
schizophrenia
SCHNEIDER’S SYMPTOMS OF THEFIRSTRANK

6. • Audible thoughts
• Voices heard arguing or discussing
• Voices heard commenting on one’s actions
• The experience of influences playing on the body
• Thought withdrawal and other interferences with thought
• Diffusion of thought
• Delusional perception
• Feelings, impulses and volitional acts experienced as the work or
influence of others
SCHNEIDER’S SYMPTOMS OF THESECOND RANK
 Other disorders of perceptions
 Sudden delusional ideas
 Perplexity
 Depressiveor euphoric changes
 Feeling of emotional impoverishment( apathy – abolia )
 Motor disturbances
T crow. N Anderson (positive vas negativeschizophrenia) 1990
Negative schizophrenia (loss of somemental functions), poor prognosis,
hypo dopaminergic pathology, brain ventricular enlargement (brain
atrophy) poor responding to antipsychotics.
1-Socialwithdrawal
2-Apathy
3-Self-neglect
4-and other symptoms described as fundamental(the 6 A) by Eugen
Bleuler
Positive schizophrenia (Reality distortion) good prognosis, hyper
dopaminergic pathology, no brain structureobserved, good responding
to antipsychotics
1- Delusions

7. 2- Hallucinations
3- Passivity phenomena (SCHNEIDER’S SYMPTOMS OF THEFIRST
RANK)
Clinical feature (main symptoms and signs) in schizophrenia
HALLUCINATIONS: Hallucinations are defined as false perceptions in the absence of
a real external stimulus. They are perceived as having the same quality as real
perceptions and are not usually subject to conscious manipulation.
Hallucinations in schizophrenia may involve any of the sensory modalities. The most
common are auditory hallucinations in the form of voices, which occur in 60–70% of
patients diagnosed with schizophrenia. Although voices in the second person are
most common, the characteristic Schneiderian’ voices are in the third person and
provide a running commentary on the patient’s actions, arguing about the patient or
repeating the patient’s thoughts. Voices may be imperative, ordering the patient to
harm him or others. Visual hallucinations occur in about 10% of patients, but should
make one suspicious of an organic disorder. Olfactory hallucinations are more
common in temporal lobe epilepsy than schizophrenia, and tactile hallucinations are
probably experienced more frequently than is reported by patients No single type of
hallucination is specific to schizophrenia, and the duration and intensity are probably
most important diagnostically
CATATONIC SYMPTOMS: These mainly motor symptoms may occur in any form of
schizophrenia but are particularly associated with the catatonic subtype
Ambitendence Alternation between opposite movements.
Echopraxia Automatic imitation of another person’s movements even when asked
not to
Stereotypies Repeated regular fixed parts of movement (or speech) that are not
goal directed, e.g. moving the arm backwards and outwards repeatedly while saying
‘but not for me
Negativism Motiveless resistance to instructions and attempts to be moved, or
doing the opposite of what is asked
Posturing Adoption of inappropriate or bizarre bodily posture continuously for a
substantial period of time
Waxy flexibility the patient’s limbs can be ‘molded’ into a position and remain fixed
for long periods of time
THOUGHT DISORDERS

