Schizophrenia

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