Introduction and symptoms of schizophrenia

Question 1

What is the prevalence of SZ?

Answer 1

Affects about 1% of the population
Males tend to be diagnosed in their mid-20s
Females tend to be diagnosed in their early 30s

Question 2

What is the prognosis of SZ?

Answer 2

According to Bleuler’s longitudinal study of 2000 patients, symptoms are most severe in early adulthood, during the first five years after onset.

Question 3

What happens to people with this disorder?

Answer 3

With drug treatment, 40% will suffer a relapse
After 10 years, 25% will recover fully.
After 10 years, 15% will be hospitalised

Question 4

What are the positive symptoms?

Answer 4

Hallucinations, delusions, disorganised speech and thinking

Question 5

What are the negative symptoms?

Answer 5

Speech poverty, lack of emotion, avolition, apathy and inappropriate affect

Question 6

What are hallucinations?

Answer 6

Fake sensory experiences that may not have any identifiable source. The most common types are auditory and visual. Less common types are olfactory and tactile.

Question 7

What are delusions?

Answer 7

False beliefs not based on evidence that are very difficult to disprove. There are many types, including those of persecution, grandeur and control

Question 8

What is disorganised speech and thinking?

Answer 8

This symptom makes it hard to concentrate on anything. Thoughts drift and there will be no connection between them, with some saying they are hazy. They have trouble finishing watching TV or books. Words may become jumbled, making it difficult for others to understand.

Question 9

What is speech poverty?

Answer 9

Alogia
Reduction in communication which is thought to result from the slowing of thoughts. This is often manifested as short empty replies. The patient has difficulty starting a conversation.

Question 10

What is lack of emotion?

Answer 10

Flat affect
A reduction or flattening of emotions. The range and intensity of facial expressions, tone of voice and eye contact are reduced.

Question 11

What is avolition?

Answer 11

Social withdrawal
Difficulty in planning and setting goals. No interest in socialising or hobbies. A person does not want to do anything and will sit in the house for hours every day. Failure to engage in goal directed behaviour.

Question 12

What is apathy?

Answer 12

Lack of motivation in goal directed behaviour and indifference to one’s surroundings. Neglecting household chores, leading to poor grooming and hygiene. In addition, the person is likely to have a very low sex drive.

Question 13

What is the inappropriate effect?

Answer 13

Emotional expressions are unsuitable for the situation, such as laughing at serious things.

Question 14

What is the diagnostic criteria for classifying schizophrenia?

Answer 14

Characteristic symptoms
Social / occupational dysfunction
Duration
Schizoaffective and mood disorder exclusion
Exclusion of known organic causes
Relationship to the autistic spectrum

Question 15

What are characteristic symptoms?

Answer 15

Two or more of the following are present for one month: delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour, negative symptoms.

Question 16

What is social / occupational dysfunction?

Answer 16

For a significant portion of the time since the onset of the disturbance, level of dysfunction in one or more major areas such as work, interpersonal relations, or self care is below the level achieved prior to the onset.

Question 17

What is duration?

Answer 17

Signs of the disturbance persist for at least six months which must include at least one month of symptoms and may include periods of prodromal or residual symptoms. The signs of disturbance during this period may be negative symptoms.

Question 18

What is schizoaffective and mood disorder exclusion?

Answer 18

It is schizophrenia if no major depressive or manic episodes have occurred concurrently with active phase symptoms. Schizophrenia affective disorder and mood disorder has been ruled out because the patient has not experienced any depressive, manic or mixed episodes at the same time as category A symptoms.

Question 19

What is exclusion of known organic causes?

Answer 19

The disturbance is not due to the physiological effects of a substance or another medical condition.

Question 20

What is relationship to the autistic spectrum?

Answer 20

The additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least one month.

Question 21

What is classification?

Answer 21

Identifying groups or patterns of behavioural, emotional, physical and motivational symptoms that occur together to form a type of mental disorder. Collectively when a group of symptoms occur together we call it a syndrome

Question 22

Why is classification important?

Answer 22

It can help with treatment, identifying the causes of their disorder, and the prognosis - predicting the future course of the disorder

Question 23

What is the DSM?

Answer 23

First published in 1952 and is used by the American Psychiatric Association. DSM - V published in May 2013. It contains over 300 mental disorders arranged into several main categories. For each disorder, it lists the diagnostic criteria that must be met for a diagnosis to be given, including symptoms that must and must not be present.