the presentation describes in detail about the mental illness, i.e. schizophrenia along with its diagnostic criteria, symptoms, prognosis, course as well as its causes.

1. Schizophrenia
Ramya Srivastava
M.A. (PSYCHOLOGY)- Final
Vasant Kanya Mahavidyalaya (B.H.U.)
SWAYAM STUDENT ID: 818a19e1f35511e9b5c91b025e725242
Acknowledgment: ACADEMIC WRITING (SWAYAM)

2.  Schizophrenia is a psychological disorder characterized by psychotic
symptoms— hallucinations and delusions—that significantly affect emotions,
behavior, and most notably, mental processes and mental contents. The
symptoms of schizophrenia can interfere with a person’s abilities to
comprehend and respond to the world in a normal way.

3. SYMPTOMS OF SCHIZOPHRENIA
 The criteria for schizophrenia fall into two clusters:
 positive symptoms• , consisting of delusions and hallucinations and
disorganized speech and behavior;
 negative symptoms• , consisting of the absence or reduction of normal mental
processes, mental contents, feelings, or behaviors, including speech,
emotional expressiveness, and/or movement.

4.  Positive symptoms are so named because they are marked by the presence of
abnormal or distorted mental processes, mental contents, or behaviors.
Positive symptoms of schizophrenia are
 hallucinations (distortions of perception),
 delusions (distortions of thought),
 disorganized speech, and
 disorganized behavior.

5. Hallucinations
 hallucinations are sensations so vivid that the perceived objects or events
seem real even though they are not. Any of the fi ve senses can be involved in
a hallucination, although auditory hallucinations—specifically, hearing voices—
are the most common type experienced by people with schizophrenia.
 People with schizophrenia are also more likely to (mis)attribute their own
internal conversations to another person (Brunelin, Combris, et al., 2006;
Keefe et al., 1999); this misattribution apparently contributes to the
experience of auditory hallucinations.

6. Delusions
 People with schizophrenia may also experience delusions—incorrect beliefs
that persist, despite evidence to the contrary. Delusions often focus on a
particular theme, and several types of themes are common among these
patients. For one, paranoid delusions involve the theme of being persecuted
by others.
 In contrast, delusions of control revolve around the belief that the person is
being controlled by other people (or aliens), who literally put thoughts into
his or her head, called thought insertion.
 Another delusional theme is believing oneself to be signifi cantly more
powerful, knowledgeable, or capable than is actually the case, referred to as
delusions of grandeur
 Yet another delusional theme is present in delusions of reference: the belief
that external events have special meaning for the individual

7. Disorganized speech
 People with schizophrenia can sometimes speak incoherently, although they
may not necessarily be aware that other people cannot understand what they
are saying. Speech can be disorganized in a variety of different ways. One
type of disorganized speech is word salad, which is a random stream of
seemingly unconnected words. It is also known as derailment of speech. For
example, a patient might say something like “Pots dog small is tabled.”
 Another type of disorganized speech involves many neologisms, or words that
the patient makes up.

8. Disorganized behavior
 Behavior that is so unfocused and disconnected from a goal that the person
cannot successfully accomplish a basic task, or the behavior is inappropriate
in the situation. Disorganized behavior can range from laughing
inappropriately in response to a serious matter or masturbating in front of
others, to being unable to perform normal daily tasks such as washing
oneself, putting together a simple meal, or even selecting appropriate clothes
to wear.
 The category of disorganized behavior also includes catatonia (also referred
to as catatonic behavior), which occurs when an individual remains in an odd
posture or position, with rigid muscles, for hours.

9. Negative symptoms
 In contrast to positive symptoms, negative symptoms are marked by the
absence or reduction of normal mental processes, mental contents, or
behaviors.
 Three types of negative symptoms: fl at affect, alogia, and avolition. Each of
these reflects the lack of a normal mental process, expression of feeling, or
behavior, but they differ in what—specifically—is lacking.

10. Flat Affect: Muted Expression
 Occurs when a person does not display a great range of emotion and hence
often seems emotionally neutral. Such people may not express or convey
much information through their facial expressions or body language, and they
tend to refrain from making eye contact (although they may smile somewhat
and do not necessarily come off as “cold”).

11. Alogia: Poverty of Speech
 People with schizophrenia who have alogia, or poverty of speech, may
respond slowly or minimally to questions and generally speak less than do
most other people. A person with alogia will take a while to muster the
mental effort necessary to respond to a question. Even choosing among words
can be challenging.
 For example, if asked how he or she liked a television show that just ended, a
person with alogia might nod once very briefly. If pushed to explain why the
show was enjoyable, he or she might take 5–10 seconds to think and then just
say “Funny.”

12. Avolition: Difficulty Initiating or
Following Through
 In avolition, the patient may sit for hours doing nothing and have difficulty
initiating a task or following through activities.

