Schizophrenia is a chronic mental disorder that causes distortions in perception, thought, emotions, language, and behavior. It is characterized by positive symptoms like hallucinations and delusions, negative symptoms like reduced speech and emotional expression, and cognitive symptoms like impaired executive functioning and attention. The causes involve both genetic and environmental factors. Family, twin, and adoption studies show schizophrenia runs in families and has high heritability among identical twins, indicating a strong genetic component. Brain abnormalities in schizophrenia patients include differences in dopamine activity and brain structure in regions involved in processing dopamine. While the exact causes are unknown, evidence points to both genetic and neurological factors contributing to the disorder.

1. schizophrenia spectrum and other
psychotic disorder

2. Definition;
 it’s a chronic Schizophrenia is a chronic and severe
mental disorder that affects how a person thinks, feels,
and behaves. People with schizophrenia may seem like
they have lost touch with reality. Although
schizophrenia is not as common as other mental
disorders, the symptoms can be very disabling.

3. The History of Schizophrenia
 Characterized by distortions: perception, thought,
language, emotions
•Greece – Hippocrates had knowledge of the basic
symptoms.
•Eugen Bleuler – Swiss psychiatrist – coined
“schizophrenia”
•Greek words for “split mind” - separation of cognitive
and emotional functions – mental confusion,
inappropriate or absent emotional expression.
•Not the same as multiple personality disorder
•Heinz Leshmann – chlorpromazine, first modern anti-
psychotic drug – made positive symptoms disappear.

4. sign and symptoms;
 Symptoms of schizophrenia usually start between ages
16 and 30. In rare cases, children have schizophrenia
too.
 The symptoms of schizophrenia fall into three
categories: positive, negative, and cognitive.
 Positive symptoms
 Negative symptoms
 Cognitive symptoms

5.  Primary Associated with positive symptoms Deficit
or primary enduring symptoms (premorbid and
deteriorative)
 Secondary Associated with extra pyramidal
symptoms, depression, or environmental deprivation

6. Positive symptoms:
 “Positive” symptoms are psychotic behaviors not
generally seen in healthy people. People with positive
symptoms may “lose touch” with some aspects of
reality. Symptoms include:
 Hallucinations
 Delusions
 Thought disorders (unusual or dysfunctional ways of
thinking)
 Biochemical factors seem to explain as primarily
factorsof schizophrenia

7.  Hallucinations: when a person sees, hears, smells,
tastes, or feels things that are not real. “Hearing voices”
is common for people with schizophrenia. People who
hear voices may hear them for a long time before
family or friends notice a problem.
 Delusions: when a person believes things that are not
true. For example, a person may believe that people on
the radio and television are talking directly to him or
her. Sometimes people believe that they are in danger
fixed false belief .

8. types of hallucination;
 auditory
 visualize
 gustatory
 olfactory
 somatic
 tactile

9.  auditory; seem to hear voices and sounds that are out of
mind. e.g. hear the voices talking to each other or feel
like they're telling you to do something.
 olfactory; smell the odor that no one else can smell. e.g.
smelling smoke
 somatic; feeling that some thing is happened inside the
stomach. e.g.. snake crawl inside stomach.

10.  visualize; vague perception, ambiguity about the view.
For example, you might see insects crawling on your
hand or on the face of someone you know.
 gustatory; You may feel that something you eat or drink
has an odd taste.
 tactile; It might seem to you that you're being tickled
even when no one else is around, or you may have a
sense that insects are crawling on or under your skin.
You might feel a blast of hot air on your face that isn't
real.

11. types of delusion;
 control
 Grandiose
 Persecutory
 refrence

12.  Delusions of persecution – Belief that others, often
a vague “they,” are out to get you. These persecutory
delusions often involve bizarre ideas and plots (e.g.
“Martians are trying to poison me with radioactive
particles delivered through my tap water”).
 Delusions of reference – A neutral environmental
event is believed to have a special and personal
meaning. For example, you might believe a billboard
or a person on TV is sending a message meant
specifically for you.

