Symptoms of Schizophrenia

12 Key excerpts on "Symptoms of Schizophrenia"

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  Abnormal Psychology

  An Integrative Approach

  • David Barlow, V. Durand, Stefan Hofmann, , David Barlow, V. Durand, Stefan Hofmann(Authors)
  • 2017(Publication Date)
  • Cengage Learning EMEA

    (Publisher)

  Previous editions of the DSM struggled with this concept in its varied presentations over the years, and, as we describe in this chapter, DSM-5 currently includes schizophrenia as well as other related psychotic disorders that fall under this heading (including schizophreniform, schizoaffective, delusional, and brief psychotic disorders). In addition, a personality disorder (schizotypal per-sonality disorder, discussed in Chapter 12) is also considered to be included under this umbrella category of schizophrenia spec-trum disorders. All of these difficulties seem to share features of extreme reality distortion (for example, hallucinations, delusions). Later we discuss the symptoms the person experiences during the disorder (active phase symptoms), the course of the disorder, and spectrum of disorders included in this category. Mental health workers typically distinguish between positive and negative Symptoms of Schizophrenia. A third dimension, dis-organized symptoms, also appears to be an important aspect of the disorder (Liddle, 2012). Positive symptoms generally refer to symptoms around distorted reality. Negative symptoms involve deficits in normal behavior in such areas as speech, blunted affect (or lack of emotional reactivity), and motivation (Foussias et al. 2014). Disorganized symptoms include rambling speech, erratic behavior, and inappropriate affect (for example, smiling when you are upset). A diagnosis of schizophrenia requires that two or more positive, negative, and/or disorganized symptoms be present for at least 1 month, with at least one of these symptoms including delusions, hallucinations, or disorganized speech.

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  Essentials of Abnormal Psychology

  • V. Durand, David Barlow, Stefan Hofmann, , V. Durand, David Barlow, Stefan Hofmann(Authors)
  • 2018(Publication Date)
  • Cengage Learning EMEA

    (Publisher)

  Mental health workers typically distinguish between positive and negative Symptoms of Schizophrenia. A third dimension, disorganized symptoms, also appears to be an important aspect of the disorder (Liddle, 2012). Positive symptoms generally refer to symptoms around distorted reality. Negative symptoms involve deficits in normal behavior in such areas as speech, blunted affect (or lack of emotional reactivity), and motivation (Foussias et al., 2014). Disorganized symptoms include rambling speech, erratic behavior, and inappropriate affect (for example, smiling when you are upset). A diagnosis of schizophre- nia requires that two or more positive, negative, and/ or disorganized symptoms be present for at least one month, with at least one of these symptoms including delusions, hallucinations, or disorganized speech. DSM-5 also includes a dimensional assessment that rates the severity of the individual’s symptoms on a 0 to 4 scale with 0 indicating a symptom is not present, 1 indicat- ing equivocal evidence (i.e., not sure), 2 indicating it is present but mild, 3 that it is present and moderate, and 4 that it is present and severe (American Psychiatric Asso- ciation, 2013). A great deal of research has focused on the different Symptoms of Schizophrenia, each of which is described here in some detail. Positive Symptoms The positive Symptoms of Schizophrenia are the more obvious signs of psychosis, including delusions and hal- lucinations. Between 50% and 70% of people with schiz- ophrenia experience hallucinations, delusions, or both (Lindenmayer & Khan, 2006). Delusions A belief that would be seen by most members of a soci- ety as a misrepresentation of reality is called a disorder of thought content, or a delusion. Because of its importance in schizophrenia, delusion has been called “the basic char- acteristic of madness” (Jaspers, 1963, p. 93).