13. Diagnostic criteria for schizophrenia
 A. Characteristic symptoms:
Two (or more) of the following, each present for a signifi cant portion of time during a
1-month period (or less if successfully treated):
 (1) delusions
 (2) hallucinations
 (3) disorganized speech
 (4) grossly disorganized or catatonic behavior
 (5) negative symptoms, i.e., affective fl attening, alogia, or avolition
Note: Only one Criterion A symptom is required if delusions are bizarre or
hallucinations consist of a voice keeping up a running commentary on the person’s
behavior or thoughts or two or more voices conversing with each other.

14.  B. Social/occupational dysfunction:
For a significant portion of the time since the onset of the disturbance, one or
more major areas of functioning, such as work, interpersonal relations, or self-
care, are markedly below the level achieved prior to the onset (or when the
onset is in childhood or adolescence, failure to achieve expected level of
interpersonal, academic, or occupational achievement).

15.  C. Duration:
Continuous signs of the disturbance persist for at least 6 months. This 6-month
period must include at least 1 month of symptoms (or less if successfully treated)
that meet Criterion A (i.e., active-phase symptoms) and may include periods of
prodromal or residual symptoms. During these prodromal or residual periods, the
signs of the disturbance may be manifested by only negative symptoms or two or
more symptoms listed in Criterion A present in an attenuated form (e.g., odd
beliefs, unusual perceptual experiences).

16. Cognitive deficits
 Research has revealed the important role that cognitive deficits (also called
neurocognitive deficits) play in the course and prognosis of schizophrenia
(Barch, 2005; Green, 2001).
 specific deficits in attention, memory, and executive functioning arise in most
people with schizophrenia (Keefe, Eesley, & Poe, 2005; Wilk et al., 2005).

17.  Attention: Cognitive deficits include difficulties in sustaining and focusing
attention, which can involve distinguishing relevant from irrelevant stimuli
(Gur et al., 2007).
 Working memory: People with schizophrenia do not organize information
effectively, which indicates that their working memories are impaired; they
may not remember something they were told or shown once or even a few
times. Deficits in working memory may also lead to disruptions in reasoning—
and hence to disorganized speech (Melinder & Barch, 2003).

18.  Executive functions: which are mental processes involved in planning,
organizing, problem solving, abstract thinking, and exercising good judgment
(Cornblatt et al., 1997; Erlenmeyer-Kimling et al., 2000; Kim et al., 2004).
Executive functions are required to organize, interpret, and transform
information in working memory—and hence a problem with such functioning
will disrupt working memory. Deficits in executive functioning can impair a
person’s overall ability to function.

19. Prevalence
 The world over—from China or Finland to the United States or New Guinea—
approximately 1% of the population will develop schizophrenia at some point
in their lives (Gottesman, 1991; Perälä et al., 2007).
 Schizophrenia is one of the top five causes of disability among adults in
developed nations, ranking with heart disease, arthritis, drug use, and HIV
(Murray & Lopez, 1996). In the United States, about 5% of people with
schizophrenia (about 100,000 individuals) are homeless, 5% are in hospitals,
and 6% are in jail or prison (Torrey, 2001). Together, these three groups of
people represent about 16% of Americans with schizophrenia; in contrast, 34%
of people with this disorder live independently.

20. Comorbidity
 Over 90% of people with schizophrenia also suffer from at least one other
psychological disorder (American Psychiatric Association, 2000; Sands &
Harrow, 1999). Substance- related disorders, mood disorders, and anxiety
disorders are the most common comorbid disorders.
 Mood disorders and anxiety disorders: Approximately 80% of people with
schizophrenia also have some type of mood disorder, most commonly
depression (Alexander, 1996; Sands & Harrow, 1999). Many people with
schizophrenia also have signifi cant anxiety problems: Almost half of them
also have panic attacks (Goodwin, Lyons, & McNally, 2002) and anxiety
disorders (Cosoff & Hafner, 1998).

21.  Substance related disorders: Up to 60% of people with schizophrenia have a
substance abuse problem that is not related to tobacco (Swartz et al., 2006).
Moreover, 90% of those with schizophrenia smoke cigarettes (Regier et al.,
1990), and they tend to inhale more deeply than do other smokers (Tidey et
al., 2005).
 In addition, some people with schizophrenia may use alcohol and other drugs
to alleviate their symptoms.

22. Course of the disorder
 Typically, schizophrenia develops in phases.
 In the premorbid phase, before symptoms develop, some people may display
personality characteristics that later evolve into negative symptoms.
 During the prodromal phase, which occurs before the onset of a psychological
disorder, symptoms may develop gradually but do not meet all the criteria for
the disorder.
 In the active phase, a person has full-blown positive and negative symptoms
that meet all of the criteria for the disorder.
 Over time, the individual may fully recover, may have intermittent episodes,
or may develop chronic symptoms that interfere with normal functioning.

