Schizophrenia occurs in people from all cultures and from all walks of life.
The disorder is characterized by an array of diverse symptoms, including
extreme oddities in perception, thinking, action, sense of self, and manner of
relating to others. However, the hallmark of schizophrenia is a significant
loss of contact with reality, referred to as psychosis. It is characterized by
DSM-5-
Two (or more) of the following, each Schizoaffective disorder and
present for a significant depressive or bipolar disorder with
portion of time during a 1-month psychotic features have been ruled
period (or less if successfully out because either (1) no major
treated). At least one of these must depressive or manic episodes have
be (1), (2), or (3) occurred concurrently with the
1.Delusions. active-phase symptoms, or (2) if
2. Hallucinations. mood episodes have occurred
3. Disorganized speech (e.g., during active-phase symptoms, they
frequent derailment or have been present for a minority of
incoherence). the total duration of the active and
4. Grossly disorganized or catatonic residual periods of the illness.
behavior.
5. Negative symptoms (i.e.,
diminished emotional expression or
avolition).
For a significant portion of the time The disturbance is not attributable
since the onset of the disturbance, to the physiological effects of a
level of functioning in one or more substance (e.g., a drug of abuse, a
major areas, such as work, medication) or another
interpersonal relations, or self-care, medical condition.
is markedly below the level
achieved prior to the onset (or when
the onset is in childhood or
adolescence, there is failure to
achieve expected level of
interpersonal, academic, or
occupational functioning).
Continuous signs of the disturbance If there is a history of autism
persist for at least 6 months. This 6- spectrum disorder or a
month period must include at least 1 communication disorder of
month of symptoms (or less if childhood onset, the additional
successfully treated) that meet diagnosis of schizophrenia is made
Criterion A (i.e., active-phase only if prominent delusions or
symptoms) and may include periods hallucinations, in addition to the
of prodromal (small negative other required symptoms of
symptoms) or residual symptoms schizophrenia, are also present for
(positive, negative). During these at least 1 month (or less if
prodromal or residual periods, the successfully treated).
signs of the disturbance may be
manifested by only negative
symptoms or by two or more
symptoms listed in Criterion A
present in an attenuated form (e.g.,
odd beliefs, unusual perceptual
,experiences).
While the presence of symptoms must persist for a minimum of 6 months to
meet the criteria for a schizophrenia diagnosis, it is not uncommon to have
prodromal symptoms that precede the active phase of the disorder and
residual symptoms that follow it. These prodromal and residual symptoms
are “subthreshold” forms of psychotic symptoms that do not cause
significant impairment in functioning, with the exception of negative
symptoms. Due to the severity of psychotic symptoms, mood disorder
symptoms are also common among individuals with schizophrenia; however,
these mood symptoms are distinct from a mood disorder diagnosis in that
psychotic features will exist beyond the remission of depressive symptoms.
Epidemiology
The risk of developing schizophrenia over the course of one’s lifetime is a
little under 1 percent—actually around 0.7 percent. This is an average
lifetime risk estimate.
-some people (e.g., those who have a parent with schizophrenia) have a
statistically higher risk of developing the disorder than do others (e.g.,
people who come from families where there has never been a case of
schizophrenia.
-people whose fathers were older (50 years or more) at the time of their birth
have an elevated risk of developing schizophrenia when they grow up.
-Having a parent who works as a dry cleaner is also a risk factor (if brain
development were disrupted during important stages of cell migration, some
cells might fail to reach their target destinations, greatly affecting the
“internal connectivity” of the brain. (Organic solvents used in the dry
cleaning business might disrupt fetal neurodevelopment).
-Rates of schizophrenia are also higher than expected in first- and second-
generation immigrants, particularly those from black Caribbean and black
African countries who live in majority white communities.
-estimated 20% of individuals diagnosed with schizophrenia report complete
recovery of symptoms.
Age
- The vast majority of cases of schizophrenia begin in late adolescence and
early adulthood, with 18 to 30 years of age being the peak time for the onset
of the illness
-Although schizophrenia is sometimes found in children, such cases are rare
Gender - The male-to female ratio is 1.4:1 every three men who develop the
disorder, only two women do so
-equal risk for both genders to develop the disorder
Men Women
-there is a peak in new cases of -women peaks during the same age
schizophrenia between ages 20 and period, but the peak is less marked
24 than it is for men
- after about age 35, the number of - a second rise in new cases that
men developing schizophrenia falls begins around age 40, as well as a
markedly third spike in onset that occurs
- also tend to have a more severe when women are in their early
form of schizophrenia sixties.