13.  Delusions of grandeur – Belief that you are a famous
or important figure, such as Jesus Christ or Napoleon.
Alternately, delusions of grandeur may involve the
belief that you have unusual powers, such as the ability
to fly.
 Delusions of control – Belief that your thoughts or
actions are being controlled by outside, alien forces.
Common delusions of control include thought
broadcasting (“My private thoughts are being
transmitted to others”), thought insertion (“Someone
is planting thoughts in my head”), and thought
withdrawal (“The CIA is robbing me of my thoughts”).

14.  Disorganized speech
 Schizophrenia can cause you to have trouble concentrating
and maintaining a train of thought, externally manifesting
itself in the way that you speak. You may respond to queries
with an unrelated answer, start sentences with one topic
and end somewhere completely different, speak
incoherently, or say illogical things.
 Disorganized behavior
 Schizophrenia disrupts goal-directed activity, impairing
your ability to take care of yourself, your work, and interact
with others. Disorganized behavior appears as:
 A decline in overall daily functioning
 Unpredictable or inappropriate emotional responses
 Behaviors that appear bizarre and have no purpose
 Lack of inhibition and impulse control

15. Disorganized speech
 Loose associations – Rapidly shifting from topic to topic,
with no connection between one thought and the
next.
 Neologisms – Made-up words or phrases that only have
meaning to you.
 Perseveration – Repetition of words and statements; saying
the same thing over and over.
 Clang – Meaningless use of rhyming words (“I said the
bread and read the shed and fed Ned at the head").

16. negative symptoms( (absence of normal behaviors)
 “Negative” symptoms are associated with disruptions
to normal emotions and behaviors. Symptoms include;
 avolition
 alogia
 fflateffect
 asociality
 anhedonia

17. “Flat affect” ; (reduced expression of emotions via facial
expression or voice tone) the patient vacantly, the
muscles of the face flaccid, the eye lifeless. when
spoken to patient, the patient answer flat and toneless
voice.
avolition; lake of energy, absence of interest in daily life
activities , the patient is unattentive to grooming and
hygiene , with un combed hair , dirty nails, unbrushed
teeth, disheveled cloth. spend their much time sitting
around doing nothing.

18.  alogia; speech is reduce, the amount of discourse is
adequate but it convey little information be and tend
to vague and reparative.
 anhedoni; inability to experience pleasure, lake of
interest in recreational activity, failure in creating close
relation with other people, and lake of interest in sex.
 asociality; patient with few friend ,poor social skills, little
interest with other people.

19. Cognitive symptoms
 For some patients, the cognitive symptoms of
schizophrenia are subtle, but for others, they are more
severe and patients may notice changes in their
memory or other aspects of thinking. Symptoms
include:
 Poor “executive functioning” (the ability to understand
information and use it to make decisions)
 Trouble focusing or paying attention
 Problems with “working memory” (the ability to use
information immediately after learning it)

20.  Difficulty using information to make decisions
 Problems using information immediately after
learning it
 Trouble paying attention

21. CAUSES
 GENETIC
 ENVIORNOMENTAL
 BRAIN STRUCTURE AND CHEMITRY

22. Genetic Factors
The closer the genetic relationship between schizophrenia
patients and their family members, the greater the likelihood
(or concordance rate) that the relatives will also have
schizophrenia
.
these are the following factors;
family system
twin study
adaptation study

23. Family, Twin & Adoption Studies
 To determine whether genetics plays any role in schizophrenia, decades ago,
researchers began by looking at the prevalence of the disorder in families along
with fraternal and identical twins. As many already know, these studies showed
that schizophrenia runs in families and has a high heritability rate among
identical twins, upward of 80 percent.
 What does heritability mean exactly? According to Anna Need, PhD,
schizophrenia researcher and assistant professor in the Center for Human
Genome Variation at Duke University, it tells us that in those particular studies,
roughly 80 percent of the variance can be explained by genetics.
 Adoption studies are another avenue for answers. This research revealed that
kids whose biological parents are schizophrenic (whether the onset was before
or after the adoption) were at an elevated risk for psychosis. But kids adopted
into families where one of the adoptive parents has schizophrenia were not at
an increased risk for developing schizophrenia.

