In this discussion, we will talk about symptoms of schizophrenia, comorbidities of schizophrenia, and medications that can induce psychosis
What is Schizophrenia?
Schizophrenia is a brain disorder. There seems to be both a genetic component and environmental component that combined to trigger the onset of schizophrenia.
Schizophrenia affects about 1% of the U.S. population, and patients can present with a wide range of symptoms. One symptom that all patients share is the presentation of delusion (false belief system that is resistant) or hallucination. Many patients also present with a lack of motivation.
Schizophrenia has been around for a very long time. It was first defined in the early 1800s by Arnold Pick. In 2011, the four A’s (association, affectivity, ambivalence, and autism) were used to describe patients with schizophrenia, but they are not used anymore.
Some definitions that are used a lot in schizophrenia are:
- Psychosis – a break from reality that can be transient or chronic. A brief psychosis episode may also be referred to as delirium.
- Delusion – a false belief system that is resistant to clear reasoning.
- Hallucination – perception in the absence of stimulus. This can be visually (most common), auditory, or sensory.
Schizophrenia are a cluster of three types of symptoms: Positive, Negative, and Cognitive
Positive symptoms are added symptoms from normal behaviors. This can be hallucination, loose association, word salad, echolalia, clanging, disorganized thoughts, or catatonic behavior (with repetitive behavior presentation.)
Catatonia in schizophrenia can present in multiple ways. Some of these are immobility, mutism, staring, rigidity, psychomotor agitation, or repetitive movements.
Negative symptoms are subtracted symptoms from normal behaviors. This can be absent or flatten affect, lack of socialization, loss of emotional correctness, lack of fun, or lack of motivation.
Cognitive symptoms are cognitive dysfunction that presents as impairment of attention, processing speed, working memory, executive function, skill acquisition, or poor social function.
Schizophrenia can be abrupt or insidious. Symptoms are subtle and can take anywhere from months to years to manifest into active schizophrenia. Patients tend to present first with positive symptoms.
This is a chronic condition, which cycle between exacerbation and recovery. The recovery phase can last for years.
Schizophrenia Subtypes:
Even though DSM-5 dropped the subtypes, it still can be useful to discuss them.
- Paranoid – these patients are usually high functioning. Auditory hallucination is more common in this subtype. Usually these patients are preoccupied with one or more delusions.
- Disorganized – these patients usually present with word salad, disorganized speech, and inappropriate affect.
- Catatonic Type – these patients either have motoric immobility or repetitive behaviors
There are also undifferentiated Type and Residual Type
DSM-5 of Schizophrenia
There are five elements:
- At least 2 symptoms for at least 1 full month. One of the them must be delusion, hallucination, or disorganized speech:
- Delusion
- Hallucination
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
- Must interfere with work, self-care, or interpersonal relations for longer than 6 months.
- No concurrent MDD or BD or due to substance abuse or other illness
- If the patient has a history of autism, the diagnosis of schizophrenia can only be made if delusions or hallucinations present for a month or longer.
Cannabis, corticosteroids, and amphetamines can induce the symptoms of schizophrenia.
Etiology of Schizophrenia
The etiology is thought to be multifactorial. The most dominant theory is the Dopamine (DA) Hypothesis. This will be discussed further in the future post.
Schizophrenia is thought to be very heritable. Environmental factors like head injury, viral infection, paternal age, and perinatal insults seem to play a role as well.
Epidemiology of Schizophrenia
This is a unique disorder due to the fact that more men than female are diagnosed.
The onset is typically during late adolescent. For men, it’s 18-25. For women, it’s 25-35. It’s very prodromal so early and late diagnoses are rare.
Common Co-Morbidities
This includes metabolic diseases, such as diabetes, CV disease, and obesity; hepatitis; depression; anxiety, PTSD, OCD
These patients have a high risk of lifetime suicide attempt (50%), and 10% will have a complete attempt.
Female patients with family history of mood disorder, high IQ, and married have better prognosis. Others with improved prognosis includes having fewer episodes, less residual symptoms between episodes, older age of onset, having predominantly positive symptoms, and no disorganized symptoms.
Other Psychotic Disorder
Schizophreniform
This is the one month period that someone has symptoms, but it hasn’t been six months so they cannot be diagnosed with schizophrenia.
Think of this as schizophrenia-forming disorder
Schizoaffective Disorder
This is a mood disorder combined with schizophrenia. These patients have constant psychosis in addition to depressive or manic episodes.
Other psychotic disorders include brief psychotic disorder, major depressive disorder with psychotic features, psychotic disorder due to medical condition, and substance/medication induced psychotic disorder.