SCHIZOPHRENIA AND PSYCHOTIC DISORDERS
Characteristics of Schizophrenia Spectrum and Psychotic
Disorders
– definitions, examples and case studies of schizophrenia and psychotic
disorders
Schizophrenia is a mental health disorder that involves positive and negative symptoms. It
affects all aspects of a person’s thinking,emotions and actions.The DSM-V defines
schizophrenic spectrum and psychotic disorders as sharing one or more of the following:
Positive symptoms
● delusions (beliefs not based in reality)
● hallucinations (sensory experiences of things that do not exist)
● disorganised thoughts/speech (mixed up racing thoughts and jumbled speech)
● catatonic behaviour (not reacting to environment, rigid and unmoving or repetitive
movements)
Negative symptoms
● loss of speech (alogia)
● loss of motivation (avolition)
● diminished facial/emotion expression
● social/emotional withdrawal
These disturbances must have been continuously present for at least 6 months with at least
one month of symptoms and cannot be attributed to illegal substances or medicine. The
person in question must also show a reduction in normal functioning
Types of schizophrenia are no longer on the syllabus.
Examples
These could include substance or medication-induced psychotic disorder (from prolonged
use or withdrawal), schizotypical (personality) disorder (great difficulty developing
emotionally meaningful relationships and flat affect), schizoaffective disorder, and catatonia
associated with another mental disorder or condition.
,Conrad
● Had his first psychotic episode while on holiday when he was 22.
● Later diagnosed with schizo-affective disorder.
● Reluctant to seek treatment at first, spent eight months in a psychiatric ward.
● Found the right drug through trial-and-error, though maintaining a healthy weight
is a challenge; now 23
John Nash
● an American mathematician who made fundamental contributions to game theory,
differential geometry, and the study of partial differential equations.
● 1958 - diagnosed with paranoid schizophrenia
● Nash thought that all men who wore red ties were part of a communist conspiracy
against him. He mailed letters to embassies in Washington, D.C., declaring that they
were establishing a government.
● In 1961, Nash was admitted to the New Jersey State Hospital at Trenton. Over the next
nine years, he spent intervals of time in psychiatric hospitals, where he received both
antipsychotic medications and insulin shock therapy.
● Although he sometimes took prescribed medication, Nash later wrote that he did so
only under pressure. Nash did not take any medication after 1970, nor was he
committed to a hospital ever again.
● Nash recovered gradually. Encouraged by his then former wife, de Lardé, Nash lived
at home and spent his time in the Princeton mathematics department where his
eccentricities were accepted even when his mental condition was poor. De Lardé
credits his recovery to maintaining "a quiet life" with social support.
– schizophrenia and beliefs
Schizophrenia is diagnosed when individual shows at least two of the following for a
significant amount of time:
● delusions,
● hallucinations,
● disorganised speech,
● disorganised or catatonic behaviour,
● and flattened affect
*for at least one month. The individual must show occupational or social functioning that
has declined and these symptoms cannot be explained by another medical factor. At least
one of these symptoms must be delusions,hallucinations or disorganised speech.
,Delusional disorder is characterised by persistent delusions but whose other behaviours are
‘normal’. There is an absence of the other psychotic symptoms of schizophrenia such as
● hallucinations,
● disorganised speech or
● negative symptoms.
Some types of delusional disorder are:
● grandiose (belief that they have a (non-existent) unrecognised high status or great
skill),
● persecutory (being conspired against or pursued by those intending to harm),
● erotomaniac (belief someone is in love with them).
● jealous (belief that partner is being unfaithful).
These are all examples of non-bizarre delusions that could be true or possible. Individuals
may also experience bizarre delusions which are logically impossible.
To receive a diagnosis of delusional disorder symptoms must have been experienced for at
least one month and be unrelated to physiological effects of substance use.
– symptom assessment using virtual reality (Freeman, 2008)
● VR is intended to eliminate challenges such as misinterpreting social interactions
when checking symptoms and developing treatments for schizophrenia
● Usually, symptom assessment requires face to face interviews with the patient to
discuss behaviour. Some patients may not answer truthfully. VR can eliminate this by
making sure that paranoid thoughts and behaviours are genuine.
● 200 nonclinical members of the general population were used
● In the author’s initial work with students, a library scene was used but subsequently
a 5-minute ride on a London underground train between 2 stations has been
developed.
● Prior to study, participants completed measures on intellectual functioning
(Wechsler Abbreviated Scale of Intelligence) and trait paranoia (Green et al. Paranoid
Thoughts Scale (GPTS) Part B) followed by numerous measures on factors in cognitive
model of paranoia. Simulator-sickness questionnaire was given before and after the
simulation.