8. Derailment occurs when the patient moves from one train of thought to another
which has no apparent connection to the first a less severe form is called
loosening of associations which merges into tangential thinking and loss of
goal
Some patients may invent neologisms (new words), exhibit verbal stereotypy
(repetition of a single word or phrase out of context), or use metonyms
(ordinary words given a special personal meaning))
Negative thought disorder includes poverty of speech (limited quantity of speech),
and poverty of content of speech (limited meaning conveyed by speech)
Thought insertion the patient believes that thoughts that are not his own are being
put into his mind by an external agency.
Thought withdrawal the patient believes that thoughts are being removed from his
mind by an external agency.
Thought broadcasting the patient believes that his thoughts are being ‘read’ by
others, as if they were being broadcast.
Thought blocking involves a sudden interruption of the train of thought, before it is
completed, leaving a ‘blank’. The patient suddenly stops talking and cannot recall
what he has been saying or thinking
DELUSIONS
A delusion is a fixed, false personal belief held with absolute conviction despite all
evidence to the contrary. The belief is outside the person’s normal culture or
subculture and dominates their viewpoint and behavior.
Delusions may be described in terms of their content (e.g. delusions of persecution
or grandeur). They can be mood congruent (the content of delusion is appropriate to
the mood of the patient), or mood incongruent. Delusions are described as
systematized if they are united by a single theme.
A primary delusion arises fully formed without any discernible connection with
previous events (also called autochthonous delusions), e.g. “I woke up and knew that
my daughter was the spawn of Satan and should die so that my son could be the
new Messiah”. Secondary delusions can be understood in terms of other
psychopathology, for example hallucinations: “The neighbors must have connected
all the telephones in the building; that’s why I can hear them all the time.”
The term delusional mood is slightly confusing in that it does not describe an
abnormal belief, but refers to an ill-defined feeling that something strange and
threatening is happening which may manifest as perplexity, uncertainty or anxiety.

9. This may precede a primary delusion or a delusional perception, which involves a
real perception occurring almost simultaneously with a delusional misinterpretation
of that perception, e.g. “I saw the traffic lights change from red to green and knew
that I was the rightful heir to the throne of England.”
Overvalued ideas are unreasonable and sustained intense preoccupations
maintained with a strong emotional investment but less than delusional intensity.
The idea or belief held is demonstrably false and not usually held by persons from
the same subculture
Delusions may be classified in terms of their content, for example...
Persecution An outside person or force is in some way interfering with the sufferer’s
life or wishes them harm, e.g. “The people upstairs are watching me by using
satellites and have poisoned my food.”
Reference The behavior of others, objects, or broadcasts on the television and radio
have a special meaning or refer directly to the person, e.g. “A parcel came from Sun
Alliance and the radio said that ‘the son of man is here’, on a Sunday, so I am the son
of God.”
Control The sensation of being the passive recipient of some controlling or
interfering agent that is alien and external. This agent can control thoughts, feeling
and actions (passivity experiences), e.g. “I feel as if my face is being pulled upwards
and something is making me laugh when I’m sad.”
Grandeur Exaggerated belief of one’s own power or importance, e.g. “I can lift
mountains by moving my hands, I could destroy you.”!
Nihilism Others, oneself, or the world does not exist or is about to cease to exist
(often called Cotard’s syndrome), e.g. “The inside of my tummy has rotted away. I
have no bowels.”
Infidelity One’s partner is being unfaithful (also known as delusional jealousy or the
Othello syndrome.)
Doubles A person known to the patient, most frequently their spouse, has been
replaced by another (also known as Capgras’ syndrome or, confusingly, ‘illusion’ of
doubles.)
Infatuation A particular person is in love with the patient (also known as erotomania
or de Clerambault’s syndrome).)
Somatic Delusional belief pertaining to part of the person’s body, e.g. “My arms
look like they’ve been melted and squashed into a mess

10. Emotional Expression
People with schizophrenia often show “blunted” or “flat” affect. This refers to a
severe reduction in emotional expressiveness. A person with schizophrenia may not
show the signs of normal emotion, perhaps may speak in a monotonous voice, have
diminished facial expressions, and appear extremely apathetic. The person may
withdraw socially, avoiding contact with others; and when forced to interact,
he or she may have nothing to say, reflecting “impoverished thought.” Motivation can
be greatly decreased, as can interest in or enjoyment of life. In some severe cases, a
person can spend entire days doing nothing at all, even neglecting basic hygiene.
These problems with emotional expression and motivation, which may be extremely
troubling to family members and friends, are symptoms of schizophrenia – not
character flaws or personal weakness