Schizophrenia

Clinical Description

Schizophrenia is a chronic, severe mental disorder that involves a range of cognitive, behavioral, and emotional dysfunctions.

Symptoms (Diagnostic Criteria)

Presence of two or more of the following symptoms (at least one must be 1, 2, or 3):

  1. Delusions: Fixed false beliefs about reality that persist despite evidence to the contrary.
  2. Hallucinations: False perceptions of objects or events that involve the senses (sight, sound, smell, touch, and taste).
  3. Disorganized speech: Examples include abrupt switching from one topic to another (derailment), constant digressing to random or irrelevant ideas and topics (tangentiality), incomprehensible speech (incoherence or "word salad").
  4. Grossly disorganized or catatonic behavior: Examples include childlike "silliness," unpredictable agitation, decreased reactivity to the environment, resistance to instructions (negativism), maintaining a rigid, inappropriate, or bizarre posture (stupor), complete lack of verbal and motor responses (mutism), purposeless and excessive motor activity without an obvious cause (catatonic excitement).
  5. Negative symptoms:
    • Flat affect: Lack of emotional response or expression.
    • Avolition: Lack of motivation or interest in self-initiated purposeful activities (apathy).
    • Anhedonia: Decreased ability to experience pleasure.
    • Asociality: Lack of interest in social interactions, activities, or relationships.
    • Alogia: Diminished speech output, or slow or delayed responses.
    • Anergia: Continual feeling of tiredness, lack of energy, or sleepiness.
    • Attention impairment

Duration

  • Each symptom must be present for a significant portion of time during a 1-month period (or less if successfully treated).
  • Continuous signs of the disturbance persist for at least 6 months, including 1 month of active-phase symptoms, and may include periods of prodromal or residual symptoms.

Age Onset and Age Requirement

  • Typically emerge between late adolescence to mid-30s.
  • Mean age onset:
    • Men: Early to mid-20s.
    • Women: Late-20s to early-30s.

Onset specifier:

  • Early onset: If onset is before age 18 years.
  • Late onset: If onset is after age 45 years.

Treatments

  • Medication: Antipsychotics to help manage symptoms.
  • Psychotherapy:
    • Cognitive Behavioral Therapy (CBT)
    • Individual psychotherapy
    • Social skills training
    • Arts therapy
  • Psychosocial support:
    • Family interventions
    • Vocational rehabilitation
    • Supported employment
    • Self-help groups
  • Electroconvulsive Therapy (ECT)
  • Assertive Community Treatment (ACT)
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