● Virtual reality environment was a 5 min journey on a London underground train
populated by computer generated ‘neutral’ avatars/characters. The avatars breathed
and also looked in a variety of directions. There was background tube noise and low
level snippets of conversation.
, ● Social paranoia scale was given after the simulation ended as well as qualitative data
collected about the participant’s experiences.
● During the virtual reality the clinician noted down the comments made by the
patient and whether these were positive, neutral or paranoid.
● Participants made comments ranging from positive (“One guy was checking me
out—flattering.”) to neutral (“Didn't think anyone thought anything about me. All
getting on with their own business. Nobody seemed to notice me.”) to paranoid
(“Thought a couple of the men were stuck up and nasty. Lady sitting down laughed at
me when I walked past.”). This shows an unambiguous demonstration of paranoid
thinking in the general public.
● Approximately one-third of the general population have persecutory thoughts about
computer characters.
● Validating the methodology, those higher in trait paranoia experienced higher levels
of persecutory ideation in VR.
● Freeman also reported that individuals who experience auditory hallucinations
experience them in the VR environment
Explanations of Schizophrenia and Delusional Disorder
– genetic (Gottesman and Shields, 1972)
● Schizophrenia appears to have a genetic cause as shown by Gottesman and Shields in
their review article of studies of adoption, siblings and twins with schizophrenia.
● An example of a genetic link is with psychosis. This consists of abnormalities such as
sensory dysfunction. These abnormalities have genetic origins (endophenotypes).
● It is believed that schizophrenic symptoms have distinct genetic markers that can be
inherited.
● All adoption studies found an increased incidence of schizophrenia in adopted
children with a schizophrenic biological parent.
● Biological siblings of children with schizophrenia showed a much higher percentage
of schizophrenia.
● All twin studies found a higher concordance rate for schizophrenia in monozygotic
(MZ) than dizygotic (DZ) twins.
● In Gottesman and Shield’s own study the rate was 58% for identical twins, and 12%
for non-identical twins.
● The sample for this study was 467 twins registered at Maudsely Hospital in London.
● 24 sets of MZ twins and 33 sets of DZ twins were used
● These twins were identified using blood group and fingerprint analysis
Characteristics of Schizophrenia Spectrum and Psychotic
Disorders
– definitions, examples and case studies of schizophrenia and psychotic
disorders
Schizophrenia is a mental health disorder that involves positive and negative symptoms. It
affects all aspects of a person’s thinking,emotions and actions.The DSM-V defines
schizophrenic spectrum and psychotic disorders as sharing one or more of the following:
Positive symptoms
● delusions (beliefs not based in reality)
● hallucinations (sensory experiences of things that do not exist)
● disorganised thoughts/speech (mixed up racing thoughts and jumbled speech)
● catatonic behaviour (not reacting to environment, rigid and unmoving or repetitive
movements)
Negative symptoms
● loss of speech (alogia)
● loss of motivation (avolition)
● diminished facial/emotion expression
● social/emotional withdrawal
These disturbances must have been continuously present for at least 6 months with at least
one month of symptoms and cannot be attributed to illegal substances or medicine. The
person in question must also show a reduction in normal functioning
Types of schizophrenia are no longer on the syllabus.
Examples
These could include substance or medication-induced psychotic disorder (from prolonged
use or withdrawal), schizotypical (personality) disorder (great difficulty developing
emotionally meaningful relationships and flat affect), schizoaffective disorder, and catatonia
associated with another mental disorder or condition.
,Conrad
● Had his first psychotic episode while on holiday when he was 22.
● Later diagnosed with schizo-affective disorder.
● Reluctant to seek treatment at first, spent eight months in a psychiatric ward.
● Found the right drug through trial-and-error, though maintaining a healthy weight
is a challenge; now 23
John Nash
● an American mathematician who made fundamental contributions to game theory,
differential geometry, and the study of partial differential equations.
● 1958 - diagnosed with paranoid schizophrenia
● Nash thought that all men who wore red ties were part of a communist conspiracy
against him. He mailed letters to embassies in Washington, D.C., declaring that they
were establishing a government.
● In 1961, Nash was admitted to the New Jersey State Hospital at Trenton. Over the next
nine years, he spent intervals of time in psychiatric hospitals, where he received both
antipsychotic medications and insulin shock therapy.
● Although he sometimes took prescribed medication, Nash later wrote that he did so
only under pressure. Nash did not take any medication after 1970, nor was he
committed to a hospital ever again.
