EPPP Study Guide - Schizophrenia Spectrum and other psychotic disorders

Schizophrenia Spectrum is categorized by the presence of one or more of the following: delusions, hallucinations, disorganized thinking, grossly disorganized behaviour, and negative symptoms.

Delusions might be persecutory (belief that you are going to be harmed by someone), referential (belief that a gesture or comment was directed at you), grandiose (belief that you have exceptional ability or fame), erotomanic (belief that a person is in love with you), nihilistic (belief that something bad is going to happen), or somatic (worried about your health). These are all beliefs that don't change despite clear evidence against them.

Hallucinations are not including in diagnosis if they happen when falling asleep or awakening as this is common. Hallucinations can occur across the senses but auditory ones are the most common in schizophrenia.

Disorganized Thinking (speech) is typically when the individual switches from one topic to the next, speaking tangentially or completely derailed from the original topic.

Abnormal motor behaviour might manifest like childlike maneurisms or unpredictable agitation. There may also be catatonic behaviours which looks like a lack of reaction to the environment (ie. mutism, maintaining a rigid posture, staring or grimacing, or echoing of speech.

Negative symptoms indicate the abnormal absence of behaviour vs. manifestation of behaviour and play a large role in schizophrenia. These include diminished emotional expression (like a lack of facial expressions or hand gestures that normally express emotion), and avolition which is a decrease in self-initiated activities (like sitting for long periods of time without doing anything).

Schizophrenia have a large genetic component in its etiology but it is more correct to say that the vulnerability to schizophrenia is inherited rather than the condition itself. Stress may activate the latent potential for the disorder.  Onset is usually in the teen to early 30s range with men typically experiencing it earlier.

An interesting fact is that people with schizophrenia in non-industrialized countries are more likely to go into remission.

Treatment includes family therapy because it effects the family so deeply. Often the family expression of emotion leads to relapse. Social skill training and Cognitive Behavioural Therapy can help. Traditional antipsychotics like halperidol can help with positive symptoms but are not effective for negative ones. Atypical drugs like chlozapine and risperidol might work with both positive and negative symptoms and are less likely to cause movement side effects.