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Schizophrenia (pronounced SKITZ-uh-FREN-EE-uh) is a primary psychotic disorder, meaning psychosis is the main symptom. Psychosis is defined as a disconnection from reality accompanied by strange sensations and behaviors.

Schizophrenia needs psychosis to appear consistently at least few times; schizophrenia can only be diagnosed once other similar disorders have been ruled out.

Schizophrenia symptoms can be split into two categories:

  • “Positive” symptoms (psychosis) - things that go beyond the human experience
    • Hallucinations, delusions, disorganized speech, inappropriate affect
    • Easier to treat
  • “Negative” symptoms - much more interfering
    • Avolition - not motivated to do anything, very interfering
    • Anhedonia - inability to experience pleasure
    • Alogia - inability to think
    • Flat affect - feelings are super flat
  • If negative symptoms pop up without positive symptoms, schizophrenia might not be diagnosed correctly, but if positive symptoms occurred, it’s much easier to determine if the patient has schizophrenia

Fast facts

  • Lifetime prevalence: 1% (pretty common)
    • Higher for African Americans (2.1%)
    • Lower for Hispanic Americans (0.8%)
    • Male and female schizophrenic distribution is equal
  • Average age of onset earlier for men than women
  • Most people diagnosed in early 20s, but early warning signs may be present during adolescence
  • First symptom: typically social withdrawal
  • Prevalence for kids: estimated to be 1 in 100,000
    • Childhood onset schizophrenia - much more gradual
  • Many different courses of schizophrenia
    • 12% of schizophrenics only have one episode
    • 10% take a weird course
  • Deinstitutionalization - schizophrenics would live in hospitals for their whole lives, but now we released a bunch of people and then they will go through the revolving door problem
    • Keep relapsing into problem
  • Need to find medication to help patients with positive symptoms
  • Schizophrenia has a genetic component
    • Perhaps environmental variables

Brief psychotic disorder vs. schizophreniform disorder vs. schizophrenia

  • Key differences
    • Psychosocial stressor is the harbinger of brief psychotic disorder, but only makes it worse for schizo (not required)
    • The longer these disorders go on for, the worse the prognosis is

Course of schizophrenia

  1. Prodromal phase - period prior to first full-blown psychotic episode
    • Variable presentation and length
    • Differential diagnosis with depression and social anxiety, especially male youth
    • The shorter, the better. The longer this phase is, the longer the active phase will last.
  2. Schizophreniform diagnosis
  3. Active phase - full blown symptoms, severe disturbances in thinking, deterioration in social relationships, and flat/inappropriate affect
    • Alcohol makes voices much worse
    • Still able to live normally with schizophrenia
  4. Residual phase - symptoms no longer prominent, if untreated, residual phrases become rarer over time, may disappear

Coping strategies

  • Ignore hallucinations, distract from them
  • Selective listening - setting limits
  • ACT - acceptance and commitment therapy - teach people to not pay attention to hallucinations and to challenge them
    • Empirically shown to make progress