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SCIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
(A) Definition:
Schizophrenia (Dementia Praecox) is a mental disorder characterized by loss of contact with the
environment, by noticeable deterioration in the level of functioning in everyday life and by
disintegration of personality expressed as disorder of feeling, thought (delusions),
perceptions (hallucinations) and behaviour
...
Prominent
delusions are beliefs that one’s thoughts, feelings or actions are being controlled by external
agents (impulses)
...
Delusions of reference (This song being played on the radio is
being played only for me by this person who wants to give me a special message), strange
proportions (My belly is extremely elongated at a certain angle) or removal of organs (My
neighbour removed my kidneys last week when I was sleeping
...


Hallucinations- A Hallucination is a sensory experience (auditory, visual,

olfactory, tactile,
gustatory) that occurs in the absence of any external perceptual stimulus
...
These mostly have affective,
conceptual or behavioural relevance for the patients who often become emotionally
involved with their hallucinations, often incorporating them into their delusions
...


Disorganized Speech- Delusions reflect a disorder of though content and disorganized speech
is the external manifestation of the same
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Sometimes, the patient makes up completely new words (neologisms)
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Disorganized and Catatonic Behaviour-

Goal directed activity, even daily routine
functioning in areas of work, social relations, self-care is disrupted
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Poor personal
hygiene, disregard for personal health and safety
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Impairment in the functioning of pre frontal of cerebral cortex is a
possible reason for this
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Negative & Positive Symptoms- Positive symptoms are those reflecting an excess in
a normal repertoire of behaviour, while Negative symptoms reflect an absence/
deficit of behaviour that are normally present
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Positive Symptoms
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Hallucinations
Delusions

Negative Symptoms
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Emotional Flattening
Poverty of Speech
A-sociality
Apathy
Anhedonia

Disorganized
Symptoms
-

Bizarre Behaviour
Disorganized Speech

(C) Subtypes:
Paranoid Type- patient shows a history of increasing suspiciousness and of severe
difficulties in interpersonal relationships
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Persecutory delusions are frequent, involving a wide range of bizarre ideas and plots
(eg
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Delusions of Grandeur are common (Patient claims to
be world’s greatest economist, philosopher), and often justify the persecution beliefs
they hold
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Disorganized Type-

occurs at an earlier age with a gradual, insidious onset
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Person gradually becomes reclusive, preoccupied with fantasies
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Incoherent and disorganized, un-story like hallucinations
and delusions are present
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Prognosis is very poor for this subtype
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Some patients are highly suggestable and obey commands or imitate
actions of others (Echopraxia) or mimic their phases (Echolalia)
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They might pass from such a state to great excitement
during which they might become violent too
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Undifferentiated Type- is like a wastebasket category of Schizophrenia wherein
the patient meets the usual criteria for the disorder (delusions, hallucinations,
distorted thoughts, bizarre behaviour) in varying degrees
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Its common in early, acute phases of schizophrenia
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They largely display
negative symptoms (flat emotions) and positive symptoms, if present, are mild
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First Generation Antipsychotics like Thorazine
and Haldol, also referred to as Neuroleptics work by blocking the action of
neurotransmitter Dopamine and helping reduce the Positive Symptoms of the disease
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A common drug from Second Generation of
Antipsychotics, used widely now, with lesser EPS than as prominent with Thorazine and
Haldol, is Clozaril
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However side effects of drowsiness and weight gain are still attached
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Family Therapy helps reduce schizophrenia relapse by altering aspects of patientrelative relationship regarded as leading to high level of expressed emotions (EE)
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Case Management is done by case managers or people who help find
patients find the services they need in order to function in community
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Social- Skills Training
is designed to help patients acquire skills needed to function better on a day to day
basis and they include- employment skills, relationship skills,

self-care skills, skills to manage medication or symptoms
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Cognitive-Behavioural Therapy aims to decrease intensity of
positive symptoms, reduce relapse, decrease social disability
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Individual Treatment is a personal non-psychodynamic approach to equip patient with
coping techniques and skills
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(E) Other Psychotic Disorders
Schizoaffective Disorder-

A hybrid of diagnosis characteristics for patients with
schizophrenia and severe mood disorder
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There are two types of Schizoaffective Disorders- Bipolar and Unipolar
subtypes
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Schizophreniform Disorder- entails schizophrenia like psychoses lasting up to

a
month but not more than 6 months
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At
present, all recent onset cases of true schizophrenia presumably must first receive a
diagnosis of schizophreniform disorder
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But gross disorganization, performance deficiencies behaviour deterioration is
absent
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Brief Psychotic Disorder-

Triggered by stress, it involves the sudden onset of
psychotic symptoms/ grossly disorganized behaviour/ catatonic behaviour
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Shared Psychotic Disorder- also “folie à deux”- involves a delusion that develops
in someone who has a close relationship with another delusional person
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