This document provides a comprehensive overview of schizophrenia, detailing its historical context, diagnostic criteria, symptoms (positive and negative), types, possible causes, and treatment options. Significant emphasis is placed on the distinction between various types of delusions and hallucinations, as well as the impact of social and biological factors on the disorder. Treatment includes medication, psychological therapies, and community-based support, highlighting the complexity of managing schizophrenia effectively.

1. Schizophrenia
M.S Sara Dawod

2. Introduction
• Emil Kraepelin (1856-1926) was the first
present the concept dementia praecox as an
early term for schizophrenia (early onset and
dementia).
• Eugen bleuler (1857-1939): proposed
schizophrenia from greek words schizen: (to
split), and phren: (mind).

3. Introduction
• It is characterized by disturbances in thought,
emotion, and behavior.
• It is not “split personality” nor one of
“multiple personalities”.
• Has two broad categories of symptoms:
• Positive symptoms: reflect excess or distortion
of normal function (criteria A: 1-4).
• Negative symptoms: reflect diminution or loss
of normal function.

4. Diagnostic criteria
A. Characteristics symptoms: two or more of the
following, each present for a significant portion
of time during 1 month period:
1. Delusion
2.Hallucination
3.Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms: affective flattening,
alogia or avolition.

5. Diagnostic criteria
B. Social/Occupational dysfunction: work, interpersonal
relation, self care, academic or occupational
achievement.
C. Duration: disturbance persist for at least 6 months
which should include one month of symptoms of
criterion A and may include residual (after active
phase) or prodromal periods (before active phase)
including:
Mild positive symptoms (unusual or odds beliefs, sense
the presence of unseen person or force, speech is
understandable but vague, abstract, collect odd or
worthless objects) and negative symptoms.

6. Positive symptoms
• Delusion
• Hallucination
• Disorganized speech
• Disorganized behaviors
• Catatonic

7. Delusion
• Delusion beliefs involve misinterpretation of
perception and experiences and the person will hold
firmly to the belief regardless of evidence to the
contrary include:
• Persecutory: more common, spied, followed.
• Referential: certain passage from ooks, story, song are
directed at him/her.
• Somatic: false belief is that the body is somehow
diseased, abnormal, or changed. An example: a person
who believes that his or her body is infested with
parasites.
• Religious.
• Grandiose: an individual exaggerates his or her sense
of self-importance.

8. Delusion
• Erotomania: a delusion in which one believes that
another person, usually someone of higher
status, is in love with him or her.
• Delusional jealousy: a person with this delusion
falsely believes that his or her spouse or lover is
having an affair. This delusion stems from
pathological jealousy and the person often
gathers ”evidence” and confronts the spouse
about the nonexistent affair.

9. Types of delusion
• Bizarre delusion: are not understandable and
do not derive from ordinary life experiences or
culture: loss of control over body and mind:
e.g. stranger has removed his internal organs
or replace them.
• Non bizarre delusion: e.g. pt’s beliefs she/he
under surveillance by police.

10. Hallucination
• Hallucination: distortion in perception without
external stimuli.
• Auditory: most common, hearing one or more of
voices (familiar or unfamiliar).
• Olfactory: false perception of odor or smell (smell
decaying fish, dead bodies, or burning rubber).
• Tactile: a false perception or sensation of
touch(something is crawling under or on the
skin).
• Gustatory: a false perception of taste (persistent
taste of metal).

11. Illusion
• An illusion is seeing, hearing, tasting, feeling,
or smelling something that is there, but
perceiving it or interpreting it incorrectly.

12. Disorganized speech
• It should be severe to affect communication and
become less severe in residual or prodromal period.
• Loss of association: slip of the track from one topic
to another.
• Tangentially: answers to questions may be not
directly related or completely unrelated.
• Incoherence or word salad: nonsense, patients
speech cannot be understand.
• Disorganized behavior: dressing unusual (wearing
multiple coats, inappropriate sexual behavior,
unpredictable or triggered agitation (shouting).

13. Catatonic motor behaviors
• Catatonic stupor: decreased reactivity to
environment, make little or no eye contact
with others and may be mute and rigid.
• Catatonic rigidity: rigid posture and resist
effort to be moved.
• Catatonic negativism: active resistant to
instructions or attempt to be moved.
• Catatonic posturing: inappropriate or bizarre
posture.

14. Catatonic motor behavior
• Catatonic excitement: purposeless and un
stimulated excessive motor activity.

15. Diagnostic criteria
• Negative symptoms are common in prodromal
and residual period and the first sign to warn
the family that something wrong happen
(withdraw, loss interest in activity, less
talkative, spend most of their time in bed,
poor hygiene).
• negative symptoms are non specific and can
occur due to others factors such as
depression, side effect of medication.

16. Negative symptoms
• Affective flattening: restriction in the range and
intensity of emotion: face appears unresponsive
with poor eye contact.
• Alogia: poor productivity of thought and speech.
• Avolition: initiation of goal directed behavior and
activities: sit for long time and little interest to
share in social activity.

17. Schizophrenia
general information
• Onset occurs between late teen and mid 30s (it can occurs
after 45 and more in women, married, better outcome).
• Men:18-25 years, women 25-mid 30s
• Women have better prognosis than men
• Higher incidence in men than women
• The majority (60-70%) do not marry
• Has poor insight about their illness
• Life expectancy is shorter than general population (suicide
10%)
• Comorbidity is high with substance (nicotine: smoking 80-
90%), anxiety, OCD, panic disorders.