- schizophrenia-related anomalies of - estrogen gives protective effect-
, brain structure are more severe in estrogen levels are low (as is true
male premenstrually) or are falling,
- men typically present with more psychotic symptoms in women with
negative symptoms schizophrenia often get worse.
Menopause
- women present with more mood-
related symptoms
Clinical Picture
Delusions
- A delusion is essentially an erroneous belief that is fixed and firmly held
despite clear contradictory evidence
- People with delusions believe things that others who share their social,
religious, and cultural backgrounds do not believe. A delusion therefore
involves a disturbance in the
content of thought. Are common in schizophrenia, occurring in more than 90
percent of patients at some time during their illness.
Prominent among these are beliefs that
- Delusions of grandeur– belief they have exceptional abilities, wealth, or
fame; belief they are God or other religious saviors
-Delusions of control– belief that others control their
thoughts/feelings/actions
-Delusions of thought broadcasting– belief that one’s thoughts are
transparent and everyone knows what they are thinking
-Delusions of persecution– belief they are going to be harmed, harassed,
plotted or discriminated against by either an individual or an institution; it is
the most common delusion
- Delusions of reference– belief that specific gestures, comments, or even
larger environmental cues are directed directly to them. When some neutral
environmental event (such as a television program or a song on the radio) is
believed to have special and personal meaning intended only for the person.
- Delusions of thought withdrawal– belief that one’s thoughts have been
removed by another source
- delusions of bodily changes (e.g., bowels do not work) or removal of organs,
are also not uncommon.
An individual with schizophrenia who comes from a highly religious family is
more likely to experience religious delusions (delusions of grandeur) than
another type of delusion.
Hallucinations
- sensory experience that seems real to the person having it, but occurs in
the absence of any external perceptual stimulus.
- can occur in any sensory modality (auditory, visual, olfactory, tactile, or
gustatory). However, auditory hallucinations (e.g., hearing voices) are by far
the most common (75 percent). Even deaf people who are diagnosed with
schizophrenia sometimes report auditory hallucinations.
-visual hallucinations were reported less frequently (39 percent of patients),
and olfactory, tactile, and gustatory hallucinations were even more rare (1–7
percent).
The combination of high stress levels and high caffeine intake is associated
with hallucinations in psychiatrically healthy people.
Study-
The disorder is characterized by an array of diverse symptoms, including
extreme oddities in perception, thinking, action, sense of self, and manner of
relating to others. However, the hallmark of schizophrenia is a significant
loss of contact with reality, referred to as psychosis. It is characterized by
DSM-5-
Two (or more) of the following, each Schizoaffective disorder and
present for a significant depressive or bipolar disorder with
portion of time during a 1-month psychotic features have been ruled
period (or less if successfully out because either (1) no major
treated). At least one of these must depressive or manic episodes have
be (1), (2), or (3) occurred concurrently with the
1.Delusions. active-phase symptoms, or (2) if
2. Hallucinations. mood episodes have occurred
3. Disorganized speech (e.g., during active-phase symptoms, they
frequent derailment or have been present for a minority of
incoherence). the total duration of the active and
4. Grossly disorganized or catatonic residual periods of the illness.
behavior.
5. Negative symptoms (i.e.,
diminished emotional expression or
avolition).
For a significant portion of the time The disturbance is not attributable
since the onset of the disturbance, to the physiological effects of a
level of functioning in one or more substance (e.g., a drug of abuse, a
major areas, such as work, medication) or another
interpersonal relations, or self-care, medical condition.
is markedly below the level
achieved prior to the onset (or when
the onset is in childhood or
adolescence, there is failure to
achieve expected level of
interpersonal, academic, or
occupational functioning).
Continuous signs of the disturbance If there is a history of autism
persist for at least 6 months. This 6- spectrum disorder or a
month period must include at least 1 communication disorder of
month of symptoms (or less if childhood onset, the additional
successfully treated) that meet diagnosis of schizophrenia is made
Criterion A (i.e., active-phase only if prominent delusions or
symptoms) and may include periods hallucinations, in addition to the
of prodromal (small negative other required symptoms of
symptoms) or residual symptoms schizophrenia, are also present for
(positive, negative). During these at least 1 month (or less if
prodromal or residual periods, the successfully treated).
signs of the disturbance may be
manifested by only negative
symptoms or by two or more
symptoms listed in Criterion A
present in an attenuated form (e.g.,
odd beliefs, unusual perceptual
,experiences).