● Nash recovered gradually. Encouraged by his then former wife, de Lardé, Nash lived
at home and spent his time in the Princeton mathematics department where his
eccentricities were accepted even when his mental condition was poor. De Lardé
credits his recovery to maintaining "a quiet life" with social support.
– schizophrenia and beliefs
Schizophrenia is diagnosed when individual shows at least two of the following for a
significant amount of time:
● delusions,
● hallucinations,
● disorganised speech,
● disorganised or catatonic behaviour,
● and flattened affect
*for at least one month. The individual must show occupational or social functioning that
has declined and these symptoms cannot be explained by another medical factor. At least
one of these symptoms must be delusions,hallucinations or disorganised speech.
,Delusional disorder is characterised by persistent delusions but whose other behaviours are
‘normal’. There is an absence of the other psychotic symptoms of schizophrenia such as
● hallucinations,
● disorganised speech or
● negative symptoms.
Some types of delusional disorder are:
● grandiose (belief that they have a (non-existent) unrecognised high status or great
skill),
● persecutory (being conspired against or pursued by those intending to harm),
● erotomaniac (belief someone is in love with them).
● jealous (belief that partner is being unfaithful).
These are all examples of non-bizarre delusions that could be true or possible. Individuals
may also experience bizarre delusions which are logically impossible.
To receive a diagnosis of delusional disorder symptoms must have been experienced for at
least one month and be unrelated to physiological effects of substance use.
– symptom assessment using virtual reality (Freeman, 2008)
● VR is intended to eliminate challenges such as misinterpreting social interactions
when checking symptoms and developing treatments for schizophrenia
● Usually, symptom assessment requires face to face interviews with the patient to
discuss behaviour. Some patients may not answer truthfully. VR can eliminate this by
making sure that paranoid thoughts and behaviours are genuine.
● 200 nonclinical members of the general population were used
● In the author’s initial work with students, a library scene was used but subsequently
a 5-minute ride on a London underground train between 2 stations has been
developed.
● Prior to study, participants completed measures on intellectual functioning
(Wechsler Abbreviated Scale of Intelligence) and trait paranoia (Green et al. Paranoid
Thoughts Scale (GPTS) Part B) followed by numerous measures on factors in cognitive
model of paranoia. Simulator-sickness questionnaire was given before and after the
simulation.
● Virtual reality environment was a 5 min journey on a London underground train
populated by computer generated ‘neutral’ avatars/characters. The avatars breathed
and also looked in a variety of directions. There was background tube noise and low
level snippets of conversation.
, ● Social paranoia scale was given after the simulation ended as well as qualitative data
collected about the participant’s experiences.
● During the virtual reality the clinician noted down the comments made by the
patient and whether these were positive, neutral or paranoid.
● Participants made comments ranging from positive (“One guy was checking me
out—flattering.”) to neutral (“Didn't think anyone thought anything about me. All
getting on with their own business. Nobody seemed to notice me.”) to paranoid
(“Thought a couple of the men were stuck up and nasty. Lady sitting down laughed at
me when I walked past.”). This shows an unambiguous demonstration of paranoid
thinking in the general public.
● Approximately one-third of the general population have persecutory thoughts about
computer characters.
● Validating the methodology, those higher in trait paranoia experienced higher levels
of persecutory ideation in VR.
● Freeman also reported that individuals who experience auditory hallucinations
experience them in the VR environment
Explanations of Schizophrenia and Delusional Disorder
– genetic (Gottesman and Shields, 1972)
● Schizophrenia appears to have a genetic cause as shown by Gottesman and Shields in
their review article of studies of adoption, siblings and twins with schizophrenia.
● An example of a genetic link is with psychosis. This consists of abnormalities such as
sensory dysfunction. These abnormalities have genetic origins (endophenotypes).
● It is believed that schizophrenic symptoms have distinct genetic markers that can be
inherited.
● All adoption studies found an increased incidence of schizophrenia in adopted
children with a schizophrenic biological parent.
● Biological siblings of children with schizophrenia showed a much higher percentage
of schizophrenia.
● All twin studies found a higher concordance rate for schizophrenia in monozygotic
(MZ) than dizygotic (DZ) twins.
● In Gottesman and Shield’s own study the rate was 58% for identical twins, and 12%
for non-identical twins.
● The sample for this study was 467 twins registered at Maudsely Hospital in London.
● 24 sets of MZ twins and 33 sets of DZ twins were used
● These twins were identified using blood group and fingerprint analysis
