SCHIZOPHRENIA GROSSLY DISORGANIZED BEHAVIOR

• ranging from childlike "silliness" to

unpredictable agitation.
• a syndrome
• spectrum Catatonic Behavior — decreased in reactivity to
the environment
Domains: DELUSIONS, HALLUCINATIONS, • Negativism — resistance to instructions
DISORGANIZED THINKING, GROSSLY • Mutism and Stupor — rigid, inappropriate
DISORGANIZED MOTOR BEHAVIOR, NEGATIVE posture to a complete lack of verbal and
SYMPTOMS motor response
• Catatonic Excitement — purposeless or
DELUSIONS excessive motor activity without cause
• fixed beliefs that cannot be changed NEGATIVE SYMPTOMS
2 most prominent: Diminished Emotional
Types of Delusions: Expression and Avolition
➢ Persecutory
- most common, belief that one is ➢ Diminished Emotional Expression
going to be harmed - decreased expression of emo tions
➢ Referential in the face, eye contact, intonation of
- certain gestures or comments are speech (prosody), and movements
directed at her/him of the hand, head, and face that
➢ Grandiose normally give an emotional
- believes that he or she has emphasis to speech.
exceptional abilities or wealth and ➢ Avolition
fame - decline in motivation
➢ Erotomania ➢ Alogia
- Believes that another person is in - diminished speech output
love with them ➢ Anhedonia
➢ Nihilistic - decrease ability to experience
- believes that a major catastrophe pleasure from positive stimuli
will occur ➢ Asociality
➢ Somatic - lack of interest in social interactions
- regarding health and organ fx
➢ Bizarre
- if the delusions are implausible or SUBTYPES OF SCHIZOPHRENIA
not understandable and not derived - paranoid, disorganized, catatonic,
from ordinary life experiences undifferentiated, and residual.