18. Subtypes of schizophrenia
• Paranoid type
• Disorganized type
• Catatonic type
• Undifferentiated type
• Residual type
• Schizophreniform disorder
• Schizoaffective disorder

19. Paranoid type
• Preoccupation with one or more delusions
(persecutory or grandiose) or frequent
auditory hallucination.
• Non of the following is prominent:
disorganized speech, disorganized or catatonic
behavior or flat or inappropriate affect

20. Paranoid type
• Onset tend to be later in life than other types
of schizophrenia.
• Show little or no impairment on
neuropsychological or other cognitive testing.

21. Disorganized type
A. All the following are prominent:
• Disorganized speech
• Disorganized behavior which may lead to
inability to perform daily activity (dressing,
meals, showering) e.g. (tie ribbon around his
big toe, incontinent)
• Flat or inappropriate affect

22. Catatonic type
• Dominated at least two of the following:
• Motoric immobility: catalepsy: waxy inflexible or
stupor.
• Excessive motor activity (purposeless and not
influenced by external stimuli, may shout and talk).
• Extreme negativism (motiveless resistance to all
instructions or maintenance of rigid posture against
attempt to be moved. and mutism: inhibition of
speech for hours or days.
• Echolalia: repetition of a word or phrase just spoken
by other person. Or echopraxia: repetition imitation
of the movements of another person. Neologisms:
creat new expression: jittersitters.

23. Undifferentiated type
• A type in which symptoms meet criterion A
are present but the criteria are not met for the
paranoid, disorganized, or catatonic type.

24. Residual type
• Absence of prominent delusion, hallucination,
disorganized speech, and grossly disorganized
or catatonic behavior.
• Continue evidence of disturbance as indicated
by the presence of negative symptoms (flat
affect, poverty of speech, avolition).
• If hallucination and delusion are present, they
are not prominent.

25. Schizophreniform disorder
• Criteria of schizophrenia are met.
• Episodes of disorders last at least 1 month but
less than 6 months.
• It differs from brief psychotic disorder which
has duration for one day and less than 1
month.

26. Schizoaffective disorder
• Uninterrupted period of illness during which
there is either major depressive episode (2
weeks), manic episode or mixed episode (1
week) concurrent with symptoms that meet
criterion A of schizophrenia.
• During the same period of illness, there have
been delusion or hallucination for at least 2
weeks in the absence of prominent mood
symptoms.

27. Possible causes of schizophrenia
• Stress: undesirable and unpleasant external
event (loss jobs, illness, poor housing).
• Lower social class: more stressors, poor
health, nutrition, inadequate education,
criminal behavior.
• family pattern communication (double bind).
• heredity (genetics):first degree relative.
• Identical twins: monozygot (44.3%) than
dizygotic twins (12.8%).

28. Possible causes of schizophrenia
• Cultural changes: migration, economic crisis,
industrialization, urbanization.
• drugs (alcohol, cannabis, cocaine,
amphetamine).
• History of temporal lobe epilepsy.
• Initiating factors: leave home to marry, work,
study, have responsibility, live alone, divorce
or death of parents, rape..etc

29. Possible causes of schizophrenia
• Physiology structural changes: ventricular
enlargment which leads to cognitive
impariment, negative symptoms, and atrophy
of frontal lope (cause infection).
• Biochemical: increase dopamine level.
• Viral infection in pregnancy or obstetrical
complication.
• Neurological abnormalities: perinatal
complication, lags in maturation of brain.

30. Possible cause of schizophrenia
• The characteristics of parents (anxious,
aggressive, rejecting, dominating mothers and
inadequate, passive, and indifferent father).
• Characteristics of child (clinging to mothers,
shared mothers room until late adolescence, had
nightmare, neurotics, fearful and panic when
away from home, friendless, lonely, shy,
disinterested, dull, destructive, prone to flight).

32. Treatment
• Insulin coma treatment: 1933 (cause death).
• Convulsive therapy: electroconvulsive therapy
(ECT) (anesthesia and muscle relaxant).
• Medication

33. Medications
• Antipsychotic agents: reduce positive
symptoms but negative one.
• Chlorpromazine
• Butyrophenones (Haldol)
• Thioxanthenes (Navane)

34. Meditation
• Side effect:
• Dry mouth, dizziness, blurred vision, restlessness,
sexual dysfunction.
• Extrapyramidal side effects: tremors of fingers,
drooling, dystonia (prolonged, repetitive muscle
contractions), muscle rigidity, chewing movement,
akasthesia (inability to remain instill), arching of back
and involuntary muscles movement.
• Neuroleptic malignant syndrome: fatal, severe muscle
rigidity accompanied by fever, increase BP and may
lapse into a coma.

35. Tratment
• Atypical antipsychotic drugs: Olanzapine
(zyprexz), resperidone (resperidal).
• Side effect: DM, pancreatitis.

36. Psychological Treatment
• Psychoanalytic therapies: communication pattern
and achieve insight into the role the past has
played in current problem and it was not
successful with pt. it assumes that pt return to
early childhood communication and the fragile
ego cannot deal with stress so we teach the pt
adult communication (eye contact).
• Social skills training: teach skills (e.g medication,
daily activity, ordering meals by role playing and
modeling).

37. Psychological Treatment
• Family therapy: hostile, overprotective,
hypercritical family leads to relapse and
hospitalization so provide education about
disease, medication, help family to avoid
blaming, improve communication and
problem solving skills, instilling hope that
things can improve and increase social
contact.

38. Treatment
• Cognitive behavioral therapy.
• Case management: multidisplinary team that
provide services in the community ranging
from medication, psychotherapy, housing,
employment.
• Residential treatment: homes in community
and have part time jobs or go to school.
• Group therapy: social skills training, psycho-
education, medication, time out groups.