n Emil
Kraepelin: First to differentiate schizophrenia (then, dementia praecox) from
manic-depressive psychosis
n Dementia:
progressive deterioration
n Praecox:
“early harvest” to denote early onset
n Eugene
Bleuler: Changed name to schizophrenia to denote splitting of personality’s
functions
n NOT
“split personality”
n Pervasive
impairment in a full range of functions, i.e., thoughts, feelings, perception
and behavior
n Medicated
vs unmedicated patient may well give the impression of two different people
n Worldwide
prevalence rate of 1%
n In
the 80s, 50% of psychiatric hospital beds were occupied by persons with
schizophrenic disorders (closer to 33% today)
n About
1 in 3 of the homeless have a schizophrenic disorder
n 3%
of the prison population; 6% of maximum security prisoners
n 1
in 4 attempt suicide, 1 in 10 are eventually successful
n Equal
gender distribution, but this is complex… early onset in males, better
prognosis for females
n Generally
onset in males, 20-25, females 25-30
n Females
show another peek after age 45
n Course
is more severe for males and for females with late onset
n Seen
in all SES groups but more common in lower SES… this relationship is complex
n Chicken-Egg
problem
n Kraepelin
and Bleuler thought they were secondary, but today, hallucinations and/or
delusions are recognized as primary symptoms and at the core of the diagnosis
n Other
characterizations: acute vs chronic, good premorbid vs bad premorbid, excesses
vs deficits, positive vs negative symptoms
n Importantly:
Persons with schizophrenic disorders are often mischaracterized as dangerous
because of Hollywood portrayals… truth is just the opposite
n The
core symptoms of schizophrenia are at the basis of what we call psychosis or
psychotic, i.e., delusions and hallucinations (positive symptoms)
n Delusion:
a false belief, a misrepresentation of reality… some are bizarre, some are not
n Hallucination:
a sensory experience without any input from the surrounding environment
n Almost
always auditory in schizophrenia
n Note
depiction in “Beautiful Mind”
DIAGNOSTIC CRITERIA
n Two or more of the following:
n Delusions
n Hallucinations
n Disorganized
speech
n Grossly
disorganized or catatonic behavior
n Negative
symptoms
n Flat
affect
n Alogia
or Avolition
n Anhedonia
n Major
impairment in functioning
n Persistent
symptoms for six months with one month of primary symptoms (May include
prodromal or residual phase of the illness)
n Rule
out schizoaffective disorder or mood disorder
n Rule
out effects of psychoactive substance use
n Rule
out medical or neurological condition
n Rule
in or out co-existing pervasive developmental disorder (autism, Asperger’s,
etc.)
Subtypes of schizophrenia
n Paranoid
n Disorganized
n Catatonic
n Undifferentiated
n Residual
n Other
Psychotic Disorder
Positive vs. Negative Distinctions
n Positive
(Type I)
n Presence
of positive (identifiable) symptoms
n Good
response to medication
n Optimistic
prognosis
n Absence
of intellectual impairment
n Negative
(Type II)
n Presence
of negative symptoms (absence of behaviors)
n Poor
response to medication
n Pessimistic
prognosis
n Intellectual
impairments obvious
Etiology of Schizophrenia
n Evidence
is clear that stress can precipitate the first appearance of schizophrenia and
can precipitate a relapse during residual or recovery phase, but genetic
vulnerability usually present
n No
support over the years for “schizophrenogenic mother” as cause (double bind,
mixed messages, ambivalence)
n Note
research on “Expressed Emotions” in families, a kind of “generic henpecking”
Treatment for schizophrenia
n Appearance
of Chlorpromazine (Thorazine, Stelazine) in the 1950s helped empty hospitals
n These
are the neuroleptics, dopamine antagonists
n Not
all pts respond, and side effects can be devastating and irreversible (e.g.,
tardive dyskinesia)
n New
drugs (atypical antipsychotics) in the 1990s came from benzodiazapine family
(clozapine and olanzapine) and helped many who were unresponsive to
conventional antipsychotics, not without their side effects (agranulocytosis)
n Rip
Van Winkle phenomenon
n Freud
never advocated psychoanalysis for schizophrenia; when tried, usually failure
n Despite
dramatic tx effects in some, the outcome of psychopharmacological approaches to
schizophrenia is still only marginally effective (around 50%)
n Supportive
psychotherapy may help sustaining adjustment but medication will always be
necessary for persons with schizophrenia
n Interesting
findings from behavior modification; note work of Teodoro Ayllon and Nathan
Azrin on Token Economy
