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
CLINICAL SYMPTOMS
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).
CLINICAL SYMPTOMS
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
CLINICAL SYMPTOMS
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
FIVE SUBTYPES OF SCHIZOPHRENIA
Disorganized Schizophrenia
Patientsexhibit 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
FIVE SUBTYPES OF SCHIZOPHRENIA
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
FIVE SUBTYPES OF SCHIZOPHRENIA
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
CASE STUDY – “JERRY”
Presenting Complaint
Personal History
Excerpt from Interview
Treatment
Prognosis
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
