• delusions
• hallucinations
• Disorganized speech and thoughts
• disorganized and/or catatonic behavior
• Negative symptoms (lack of important things)

o   Delusions of persecution: belief that someone is following them, watching them, persecuting them in some way. Recently it’s common to have delusions of persecutions on the internet. Sometimes hard for therapist to tell whether delusions are actually true.

o   Delusions of control: belief that people can influence actions and thoughts.

o   Delusions (or ideas) of reference: belief that things happening around them have special significance to them. People on TV are talking to them, etc. A Beautiful Mind.

o   Delusions of grandeur: person is very important or has special powers. Some believe they are Jesus or prophets, Michael Jackson. Can read people’s minds. These lines are fuzzy, but most important thing is how “delusions” are impacting the person’s life.

o   Delusions of sin and guilt: some people think they have done something specifically bad, like murder. Others are more vague, just know they’ve been bad.

o   Hypochondriachal (somatic) delusions: something is going on with their body that’s not actually happening. Like being sick or pregnant.

o   Nihilistic delusions: person is dead, world is ended, other people dead. Very negative and have to do with death.

-Thought broadcasting-other people are aware of their thoughts

-Thought insertion-someone is putting thoughts into your head.

-Thought withdrawal: people taking thoughts out of your head.

• Usually auditory or visual (mostly auditory). Voice is ungendered and perceived as coming from outside of self. on EEG, auditory part of brain is active, not sure why. voices often comment on behavior and are usually negative but sometimes positive.
• Command hallucinations: when people interpret voices as commands they must obey.
• more unusual: olfactory, tactile, gustatory: odors can be hallucinated (connected with epilepsy), feelings of things crawling on skin (associated with drug/alchohol withdrawal). gustatory-feelings of organs moving around. unusual.

• Problems in dressing, feeding, grooming self. unpredictable, extreme agitation, innapropriate behavior.
• Shuffle-may be due to medication, not disease
• Catatonic behavior-stupor, rigidity, excitement
• Stereotypy-engaging in purposeless behaviors repetively over long periods of time

1. Blunted Affect - low emotion
2. Flat affect - no emotion
3. Innapropriate affect - wrong emotion
4. Social withdrawal - lack of attention to goings on of external world
5. Impaired social skills 
6. Anhedonia - loss of interest in everything in life
7. Alogia - severe reduction or complete absence of speech
8. Avolition - inability to persist at common, goal-oriented tasks such as getting dressed and eating breakfast

• 1-2% of general population
• Some differences in different countries and in different parts of the same country. Ex-more common in urban China than rural China.
• People with schizophrenia occupy about 50% of available hospital beds
• Cost – 62.7 billion (22.7 billion is due to direct care). Meaning it’s very severe and has big impact on resources.

1. paranoid
2. disorganized
3. catatonic
4. undifferentiated
5. residual

1. uninterrupted period of illness during which there is either a major depressive episode, a manic episode, or a mixed episode concurrent with symptoms that meet first criterion for schizophrenia
2. during same people of illness, there have been delusions or hallucinations for at least 2 weeks in absence of prominent mood symptoms
3. symptoms that meet criteria for a mood episode are present for a substantial portion of total durtation of active and residual periods of illnes

• pronounced incoherent speech
• mood disturbance
• disorganized behavior/lack of goal orientation
• NOT prominent-delusions/hallucinations, fear of persecution (if there, it's vague)

• marked disturbance in motor behavior
• catatonic stupor - like a coma, don't even respond to chest rubbing
• waxy flexibility
• bizarre gestures and posturing - like walking and freezing, walking and freezing...
• catatonic rigidity - opposite of waxy
• echolalia- mimicking speech
• echopraxia - mimicking movement

•  
  • Positive symptoms: presence of something normally absent (respond better to anti-psychotic meds)
  • Negative symptoms – absence of something that is normally present
  • Associated with onset and premorbid functioning
  • Associated with response to medications

• Low socioeconomic status (unemployed, urban dwellers, single)
• Late adolescence/early adulthood (earlier age, poorer prognosis)
• Women get it later than men, paranoid is more common at later age.
• But overall, men more likely to be diagnosed and have negative symptoms.
• Poor prognosis in industrialized countries. USA has one of highest diagnosis rates.

•  
  • Family studies
    • One parent with schizophrenia – 13% risk
    • Two parents with schizophrenia – 46% risk
  • Twin studies
    • Concordance rate for MZ twins – 46%
    • The more severe the symptoms, the greater discordance

•  
  • People with chronic schizophrenia have smaller brains, but this could be the effect of medication
  • Some show enlarged brain ventricles as well as abnormalities in structures near ventricles
  • Problems with frontal lobe, temporal lobe, and (primarily) basal ganglia-part of limbic system. Close to ventricles, so there may be a connection.

1. there may be excess dopamine activity in the mesolimbic pathway (involved in cognition and emotion)
2. Leads to positive symptoms (low dopamine leads to negative symptoms)
3. makes sense, because atypical antipsychotics help many people, and they affect this region. 

1. medication management
2. symptom management
3. conversation skills
4. interpersonal problem-solving skills
5. recreation for leisure
6. community re-entry

1. Schizophrenia
2. Schizophreniform disorder - same as schizo but lasts less than 6 months
3. Schizoaffective disorder
4. Delusional disorder - only nonbizarre delusions of at least one month. high functioning
5. Brief psychotic disorder - presence of symptoms for more than a day, less than a month
6. shared psychotic disorder - individual is in close relationship with someone who is delusional with similar delusions
7. substance-induced psychotic disorder