Dementia praecox: The term coined by Kraepelin to describe what is currently known as schizophrenia. According to Kraepelin, this condition involves a degeneration of the brain that begins at a young age and ultimately leads to a disintegration of the entire personality.
Bleuler’s ideas about schizophrenia are still influential.
Prodromal phase: A period in the course of schizophrenia, prior to the active phase of symptoms, during which the individual shows progressive deterioration in social and interpersonal functioning. Active phase: A period in the course of schizophrenia in which psychotic symptoms are present. Residual phase: A period in the course of schizophrenia, following the active phase, in which there are continuing indications of disturbance, evidenced by the same kinds of behaviors that characterize the prodromal phase.
Some instances are not as dramatic. Instead, the schizophrenic might speak in a peculiar way and use awkward speech, odd intonations. Schizophrenics may lack normal expressiveness and gestures. Or they may spent hours or days without talking.
Positive symptoms are viewed as direct lead-ins to full expression of psychosis. Clinicians often find it difficult to diagnose negative symptoms, because most people at one time or another act in these ways, as when they are fatigued or depressed.
Delusions: Beliefs that are grossly out of touch with reality. Hallucinations: A false perception not corresponding to the objective stimuli present in the environment. Affective flattening: A symptom of schizophrenia in which an individual seems unresponsive and which is reflected in relatively motionless body language and facial reactions as well as minimal eye contact. Alogia: Speechlessness or a notable lack of spontaneity or responsiveness in conversation. Avolition: Lack of initiative and unwillingness to act. Affective flattening: A symptom of schizophrenia in which an individual seems unresponsive and which is reflected in relatively motionless body language and facial reactions as well as minimal eye contact. Anhedonia: A loss of interest in or ability to experience pleasure from activities that most people find appealing.
Examples of extreme negation: Rigid posturing or resistance to instruction. Example of peculiar movement: Bizarre posture. Echolalia: Senseless repetition of words or phrases. Echopraxia: Repetition by imitation of another’s movements.
Onset tends to occur earlier in life and interferes with personality development.
This is the most common type of schizophrenia.
The individual may show symptoms such as delusions, hallucinations, incoherence, or disorganized behavior, but does not meet the criteria for the paranoid (systematic bizarre delusions), catatonic (abnormalities of movement), or disorganized (disturbed or flat affect) types.
Schizophrenia, residual type: A type of schizophrenia in which people who have previously been diagnosed as having schizophrenia may no longer have prominent psychotic symptoms but still show some lingering signs of the disorder, such as emotional dullness, social withdrawal, eccentric behavior, or illogical thinking.
Many researchers and clinicians feel the subtypes do not capture the essential dimensions underlying individual differences in symptoms. The DSM-IV-TR has proposed an alternate three-factor model to rate individuals for the degree to which their symptoms are psychotic, negative, or disorganized.
In the most serious cases, the individual experiences continuous positive symptoms with no remission. Recurring episodes: Other people have episodes of positive symptoms, but between these episodes, only negative symptoms are evident. Some have had a single episode of schizophrenia, then live the rest of their lives without a recurrence of the disorder.
Premorbid functioning: How well the person functioned during the period prior to the onset of the individual's symptoms. Acute onset: The more abruptly the condition began, the better the prognosis is. Additional factors include: A precipitating event associated with onset of symptoms. The presence of an associated mood disorder. A family history of mood disorder. Treatment with antipsychotic medication soon after onset of disorder.
Each is a form of psychosis representing a serious break with reality. The condition is not caused by a disorder of cognitive impairment like Alzheimer’s. Mood disturbance is not a primary symptom. Further, each has a different set of proposed causes, symptom picture, and recommended course of treatment.
For at least a day but less than a month, the individual experiences at least one major psychotic symptom not attributable to another disorder, substance, or medical condition. Experts believe most cases result from psychological factors. The nature of the treatment depends on the nature of the stressor, when one is evident.
Researchers have found people with this disorder to have larger ventricles in the brain, a phenomenon also observed with schizophrenia. Most need medication to help bring their symptoms under control. For some, the symptoms go away spontaneously.
Schizoaffective disorder: A psychotic disorder involving the experience of a major depressive episode, a manic episode, or a mixed episode while also meeting the diagnostic criteria for schizophrenia. Clinicians are sometimes reluctant to use this diagnosis, because it has no systematic treatment protocol. Pharmacological intervention is trial-and-error.
People with erotomanic type have a delusion that another person is deeply in love with them. Grandiose type is characterized by the delusion they are extremely important. Jealous type is characterized by the delusion that one’s sexual partner is unfaithful. People with persecutory type believe they are being harassed or oppressed. People with somatic type believe they have a dreaded disease or are dying.
The nonpsychotic person gets caught up in the delusions of the psychotic person and becomes similarly consumed by the irrational belief. Typically two people are involved: folie a deux (folly of two). Example: Members of the Heaven’s Gate cult shared the delusions of their leader Marshall Applewhite, who convinced them they should commit suicide in order to board a spacecraft traveling to a higher plane of existence. These people rarely seek treatment.
Theories accounting for the origin of schizophrenia have traditionally fallen into two categories: biological and psychological. Cortical atrophy: A wasting away of tissue in the cerebral cortex of the brain. Loss of brain volume is particularly pronounced in the front and temporal lobes as well as the relay centers in the thalamus. Reduced brain activation: Functional deficits have been found in brain centers involved in the pleasant sensations of smell. Other areas are being explored. The dopamine hypothesis attributes the psychotic symptoms to overactivity of dopamine neurons. Antipsychotic medications reduced the frequency of hallucinations and delusions by blocking dopamine receptors. Drugs biochemically related to dopamine (such as amphetamines) increase frequency of psychotic symptoms.
The closer a relative is to an individual with schizophrenia, the greater the likelihood of concordance. Biological markers: Measurable characteristics or traits whose patterns parallel the inheritance of a disorder or other characteristic. Sustained attention: People with schizophrenia typically do poorly at tasks that require sustaining attention, especially when task demands are increased. Smooth pursuit eye movements: Unlike normal individuals, schizophrenics do not move their eyes smoothly when watching a moving target.
There is no credible theory that proposes that psychological phenomena such as life experiences, developmental difficulties, interpersonal problems, or emotional difficulties directly cause schizophrenia.
Behavioral theorists first advanced these ideas in the 1960s in light of evidence from early experiments, showing that people with schizophrenic symptoms could, through proper reinforcements, behave in socially appropriate ways.
Expressed emotion (EE): An index of the degree to which family members speak in ways that reflect criticism, hostile feelings, and emotional overinvolvement or overconcern with regard to the schizophrenic individual.
Neuroleptics: antipsychotic medications; major tranquilizers: Lowest potency- Chlorpromazine (Thorazine) and Thioridazine (Mellaril). Middle level of potency- Trifluoperazine (Stelazine) and Thiothixine (Navane). Most potent - Haloperidol (Haldol) and Fluphenazine (Prolixin). Tardive dyskinesia: involuntary, repetitive movements
The most common psychological interventions are derived from the behavioral perspective. Token economy: A form of contingency management in which a client who performs desired activities earns chips or tokens that can later be exchanged for tangible benefits. Cognitive-behavioral techniques may help reduce distorted thinking. Milieu therapy: A treatment approach, used in an inpatient psychiatric facility, in which all facets of the milieu, or environment, are components of the treatment. Family-managed individuals show greater ability to maintain improvements over time. Biopsychosocial approach: Integrative method, combining medication with psychosocial intervention.
