Schizophrenia Spectrum

Delusional

Diagnostic Criteria: False belief, delusions lasting at least 1 month.

Subtypes: Erotomaniac (the person believes that another person is in love with him or her). Grandiose (the person believes he/she has great but unrecognized talent or insight). ) Jealous (the person believes his/her spouse or partner is unfaithful), persecutory (the person believes he/she is being conspired against, spied on, poisoned, or maliciously maligned); somatic (the person’s delusion involves bodily functions or sensations).

Brief Psychotic

Description: Brief episodes of psychosis.

Etiology: Stress, trauma.

Top Comorbidities: Mood disorders, anxiety.

Schizoaffective

Schizophrenia

Schizophreniform

Diagnostic Criteria: Positive and negative symptoms (Delusions, hallucinations, or disorganized speech, grossly disorganized or catatonic behavior) and negative symptoms, Affect, Ambivalence, alogia (difficulty to speak), Anhedonia (no pleasure), Blunted affect, Asociality)). Active phase last 1 month, signs continue 6 months**.

Top Comorbidities: substance use disorders (70-85% tobacco user). Anxiety, OCD.

Diagnostic Criteria: Symptoms, (Delusions, Hallucinations, or disorganized speech) for 1-6 months.

Top Comorbidities: Mood disorders, anxiety.

Diagnostic Criteria: Schizophrenia symptoms + mood episodes (Major depressive or manic episode), but with the presence of delusions or hallucinations for two or more weeks without mood symptoms.

Top Comorbidities: Substance use disorders, mood disorders.

At least 1 Day, but less than 1 month with at least one of being delusions, hallucinations, or disorganized speech.

Concordance Rate

Parent 6%

Biological sibling 9%

Child of one parent with schizophrenia 13%

Dizygotic (fraternal) twin 17%

Child of two parents with schizophrenia 46%

Monozygotic (identical) twin 48%

Neurotransmitters: Dopamine, Glutamate, Serotonin

Positive symptoms of schizophrenia are due to dopamine hyperactivity in subcortical regions of the brain

Negative symptoms are due to dopamine hypoactivity in cortical regions

Onset: Late teens, early 30s. (Males: early to mid 20s) (Females: Late 20s)

Hint: Schizo (delusions, hallucinations-Effective, mood). Delusions and hallucinations with mood can’t be together, they are separate. E

The DSM-5 distinguishes between the following subtypes: (a) erotomanic (the person believes that another person is in love with him/her); (b) grandiose (the person believes he/she has great but unrecognized talent or insight); (c) jealous (the person believes his/her spouse or partner is unfaithful); (d) persecutory (the person believes he/she is being conspired against, spied on, poisoned, or maliciously maligned); and (e) somatic (the person’s delusion involves bodily functions or sensations).

Schizoid

Voluntary Social isolation, Indifferent to other people

Don't experience hallucinations & Delusions.

No odd, disorganized though, appearance & behavior.

Schizotypal

Don't experience hallucinations & Delusions

Interpersonal difficulties & Social anxiety

Have odd, thought, appearance & behavior.

Treatment:** psychosocial interventions, an antipsychotic drug, and adjunctive medications to treat comorbid disorders. Evidence-based psychosocial interventions include assertive community treatment, cognitive-behavior therapy for psychosis, cognitive remediation for schizophrenia, family psychoeducation, social skills training, supported employment, and acceptance and commitment therapy.

ccording to the dopamine hypothesis, Schizophrenia is due to overactivity at dopamine receptors either as the result of oversensitivity of the receptors or excessive dopamine levels.
Revised dopamine hypothesis- too much dopamine =hyperactivity of positive symptoms in subcortical parts of brain, hypo=negative symptoms like depression affect- cortical/pre-frontal cortex