 1 in 100 Americans develop Schizophrenia in their lifetime

 In the Philippines, it is the top brain disorder, affecting at least 42 percent of

patients who seek psychological treatment and consultation
 Equally prevalent in men and women; earlier onset in men
 Peak ages are 10-25 in men and 25 to 35 in women
 Usually begins before age 25
 Men are more likely to be impaired with negative symptoms
 Better social functioning before disease onset for women
 Genetics

Neuropharmacology

Schizophrenia

Neuroanatomy

Neural circuit
dysfunction
Genetic vulnerability +
environmental factors • In utero infections
• Stress and
malnutrition
• Perinatal
variables
• Urbanicity
= Schizophrenia
 Cousins
Less
related Half-sibling

Parent

Sibling

Children

Dizygotic twin

Sibling & one parent

More Both parents
related
Monozygotic twin

0 10 20 30 40 50 %
Riley et al, In Weinberger (Ed.), Schizophrenia, 2003
 Neurodevelopment and neuroprotection
 Dysbindin, BDNF, DISC-1

 Glutamate function
 Neuregulin-1

 Monoamine function and receptors

 Dysbindin, COMT, MAOA
 Too much dopaminergic activity
 Excess serotonin
 Selective neuronal degeneration within the norepinephrine reward neural system
 Loss of GABAergic neurons in the hippocampus→ hyperactivity of dopaminergic
neurons
 Alteration in neuropeptide mechanisms which alter firing of neuronal systems
 Antagonist to glutamate
 Decreased muscarinic and nicotinic receptors in the caudate-putamen,
hippocampus, and selected regions of the prefrontal cortex
Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications
Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications
Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications
Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications
Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications
Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications
 Lateral and third ventricle
enlargement and some reduction in
cortical volume
 Reduced symmetry in temporal,
frontal, and occipital lobes
 Decrease in size of limbic region,
amygdala, hippocampus, and
parahippocampal gyrus
 Abnormalities in prefrontal cortex
 Volume shrinkageor neuronal loss of
thalamus
 dysfunction of the anterior cingulate basal ganglia thalamocortical circuit underlies
the production of positive psychotic symptoms,
 dysfunction of the dorsolateral prefrontal circuit underlies the production of
primary, enduring, negative or deficit symptoms.
 Psychoanalytic theory
 Family dynamics
 Double bind
 Schisms and Skewed families
 Pseudomutual and pseudohostile families
 Expressed emotion
 Diagnosis of Schizophrenia: DSM-5

A. Two (or more) of the following, each present for a

significant portion of time during a 1-month period
(or less if successfully treated). At least one of these
must be 1, 2, or 3.
1) Delusions
2) Hallucinations
3) Disorganized speech (freq. derailment or incoherence)
4) Grossly disorganized or catatonic behavior
5) Negative symptoms (i.e., diminished emotional
expression or avolition

Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

American Psychiatric Publishing, Washington DC, 2013
 Diagnosis of Schizophrenia: DSM-5
B. Social/occupational dysfunction
C. Duration: Continuous signs for at least 6
months (psychosis + prodrome + residual sx)
D. Schizoaffective and psychotic mood disorder
have been excluded
E. Not attributable to substance or general
medical condition
F. Not a manifestation of a pervasive
developmental disorder

Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

American Psychiatric Publishing, Washington DC, 2013
Positive Symptoms Negative Symptoms
Loss of insight • Affective flattening
• Delusions (anosognosia)
• Hallucinations • Anhedonia
• Disorganization • Alogia
• Catatonia • Avolition
Social/Occupational Dysfunction • Social withdrawal
• Work
• Interpersonal relationships
• Self-care

Cognitive Deficits Mood Symptoms

• Attention • Depression
• Memory Comorbid • Hopelessness
• Executive functions Substance Abuse • Suicidality
(eg, abstraction) • Anxiety
• Agitation
• Hostility
Adapted from Maguire GA, 2002
Type
Paranoid Preoccupation with one or more delusions or frequent auditory
hallucinations
No prominent disorganized speech, disorganized or catatonic behavior,
or flat or inappropriate affect
Disorganized Prominent disorganized speech
Disorganized behavior and Flat or inappropriate affect
Catatonic Motoric immobility, waxy flexibility or stupor
Excessive, purposeless motor activity
Mutism
Undifferentiated Patients with schizophrenia wo cannot be easily fit into one type or
another
Residual continuing evidence of the schizophrenic disturbance in the absence of a
complete set of active symptoms or of sufficient symptoms to meet the
diagnosis of another type of schizophrenia
 Good

Function

Psycho-
pathology

Prodromal
Premorbid Progression Stable
Relapsing
Poor
15 20 30 40 50 60 70
Age (Years)
Sheitman BB, Lieberman JA. The natural history and pathophysiology of treatment-resistant schizophrenia. J Psychiatr Res. 1998(May-Aug);32(3-4):143-150
Kaplan
 Antipsychotic medications
 First generation antipsychotics (haloperidol, fluphenazine)
 Second generation antipsychotics (clozapine risperidone, olanzapine)

 Psychosocial modalities
 Social skills training
 Family oriented therapies
 Case Management
 Assertive Community Treatment (ACT)
 Group therapy
 Cognitive behavioral therapy
 Individual psychotherapy
 Vocational therapy
 Art therapy
A. Period of illness w/ either mania or major
depression and criteria A of schizophrenia
B. During same episode as above, delusions or
hallucinations x ≥2 weeks w/o mood sx
C. Prominent mood episodes throughout total
duration of illness
D. Not d/t substances, gen’l med. Condition
E. Specifiers: Bipolar/Depressive type

Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

American Psychiatric Publishing, Washington DC, 2013
A. Criteria A, D, & E of schizophrenia are met
B. Episode (including prodromal, active, residual phases)
lasts ≥ 1 month but <6 months
C. “Provisional” if waiting for 6-month point
D. Specifiers: w/ vs w/o good prognostic features; w/
catatonia

Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

American Psychiatric Publishing, Washington DC, 2013
A. Presence of ≥1 of: delusions; hallucinations;
disorganized speech; grossly
disorganized/catatonic behavior
B. Duration of sx: ≥ 1 day, < 1 month; full return
to premorbid function
C. Not d/t mood, other psychotic disorder or
substances or gen’l med. Condition
D. Specifiers: w/ vs w/o marked stressors;
postpartum

Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

American Psychiatric Publishing, Washington DC, 2013
A. Delusion(s) of ≥ 1 month duration
B. Criteria A of schizophrenia never fully met
C. Behavior & function not markedly impaired
except as affected by delusions
D. Total duration of mania or depression brief
relative to duration of delusions
E. Not d/t substances or gen’l med. condition
F. Specifiers: Erotomanic, grandiose, jealous,
persecutory, somatic, mixed

Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

American Psychiatric Publishing, Washington DC, 2013
Type
Persecutory Convinced they are being persecuted or harmed
Jealous Delusions of infidelity “conjugal paranoia”
Erotomanic “de Clerambault’s syndrome” A person, usually of higher power, is in
love with him/her
Somatic Delusion of infestation
Delation of dysmorphobia
Delusion of foul body odors or halitosis
Grandiose Delusions of grandeur
Mixed Patients with two or more delusions