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  Handbook of Clinical Interviewing With Adults

  • Michel Hersen, Jay C. Thomas(Authors)
  • 2007(Publication Date)
  • SAGE Publications, Inc

    (Publisher)

  The two major classification systems, the Diagnostic and Statistical Manual of Mental Disorders ( DSM; American Psychiatric Associa-tion, 1980, 1994) and the International Classifica-tion of Diseases (World Health Organization, 1992) both specify that the diagnosis of schizophrenia is based on the presence of specific symptoms, the absence of other symptoms, and psychosocial difficulties that persist over a significant period of time. Symptoms and impairments must be pre-sent in the absence of general medical or so-called organic conditions (e.g., substance abuse and neurological disorders such as Huntington’s disease) that could lead to a similar clinical presentation. Core Symptoms and Impairments of Schizophrenia For descriptive purposes, the core Symptoms of Schizophrenia are divided into three broad categories: positive, negative, and cognitive symptoms or impairments. Positive symptoms are the presence of percep-tual experiences, thoughts, and behaviors that are ordinarily absent in people without a psychiatric 166 Schizophrenia 167 illness. The typical positive symptoms are halluci-nations (primarily hearing, but also feeling, seeing, tasting, or smelling in the absence of envi-ronmental stimuli), delusions (false or patently absurd beliefs that are not shared by others in the person’s environment), and disorganization of thought and behavior (disconnected thoughts and strange or apparently purposeless behavior). Some positive symptoms are considered highly specific, such as first-rank symptoms (e.g., delu-sions of thought insertion or auditory hallucina-tions with a running commentary), and perhaps even pathognomonic (particularly affect, i.e., emotional expression, that is inappropriate to the content of the person’s thoughts at that time).

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  Pseudoscience in Child and Adolescent Psychotherapy

  A Skeptical Field Guide

  • Stephen Hupp(Author)
  • 2019(Publication Date)
  • Cambridge University Press

    (Publisher)

  7 Psychosis Rachel Waford and Carina A. Iati Psychosis refers to a set of symptoms that impair a person’s ability to interact with reality. Individuals who experience psychosis may have some or all of the possible symptoms. Symptoms of psychosis are divided into roughly four categories: positive symptoms, negative symptoms, symptoms of disorganization, and cognitive symptoms. Positive symp- toms refer to experiences that were not present before the illness and are in addition to typical experience. Positive symptoms include hallucina- tions (false sensory experiences) and delusions (firmly held false beliefs). Negative symptoms refer to qualities that are typically present before the onset of the illness but are now decreased or absent. Loss of motivation, decreased ability to display emotion in facial expression, and social isolation are examples of possible negative symptoms. Symptoms of disorganization generally present as a confused way of speaking or behaving. An individual who is disorganized may speak or behave in ways that do not make sense to the people around them. Cognitive symptoms may present as a newly emerging difficulty with attention, concentration, impulse control, or memory. Psychosis can occur as part of a number of mental health conditions. Up to 3% of the general population may experience psychosis in their lifetime (Perälä et al., 2007). Each condition differs from the others in a meaningful way and is defined by a set of criteria that describe the particular set of symptoms comprising the illness. The Diagnostic and Statistical Manual of Mental Disorders (5th ed) (DSM-5; American Psychiatric Association, 2013) classifies these illnesses under Schizophrenia Spectrum and Other Psychotic Disorders section and identifies illnesses that always include a component of psychosis. These illnesses include schizophreniform disorder, schizophrenia, brief psycho- tic disorder, delusional disorder, and schizoaffective disorder.

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  Introduction to Psychiatry

  Preclinical Foundations and Clinical Essentials

  • Audrey Walker, Steven Schlozman, Jonathan Alpert(Authors)
  • 2021(Publication Date)
  • Cambridge University Press

    (Publisher)

  Here the social worker dealing with the family is an important team member of the treatment team. Clinicians who care for patients with schizophrenia need to be skilled at treating all major domains of psychopathology, not just psychosis. Mood episodes (major depression and mania), anxiety disorders (especially panic attacks and obsessive compulsive disorder), and substance use are all highly comorbid with schizophre- nia and need to be adequately addressed. In addition, impulsivity and anger can be significant components of the clinical presentation. Finally, partial or poor treatment adherence is common in this condition and this is associated with poor outcomes. Another important clinical aspect of schizophrenia is its heterogeneity. Patients with this condition present with a variety of clinical pictures. Some have a classic paranoid psychosis with hallucinations and delusions but preserved cognition; others have poorly formed delusions but pronounced negative and cognitive symptoms; others still evolve in their presentation over time. Note that the symptomatic criteria for schizophrenia can be satisfied equally well by totally non-overlapping presenta- tions (e.g., in Table 5.1 criterion A, items (1+4) by one patient but (2+5) by another). Previous classification schemes had described schizophrenia subtypes based on this heterogeneity. DSM-5 no longer recognizes the historical subtypes of schizophrenia Introduction 113 (i.e., paranoid, hebephrenic, and catatonic), as they are unstable and as they do not adequately capture the diversity among patients with the condition. Instead, clinicians are asked to capture dimensions of psychopathology to describe individual patients. Description of Symptoms Positive symptoms include delusions, hallucinations, (formal) thought disor- der, and disorganized motor and social behavior. Delusions are false beliefs that cannot be attributed to the patient’s culture or background and are resistant to change.