23.  Premorbid Phase: In the premorbid phase, a person who later goes on to
develop schizophrenia may appear odd or eccentric and may have diffi culty
interacting with other people appropriately.
 Prodromal Phase: The prodromal phase, which may last from months to
years, is marked by signs of suspiciousness, some disorganized thinking or
behavior, poor hygiene, angry outbursts, and social withdrawal. These
behaviors can be seen as precursors of the symptoms of schizophrenia, but
they have not reached the level of positive and negative symptoms necessary
for a diagnosis of schizophrenia (Heinssen et al., 2001; Maurer & Häfner,
1995).

24.  Active phase: During the active phase (which is also sometimes referred to as
an episode of schizophrenia or psychotic episode), symptoms become full-
blown, thereby meeting the diagnostic criteria for schizophrenia. It is usually
positive symptoms that lead to the diagnosis. For up to 80% of people having a
first episode of schizophrenia, the symptoms subside after treatment—they go
into remission (Robinson et al., 1999).
 Middle to late phase: For people who continue to have active episodes of
schizophrenia, cognitive functioning may decline significantly during the fi rst
5 years of the illness; also, as they remain or become more disorganized,
their ability to care for themselves declines. For example, they may reach a
point where they cannot keep themselves properly groomed, or even dress
themselves

25. Prognosis
 In general, the long-term prognosis for schizophrenia follows the rule of
thirds: one third of patients improve significantly;
 One third basically stay the same, having episodic relapses and some
permanent deficits in functioning, but able to hold a “sheltered” job—a job
designed for people with mild to moderate disabilities;
 One third become chronically and severely disabled by their illness.

26. Neurological factors in schizophrenia
 Brain systems:
People who have schizophrenia have abnormalities in the structure and function
of their brains. Early research on this topic came from autopsy studies in which
researchers compared the brains of people who had schizophrenia with those of
people who did not (Rosanoff, 1914; Southard, 1910).
These researchers found that the brains of people who had schizophrenia were
atrophied (shrunken) relative to the brains of people without the disorder.
Neuroimaging studies have since documented more specifi c differences in brain
structure and function between those with schizophrenia and those who do not
have the disorder.

27. Brain structures with abnormalities:
 Frontal lobe defect
 Impaired Temporal Lobe and Thalamus
 Abnormal Hippocampus
 Disrupted Interactions Among Brain Areas
Other possible causes:
 Maternal Malnourishment
 Maternal Illness and Stress
 Oxygen Deprivation

28.  Neural communication:
Schizophrenia is likely to involve a complex interplay of many brain systems and
neurotransmitters, including dopamine, serotonin, and glutamate, as well as the
stress hormone, cortisol.
 Dopamine
Neuroimaging studies of people with schizophrenia have found abnormally low
numbers of dopamine receptors in their frontal lobes (Okubo et al., 1997), as
well as increased production of dopamine (possibly to compensate for the
reduced numbers of receptors in the frontal lobes) in the striatum (parts of the
basal ganglia that produce dopamine; Heinz, 2000). The dopamine hypothesis
proposes that an overproduction of dopamine or an increase in the number or
sensitivity of dopamine receptors is responsible for schizophrenia

29.  Serotonin and Glutamate: serotonin has been shown to enhance the effect of
glutamate, which is the most common fast-acting excitatory transmitter in
the brain (Aghajanian & Marek, 2000). This is relevant to understanding
schizophrenia because the N-methyl-D-aspartate (NMDA) glutamate receptor
has been shown to play a crucial role in learning and memory, and hence
abnormalities in its functioning may explain some of the deficits associated
with schizophrenia, such as deficits in working memory.

30.  Stress and Cortisol:
Research findings suggest that stress can contribute to schizophrenia, because
stress affects cortisol production, which in turn affects the brain; the effects of
stress probably start well before the first episode of schizophrenia emerges. The
relationship with cortisol appears even in childhood. Children who are at risk for
schizophrenia react more strongly to stress, and their baseline levels of cortisol
are higher than those of other children (Walker, Logan, & Walker, 1999).

31.  Effects of Estrogen:
When women develop schizophrenia, they often have different symptoms than
men do and tend to function better. Such fi ndings have led to the estrogen
protection hypothesis (Seeman & Lang, 1990). According to this hypothesis, the
hormone estrogen, which occurs at higher levels in women, protects against
symptoms of schizophrenia through its effects on serotonin and dopamine
activity. This protection may explain why women are likely to have a later onset
of the disorder than do men.

32. References
 Seeman, M. V. (2000). Women and psychosis. Medscape Women’s Health, 5,
n.p. Retrieved February 9, 2009, from http://www.
medscape.com/viewarticle/408912.
 Walker, E. F., Logan, C. B., & Walder, D. (1999). Indicators of
neurdevelopmental abnormality in schizotypal personality disorder.
Psychiatric Annals, 29, 132–136.
 Okubo, Y., Suhara, T., Suzuki, K., Kobayashi, K., Inoue, O., Terasaki, O.,
Someya, Y., Sassa, T., Sudo, Y., Matsushima, E., Iyo, M., Tateno, Y., & Toru, M.
(1997) Decreased prefrontal dopamine D1 receptors in schizophrenia revealed
by PET. Nature, 385, 578–579.

33. Thank you 