Sub-types of Schizophrenia

(1)   Simple Schizophrenia

·        Slow and gradual onset (Late adolescence)

·         Symptoms
-  Social deterioration
- Apathy
- Loss of drive and interest
-Performance decline
-Social skills difficulties

·         Recognized in ICD but not in DSM

(2)    Hebepherenic (Disorganised) Schizophrenia

·         Slow and gradual onset (Early Twenties)

·         Typically progressive and irreversible

·         Most first rank and behavioural characteristics displayed

(3)    Catatonic Schizophrenia

·         Severe and sudden onset (usually in early adulthood)

·         Principal disturbance in psychomotor (e.g. agitated catatonia, elective mutism, waxy flexibility)

·         Often accompanied by ‘negativism’

(4)    Paranoid Schizophrenia

·         Gradual onset (usually mid-thirties)

·         Principal disturbances are delusions and hallucinations

·         Much less disturbed in other respects

(5)    Undifferentiated Schizophrenia

·         Also known as ‘atypical’

·         A catch-all category for those not easy to classify

Slater and Roth's (1969) Behavioural Characteristics

These are objective diagnostic indicators

(1) Thought process disorder

• Loose associations (derailment): Wandering from topic to topic, with the wandering often triggered by 'cue' words.
• Word salad: Extremely loose associations producing incoherent speech.
• Neologism: The use of non-words or the novel combination of actual words.
• Clang associations: The linking of words with no relationship to each other, apart from them sounding alike (e.g. rhyming).
• Poverty of content: Talking a lot, but saying little of any meaning.
• Literal interpretation: For example, proverbs
• Thought blocking: Stopping abrupt during speech and failing to remember what comes next.

(2) Disturbances of Affect (emotion)

• Blunted affect: Diminished emotional experience
• Flattened affect: The absence of emotional experience
• Inappropriate affect: Producing the opposite (or different) expected emotion

(3) Psychomoter Disorders (movement)

• Catatonia (Catatonic stupor or excitement): Can range from mutism to agitation
• Stereotypy: Production of repeated movements (e.g. body rocking)

(4) Lack of Volition (movement)

• Apathy: Loss of interest in personal things and/or the environment
• Loss of drive: Lack of motivation to do things

Clinical Characteristics of Schizophrenia

Schneider's (1959) 'first rank' symptoms (subjective experiences)
1. Passivity experiences and thought disturbances
2. Hallucinations
3. Primary delusions

(1) Though broadcasting, thought withdrawal, and thought insertion
(2) Mainly auditory, but can be visual, tactile, olfactory and gustatory.
     Can be third person, insulting, running commentary. Can be second person. Can be internal.
     Can be external. Can be a distortion
(3) Delusion - A false belief which is maintained even when there is evidence to contradict it.
- Delusions of Grandeur (claim to be someone of historical significance)
- Delusions of Persecution - Paranoid
- Delusions of Reference
- Delusions of sin and guilt
- Hypochondria (cal delusions)
- Delusions of Nihilism
- Control (or delusions of influence) - someone/something is controlling their thoughts
- Capgras syndrome - The belief that people you know have been replaced by identical doubles
- Fregoli syndrome - The belief that other people can take the form of others

Schizophrenia

• A psychotic disorder
• Causes may be organic or functional
  Organic = Known to have a physical cause
  Functional = Suspected to have a physical cause but not yet proven
• Originally called dementia praecox (senility of youth)
• NOT the same thing as multiple personality disorder
• Worldwide incidence is around 0.2 to 2%
• Typically occurs in the late teens/early twenties (men) and late twenties (women)
• Can have a slow and gradual onset OR a sudden and severe onset
• Can be divided into the prodromal phasw, the active phase, and the residual phase
• The outcome is different for different people
• More common in some social classes than others:

            - Social drift hypothesis
            - Economic stress
            - Bias in diagnosis

Mental Disorders

Psychosis (e.g. schizophrenia)
- Out of touch with reality
- Lacks insight
- No anxiety

Neurosis (e.g. Phobias)
- In touch with reality
- Have insight about the condition
- Experience intense anxiety

Personality Disorders (e.g. Psychopathology)
- In touch with reality
- Lack insight
- No guilt or anxiety

Specification notes

Schizophrenia

• Clinical Characteristics of Schizophrenia (Psychological causes) OR Symptoms (Biological causes)
• Issues surrounding the classification and diagnosis of schizophrenia, including reliability and validity
• Biological explanations of schizophrenia, for example, genetics, biochemistry 
• Psychological explanations of schizophrenia, for example, behavioural, cognitive, psychodynamic and socio-cultural
• Biological therapies for schizophrenia including their evaluation in terms of appropriateness and effectiveness
• Psychological therapies for schizophrenia, for example, behavioural, psychodynamic and cognitive-behavioural, including their evaluation in terms of appropriateness and effectiveness