Schizophrenia – Clinical Features

⦿ an estimated 1% of population has Schizophrenia.

⦿ In DSM-5 Schizophrenia is defined as :

1. a group of characteristic positive or negative symptoms,
2. deterioration in social, work or interpersonal relationships &
3. continuous signs of the disturbance for at least 6 months.

Dimensional Approach to Schizophrenia:

There are 3 symptoms dimensions:
1. Psychotic Dimension
2. Disorganization Dimension
3. Negative Dimension.

1. Psychotic Dimension

(i) Hallucinations :

Hallucinations are the perceptions experienced without an external stimulus with a quality similar to a true perception.

(ii) Delusions:

Delusions are firmly held beliefs that are untrue, as well as contrary to person’s educational and cultural background.

2. Disorganization Dimension

(i) Disorganized speech or thought disorder:

  • Derailment (Loosening of Association)
  • Poverty of speech
  • Poverty of content of speech
  • Tangentiality
  • Perseveration
  • Distractibility
  • Neologism
  • Echolalia
  • Thought blocking

(ii) Disorganized Motor & Social Behavior

(a) Disorganized Motor Behaviour:

  • Catatonic stupor: immobile, mute & unresponsive yet conscious
  • Catatonic excitement: Uncontrolled & aimless motor activity
  • Stereotypy: Repeated non-goal directed activity.
  • Grimacing
  • Echopraxia: Imitating movements & gestures of another person.
  • Automatic obedience: Carrying out simple commands in a robot like fashion.
  • Negativism: refusing to cooperate with simple requests for no apparent reason.

(b) Disorganized social behaviour:

  • Poor Personal Hygiene
  • Masturbating in public
  • Shouting obscenities

(iii) Incongruity of affect:

  • Patient may smile inappropriately on sad topics.
  • Giggle for no apparent reason.

3. Negative Dimension

Five A’s :

(i) Affective Flattening/blunting
(ii) Avolition : loss of ability to initiate goal directed activity & carry it through to completion.
(iii) Alogia : poverty of speech.
(iv) Anhedonia : inability to experience Pleasure.
(v) Attention Impairment.

Reference:

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