24. The familial risk of schizophrenia.
Generally speaking, the
more closely one is
related to people who
have developed
schizophrenia, the greater
the risk of developing
schizophrenia for oneself.
Monozygotic (MZ)
twins, whose genetic
heritages are identical,
are much more likely than
dizygotic (DZ) twins,
whose genes overlap by
50%, to be concordant for
schizophrenia.

25. Different brain chemistry and structure
 The Dopamine Theory of Schizophrenia
 Pharmacological treatments support the idea that an overactive
dopamine system may result in schizophrenia: Medications that
block dopamine receptors, specifically D2 receptors, reduce
schizophrenia symptoms.
 The brain regions known as the thalamus and the striatum are
affected by dopaminergic activity. Manzano et al. explain that
schizophrenia results in altered levels of D2 binding potential in
those two regions of the brain. For example, the authors note
that schizophrenia patients who do not
take antipsychotic medications have a lower thalamic D2
binding potential. In addition, untreated schizophrenia patients
have a higher number of D2 receptors in the striatum.

26. Brain Abnormalities
We have compelling evidence of both structural changes (loss
of brain tissue) and functional disturbance (abnormalities of
functioning) in the brains of schizophrenia patients.
However, we have yet to discover any one source of pathology
in the brain that is specific to schizophrenia or present in all
cases of schizophrenia.
The most prominent finding of structural changes is the loss
of brain tissue (gray matter) of about 5% on the average in
schizophrenia patients as compared to normal controls.
These brain abnormalities are responsible for Type II
(negative) symptoms of schizophrenia.

27. Chemical Defect in the Brain
 Basic knowledge about brain chemistry and its link
to schizophrenia is expanding rapidly.
Neurotransmitters, substances that allow
communication between nerve cells, have long been
thought to be involved in the development of
schizophrenia. It is likely, although not yet certain,
that the disorder is associated with some imbalance of
the complex, interrelated chemical systems of the
brain, perhaps involving the
neurotransmitters dopamine and glutamate

28. Loss of brain tissue in adolescents with early-onset
schizophrenia
The brains of adolescents with early-onset schizophrenia (right image)
show a substantial loss of gray matter. Some shrinkage of gray matter
occurs normally during adolescence (left image), but the loss is more
pronounced in adolescents with schizophrenia.

29. Structural changes in the brain of a person with schizophrenia as
compared with that of a normal subject
The magnetic resonance imaging (MRI) of the brain of a person with
schizophrenia (left) shows a relatively shrunken hippocampus (yellow)
and relatively enlarged, fluid-filled ventricles (white) when compared to
the structures of the normal subject (right).

30. PET scans of people with schizophrenia versus normal's
Positron emission tomography (PET) scan evidence of the metabolic
processes of the brain shows relatively less metabolic activity (indicated
by less yellow and red) in the frontal lobes of the brains of people with
schizophrenia. PET scans of the brains of four normal people are shown
in the top row, and PET scans of the brains of four people with
schizophrenia are shown below.

31. ENVIORNMENTAL
 Scientists also think that interactions between genes
and aspects of the individual’s environment are
necessary for schizophrenia to develop. Environmental
factors may involve:
 Exposure to viruses
 Malnutrition before birth
 Problems during birth
 Psychosocial factors

32. Types of Schizophrenia
 The criteria in the DSM-v divided schizophrenia by different
types. Though this specification is longer used in the updated
DSM-5, they remain below for informational and historical
purposes.
 A brief list of types of schizophrenia, according to DSM-IV:
 Paranoid schizophrenia— a person feels extremely suspicious,
persecuted, grandiose, or experiences a combination of these
emotions.
 Disorganized schizophrenia — a person is often incoherent but may not
have delusions.
 Catatonic schizophrenia— a person is withdrawn, mute, negative
and often assumes very unusual postures.
 Residual schizophrenia — a person is no longer delusion or
hallucinating, but has no motivation or interest in life. These
symptoms can be most devastating.