PARANOID TYPE
Thought withdrawal — one’s thoughts have
been removed • Focuses on delusions (often persecution or
grandeur) and frequent auditory
Thought insertion — thoughts have been put
hallucinations. Typically develops later in
into one’s mind life, with fewer declines in thinking and
Delusions of Control — body or actions are behavior compared to other types.
being manipulated by some outside force DISORGANIZED TYPE
• severe thought disorder, lack of reality
HALLUCINATIONS awareness, and disorganized behavior.
Patients often appear messy, laugh
• perception-like experiences that don't inappropriately, and behave aimlessly.
require external stimulus Usually begins before age 25.
• uncontrollable, clear, and vivid, possessing CATATONIC TYPE
the full force and impact of normal • extreme motor issues, including immobility,
perceptions. agitation, and odd postures. Patients may
be mute and require medical care due to
o Auditory = voices perceived as separate self-neglect or harm.
from the person’s thoughts UNDIFFERENTIATED TYPE
o Hypnagogic = hallucinations that occur • patients who show clear signs of
while asleep schizophrenia but don’t fit into a specific
o Hynopompic = occur while awake category.
RESIDUAL TYPE
DISORGANIZED THINKING • Symptoms persist but are mild. Includes
• Formal Thought Disorder — infer social withdrawal, unusual behavior, and
disorganized thinking weak delusions or hallucinations with little
• Derailment or loose associations — emotional impact.
switch from one topic to anothet OTHER SUBTYPES
• Tangentiality — answers to auestions are ➢ Bouffée Délirante (Acute Delusional
completely unrelated Psychosis)
• Incoherence or Word Salad — speech - Short-term psychotic symptoms
severely disorganized and lasting less than three months, with
incomprehensible and resemble aphasia 40% of cases developing into
schizophrenia.
 ➢ Latent Schizophrenia ETIOLOGY/PATHOPHYSIO
- Previously used for borderline,
schizoid, or schizotypal personality
GENETIC FACTORS
disorders. Patients have odd
behaviors and thought disturbances
but no consistent psychotic Genetic Factors
symptoms. - strong hereditary component, often
appearing in families with
➢ Oneiroid Schizophrenia schizotypal personality disorder.
- dream-like state where patients are - Risk increases with genetic
confused and detached from reality, closeness to an affected relative
fully engaged in their hallucinations. (highest in monozygotic twins, ~50%
Requires evaluation for medical or concordance).
neurological causes. - Advanced paternal age (60+) is
linked to higher risk due to
➢ Paraphrenia epigenetic damage in sperm.
- Sometimes used as another term for
paranoid schizophrenia, or for cases ENVIRONMENTAL FACTORS
with a worsening course or highly Neurodevelopmental Hypothesis
organized delusions. - Schizophrenia is influenced by
maternal stress, nutritional
➢ Pseudoneurotic Schizophrenia deficiencies, infections, pregnancy
- Starts with severe anxiety, phobias, complications, and intrauterine
and obsessions before progressing growth issues.
to thought disorders and psychotic - Higher prevalence in individuals with
symptoms. Now classified as low socioeconomic status, childhood
borderline personality disorder. adversity, and first-generation
immigrant backgrounds.
➢ Simple Deteriorative Disorder (Simple - Higher incidence in those born in
Schizophrenia) late winter/early spring, raised in
- gradual loss of motivation and social urban areas, or with fathers over 30.
withdrawal without persistent - Cannabis use, high THC exposure,
hallucinations or delusions. Must be autism, and severe infections after
distinguished from depression and brain injury increase risk.
dementia.
BIOCHEMICAL FACTORS
➢ Postpsychotic Depressive Disorder of ❖ Dopamine Hypothesis
Schizophrenia ❖ Serotonin: clozapine’s serotonin-blocking
- Depression following an acute effects improve symptoms.
schizophrenic episode, affecting up ❖ Norepinephrine: Impairments lead to
to 25% of patients and increasing anhedonia and emotional dysfunction.
suicide risk. Must be differentiated ❖ GABA: Loss of inhibitory GABAergic
from medication side effects and neurons in the hippocampus leads to
mood disorders. dopaminergic hyperactivity.
❖ Neuropeptides: Substance P and
➢ Early-Onset Schizophrenia neurotensin affect neurotransmitter
- Rare but severe form appearing in regulation.
childhood with a slow progression ❖ Glutamate: Dysfunction contributes to
and poor prognosis. Must be symptoms; phencyclidine (PCP) can mimic
distinguished from intellectual schizophrenia.
disability and autism. ❖ Acetylcholine/Nicotine: Reduced receptor
activity in cognition-related areas.
➢ Late-Onset Schizophrenia
- Develops after age 45, more NEUROPATHOLOGY FACTORS
common in women, with a better
❖ Brain Volume: Reduced due to loss of
prognosis and good response to
axons, dendrites, and synapses.
antipsychotic treatment.
❖ Cerebral Ventricles: Enlarged lateral/third
ventricles, reduced cortical volume.
➢ Deficit Schizophrenia
❖ Reduced Symmetry: Found in temporal,
- subtype with long-lasting negative
frontal, and occipital lobes, possibly from
symptoms, such as emotional
fetal development.
flatness and social withdrawal. Non-
❖ Limbic System: Smaller amygdala,
deficit schizophrenia includes more
hippocampus, and parahippocampal gyrus,
positive symptoms like delusions
affecting emotional regulation.
and hallucinations.
❖ Prefrontal Cortex: Functional deficits
EPIDEMIOLOGY impact cognition and decision-making.
❖ Thalamus: Reduced volume or neuronal
• Men develop symptoms earlier (10-25 loss in some cases.
years) than women (25-35) ❖ Basal Ganglia & Cerebellum: Linked to
• Women have a second peak in middle age movement disorders seen in schizophrenia.
• Onset before 10 or after 60 is rare
• Men have more negative symptoms
Etiology & Pathophysiology of Schizophrenia
 BRAIN METABOLISM FACTORS ❖ Abnormal Behaviors
Magnetic resonance spectroscopy shows - Tics, stereotypies, mannerisms, and
hippocampal and frontal lobe biochemical occasionally echopraxia (involuntary
abnormalities (e.g., reduced N-acetyl aspartate). imitation of another person’s posture
or behavior).
Electrophysiology & Eye Movement Dysfunction ❖ Catatonia:
❖ EEG: Irregular brain activity, heightened • Completely lifeless appearance
sensitivity to stimuli, decreased alpha • Muteness, negativism, and automatic
waves, increased theta/delta waves. obedience
❖ Complex Partial Epilepsy: Temporal lobe • Sitting immobile and speechless
involvement may trigger schizophrenia-like • Short responses to questions
symptoms. • Movement only when directed
❖ Evoked Potentials: Abnormal P300 wave • Odd clumsiness or stiffness in body
patterns, often in at-risk children. movements
❖ Eye Movement Dysfunction: Blunted • Marked social withdrawal, egocentricity,
affect in 50–85% of cases, independent of lack of spontaneous speech or movement,
treatment. and an absence of goal-directed behavior