While the presence of symptoms must persist for a minimum of 6 months to
meet the criteria for a schizophrenia diagnosis, it is not uncommon to have
prodromal symptoms that precede the active phase of the disorder and
residual symptoms that follow it. These prodromal and residual symptoms
are “subthreshold” forms of psychotic symptoms that do not cause
significant impairment in functioning, with the exception of negative
symptoms. Due to the severity of psychotic symptoms, mood disorder
symptoms are also common among individuals with schizophrenia; however,
these mood symptoms are distinct from a mood disorder diagnosis in that
psychotic features will exist beyond the remission of depressive symptoms.
Epidemiology
The risk of developing schizophrenia over the course of one’s lifetime is a
little under 1 percent—actually around 0.7 percent. This is an average
lifetime risk estimate.
-some people (e.g., those who have a parent with schizophrenia) have a
statistically higher risk of developing the disorder than do others (e.g.,
people who come from families where there has never been a case of
schizophrenia.
-people whose fathers were older (50 years or more) at the time of their birth
have an elevated risk of developing schizophrenia when they grow up.
-Having a parent who works as a dry cleaner is also a risk factor (if brain
development were disrupted during important stages of cell migration, some
cells might fail to reach their target destinations, greatly affecting the
“internal connectivity” of the brain. (Organic solvents used in the dry
cleaning business might disrupt fetal neurodevelopment).
-Rates of schizophrenia are also higher than expected in first- and second-
generation immigrants, particularly those from black Caribbean and black
African countries who live in majority white communities.
-estimated 20% of individuals diagnosed with schizophrenia report complete
recovery of symptoms.
Age
- The vast majority of cases of schizophrenia begin in late adolescence and
early adulthood, with 18 to 30 years of age being the peak time for the onset
of the illness
-Although schizophrenia is sometimes found in children, such cases are rare
Gender - The male-to female ratio is 1.4:1 every three men who develop the
disorder, only two women do so
-equal risk for both genders to develop the disorder
Men Women
-there is a peak in new cases of -women peaks during the same age
schizophrenia between ages 20 and period, but the peak is less marked
24 than it is for men
- after about age 35, the number of - a second rise in new cases that
men developing schizophrenia falls begins around age 40, as well as a
markedly third spike in onset that occurs
- also tend to have a more severe when women are in their early
form of schizophrenia sixties.
- schizophrenia-related anomalies of - estrogen gives protective effect-
, brain structure are more severe in estrogen levels are low (as is true
male premenstrually) or are falling,
- men typically present with more psychotic symptoms in women with
negative symptoms schizophrenia often get worse.
Menopause
- women present with more mood-
related symptoms
Clinical Picture
Delusions
- A delusion is essentially an erroneous belief that is fixed and firmly held
despite clear contradictory evidence
- People with delusions believe things that others who share their social,
religious, and cultural backgrounds do not believe. A delusion therefore
involves a disturbance in the
content of thought. Are common in schizophrenia, occurring in more than 90
percent of patients at some time during their illness.
Prominent among these are beliefs that
- Delusions of grandeur– belief they have exceptional abilities, wealth, or
fame; belief they are God or other religious saviors
-Delusions of control– belief that others control their
thoughts/feelings/actions
-Delusions of thought broadcasting– belief that one’s thoughts are
transparent and everyone knows what they are thinking
-Delusions of persecution– belief they are going to be harmed, harassed,
plotted or discriminated against by either an individual or an institution; it is
the most common delusion
- Delusions of reference– belief that specific gestures, comments, or even
larger environmental cues are directed directly to them. When some neutral
environmental event (such as a television program or a song on the radio) is
believed to have special and personal meaning intended only for the person.
- Delusions of thought withdrawal– belief that one’s thoughts have been
removed by another source
- delusions of bodily changes (e.g., bowels do not work) or removal of organs,
are also not uncommon.
An individual with schizophrenia who comes from a highly religious family is
more likely to experience religious delusions (delusions of grandeur) than
another type of delusion.
Hallucinations
- sensory experience that seems real to the person having it, but occurs in
the absence of any external perceptual stimulus.
- can occur in any sensory modality (auditory, visual, olfactory, tactile, or
gustatory). However, auditory hallucinations (e.g., hearing voices) are by far
the most common (75 percent). Even deaf people who are diagnosed with
schizophrenia sometimes report auditory hallucinations.
-visual hallucinations were reported less frequently (39 percent of patients),
and olfactory, tactile, and gustatory hallucinations were even more rare (1–7
percent).
The combination of high stress levels and high caffeine intake is associated
with hallucinations in psychiatrically healthy people.
Study-