33. TREATMENTS
 Two main types of treatment can help with symptoms:
biological treatment
psychosocial treatments.

34. Antipsychotic medications
 help patients with the psychotic symptoms of schizophrenia.
Some people have side effects when they start taking
medications, but most side effects go away after a few days. Side
effects include:
 Blurry vision
 Body movements a person can’t control, such as shaking
 Dizziness
 Drowsiness
 Fast heartbeat
 Feeling restless
 Menstrual problems
 Sensitivity to the sun
 Skin rashes
 Stiffness in the body

35. Biological Treatment: Medication
 Antipsychotic drugs do not “cure” schizophrenia, they
just treat it.
 Are very effective in treating hallucinations and
delusions.
 Work differently from individual to individual.
 Examples: Clozaril, Risperdal, Zyprexa, Haldol,
Thorazine, Seroquel.
 Long-acting injectable forms. No need to take pills.
E.g.: Haldol, Prolix in, Trilafon.
 Side effects: Drowsiness, restlessness, muscle
spasms, tremor, dry mouth, blurring of vision, Tardive
dyskinesia, weight gain, social withdrawal and
symptoms resembling Parkinson's Disease.
 Focus on improving the patient's social functioning.

36. Drug Treatment
 Drug therapies for schizophrenia have radically revolutionised
the way schizophrenia sufferers are treated and cared for.
 The use of effective antipsychotic drugs became common in the
1960s and 1970s, seeing a drastic reduction in the number of
schizophrenic sufferers who need long-term institutionalised
care.
 It has led to such sufferers reaching a level of normal
functioning that permits care to take place in the community.
 Indeed, Lamb (1984) found that prior to the 1980s, it was
estimated that 2 of 3 patients would spend their lives in a
psychiatric institution; the average length of stay is down to
about 2 months, post 1980s.

37. Drug Treatment Contd…
 These drugs not only reduce the major positive symptoms,
e.g. thought disorder and hallucinations, but can also
reduce major negative symptoms, e.g. social withdrawal,
too.
 The NHS use recommend the use of both typical (those
developed in the 1950s) and atypical antipsychotics (those
developed during the 1990s) to patients till episodes of
acute schizophrenia have passed.
 The NHS also recommend their long-term use to prevent
further acute schizophrenic episodes occurring
 Antipsychotics, e.g. chlorpromazine and haloperidol, block
dopamine receptors and help to reduce the high levels of
dopamine in the brains of schizophrenics.

38. The NHS have reported the following side effects which
schizophrenic patients have had:-
 Typical Antipsychotics
 drowsiness,
 shaking,
 trembling,
 muscle twitches, and
 spasms.
 Typical and Atypical
Antipsychotics
 weight gain,
 blurred vision,
 constipation,
 lack of sex drive, and
 dry mouth.

39.  ; Family education: teaches the whole family how to
cope with the illness and help their loved one
 Illness management skills: helps the patient learn
about schizophrenia and manage it from day-to-day.
 Cognitive behavioral therapy (CBT): helps the
patient identify current problems and how to solve
them. A CBT therapist focuses on changing unhelpful
patterns of thinking and behavior.
Rehabilitation: helps with getting a job or going to school
and everyday living skills
 Self-help groups: provide support from other people
with the illness and their families
 Treatment for drug and alcohol misuse: is often
combined with other treatments for schizophrenia

40. REHABILITATION
 Includes a wide range of non-medical interventions.
 Social and vocational training helps patients overcome
difficulties.
 Vocational counseling, job training, problem-solving
and money management skills, use of public
transportation, and social skills training.
 Provided by Partial Hospital or Day Treatment
Programs (4 to 6 hrs per day, several days per week).
 Learning is both educational and experiential.