IMMUNE AND ENDOCRINE FACTORS MOOD, FEELINGS, & AFFECT

❖ Psychoneuroimmunology: Impaired ❖ Reduced Emotional Responsiveness:
immune function (e.g., low T-cell interleukin- - Severe enough to warrant
2, abnormal lymphocyte responses). No anhedonia.
clear viral link. ❖ Overactive and Inappropriate Emotions:
❖ Psychoneuroendocrinology: Abnormal - Extremes of rage, happiness, and
dexamethasone suppression test results, anxiety.
altered hormone levels based on illness ❖ Other Feelings:
duration. - Perplexity, isolation, overwhelming
ambivalence, depression, and
religious ecstasy.
SIGNS AND SYMPTOMS
• no single unique sign or symptom PERCEPTUAL DISTURBANCES
• every symptom observed in the disorder hallucinations affecting any of the five senses:
can also be found in other psychiatric and ❖ Auditory Hallucinations: Most common,
neurological conditions, challenging the often threatening, obscene, accusatory, or
common belief that certain symptoms are insulting.
definitive for schizophrenia. ❖ Visual Hallucinations: Less frequent.
• difficulty with abstract thinking, for example, ❖ Tactile, Olfactory, and Gustatory
may stem from educational or intellectual Hallucinations: Unusual.
factors rather than the disorder itself. ❖ Illusions: Distortions of real images or
• behaviors associated with religious or sensations occurring during active,
cultural groups may also appear unusual to prodromal, and remission phases.
outsiders but are typical within their own
context. THOUGHT DISTURBANCES
three types of thought disturbances:
PREMORBID SX AND SYMPTOMS
• involve schizoid or schizotypal personalities THOUGHT CONTENT
characterized as quiet, passive, and • Delusions (persecutory, grandiose,
introverted religious, somatic)
• As children, they had few friends. • Belief in external control of thoughts or
• Pre-schizophrenic adolescents may have no behavior
close friends or dates and may avoid team • Intense preoccupation with abstract or
sports philosophical ideas
• often prefer watching movies and television, • Somatic delusions (e.g., belief that aliens
listening to music, or playing computer inside testicles affect fertility)
games over social activities. Some may • Loss of ego boundaries (e.g., merging with
show a sudden onset of obsessive- objects, cosmic identity)
compulsive behavior.
• Ideas of reference (e.g., believing TV or
newspapers address them directly)
MENTAL STATUS EXAMINATION
❖ Appearance and Behavior FORM OF THOUGHT
- Disheveled appearance, agitation, • Looseness of associations, derailment,
persistent screaming, complete incoherence, tangentiality, circumstantiality
silence, or immobility. They might be • Neologisms, echolalia, verbigeration, word
excessively talkative or display salad, mutism
unusual postures. Agitation or
violent behavior can emerge THOUGHT PROCESS
spontaneously or as a reaction to • Flight of ideas, thought blocking, impaired
hallucinations. attention
❖ Grooming and Hygiene: • Poverty of thought content, poor abstraction
- Poor grooming, failure to bathe, and abilities, perseveration
inappropriate dress for the prevailing • Idiosyncratic associations, overinclusion,
temperature. circumstantiality
 • Thought control, thought broadcasting

IMPULSIVENESS, VIOLENCE, SUICIDE

• Agitation and Poor Impulse Control:
Abruptly changing TV channels, throwing
food.
• Suicide Risk: Can occur suddenly without
verbal warnings.
• Violence: Common in untreated cases,
excluding homicide.

