Schizophrenia: An Overview

Definition

• Schizo: Split
• Phrenia: Mind
• Schizophrenia: Describes a scattered or fragmented pattern of thinking, not split personality.

Symptoms

• Syndrome: Variety of symptoms, different in each patient.
• Symptoms categorized into:
  • Positive Symptoms: New psychotic features.
    • Delusions: False beliefs, resistant to contrary evidence.
      • E.g., Delusion of control, delusions of reference.
    • Hallucinations: Sensations not present (visual, auditory).
    • Disorganized Speech: Random words/phrases (word salad).
    • Disorganized Behavior: Bizarre, purposeless behavior.
    • Catatonic Behavior: Movement/posture issues, unresponsive stupor.
  • Negative Symptoms: Reduction/removal of normal processes.
    • Flat Affect: Lack of emotional response.
    • Alogia: Poverty of speech.
    • Avolition: Decrease in motivation.
  • Cognitive Symptoms: Subtle, difficult to notice.
    • Examples: Trouble remembering, learning, understanding.

Phases of Schizophrenia

1. Prodromal Phase: Withdrawal, similar to depression/anxiety.
2. Active Phase: Severe symptoms emerge.
3. Residual Phase: Cognitive symptoms, withdrawal.

Diagnosis Criteria

• Diagnosis requires two of: delusions, hallucinations, disorganized speech, behavior, or catatonic behavior, or negative symptoms.
• One must be delusions, hallucinations, or disorganized speech.
• Symptoms must persist for at least six months, with one month of active phase symptoms.
• Symptoms must not be due to other conditions (e.g., substance abuse).

Causes

• Causes are not well understood.
• Dopamine Hypothesis: Antipsychotic medications block dopamine receptor D2.
• Neurotransmitter Systems: Involvement of norepinephrine, serotonin, GABA.
• Genetic Basis: Supported by twin studies, no specific genes identified.
• Environmental Factors: Prenatal exposure, autoimmune disorders linked.
• Epidemiology:
  • Slightly more common in men.
  • Onset: Mid-20s for men, late 20s for women.
  • Estrogen's role in dopamine regulation.
  • No racial differences.

Treatment

• Treatment is complex and requires a multi-disciplinary approach.
• Antipsychotic Medications: Reduce symptoms but have side effects (tolerance, dependence, withdrawal).
• Collaborative Care: Combines therapy, counseling, medicine, psychopharmacology.