41. COGNITIVE BEHAVIORAL PSYCHOTHERAPY
 More effective than other types of psychotherapy in treating
depression and panic attacks.
 Two approaches combine to effectively treat schizophrenia.
 Cognitive treatment helps treat distorted perceptions of the
world, including self, and disordered or disorganized thinking.
 Behavioral therapy is used within a structured psychosocial
rehabilitation program rather than individually because
schizophrenia is seen as a life-long illness.
 Behavior therapy teaches the social skills never learned, and
helps understand when to apply those skills to problems in the
world.
 Examples of training: Stress Management Training,
Assertiveness Training, Communication Skills Training, Problem
Solving Skills.

42. FAMILY EDUCATION
 It is important for family members to lern all they can
about schizophrenia when they have to take care of a
family member who has been discharged from the
hospital.
 Family psycho education includes teaching various
coping strategies and problem-solving skills. It is a
cognitive-behavioral treatment approach to family
therapy.
 This approach helps families to deal more effectively
with their ill relative and to contribute to an improved
outcome for the patient.

43. SELF-HELP GROUPS
 Members provide continuing mutual support as well as
comfort in knowing that they are not alone in the problems
they face.
 Families working together can more effectively serve as
supporters for needed research and hospital and
community treatment programs.
 Patients acting as a group rather than individually may be
better able to dismiss dishonor and draw public attention
to such abuses as discrimination against the mentally ill.
 Groups are very active and provide useful information and
assistance for patients and families of patients with
schizophrenia.

44. COMMUNITY AND SOCIAL SUPPORT
 Patients with schizophrenia may need help from people
in their family or community.
 Ensuring that a person with schizophrenia continues to
get treatment after hospitalization is important.
 Encouraging the patient to continue treatment and
assisting him or her in the treatment process can
positively influence recovery.
 A positive approach may be helpful and perhaps more
effective in the long run than criticism.

45. INDIVIDUAL PSYCHOTHERAPY
 Involves regularly scheduled talks between the
patient and a mental health professional (psychiatrist,
psychologist, psychiatric social worker, nurse).
 Talks focus on current or past problems, experiences,
thoughts, feelings and relationships.
 Individuals gradually come to understand more about
themselves and their problems.
 Psychotherapy is not a substitute for antipsychotic
medication.
 It is most helpful once a patient’s psychotic symptoms
have first been relieved by drug treatment.

46. Treatment of Schizophrenia
 The acute psychotic schizophrenic patients will respond
usually to antipsychotic medication.
 According to current consensus we use in the first line
therapy the newer atypical antipsychotics, because their use
is not complicated by appearance of extrapyramidal side-
effects, or these are much lower than with classical
antipsychotics.
conventional
antipsychotics
(classical
neuroleptics)
chlorpromazine, chlorprotixene, clopenthixole,
levopromazine, periciazine, thioridazine
droperidole, flupentixol, fluphenazine,
fluspirilene, haloperidol, melperone,
oxyprothepine, penfluridol, perphenazine,
pimozide, prochlorperazine, trifluoperazine
atypical
antipsychotics
amisulpiride, clozapine, olanzapine,
quetiapine, risperidone, sertindole, sulpiride

47. Theoretical Perspectives
 learning theory
 psychodynamic theory
 biological theory
 double bind theory

48. Psychodynamic Perspectives
Within the psychodynamic perspective, schizophrenia
represents the overwhelming of the ego by primitive sexual or
aggressive drives or impulses arising from the id.
These impulses threaten the ego and give rise to intense
intrapsychic conflict.
Under such a threat, the person regresses to an early period in
the oral stage, referred to as primary narcissism.

