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By
PREETY SHEKHARASSISTANT PROFESSOR & HEAD, DEPARTMENT OF PSYCHOLOGY
GAUTAM BUDDHA MAHILA COLLEGE, GAYA
MAGADH UNIVERSITY, BODH GAYA
Volume I
SCHIZOPHRENIA
Me
an
ing
& N
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› What is Schizophrenia?› History of the Concept of Schizophrenia› DSM-IV-TR Diagnostic Criteria for Schizophrenia› Symptoms of Schizophrenia
✓Positive Symptoms of Schizophrenia✓Negative Symptoms of Schizophrenia
› Eight categories of symptoms of Schizophrenics› Schizophrenia: Facts at a Glance› WHO Key Facts regarding Schizophrenia
What is Schizophrenia?
Schizophrenia is a psychological disorder characterizedby psychotic symptoms that significantly affectemotions, behavior, mental processes and mentalcontents.
According to Davison & Neale (1984), “Schizophrenia isa psychotic disorder characterised by majordisturbances in thoughts, emotion, and behaviour-disordered thinking in which ideas are not logicallyrelated; faulty perception and attention; flat orinappropriate affect; and bizarre disturbances in motoractivity. Patients with schizophrenia withdraw frompeople and reality, often into a fantasy life of delusionsand hallucinations.”
Schizophrenia is a major psychiatric disorder that can
have a profound effect on the individual, his or her family
members, and society at large.
Schizophrenia is characterized by a combination of
psychotic symptoms, such as hallucinations and delusions,
and negative (or deficit) symptoms, such as apathy,
paranoia, and blunted affect.
Symptoms of the disease is impaired functioning,
including the ability to participate in meaningful and
reciprocal relationships with others, to take care of
oneself, and to function at work, school, or as a parent.
What is Schizophrenia?
Because of the long-term impact of schizophrenia on
functioning, and the episodic nature of psychotic symptoms
that tend to vary in their presence and intensity—at timesrequiring temporary hospitalization to protect the individual or
others—most people with schizophrenia rely on family membersand disability benefits to meet their basic needs. The loss in
functional capacity, combined with the intermittent need for
inpatient psychiatric treatment, makes schizophrenia a costly
disease to society (Rice, 1999; Samnaliev & Clark, 2008).
In fact, due to the loss of productivity and premature death
attributed to schizophrenia, it is considered one of the top 10 of
all diseases in the world contributing to disability burden (Murray
& Lopez, 1996).
What is Schizophrenia?
History of the Concept of Schizophrenia
❖ The concept of Schizophrenia was initiallyformulated by two European psychiatrists; EmilKraepelin and Eugen Bleuler.
❖ In 1898, Emil Kraepelin, the German psychiatrist, firstpresented his notion of DEMENTIA PRAECOX, theearly term of Schizophrenia.
❖ His term dementia praecox reflected what hebelieve was the common core-✓ Praecox- an early onset.✓ Dementia- deteriorating course marked by a
progressive intellectual deterioration.
History of the Concept of Schizophrenia
❖ Eugen Bleuler, the Swiss psychiatrist , contributed to theconceptions of Schizophrenia and coined the term.
❖ Bleuler broke with Kraepelin on two major points:✓ He believed that the disorder did not necessarily
have an early onset.✓ He also believed that it does not inevitably
progress towards dementia.
❖ Thus the label dementia praecox was no longerappropriate.
❖ In 1908, Bleuler proposed the term, Schizophrenia fromthe Greek word Schizein meaning “to split” and Phrenmeaning “mind”.
Kurt Schneider, a German psychiatrist, proposed thatparticular forms of hallucinations and delusions, whichhe calls First-Rank symptoms, are the central todefining Schizophrenia and it’s diagnosis.✓ Voices Arguing,✓ Voices commenting on 1’s action,✓ Thought withdrawal,✓ Thought Insertion,✓ Thought Broadcasting,✓ Made feelings,✓ Made Impulses,✓ Made Volitional acts,✓ Delusional perception &✓ Somatic Passivity
DSM-IV-TR Diagnostic Criteria forSchizophrenia
A. Characteristic symptoms: Two (or more) of the following,
each present for a significant portion of time during a 1-month
period (or less if successfully treated):
(1) delusions
(2) hallucinations
(3) disorganized speech
(4) grossly disorganized or catatonic behavior
(5) negative symptoms, i.e., affective flattening, alogia, or
avolition
Note: Only one Criterion A symptom is required if delusions are
bizarre or hallucinations consist of a voice keeping up a running
commentary on the person’s behavior or thoughts or two ormore voices conversing with each other.
DSM-IV-TR Diagnostic Criteria forSchizophrenia
B. Social/Occupational dysfunction: For a significant portion of the time
since the onset of the disturbance, one or more major areas of
functioning, such as work, interpersonal relations, or self-care, are
markedly below the level achieved prior to the onset (or when the onsetis in childhood or adolescence, failure to achieve expected level of
interpersonal, academic, or occupational achievement).
C. Duration: Continuous signs of the disturbance persist for at least 6
months. This 6-month period must include at least 1 month of symptoms
(or less if successfully treated) that meet Criterion A (i.e., active-phase
symptoms) and may include periods of prodromal or residual symptoms.
During these prodromal or residual periods, the signs of the disturbance
may be manifested by only negative symptoms or two or more symptomslisted in Criterion A present in an attenuated form (e.g., odd beliefs,
unusual perceptual experiences).