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  Madness: A Biography

  • Paul Fallon(Author)
  • 2019(Publication Date)
  • Bloomsbury Academic

    (Publisher)

  A number of researchers have pointed out that symptoms such as hearing voices are actually quite common. A number of studies of students have consistently found that around 37–39 per cent report experiencing hearing voices and general pop-ulation studies have found rates of between 10 and 25 per cent of people who have experienced hearing voices at least once (Morrison et al., 2000 ). Schizophrenia is a complex disorder characterised by an array of symptoms that vary between individuals leading to diverse symptom profiles. Symptoms such as delusions (a false or erroneous belief), hal-lucinations and thought disorder (disorganised thinking), are often described as positive symptoms whereas other symptoms such as cog-nitive deficits and poverty of speech are usually described as negative symptoms (Egan & Weinberger, 1997; Harrison, 1999 ). Despite over a hundred years of refinements in the description of schizophrenia, its classification has never been free of controversy, as each subsequent generation of psychiatrists and psychologists has challenged the MADNESS: A BIOGRAPHY 96 conceptual framework used by the previous generation and sought to change its parameters. Psychiatrists in the nineteenth century were inspired by advances in general medicine where clinically identifiable syndromes were being described, and sought to replicate this for the existing global concepts of dementia, delirium and insanity (Wing & Agrawal, 2003). Emile Kraepelin originally argued that dementia praecox (an early description of what later became known as schizophrenia) and manic-depressive psychosis (what we now call bipolar affective disorder) were separate entities and he was the first to systematically describe the main symptoms of each. However, Kraepelin’s views were not rigid and he continued to develop them to the point that, by 1920, he came to believe that dementia praecox and manic-depressive psychosis could coexist, possibly as a unitary psychosis.

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  Clinical Handbook of Psychological Disorders

  A Step-by-Step Treatment Manual

  • David H. Barlow(Author)
  • 2021(Publication Date)
  • The Guilford Press

    (Publisher)

  —D. H. B. S chizophrenia is a serious mental health problem that is characterized by positive symptoms of hal- lucinations, delusions, and disorders of thought. Typi- cally, hallucinations are auditory, in the form of hearing voices that often talk about the person and in the third person, although hallucinations can occur in other senses. Delusions are strongly held beliefs that are cul- turally unacceptable or that other people do not share and often involve a misinterpretation of perception or experience. The content of delusions may include a va- riety of themes, including alien control; persecution; reference; and somatic, religious, or grandiose ideas. Disorders of thought are inferred from disruption and disorganization in language. Hallucinations and delu- sions, and sometimes thought disorders, are referred to as “positive symptoms” and reflect an excess or distor- tion of normal functioning. “Negative symptoms” are also frequently present and reflect a decrease in or loss of normal function, including restrictions in the ex- pression of emotions, in the fluency and productivity of thought and language, and in the initiation of behavior. The consequences of these symptoms can be disrup- tions in personal, social, occupational, and vocational functioning. Comorbid disorders, especially depression and anxiety, are frequently present and further impair functioning. Suicide risk is high. Aspects of description, diagnosis, and classification of schizophrenia and other psychotic disorders have stimulated much debate and C H A P T E R 13 Schizophrenia and Other Psychotic Disorders Nicholas Tarrier Katherine Berry Schizophrenia and Other Psychotic Disorders 523 controversy over the decades, and details can be found in most psychiatry and abnormal psychology text- books. They do not concern us here except to say that there can be considerable variation in clinical presenta- tion between people and in the same person over time.