49. Learning Perspectives
Although learning theory does not offer a complete explanation
of schizophrenia, the development of some forms of
schizophrenic behavior can be understood in terms of the
principles of conditioning and observational learning.
From this perspective, people with schizophrenia learn to
exhibit certain bizarre behaviors when these are more likely to
be reinforced than normal behaviors.
Social-cognitive theorists suggest that modeling of
schizophrenic behavior can occur within the mental hospital,
where patients may begin to model themselves after fellow
patients who act strangely

50. Biological Perspectives
Although we still have much to learn about the
biological underpinnings of schizophrenia, most
investigators today recognize that biological
factors play a determining role through:
 brain abnormality
 genetic factor

51. An early, but since discredited theory, focused on the role of the
schizophrenogenic mother (Fromm-Reichmann, 1948, 1950).
In what some feminists view as historic psychiatric sexism, the
schizophrenogenic mother was described as cold, aloof,
overprotective, and domineering. She was characterized as
stripping her children of self-esteem, stifling their
independence, and forcing them into dependency on her.
Children reared by such mothers were believed to be at special
risk for developing schizophrenia if their fathers were passive
and failed to counteract the mother’s pathogenic influences.
family influences have turned to consider the effects of:
1.communication device
2.emotion express

52. Communication Deviance (CD)
A pattern of unclear, vague, disruptive, or fragmented
communication that is often found among parents and family
members of schizophrenia patients.
CD is speech that is hard to follow and from which it is
difficult to extract any shared meaning.
High CD parents often have difficulty focusing on what their
children are saying.

53. Expressed Emotion (EE)
Another form of disturbed family communication, EE is a
pattern of responding to the schizophrenic family member in
hostile, critical, and unsupportive ways.
Schizophrenia patients from high EE families stand a higher
risk of relapsing than those with low EE (more supportive)
families.
High EE relatives typically show less empathy, tolerance, and
flexibility than low EE relatives.

54. Relapse rates of people with schizophrenia in high and
low EE families
People with schizophrenia whose families are high in expressed emotion
(EE) are at greater risk of relapse than those whose families are low in
EE. Whereas low-EE families may help protect the family member with
schizophrenia from environmental stressors, high-EE families may
impose additional stress.

55. Family Systems Theory
 Origins in:
 The psychoanalytical tradition (the influence of the
family on abnormal behavior)
 Systems thinking (idea that things are best understood
by looking at the relationships between a set of entities)
 Schizophrenic symptoms represent an attempt to escape
from the double bind
psychlotron.org.uk

56. Family Factors in Schizophrenia:
Causesor Sources of Stress?
No evidence supports the belief that family factors, such as
negative family interactions, lead to schizophrenia in children
who do not have a genetic vulnerability.
Rather, a genetic vulnerability to schizophrenia renders
individuals more susceptible to troubled family and social
relationships.
Within the diathesis–stress model, disturbed patterns of
family interaction and communication represent sources of life
stress that increase the risks of developing schizophrenia
among people with a genetic predisposition for the disorder

57. The Diathesis–Stress Model
Note that the question of whether stress directly triggers the initial
onset of schizophrenia in genetically vulnerable individuals is still
open to debate (Walker & Diforio, 1997)

58. Double Bind Theory (Bateson, 1956)
 Schizophrenia is a consequence of abnormal patterns
in family communication
 The patient is a ‘symptom’ of a family-wide problem
 They become ‘ill’ to protect the stability of the family
system.
 In a double bind situation a person is given mutually
contradictory signals by another person
 This places them in an impossible situation, causing
internal conflict
psychlotron.org.uk

59. Double Bind Theory
 Bateson (1956) reports clinical evidence (interviews,
observations) illustrating use of double bind
communication by parents of schizophrenia patients
 Issues of researcher (confirmatory) bias
 Problems with direction of causality.
 Liem et al (1974) compared communication patterns in
families with & without a schizophrenic member
 Abnormality in parental communication was a response
to the schizophrenic symptoms, not vice versa
 Some issues with ecological validity
psychlotron.org.uk