Source: The Diagnostic and Statistical Manual of Mental Disorders, Text Revision, Fourth Edition,
(Copyright 2000) American Psychiatric Association.
Symptoms of Schizophrenia
The criteria for schizophrenia in DSM-IV-TR fall into two clusters:
• Positive symptoms: it comprise excesses or distortions such asdelusions, hallucinations , disorganized speech and
disorganized behavior. These symptoms are of an acute
episode of Schizophrenia.
• Negative symptoms: consisting of the absence or reductionof normal mental processes, mental contents, feelings, or
behaviors, including speech, emotional expressiveness, and/or
movement. It consist of behavioral deficits, such as avolition,
alogia, anhedonia, flat affect, and asociality.
Positive Symptoms of Schizophrenia
Positive symptoms are so named because they are
marked by the presence of abnormal or distorted
mental processes, mental contents, or behaviors.
Positive symptoms of schizophrenia are:
• hallucinations (distortions of perception),• delusions (distortions of thought),• disorganized speech, and• disorganized behavior.
NegativeSymptoms of Schizophrenia
In contrast to positive symptoms, negative symptoms
are marked by the absence or reduction of normal
mental processes, mental contents, or behaviors.
DSM-IV-TR specifies three types of negative symptoms:
• flat affect,• alogia, and• avolition.
Each of these reflects the lack of a normal mental
process, expression of feeling, or behavior, but they
differ in what—specifically—is lacking.
Eight categories of symptoms of Schizophrenics
While at some point in their disorder all Schizophrenicseither have some type of thoughts disorder orhallucinations, they typically also show disturbances inseveral other symptoms categories as well. Eightcategories of symptoms are as follows:
1. Content of Thought: Here the major symptom is somedelusion or false belief.
2. Form of Thought: Formal thought disorder involvesabnormalities I the way a person’s thought processesare organised. “Loose association” in which ideas shiftfrom one unrelated topic to another, are a commonexample of this type of symptom.
Eight categories of symptoms of Schizophrenics
3. Perceptions: Hallucinations or the reporting ofexperiences for which there appear to be no tangiblestimuli are the major symptoms of this category.
4. Affect: This category involves disturbed emotions.Most common are emotions that are blunted, flat orinappropriate to the situation.
5. Sense of Self: These symptoms refers to persons’confusion about their identities; they may feel unreal oruncontrolled by forces outside their control.
Eight categories of symptoms of Schizophrenics
6. Volition: The symptoms involves reduced motivationand interest in pursuing almost any sort of goal. Theyinterfere severely with a person’s ability to work.
7. Relationship to the external world: Schizophrenicsoften withdraw from the external world and becomepreoccupied with internal fantasies and odd ideas.These symptoms are sometimes called “autistic”.
8. Psychomotor behaviour: Abnormalities of movementinclude rocking, pacing, stereotyped actions, andbizarre behaviour rituals. Some schizophrenicsbecomes almost totally immobile; others take on avery dishevelled look or dress very strangely.
Prevalence• Approximately 1% of people worldwide have schizophrenia(Gottesman, 1991; Tandon, Keshavan, & Nasrallah, 2008).
Comorbidity• Over 90% of people with schizophrenia also have anotherdisorder. The most frequent comorbid disorders are mood,
anxiety, and substance-related disorders.
Onset• Men are more likely to develop the disorder between 18 and25, whereas women are more likely to develop it between 26
and 45 years old.
Schizophrenia: Facts at a Glance
Course• About two thirds of people who have had one episode willgo on to have subsequent episodes.
• About a third of people with schizophrenia becomechronically ill, without much reduction of symptoms; for most
others, the symptoms subside.
Gender Differences• Schizophrenia affects men more frequently than women(1.4:1 male-to-female ratio; McGrath, 2006), and—as notedabove—women tend to develop the disorder at older agesthan do men.
• Women have fewer negative symptoms than do men.
Schizophrenia: Facts at a Glance
Cultural Differences• Schizophrenia is more common among those living in urbanareas and those from lower socioeconomic groups (Freeman,
1994; Mortensen et al., 1999; Saha et al., 2005).
• In non-Western countries, people with schizophreniagenerally function better in society than do those in Western
countries (Hopper et al., 2007).
• In a given country, immigrants are almost twice as likely todevelop schizophrenia as are native-born residents (Saha et
al., 2005).
• Within the United States, Latinos and Whites are less likely todevelop schizophrenia than are Blacks (Zhang & Snowden,
1999).
Source: Unless otherwise noted, citations for above data are: American
Psychiatric Association, 2000.
Schizophrenia: Facts at a Glance
❖ Schizophrenia is a chronic and severe mental
disorder affecting 20 million people worldwide.
❖ Schizophrenia is characterized by distortions in
thinking, perception, emotions, language, sense of
self and behaviour. Common experiences include
hallucinations (hearing voices or seeing things that
are not there) and delusions (fixed, false beliefs).
❖ Worldwide, schizophrenia is associated with
considerable disability and may affect educational
and occupational performance.
WHO Key Facts regardingSchizophrenia
❖ People with schizophrenia are 2-3 times more likely to die
early than the general population. This is often due to
preventable physical diseases, such as cardiovascular
disease, metabolic disease and infections.
❖ Stigma, discrimination and violation of human rights of
people with schizophrenia is common.
❖ Schizophrenia is treatable. Treatment with medicines and
psychosocial support is effective.
❖ Facilitation of assisted living, supported housing and
supported employment are effective management strategies
for people with schizophrenia.
WHO Key Facts regardingSchizophrenia
THANK YOU
To be continued…Volume II