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  Essentials of Understanding Abnormal Behavior

  • David Sue, Derald Wing Sue, Diane Sue, Stanley Sue(Authors)
  • 2016(Publication Date)
  • Cengage Learning EMEA

    (Publisher)

  The spectrum includes disorders that differ from schizophrenia in a variety of ways, including the specific symp-toms involved, the duration of symptoms, or the presence of additional symptoms. Additional disorders on the schizophrenia spectrum include delusional disorder, brief psychotic disorder, schizophreniform disorder, and schizoaffective disorder (see Table 11.3). Delusional Disorder D i S O R D E R S C h a R T Disorder Symptoms Prevalence Gender Differences Age of Onset Schizophrenia Two or more psychotic symptoms of which at least one must be delusions, hallucinations, or disorganized speech; impaired life functioning • About 1% of the population • About equal • 18–24 for men • 24–35 for women Brief psychotic disorder One or more psychotic symptoms, of which at least one must be delusions, hallucinations, or disorganized speech for at least 1 day but less than 1 month • Up to 9% of new cases of psychosis • Much higher in developing countries • Twice as common in women • Can occur at any age • Most common in 30s Schizophreniform disorder Two or more psychotic symptoms, of which at least one must be delusions, hallucinations, or disorganized speech for at least 1 month but less than 6 months • Much lower rate than schizophrenia • Higher in developing countries • About equal • 18–24 for men • 24–35 for women Delusional disorder One or more delusions for at least 1 month • Rare: from 0.03%–0.18% • About equal • More prevalent in older adults Schizoaffective disorder Episode of mania or major depression concurrent with delusions, hallucinations, or disorganized speech; psychotic symptoms persist after the mood episode ends • About 0.32% • More females • Usually early adulthood Table 11.3 Schizophrenia Spectrum and Other Psychotic Disorders Source: APA (2013); Bhalla (2013); Brannon & Bienenfeld (2012); Memon (2013).

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  Hysteria and Related Mental Disorders

  An Approach to Psychological Medicine

  • D. Wilfred Abse(Author)
  • 2013(Publication Date)
  • Butterworth-Heinemann

    (Publisher)

  C H A P T E R V I SCHIZOPHRENIA BEFORE proceeding to discussion of the differentiation of hysteria from schizophrenia, it is necessary to provide some background information about the group of schizophrenias. For the most part this will be a discussion of symptoms, with no attempt to delve into the aetiology and psychopathology of these diseases, except in so far as this better serves the purpose of diagnostic differentiation, as discussed in Chapter V I L * Any personality disturbance, and schizophrenia is one of these, may be manifest in symptoms. These may be similar in different varieties of personality disturbance, so that the presence of a particular symptom is not necessarily indicative of a schizophrenic disorder. A symptom common enough in schizophrenia may be the manifestation of a quite different disturbance, even one of a fleeting character due to fatigue, arousal of strong emotion, excessive ingestion of alcohol, or a combina-tion of such factors. When, therefore, we describe the sorts of symptoms encountered in schizophrenic disease, even the most florid varieties of schizophrenia, it must not be assumed that their occurrence implies the presence of schizophrenia. For example, persistent and grave symptoms of personality disturbance may be due to a tumour of the brain. Such questions of differential diagnosis can only be settled by physical investigation. Certain varieties of schizophrenic personality disturbance are mani-fested by characteristic patterns of Symptoms, so that the study of symp-toms immediately assumes importance, though we have always to bear in mind problems of differential diagnosis as already stated. There is a difficulty of another order too, and that is as to what is recognizable as 'symptomatic' of severe personality disturbance. This may be best demonstrated by a discussion of a particular symptom not uncommon in schizophrenia, i.e., the symptom of delusion.

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  Cognitive Impairment in Schizophrenia

  Characteristics, Assessment and Treatment

  • Philip D. Harvey(Author)
  • 2013(Publication Date)
  • Cambridge University Press

    (Publisher)