60. Double Bind Theory
 Some evidence that family processes play a role in
relapse of schizophrenia patients following
stabilization
 Relapse more likely (58% vs. 10%) where family is high
in ‘expressed emotion’ (Brown et al, 1966)
 Families high in criticism, hostility & over-involvement
lead to more relapse (Vaughn & Leff, 1976)
psychlotron.org.uk

61. F20-F29 Schizophrenia, Schizotypal and Delusional Disorders
F20 Schizophrenia
F20.0 Paranoid schizophrenia
F20.1 Hebephrenic schizophrenia
F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia
F20.4 Post-schizophrenic depression
F20.5 Residual schizophrenia
F20.6 Simple schizophrenia
F20.8 Other schizophrenia
F20.9 Schizophrenia, unspecified

62. F20-F29 Schizophrenia, Schizotypal and Delusional Disorders
F21 Schizotypal disorder
F22 Persistent delusional disorders
F22.0 Delusional disorder
F22.8 Other persistent delusional disorders
F22.9 Persistent delusional disorder, unspecified
F23 Acute and transient psychotic disorders
F23.1 Acute polymorphic psychotic disorder with symptoms
of schizophrenia
F23.2 Acute schizophrenia-like psychotic disorder
F23.3 Other acute predominantly delusional psychotic
disorders
F23.8 Other acute and transient psychotic disorders
F23.9 Acute and transient psychotic disorder, unspecified

63. F20-F29 Schizophrenia, Schizotypal and Delusional Disorders
F24 Induced delusional disorder
F25 Schizoaffective disorders
F25.0 Schizoaffective disorder, manic type
F25.1 Schizoaffective disorder, depressive type
F25.2 Schizoaffective disorder, mixed type
F25.8 Other schizoaffective disorders
F25.9 Schizoaffective disorder, unspecified
F28 Other nonorganic psychotic disorders
F29 Unspecified nonorganic psychosis

64. F20.0 Paranoid Schizophrenia
 Paranoid schizophrenia is characterized mainly by
delusions of persecution, feelings of passive or
active control, feelings of intrusion, and often by
megalomanic tendencies also. The delusions are
not usually systemized too much, without tight
logical connections and are often combined with
hallucinations of different senses, mostly with
hearing voices.
 Disturbances of affect, volition and speech, and
catatonic symptoms, are either absent or relatively
inconspicuous.

65. F20.1 Hebephrenic Schizophrenia
 Hebephrenic schizophrenia is characterized by disorganized
thinking with blunted and inappropriate emotions. It begins
mostly in adolescent age, the behavior is often bizarre. There
could appear mannerisms, grimacing, inappropriate laugh
and joking, pseudo philosophical brooding and sudden
impulsive reactions without external stimulation. There is a
tendency to social isolation.
 Usually the prognosis is poor because of the rapid
development of "negative" symptoms, particularly flattening
of affect and loss of volition. Hebephrenic should normally
be diagnosed only in adolescents or young adults.
 Denoted also as disorganized schizophrenia

66. F20.2 Catatonic Schizophrenia
 Catatonic schizophrenia is characterized mainly by
motoric activity, which might be strongly increased
(hypekinesis) or decreased (stupor), or automatic
obedience and negativism.
 We recognize two forms:
 productive form — which shows catatonic excitement,
extreme and often aggressive activity. Treatment by
neuroleptics or by electroconvulsive therapy.
 stuporose form — characterized by general inhibition of
patient’s behavior or at least by retardation and slowness,
followed often by mutism, negativism, fexibilitas cerea or
by stupor. The consciousness is not absent.

67. F20.3 Undifferentiated Schizophrenia
 Psychotic conditions meeting the general
diagnostic criteria for schizophrenia but not
conforming to any of the subtypes in F20.0-F20.2,
or exhibiting the features of more than one of
them without a clear predominance of a particular
set of diagnostic characteristics.
 This subgroup represents also the former diagnosis
of atypical schizophrenia.

