Schizophrenia

by PammyMcB

DSM Category 1: Schizophrenia

Diagnostic Features:

A. Two or more of the following each being present for a significant portion of time during a one-month period

  1. Delusions
  2.  Hallucinations
  3. Disorganized speech
  4. Grossly disorganized or catatonic behavior
  5. Negative Symptoms

Note: Only one criterion is required if numbers 1-2 are overwhelming and impede normal functioning.

B. Social occupational dysfunction: One or more areas of major functioning are affected due to regression

C. Duration: Continuous disturbance for at least 6 months, with 1 month of Criterion A Symptoms and may include prodromal or residual symptoms

D. Schizoaffective and Mood Disorder Exclusion: Ruled out due to no major depressive, manic or mixed episodes occurred with active phase symptoms or mood episodes occurred during active phase symptoms for a brief period of time.

E. Substance/General Medical Exclusion: Disturbance that is not due to drug abuse or a medical condition

F. Relationship to a Pervasive Developmental Disorder (PDD): If there exists an autism spectrum disorder there must exhibit prominent delusions or hallucinations for at least 1 month.

Associated Features:

  1. Inappropriate Affect
  2. Depression, Anxiety, or Anger
  3. Loss of Interest or Pleasure
  4. Disturbances in Sleep Pattern
  5. Changes in Eating Routine
  6. Abnormal Psychomotor Activities
  7. Concentration, Attention, and Memory Difficulties
  8. Poor Insight towards Illness (manifestation rather than coping)
  9. Depersonalization, Derealization and Somatic Concerns
  10. Phobia
  11. Motor Abnormalities
  12. Short life expectancy (suicide, stress, etc.)
  13. Assaultive and Violent Behavior
  14. Substance Abuse (Rates of comorbidity are high with Substance-Related Disorder)
  15. Other Comorbid Disorders- Anxiety disorders, obsessive-compulsive disorder, panic disorder, schizotypal disorder, schizoid disorder, paranoid personality disorder, etc.
  16. An increase has been found due to prenatal and childhood factors, exposure to illness, famine, obstetric complications, etc.

Specific Culture, Age, and Gender Features:

Culture

Cultural differences should be considered for example delusions in one culture might not be seen as delusions in another. Hallucinations may be acceptable in other cultures (religion, sorcery, witchcraft, etc.). Disorganized speech may be due to not speaking in one’s native tongue. Be cautious of cultural bias and insensitivity.

Age

Onset occurs between late teens and mid-thirties, early onset is rare. Children’s hallucinations and delusions are less elaborate, where as adults most commonly experience visual hallucinations.

Gender

Proportion of late onset cases is greater in women. Schizophrenia differs in men and women. For men the age of onset is 18-25 years old and for women onset is around 25-35 years old. Women may experience a late life second peak, however women have a better premorbid functioning than men. Women express more affective symptomatology, paranoid delusions and hallucinations. Men have more negative symptoms; therefore women tend to have a better prognosis. There is a higher incidence of schizophrenia in men than in women.

Prevalence:

A worldwide condition that affects 0.5%-1.5% of adults. Also more prevalent in urban born adults rather than rural born adults.

Course:

May be variable, for instance it could become progressively worse over time, go into remission (complete remission is not common), or be consistently chronic. Positive and Negative symptoms exist.

Familial Pattern:

First degree biological relatives are 10 times more likely to have schizophrenia. There exist a stronger correlation in identical twins rather than fraternal twins. Schizophrenia is more likely to appear in biological relatives of individuals with schizophrenia, as well as other mental disorders.

Differential Diagnosis:

  • Psychotic Disorder due to a general medical condition
  • Delirium
  • Dementia
  • Substance Induced Psychotic Disorder
  • Substance Induced Delirium
  • Substance Induced Persisting Dementia
  • Substance Related Disorders
  • Mood Disorders with Psychotic Features
  • Schizoaffective Disorder
  • Depressive Disorder Not Otherwise Specified
  • Bipolar Disorder Not Otherwise Specified
  • Mood Disorder with Catatonic Disorders
  • Schizophreniform Disorder
  • Brief Psychotic Disorder
  • Delusional Disorder
  • Psychotic Disorder Not Otherwise Specified
  • Pervasive Developmental Disorder
  • Childhood Presentations combining disorganized speech (From a communication disorder)
  • Attention Deficit Hyperactivity Disorder
  • Schizotypal, Schizoid, Paranoid Personality Disorder

Schizophrenia Subtypes

Subtype 1: Paranoid Type
Subtype 2: Disorganized Type
Subtype 3: Catatonic Type
Subtype 4: Undifferentiated Type
Subtype 5: Residual Type
Subtype 6: Schizophreniform Disorder
Subtype 7: Schizoaffective Disorder

Bipolar Type
Depressive Type

Subtype 8: Delusional Disorder

Erotomanic Type
Grandiose Type
Jealous Type
Persecutory Type
Somatic Type
Mixed Type
Unspecified Type

Subtype 9: Brief Psychotic Disorder
Subtype 10: Shared Psychotic Disorder
Subtype 11: Psychotic Disorder due to General Medical Condition

With Delusions
With Hallucinations

Subtype 12: Substance Induced Psychotic Disorder

With Delusions
With Hallucinations

Subtype 13: Psychotic Disorder Not Otherwise Specified (NOS)

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