SENSORIUM AND COGNITION

• Orientation: Usually oriented to person,
time, and place, though some may provide
bizarre answers.
• Memory: Generally intact but with minor
cognitive deficiencies.
• Cognitive Impairment: Deficits in attention,
executive function, working memory, and
episodic memory.
• Judgment and Insight: Poor insight into
illness, leading to poor treatment
compliance.
• Reliability: Schizophrenic patients are no
less reliable than other psychiatric patients.

SOMATIC COMORBIDITY
Neurologic Findings
• Increased severity correlates with affective
blunting and poor prognosis.
• More common nonlocalizing (soft)
neurological signs:
o Dysdiadochokinesia
o Astereognosis
o Primitive reflexes
o Diminished dexterity
o Tics, stereotypies, grimacing,
impaired fine motor skills, abnormal
motor tone and movements

✓ Eye Examination = Elevated blink rate,

indicating hyperdopaminergic activity.
✓ Speech = Disorganized speech, possible
mild aphasia linked to the parietal lobe. COURSE & PROGNOSIS
✓ Difficulty with tasks, left-right confusion, and ❖ Premorbid Symptoms
lack of self-awareness. - Begin during adolescence, followed
by prodromal symptoms that can last
OTHER FINDINGS up to a year before full psychotic
❖ Obesity symptoms.
- Higher body mass index (BMI) due ❖ Triggers
to antipsychotics, poor diet, and - Significant life changes (e.g., moving
inactivity, increasing cardiovascular away to college, substance use, or a
and metabolic risks. death in the family) can trigger
❖ Diabetes Mellitus symptoms.
- Increased risk of type II diabetes due
to obesity and medication effects. Course:
❖ Cardiovascular Disease • Involves exacerbations and remissions.
- Higher risk due to obesity, smoking, • Relapses are common in the first 5 years,
hyperlipidemia, and sedentary contributing to functional decline.
lifestyle. • Post-psychotic depression is common after
❖ HIV episodes.
- 1.5 to 2 times the risk due to • Negative symptoms tend to worsen over
increased risky behaviors (e.g., time (e.g., social withdrawal, inactivity).
unprotected sex, multiple partners, • Increased risk of homelessness and
drug use). poverty.
❖ Chronic Obstructive Pulmonary Disease
(COPD): Higher rates due to increased Prognosis:
smoking prevalence. • 10-20% achieve good outcomes after 5-10
• Rheumatoid Arthritis: years.
Schizophrenic patients have approximately one-
• 20-30% lead relatively normal lives.
third the risk compared to the general population
• 20-30% experience moderate symptoms.
 • 40-60% remain significantly impaired. • Fixed belief of a physical illness.
• Schizophrenia patients tend to be poorer
than those with mood disorders. Main subtypes include:
1. Infestation (parasites in body)
SCHIZOAFFECTIVE AND 2. Dysmorphophobia (body deformities)
SCHIZOPHRENIFORM 3. Foul odors (olfactory reference syndrome)