  Section 1 Chapter 1 Characteristics of cognitive impairment in schizophrenia Cognition as a central illness feature in schizophrenia R. Walter Heinrichs, Ashley A. Miles, Narmeen Ammari, and Eva Muharib Introduction Schizophrenia is a loose and heterogeneous syndrome defined by implausible and peculiar beliefs and sensory experiences, social withdrawal, restricted or inappropriate emotional expression, and disorganized behavior. These positive and negative symptoms were described clearly and comprehensively in Kraepelin’s (1896, 1919) seminal accounts of dementia praecox. It is perhaps less well appreciated that a range of cognitive deficits were also considered characteristic of the illness (Table 1.1). Indeed, another pioneer, Bleuler (1943, 1950), argued that impairments in “associative” thinking were “fundamental” abnormalities in schizophrenia whereas delusions and hallucinations were only “accessory” symptoms. Nevertheless, for several decades psychotic symptoms were used to define the disorder and impairments in basic cognitive processes were neglected, excluded, or viewed as peripheral treatment artifacts (Randolph et al., 1993). Over the last 20 years this situation has changed and cognition has re-emerged as a core domain of schizophrenia research and intervention initiatives. Yet determining the meaning and significance of cognitive performance and impairment in the disorder remains both a challenge and an opportunity. Is an understanding of cognition essential to advance schizophrenia science and treatment or is it a secondary problem, an interesting sideline that addresses a correlate, but not a determinant of the disorder? This chapter considers evidence from both perspectives and argues for a critical appraisal of the role of cognition in psychotic illness.

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  Understanding Abnormal Behavior

  • David Sue, Derald Wing Sue, Stanley Sue, Diane Sue, David Sue, Derald Wing Sue, Diane Sue, Stanley Sue(Authors)
  • 2020(Publication Date)
  • Cengage Learning EMEA

    (Publisher)

  American Psychiatric Association Copyright 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Etiology of Schizophrenia | 381 own perspectives without understanding that others have their own viewpoint. As you might imagine, this could create major difficulties in communication and inter-personal interactions. In an interesting study, 79 individuals with psychotic symptoms described their delusions to an interviewer and were asked if the situation was believ-able for them and for the interviewer. The vast majority of participants indicated that they found the situation believable; 85 percent also thought the interviewer would find it believable. Two weeks later, all participants went through the same interview process. During this second interview session, a few more participants reported that the delusion was not believable, and 75 percent indicated that the interviewer might not find it believable. The researchers concluded that by considering a third-person perspective (e.g., the interviewer’s perspective on the situation), some participants were able to increase their insight and understanding that their beliefs were not based on reality (Islam et al., 2011). Early cognitive deficits are also associated with schizophrenia. Numerous studies have documented an association between early developmental delay and schizophre-nia. One large prospective population study found that infants who later developed schizophrenia were slower to smile, lift their heads, sit, crawl, and walk compared to infants who did not develop schizophrenia (Sørensen et al., 2010).

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  Abnormal Psychology

  • Gordon L. Flett, Nancy L. Kocovski, Gerald C. Davison, John M. Neale(Authors)
  • 2018(Publication Date)
  • Wiley

    (Publisher)

  People with schizophrenia also reported more child- hood “social troubles.” These manifestations of schizophrenia are often the first to appear, beginning in childhood before the onset of more psychotic symptoms. Some of these inter- personal deficits could reflect related deficits in the ability to recognize emotional cues displayed by others (Addington & Addington, 1998). Other Symptoms Some authors (e.g., Heinrichs, 1993, 2001) have taken issue with the usefulness of the positive vs. negative symptom distinction. One problem is that positive and negative symp- toms do not necessarily reflect exclusive subtypes because they are dimensions that often coexist within the same per- son. Moreover, several other Symptoms of Schizophrenia do not fit neatly into the positive-negative scheme. Two impor- tant symptoms in this category are catatonia and inappropri- ate affect. Many people also exhibit various forms of bizarre behaviour. They may talk to themselves in public, hoard food, or collect garbage. Catatonia Catatonia is defined by several motor abnor- malities. Some clients gesture repeatedly, using peculiar and sometimes complex sequences of finger, hand, and arm An 1896 photo showing a group of people with catatonic immobility. These men held these unusual positions for long periods of time. From Sander L. Gilman, Seeing the Insane, 1996, University of Nebraska Press. 312 CHAPTER 11 Schizophrenia blocking—an apparently total loss of a train of thought—as a complete disruption of the person’s associative threads. Although Kraepelin recognized that a small percentage of clients who originally manifested symptoms of dementia praecox did not deteriorate, he preferred to limit this diagnostic category to clients who had a poor prognosis. Bleuler’s work, in contrast, led to a broader concept of schizophrenia.

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