Schizophrenia Spectrum and other Psychotic Disorders

Schizophrenia Spectrum and other Psychotic Disorders

  • The word schizophrenia is derived from the Greek words skhizo (split) and phren (mind).
  • The diagnosis of schizophrenia is commonly misinterpreted as a split personality.
  • Schizophrenia is probably caused by a combination of factors, including:
    • Genetic predisposition
    • Biochemical dysfunction
    • Physiological factors
    • Psychosocial stress
  • Schizophrenia requires treatment that is comprehensive and presented in a multidisciplinary effort.
  • Of all mental illnesses, schizophrenia probably causes more:
    • Lengthy hospitalizations
    • Chaos in family life
    • Exorbitant costs to people and governments 
    • Fears

Nature of the Disorder

  • Schizophrenia causes disturbances in:
    • Thought processes
    • Perception
    • Affect
  • With schizophrenia, there is a severe deterioration of social and occupational functioning.
  • In the United States, the lifetime prevalence of schizophrenia is about 1%.
  • Premorbid behavior of the patient with schizophrenia can be viewed in four phases.

Phase 1

  • Premorbid phase
    • Shy and withdrawn
    • Poor peer relationships
    • Doing poorly in school
    • Antisocial behavior

Phase 2

  • Prodromal phase
    • Lasts from a few weeks to a few years
    • Deterioration in role functioning and social withdrawal
    • Substantial functional impairment
    • Depressed mood, poor concentration, fatigue
    • Sudden onset of obsessive-compulsive behavior

Phase 3

  • Acute schizophrenic episode
    • In the active phase of the disorder, psychotic symptoms are prominent.
    • Delusions
    • Hallucinations
    • Impairment in work, social relations, and self-care

Phase 4

  • Residual phase
    • Symptoms similar to those of the prodromal phase.
    • Flat affect and impairment in role functioning are prominent.

Prognosis

Factors associated with a positive prognosis

  • Good premorbid functioning
    • Later age at onset
    • Female gender
    • Abrupt onset precipitated by a stressful event
    • Associated mood disturbance
    • Brief duration of active-phase symptoms
    • Minimal residual symptoms
    • Absence of structural brain abnormalities
    • Normal neurological functioning
    • No family history of schizophrenia