SCHIZOAFFECTIVE DISORDER • Patients often seek medical, not psychiatric,

• Schizophrenia + mood disorder symptoms help.
1. schizophrenia with mood symptoms
2. mood disorder with schizophrenia GRANDIOSE TYPE
symptoms • Delusions of exaggerated self-importance or
3. both schizophrenia and mood disorder power (megalomania).
MIXED TYPE
4. a third psychosis unrelated to either
5. a continuum between schizophrenia and • multiple delusional themes without one
mood disorder dominating.
UNSPECIFIED TYPE
6. combination of the above.
• Rare delusions that don’t fit other types,
• Bipolar subtype — affects men and women including:
equally, young adults ❖ Capgras Syndrome: loved ones are
• Depressive subtype — twice as common in impostors.
women, older adults ❖ Frégoli’s Phenomenon: persecutors
disguise themselves as different people.
SCHIZOPHRENIFORM DISORDER ❖ Intermetamorphosis:people can transform
• mood symptoms + clouded consciousness into others.
❖ Cotard Syndrome: Delusion of losing body
• sudden onset and benign course
parts, possessions, or believing the world
• last 1 month and less than 6 months
• typically return to baseline fx no longer exists. Often linked to
schizophrenia or depression.

DELUSIONAL DISORDERS EPIDEMIOLOGY

• slight female predominance
• fixed false beliefs outside cultural norms • men commonly develop paranoid delusions
• complex and challenging psychiatric • women often experience erotomanic
symptom delusions
• requires the presence of non bizarre • kasagaran kay married and employed
delusions

Non-Bizarre Delusions:
• naa gihapon shay possibility but these
beliefs are untrue
• beliefs concerning situations that could PSYCHOTIC DISORDERS
occur in real life
SHARED PSYCHOTIC DISORDER
TYPES OF DELUSIONAL DISORDERS • aka shared paranoid disorder
• px who is chronically ill impose their
PERSECUTORY TYPE delusion on a more suggestible partner and
• Strong belief of being targeted or harmed, the parter is usually less intelligent, gullible,
leading to anger, irritability, legal action, or passive, less confident and etc
even aggression. • most common rs: sister-sister, husband-
• Unlike schizophrenia, delusions are logical wife, mother-child
and detailed with little functional decline. BRIEF PSYCHOTIC DISORDER
• sudden onset of psychotic symptoms, which
JEALOUS TYPE (ORTHELLO SYNDROME) lasts 1 day or more but less than 1 month.
• Persistent belief that a partner is unfaithful, • remission is full
often leading to violence. • acute and transient psychotic syndrome
• Common in men without prior psychiatric
issues and seen in schizophrenia, mood Epidemiology:
disorders, and substance abuse. • more often in younger patients (20s-30s)
• Treatment is difficult and may require • more prevalent in women
PSYCHOTIC DISORDER NOT OTHERWISE SPECIFIED
separation.
• clinical presentations of psychosis that do
EROTOMANIC TYPE (DE CLÉRAMBAULT SYNDROME) not fit established diagnostic criteria.
AUTOSCOPIC PSYCHOSIS
• Delusion that someone, usually of higher
status, is in love with the patient. • Visual hallucination of one’s own body or
• More common in socially withdrawn women. body parts, appearing like a phantom in a
Denials are misinterpreted as affirmations. mirror.
• Men with this delusion tend to be more • The phantom is usually colorless and
aggressive and may engage in stalking or transparent, mimicking movements.
violence. • Rare, can occur once or multiple times, with
no clear link to sex, age, heredity, or
SOMATIC TYPE (MONO SYMPTOMATIC intelligence.
HYPOCHONDRIACAL PSYCHOSIS) MOTILITY PSYCHOSIS
 • Likely a variant of brief psychotic disorder
with two forms:
1. Akinetic: Resembles catatonic stupor but
resolves quickly.
2. Hyperkinetic: Mimics manic or catatonic
excitement, with sudden shifts between forms.
• Mood instability is a key symptom. Unlike
catatonic schizophrenia, it does not cause
long-term personality deterioration.
POSTPARTUM PSYCHOSIS
• A severe psychiatric condition in new
mothers, often featuring depression,
delusions, and thoughts of harming the
baby or themselves.
• Requires urgent medical intervention.
DUE TO MEDICAL CONDITIONS OR SUBSTANCES
• Psychotic symptoms may result from a
medical condition (e.g., brain tumor) or
substance use (e.g., PCP, alcohol, or
medications like cortisol).

Epidemiology:
• Limited data on prevalence.
• Long-term substance abuse increases risk.
• Women are more prone to delusional
syndromes linked to complex partial seizures.