SCZ

Gurvinder Kalra, FRANZCP, MD, MBBS

Psychiatrist
Flynn Adult Inpatient Psychiatric Unit
LRH MHS
Traralgon, Victoria
Your understanding of SCZ?
DSM 5
A. >2of the foll each present for a significant
time during a 1m period (or less if
successfully Ttd). At least one must be (1),
(2), or (3):

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized / catatonic behavior
5. Negative symptoms
B. For significant portion of time since onset of disturbance,
level of fn in >1 areas (work, IP relations, self-care) is markedly
below the level achieved prior to the onset (in children /
adolescence, failure to achieve the level).

C. Continuous signs of disturbance persist for at least 6m. This

period must include at least 1m of symptoms (or less if
successfully Ttd) that meet criterion A (i.e. active-phase
symptoms) & may include periods of prodromal / residual
symptoms.

D. SCAD & MDD / BPAD with psychotic features have been r/o
(no MDD / manic epi have occurred concurrently with active-
phase symptoms; if mood epi have occurred during active-phase
symptoms, they have been present for a minority of the total
duration of active / residual periods of the illness.
E. r/o physiological effects of a substance (drug of abuse /
medication) or a GMC.

F. If there is a h/o ASD or a communication d/o of childhood

onset, the additional diagnosis of SCZ is made only if prominent
delusions /hallucinations, in addition to the other symptoms of
SCZ are also present for at least 1m (or less if successfully
Ttd).
Specifiers
Course specifiers used after a 1y duration of d/o
 1st epi Currently in acute epi
partial remission
full remission

 Multiple epi Currently in acute epi

partial remission
full remission

 Continuous

 Unspecified
Specifiers
Specify if with catatonia
Symptoms
 Positive
• Hallucinations / Delusions / disorganized speech &
behavior / catatonia

 Negative:
• Avolition, Amotivation, Apathy

• Alogia
Hard to recognise / Tt
• Asociality
More disabling
• Blunted Affect

• Anhedonia
Hallucinations
 AH: MC form of hallucination – 40-80% prevalence
 Typically ‘voices’. May take other forms e.g.
machinery, music
 May come from within the head or from an external
source
 Non-auditory hallucinations possible but may suggest
an alternative diagnosis
 Delusion
 Delusion: false unshakeable idea / belief which is out of
keeping with the patient’s educational, cultural, & social b/g.
It is held with extraordinary conviction & subjective
certainty.
 Present in ~80% of SCZ patients

 Overvalued idea vs delusion

 Bizarre vs non-bizarre.
 Types of delusions
 Persecution / prejudice
 Morbid jealousy / del of infidelity (Othello’s syndrome)
 Love (erotomania / de Clerambault syndrome / psychose
passionelle / Old maid’s insanity
 Grandiosity
 Religiosity
 Guilt / unworthiness
 Nihilistic / negation (Cotard’s syndrome)
 Hypochondriacal
 Infestation (Ekbom’s syndrome)
 Shared delusional d/o (Folie à deux)
 Delusion of control
 Delusion
Delusional mis-identification syndrome
 Capgras (close emotional ties & feelings of ambivalence)

 Fregoli
 Syndrome of intermetamorphosis: familiar person & misidentified
stranger share physical as well as psychological similarities.

 Syndrome of subjective doubles i.e. doppelganger &

autoscopy)
 Held with unusual
conviction

Delusion

Not amenable to
Erroneousness of
logic
their content is
manifest to other
Jaspers (1959)
people
 Bleuler’s 4 As
 Affect flattening

 Ambivalence

 LoA

 Autism
 Schneider’s FRS
 Hallucinations (audible thoughts, voices arguing/ discussing,
voices commenting)

 Somatic passivity (affect/ impulse / volition)

 Delusional perception (normal percept interpreted with
delusional meaning)

 Thought alienation (insertion / withdrawal / broadcasting)

 Not specific for SCZ; seen in other psych d/o

 Risk factors
 Family history
 Substance abuse

 Male
 Psychological stress
 Immigrant
 Obstetric insult
 Season of birth
 DDx
 Other psychotic illness: Delusional disorder, Brief psychotic
disorder, schizophreniform disorder, SCAD
 Other psychiatric conditions:

o MDD, BPAD with psychotic or catatonic features

o PTSD, OCD, body dysmorphic disorder
o Delirium
o Dementia
o Substance-induced
o Other organic cause: E.g. mass lesion, TLE, traumatic brain
injury, Wilson’s disease
DDx
Etiological considerations
 Unknown – genetic basis (twin studies)

 Family dynamics – High EE, schizophrenogenic

family

 Neurochemical –
 Hyper – Dopamine, Serotonin, alpha-adrenergic
 Hypo – Glutamine, GABA