1.6 Problem 3
A Beautiful Mind
Schizophrenia
In all people from all cultures
Characterised by diverse symptoms inc:
o extreme oddities in perception
o thinking
o action
o sense of self
o manner of relating to others
o psychosis- significant loss of contact with reality
positive symptoms- symptoms that are an over-exaggeration of normal brain
processes (new to the individual)
negative symptoms- inability or decreased ability to initiate actions, speech,
express emotions, or feel pleasure
2 of following for at least 1 month, persisting for 6 months:
Delusions
Hallucinations
Disorganised speech
Disorganised/abnormal behaviour
Negative symptoms
These create significant impairment in individual’s ability to engage in
normal daily functioning
Presentation of schizophrenia varies significant among individuals
A. 2+ each for min. 1 month (must include either:
1,2, or 3)
1. Delusions
2. Hallucinations
3. Disorganized speech
(derailment/incoherence)
4. Grossly disorganized/catatonic behavior
5. Negative symptoms (e.g. avolition/less em.
Ex)
B. Life before was much better
C. Last for 6+ months (with min. 1 month of
symptoms of A) – Prodromal = very early
signs/residual periods
D. No major depressive/manic episodes
E. Not caused by substance/other medical condition
F. If history of autism, diagnose only if
hallucinations/severe delusions
Epidemiology
0.7%
Most cases begin late adolescence and early adulthood (18-30 years of age peak
time for onset)
Earlier onset, predictive of worse overall prognosis
Onset, typically gradual with initial symptoms similar to depressive disorder
Negative symptoms are more predictive
Perhaps as most persistent and difficult to treat
20% have complete symptom recovering
Men:
o More common
Perhaps as female sex hormones play protect role: when
estrogen levels are low, psychotic symptoms in women get
worse: protective effect of estrogen may help explain
delayed onset of schizophrenia
o More severe form
o Schizophrenia-related anomalies of brain structure more severe
, o Peak in cases between 20-24yrs
35+ strong decline in cases
Women
o Peak less marked, also 20-24yrs
Second spike around 40yrs
Third spike, around early 60s
Increased risk:
o 1st & 2nd generation immigrants, particularly black Caribbean and black
African countries who live in majority white communities (stress and social
adversity)
o If fathers are older at time of birth
o Parent who works as a dry cleaner
o Complicated pregnancy or delivery
o Early prenatal nutrient deficiency
o Living in an urban environment
o Using cannabis
o Theory of Viral infection- mother has virus in first trimester
o RH incompatibility (different blood types) between foetus and mother:
increases likeliness of brain abnormalities
Delusions (Positive Symptom)
Delusions- fixed beliefs that are not amenable to change in light of conflicting evidence
Individual unable to distinguish thoughts from reality, likely from lack of
insight
Presentation of delusion primarily related to social, emotional, educational,
cultural background. Eg. highly religious family, likelier to experience
grandeur
Types:
Delusions of grandeur- belief they have exceptional abilities, wealth, or fame
(eg. believe they’re God)
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 institution
o Most common delusion
Delusions of reference- belief that specific gestures, comments or larger
environmental cues are directed directly to them
Delusions of thought withdrawal- belief that one’s thoughts have been
removed by another source
Hallucinations (Positive Symptom)
Hallucinations- a sensory experience that seems real to the person having it,
but occurs in absence of any external perceptual stimulus
Occur in any of 5 senses: hearing= auditory hallucinations (most common)
Voices talking to patient
Voices talking to one another
Usually not someone person knows
Clear, objective, definite
Can be pleasurable or malicious
Seeing= visual hallucinations
Smelling= olfactory hallucinations
Touching= tactile hallucinations
Tasting= gustatory hallucinations
Can occur in single modality or combination of modalities
Usually recognise hallucinations aren’t real and attempt to engage in normal
behaviour during them
A Beautiful Mind
Schizophrenia
In all people from all cultures
Characterised by diverse symptoms inc:
o extreme oddities in perception
o thinking
o action
o sense of self
o manner of relating to others
o psychosis- significant loss of contact with reality
positive symptoms- symptoms that are an over-exaggeration of normal brain
processes (new to the individual)
negative symptoms- inability or decreased ability to initiate actions, speech,
express emotions, or feel pleasure
2 of following for at least 1 month, persisting for 6 months:
Delusions
Hallucinations
Disorganised speech
Disorganised/abnormal behaviour
Negative symptoms
These create significant impairment in individual’s ability to engage in
normal daily functioning
Presentation of schizophrenia varies significant among individuals
A. 2+ each for min. 1 month (must include either:
1,2, or 3)
1. Delusions
2. Hallucinations
3. Disorganized speech
(derailment/incoherence)
4. Grossly disorganized/catatonic behavior
5. Negative symptoms (e.g. avolition/less em.
Ex)
B. Life before was much better
C. Last for 6+ months (with min. 1 month of
symptoms of A) – Prodromal = very early
signs/residual periods
D. No major depressive/manic episodes
E. Not caused by substance/other medical condition
F. If history of autism, diagnose only if
hallucinations/severe delusions
Epidemiology
0.7%
Most cases begin late adolescence and early adulthood (18-30 years of age peak
time for onset)
Earlier onset, predictive of worse overall prognosis
Onset, typically gradual with initial symptoms similar to depressive disorder
Negative symptoms are more predictive
Perhaps as most persistent and difficult to treat
20% have complete symptom recovering
Men:
o More common
Perhaps as female sex hormones play protect role: when
estrogen levels are low, psychotic symptoms in women get
worse: protective effect of estrogen may help explain
delayed onset of schizophrenia
o More severe form
o Schizophrenia-related anomalies of brain structure more severe
, o Peak in cases between 20-24yrs
35+ strong decline in cases
Women
o Peak less marked, also 20-24yrs
Second spike around 40yrs
Third spike, around early 60s
Increased risk:
o 1st & 2nd generation immigrants, particularly black Caribbean and black
African countries who live in majority white communities (stress and social
adversity)
o If fathers are older at time of birth
o Parent who works as a dry cleaner
o Complicated pregnancy or delivery
o Early prenatal nutrient deficiency
o Living in an urban environment
o Using cannabis
o Theory of Viral infection- mother has virus in first trimester
o RH incompatibility (different blood types) between foetus and mother:
increases likeliness of brain abnormalities
Delusions (Positive Symptom)
Delusions- fixed beliefs that are not amenable to change in light of conflicting evidence
Individual unable to distinguish thoughts from reality, likely from lack of
insight
Presentation of delusion primarily related to social, emotional, educational,
cultural background. Eg. highly religious family, likelier to experience
grandeur
Types:
Delusions of grandeur- belief they have exceptional abilities, wealth, or fame
(eg. believe they’re God)
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 institution
o Most common delusion
Delusions of reference- belief that specific gestures, comments or larger
environmental cues are directed directly to them
Delusions of thought withdrawal- belief that one’s thoughts have been
removed by another source
Hallucinations (Positive Symptom)
Hallucinations- a sensory experience that seems real to the person having it,
but occurs in absence of any external perceptual stimulus
Occur in any of 5 senses: hearing= auditory hallucinations (most common)
Voices talking to patient
Voices talking to one another
Usually not someone person knows
Clear, objective, definite
Can be pleasurable or malicious
Seeing= visual hallucinations
Smelling= olfactory hallucinations
Touching= tactile hallucinations
Tasting= gustatory hallucinations
Can occur in single modality or combination of modalities
Usually recognise hallucinations aren’t real and attempt to engage in normal
behaviour during them
