Lesson 12: Schizophrenia
Introduction
This is one of the most important lessons in the course because schizophrenia can be considered the most severe of all mental illnesses…
Lesson Objectives
- Recognize the diagnostic criteria for the differences between the various psychotic disorders.
- Identify the etiology, course, and treatment of psychotic disorders.
- Differentiate between the different symptom categories.
- Differentiate between the various kinds of delusions and hallucinations.
Lesson Readings and Activities
By the end of this lesson, make sure you have completed the readings and activities found in the Lesson 12 Course Schedule.
Schizophrenia: Basic Information
- Severely impaired cognitive processes
- Loss of contact with reality (hallucinations, delusions)
- Often requires inpatient care
Fact or Myth?
Myth: Women are more likely to be diagnosed. Men are affected earlier and often more severely.
Etiology
Biological Dimension
- Genes and brain structure
- Dopamine dysregulation
Psychological Dimension
- Childhood trauma
- Low self-esteem and depression
Social and Sociocultural Dimensions
- Family stress and poverty
- Migration and gender-related stressors
Course of Schizophrenia
- Prodromal: Social withdrawal, odd behavior
- Active: Prominent hallucinations/delusions
- Residual: Partial remission
Schizophrenia Symptom Categories
Positive Symptoms
- Delusions
- Hallucinations
Disorganized Speech
Examples: Loose associations, cognitive slippage
Catatonia
- Excited: Hyperactivity
- Withdrawn: Mute, waxy flexibility
Negative Symptoms
- Avolition
- Alogia
- Asociality
- Diminished emotional expression
DSM Diagnosis of Schizophrenia
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized/catatonic behavior
- Negative symptoms
Schizophrenia Specifiers
- First episode, acute/remission
- Multiple episodes
- Continuous course
Treatment
Distraction & Selective Listening
Teach clients to shift focus or filter voices.
Medication
- Conventional antipsychotics (e.g., Thorazine)
- Atypical antipsychotics (e.g., Risperdal, Abilify)
Lesson 12 Summary
We explored schizophrenia spectrum basics, symptoms, DSM diagnosis, and treatment.
References
- American Psychiatric Association (2013)
- Gottesman (1991)
- Sue et al. (2016)
- Jongsma & Peterson (2003)
- Hartling et al. (2012); Lieberman et al. (2005)
Schizoaffective Disorder
A condition involving the existence of symptoms from both schizophrenia and depression/bipolar.
DSM-5 Criteria
- An uninterrupted period of illness during which there is either a Major Depressive or Manic Episode concurrent with criterion A of schizophrenia.
- There have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.
- Mood episode symptoms are present for a substantial portion of the total duration of the active & residual phase.
Subtypes: Bipolar Type and Depressive Type
Delusional Disorder
A condition marked by persistent delusions without other unusual or odd behaviors.
DSM-5 Criteria
- Presence of one (or more) delusions for one month or longer.
- Absence of characteristic schizophrenia symptoms (aside from delusions).
- Functioning is not markedly impaired and behavior is not obviously bizarre.
Common Nonbizarre Delusions
- Erotomania: Belief that someone is in love with you.
- Jealousy: Conviction that one’s partner is unfaithful.
- Somatic Complaints: Beliefs involving body malfunctions, odors, or infestation.
Guess the Delusion!
Match the example to the delusion type:
- “There are tapeworms inside of me that eat all of my food.”
- “I am absolutely convinced that my spouse is cheating on me.”
- “My neighbors can hear what I am thinking.”
- “I am actually the king of Atlantis.”
- “Aliens are using me to make preparations for the coming invasion.”
- “Katy Perry is taking me on a date and bringing me a box of chocolates.”
- “My co-workers are using telepathy to steal ideas from my mind.”
- “My co-workers are forming a conspiracy to get me fired.”
- “My thoughts can affect the weather.”
Answers:
- 1: Somatic Complaints
- 2: Jealousy
- 3: Thought Broadcasting
- 4: Grandeur
- 5: Control
- 6: Erotomania
- 7: Thought Withdrawal
- 8: Persecution
- 9: Reference
Assignment:
Create your own “Guess the Delusion” item and identify the type:
- Michelle Obama fell in love with me after she saw my photo online. (Erotomania)
- My hands are being controlled by satellite signals from a secret government base in Turkey. (Control)
- I was born with the ability to cure cancer by touching people. (Grandeur)
- My husband flirts with the bank teller just to humiliate me. (Jealousy)
- The barista at Starbucks is putting cyanide in my drinks. (Persecution)
- Every time I pass a billboard on the highway, it changes, based on what I’m thinking. (Reference)
- There’s a fungus growing inside my lungs that doctors are refusing to remove. (Somatic Complaints)
- People on the subway can hear my thoughts and are laughing at them. (Thought Broadcasting)
- Every time I try to write something down, my ideas are stolen from my brain. (Thought Withdrawal)
Shared Psychotic Disorder (Folie à Deux)
A rare condition in which a delusion is transmitted from a dominant individual to a more submissive one in a close relationship.
DSM Criteria
- A delusion develops in the context of a close relationship with another person who already has an established delusion.
- The delusion is similar in content to that of the person with the established delusion.
Lesson Summary
We explored the “other psychotic disorders” not covered in Lesson 12 and played the “Guess the Delusion” game. Next, we will examine traumatic brain injury (TBI), which must be ruled out before diagnosing psychotic disorders.
References
- American Psychiatric Association (2000). DSM-IV-TR.
- American Psychiatric Association (2013). DSM-5.
- Brannon & Bienenfeld (2012).
- Sue, D. et al. (2010). Understanding Abnormal Behavior, 9th Ed.
- Sue, D. et al. (2016). Understanding Abnormal Behavior, 11th Ed.
- Wehmeier, P.M. et al. (2003). Induced Delusional Disorder. Psychopathology.