Schizophrenia
Reference: Butcher, J. N., Hooley, J.S., & Mineka, S. (2004). Schizophrenia and Other Psychotic Disorders. Abnormal
Psychology, 12th ed. (p. 458-466). New Jersey: Pearson Education, Inc.
Clinical Symptoms
Characterized by the presence of sever disturbances in thought, behaviour, and interpersonal
relationships
Hallmark is a significant loss of contact with reality, often referred to as Psychosis
Clinical Symptoms
Delusions
An erroneous belief that is fixed and firmly held despite clear contradictory evidence
Involves a disturbance in the content of thought
Common in schizophrenics, occurring in more than 90% of patients at a time
Hallucinations
A sensory experience that occurs in the absence of any external perceptual stimulus
Can occur in any sensory modality
Disorganized Speech
External manifestation of a disorder in thought form
Affected person fails to make sense despite seeming to conform to the semantic and
syntactic rules governing verbal communication
Words and combinations sounds communicative but fails to get the message across
Neologisms – completely new, made-up words sometimes appear in a patient’s speech
I have also "killed" my ex-wife in a 2.5 to 3.0 hours sex bout in Devon Pennsylvania in 1976, while two
Pitcairns were reading in my next room closet, hearing the event. Enclosed, please find my urology
report, indicating that my male genitals, specifically my penis, are within normal size and that I'm
capable or normal intercourse with any woman, signed by Dr. [name], a urologist and surgeon who
performed a circumcision on me in 1982. Conclusion: I cannot be a nincompoop in a physical sense
(unless Society would feed me chemicals for my picture in the nincompoop book).
Disorganized and Catatonic Behaviour
Goal-oriented activity is universally disrupted
Impairment occurs in areas of routine daily functioning
Catatonia involves the total absence of all movement and speech where the patient can
be in what is called a “catatonic stupor”
A patient may also hold an unusual position for an extended period of time without any
seeming discomfort
Schizophrenia is an episodic disorder with three distinct phases
Prodromal phase
Significant deterioration of social and cognitive functioning from a premorbid
level
Withdrawal from social situations, neglect of duties and hygiene, strange
thoughts and emotions, loss of energy and initiative
Active phase
Markedly psychotic behaviours emerge: delusions, hallucinations, disorganized
thought patterns, odd speech, incoherence, inappropriate or restricted
emotional reactions
Residual phase
Symptoms similar to those in prodromal phase with the exception of emotional
blunting and particularly pronounced neglect for one’s duties
Five Subtypes of Schizophrenia
Catatonic Schizophrenia
Severe disturbances in psychomotor behaviour
Patients are frequently mute and unresponsive
Patients may assume rigid, passive, or bizarre postures
Unifying quality of catatonics: almost completely unresponsive to their environment
Some of these patients are highly suggestible and will automatically obey commands or
imitate the actions of others (echopraxia) or mimic their phrases (echolalia)
May pass suddenly from extreme stupor to a state of great excitement, during which
they may seem to be under "great pressure of activity" and may become violent
Disorganized Schizophrenia
Patients exhibit strange, incoherent, and often silly behaviour
Gross disturbances in thought processes versus their psychomotor processes
Speech is characterized by loose associations, neologisms, and clanging
Appear to be somewhat responsive to the enviroment, responses however may be
incomprehensible and unpredictable
Usually occurs at an earlier age and has a gradual, insidious onset
Person gradually becomes more reclusive and preoccupied with fantasies
Paranoid Schizophrenia
Preoccupation with elaborate delusional systems, usually relating to themes of
grandiosity, persecution, jealousy, and/or suspiciousness
Cast of delusional systems typically involves divine or supernatural beings, important
people in the patient’s life, or images from history or the media
Usually appear to act fairly normally, at least in the superficial level, unless they are in
the process of acting on their delusions
Eventual clinical picture is dominated by absurd and illogical ideas and beliefs that are
often highly elaborated and organized into a coherent, though delusional, framework
Undifferentiated Schizophrenia
Either display prominent psychotic symptoms from more than one of the above
categories or show symptoms that do not fit easily into any of the above categories
The “garbage can” label
Residual Schizophrenia
People who have suffered from at least one episode of schizophrenia but do not now
show any prominent symptoms such as hallucinations, delusions, or disorganized
speech or behavior
Exhibit relatively mild signs of schizophrenia
Patient’s life taken as a whole generally lacks meaning and coherence with a severe
deficit in many of the higher-order abilities
Considerations and Recommendations
Schizophrenia constitutes a diverse class of disorders that progress through distinct phases and
manifest in a variety of ways
Cases show great individual differences in behaviour patterns making it very difficult, if not
impossible, to predict when a patient will enter an active phase
About 1% of the population will suffer some form of schizophrenia during their lifetimes
Public perception is based almost exclusively on the psychotic symptoms emerging in the active
phase
Considerations and Recommendations
It is clear that schizophrenia has a genetic component but little is known about the causes of the
disorder
NO CURE: treatment is primarily through the administration of antipsychotic medication with
the goal of decreasing psychotic symptoms and controlling residual symptoms to the point
where the patient can function in a more manageable and productive level
Dosage of medication depends on the patient’s needs
The “revolving door syndrome”: cycle of treatment and decompensation
Considerations and Recommendations
On the occasion that a patient does not show any residual signs following the abatement of
psychotic symptoms, he or she may be withdrawn from medication entirely, but it is possible
that the person suffers from another disorder with psychotic features
Therapists must be wary of the possible side effects of medication, particularly a condition
known as tardive dyskensia where a person’s motor movements are impaired and shakiness is
experienced due to prolonged pharmacological treatment
