Chapter 11 - Schizophrenia

PSYC 300
Chapter 11 – Schizophrenia
1.1 Clinical Symptoms of Schizophrenia
- Symptoms of people with schizophrenia involve disturbances in several major areas:
 Thought, perception, and attention
 Motor behaviour
 Affect or emotion
 Life functioning.
- The range of problems of people diagnosed as schizophrenic is extensive  only some problems
may be present at any given time.
- DSM determines how many problems must be present and in what degree to justify a diagnosis
 Duration of the disorder is also important in diagnosis
- Heterogeneity suggests it may be appropriate to subdivide people with schizophrenia into types
that manifest various problems.
- The main symptoms of schizophrenia fit in two categories: positive and negative

Positive Symptoms
- Positive symptoms: schizophrenic symptoms and behavioural excesses, such as hallucinations
and bizarre behaviour
 Positive symptoms are the presence of too much of a behaviour that is not apparent in
most people
 Negative symptoms are the absence of a behaviour that should be evident in most
people.
- Disorganized speech
 Also known as formal thought disorder, disorganized speech is a disorder in which the
client has problems in organizing ideas and in speaking so that a listener can understand.
o Disorganized speech: problems in organizing ideas and in speaking so that a
listener can understand (used to be known as formal thought disorder)
 Incoherence sometimes forms in the conversation of individuals with schizophrenia.
o Incoherence: aspect of thought disorder wherein verbal expression is marked by
disconnectedness, fragmented thoughts, and jumbled phrases.
o Although the person may make repeated references to central ideas or a theme,
the images and fragments of thought are not connected
o Difficult to understand exactly what the person is trying to say.
 Speech may also be disordered by loose associations (or derailment)
o Loose association: aspect of thought disorder where the client has difficulty
sticking to one topic and drifts on a train of association evoked by past ideas.
o Person may be more successful in communicating with a listener but has
difficulty sticking to one topic.
o Clients have themselves provided descriptions of this state.
 Evidence indicates speech of schizophrenics is not disorganized and the presence of
disorganized speech does not discriminate well between schizophrenia and other
psychoses (e.g., some mood disorders)
o E.g., people in a manic episode exhibit loose associations as much as do people
with schizophrenia.
- Delusions
 Delusions: beliefs contrary to reality firmly held despite evidence to the contrary
o Common in paranoid disorders
o Belief that one is being manipulated by some external force such as radar,
television, or a creature from outer space

, o Belief that one is an especially important or powerful person
o Belief that one is being plotted against or oppressed by others (persecutory
delusion)
 Beliefs held contrary to reality are common positive symptoms of schizophrenia.
 Persecutory delusions are found in 65% of a large, cross-national sample of people with
schizophrenia
 Delusions may take several other forms
 Kurt Schneider introduced some of the most important delusions.
o Person may be unwilling recipient of bodily sensations or thoughts imposed by
an external agency.
o People may believe their thoughts are broadcasted or transmitted  others
know what they are thinking
o People may think their thoughts are being stolen from them, suddenly and
unexpectedly, by an external force.
o Some believe their feelings are controlled by an external force.
o Some believe impulses to behave in certain ways are imposed on them by some
external force
- Hallucinations (Distortions of Perception)
 People with schizophrenia often report that the world seems different and unreal to them.
o A person may mention changes in how their body feels, or the person's body
may become so depersonalized it feels like a machine.
 Kurt Schneider (German psychiatrist) proposed forms of hallucinations and delusions,
(first-rank symptoms) are central to defining schizophrenia.
 Most dramatic distortions of perception are hallucinations  sensory experiences in the
absence of any stimulation from the environment.
o More often auditory than visual
o Like delusions, hallucinations can be frightening experiences.
 Some hallucinations are thought to be important diagnostically  occur more often in
people with schizophrenia than other psychotic disorders, include:
o Report hearing voices and thoughts other than their own
o Some report they hear voices arguing
o Some report hearing voices commenting on their actions/behaviour

Negative Symptoms
- Negative symptoms: behavioural deficits in schizophrenia:
 Apathy
o Negative symptom in which the individual lacks interest, energy, and drive.
o Apathy is a lack of energy and seeming absence of interest in usual routine
activities.
o Clients may become inattentive to grooming and personal hygiene 
uncombed hair, dirty nails, and dishevelled clothes.
o Difficulty persisting at work, school, or household chores and may spend much
of their time sitting around doing nothing.
 Alogia
o Negative symptom, marked by poverty of speech and of speech content.
o Poverty of speech  sheer amount of speech is reduced.
o Poverty of content of speech  amount of discourse is adequate but conveys
little or no information, tends to be vague and repetitive.
 Anhedonia