68. F20.4 Post schizophrenic Depression
 A depressive episode, which may be prolonged,
arising in the aftermath of a schizophrenic illness.
Some schizophrenic symptoms, either „positive“ or
„negative“, must still be present but they no longer
dominate the clinical picture.
 These depressive states are associated with an
increased risk of suicide.

69. F20.5 Residual Schizophrenia
 A chronic stage in the development of
schizophrenia with clear succession from the
initial stage with one or more episodes
characterized by general criteria of schizophrenia
to the late stage with long-lasting negative
symptoms and deterioration (not necessarily
irreversible).

70. F20.6 Simple Schizophrenia
 Simple schizophrenia is characterized by early and
slowly developing initial stage with growing social
isolation, withdrawal, small activity, passivity,
avolition and dependence on the others.
 The patients are indifferent, without any initiative
and volition. There is not expressed the presence
of hallucinations and delusions.

71. F21 Schizotypal disorder
 According to lCD-10 this disorder is characterized
by eccentric behavior and by deviations of
thinking and affectivity, which are similar to that
occurring in schizophrenia, but without psychotic
features and expressed symptoms of schizophrenia
of any type.

72. F22 Persistent Delusional Disorders
 Includes a variety of disorders in which long-
standing delusions constitute the only, or the most
conspicuous, clinical characteristic and which
cannot be classified as organic, schizophrenic or
affective.
 Their origin is probably heterogeneous, but it
seems, that there is some relation to
schizophrenia.

73. F22.0 Delusional Disorder
 A disorder characterized by the development of
one delusion or of the group of similar related
delusions, which are persisting unusually long,
very often for the whole life.
 Other psychopathological symptoms —
hallucinations, intrusion of thoughts etc. are not
present and are excluding this diagnosis.
 It begins usually in the middle age.

74. F23 Acute and Transient Psychotic
Disorders
 The criteria should be the following features:
 acute beginning (to two weeks)
 presence of typical symptoms (quickly changing
“polymorphic symptoms”)
 presence of typical schizophrenic symptoms.
 Complete recovery usually occurs within a few
months, often within a few weeks or even days.
 The disorder may or may not be associated with
acute stress, defined as usually stressful events
preceding the onset by one to two weeks.

75. F24 Induced Delusional Disorder
 A delusional disorder shared by two or more
people with close emotional links. Only one of the
people suffers from a genuine psychotic disorder;
the delusions are induced in the other(s) and
usually disappear when the people are separated.
 The psychotic disorder of the dominant member
of this dyad is mainly, but not necessarily, of
schizophrenic type. The original delusions of
dominant member and his partner are usually
chronic, either persecutory or megalomanic.

76. F25 Schizoaffective Disorders
 Episodic disorders in which both affective and schizophrenic
symptoms are prominent (during the same episode of the
illness or at least during few days) but which do not justify a
diagnosis of either schizophrenia or depressive or manic
episodes.
 Patients suffering from periodic schizoaffective disorders,
especially with manic symptoms, have usually good
prognosis with full remissions without any remaining
defects.
 They are divided in different subgroups:
 F25.0 Schizoaffective disorder, manic type
 F25.1 Schizoaffective disorder, depressive type
 F25.2 Schizoaffective disorder, mixed type
 F25.8 Other schizoaffective disorders
 F25.9 Schizoaffective disorder, unspecified

77. http://www.hubin.org/facts/history/history_schizophrenia_en.html
http://encarta.msn.com/medias_761552061/Schizophrenia.html
http://www.psychologyinfo.com/schizophrenia/treatment.htm
Newton, David; Olendorf, Donna; Jeryan, Cristine; Boyden,
Karen "SCHIZOPHRENIA." SICK! – Diseases and
Disorders, Injuries and Infections. 2000.
http://www.schizophrenia.com/schizpictures.html
Glassman: Approaches to Psychology Department of Psychiatry
1st Faculty of Medicine
Charles University, Prague
Head: Prof. MUDr. Jiří Raboch, DrSc
Credits
By John M. Grohol, Psy.D. on 31 Aug 2016
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