Schizophrenia Spectrum Disorders

After Neurodevelopmental Disorders, the diagnostic manual takes a different direction and introduces us to Schizophrenia Spectrum Disorders and other Psychotic Disorders. Here we encounter at least three new terms: spectrum, schizophrenia, and psychotic.

In psychiatry, when we talk about a spectrum, we refer to a series of disorders with a common "root." We will see disorders that have the term "schizo-" in their names and similar symptoms, but in reality, they are different. The word 'schizophrenia' can be divided into 'schizo' and 'phrenia.' 'Schizo' in Greek means split, divided, separated, and 'phrenia' means mind. Therefore, schizophrenia suggests the concept of a divided mind.

The term 'psychotic' can be associated, in terms of assonance, with various words such as psychosis, psychotic symptoms, psychopathic, and psychotropic. All these words have different meanings, and only two of them are relevant to the topic of this post. Let's explore them:

• Psychosis: can be considered a synonym for Psychotic Disorders, which are characterized by presenting psychotic symptoms and, in the diagnostic manual, are represented by schizophrenia and other disorders.
• Psychotic symptoms: are symptoms that cause a detachment from reality, including delusions, hallucinations, disorganized thinking, disorganized motor behavior, and negative symptoms.
• Psychopathic: refers to a person with a severe personality problem that can lead to extreme behaviors without feeling remorse. It has nothing to do with schizophrenia or psychoses.
• Psychotropic: refers to a substance capable of altering cognitive, emotional, and behavioral functions of an individual. It has nothing to do with schizophrenia or psychoses.

To discuss Psychosis, I need to recall some terms I used in an old post and present them again.

Delusions: You might have told someone, "you're delusional!" Why did you say that? Probably because they were saying something that you felt was illogical or absurd. A delusion is a false belief in reality that is strongly held and cannot be modified. For example, if I assert that "Angelina Jolie is in love with me," I say it because in her movies, it is clear that she is winking at me, and no matter what you say, I know that she loves me. This is a (simplified) example of an 'erotomanic' delusion.

Hallucinations: These are easy to explain because we experience them daily through our senses. Hearing someone's voice who is not in the room would worry us a lot because we know that sound has an origin. Hallucinations are perceptual experiences that seem extremely real but have no origin in the surrounding reality. Auditory hallucinations are the most common but can also affect other senses.

Disorganized Thinking: How do we claim that thoughts are disordered? Well... we have to base it on when thoughts are expressed: in speech. You decided to start a discussion about pizza with your friend, but it seems to you that he is talking about everything except pizza (this is called tangentiality). Another example is when your friend quickly switches from one topic to another without advancing the discussion (this is called incoherence).

Abnormal Motor Behavior: Now the disorganization is not in language but in movement. Your friend this time doesn't seem to be reacting to what's happening around him (technically catatonia). If you tell him to raise his hand, he resists (negativism), and he doesn't respond to what you say anymore (mutism). This can lead to the extreme situation of total absence of motor responses (stupor). Search for "stupor" on Google Images to get an intuitive idea of what it is.

Negative Symptoms: I remember them as the five "A's": anhedonia, abulia, alogia, asociality, and flattened affect. In medical terms, the prefix 'a-' means something is missing. Anhedonia: What's missing? The ability to experience pleasure. Avolition: What's missing? The will to start any activity. Alogia: What's missing? Language. Speech is impoverished. Asociality: What's missing? The pursuit of social contact. Diminished emotional: Here there's no 'a-' that deprives something; the meaning is a low tone in emotions.

Sources:

- American Psychiatric Association (2013) - Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

- Bernhill, J. W. (2014) - DSM-5 Clinical Cases.

If you want me to describe a psychology topic in my own words, write it in the comments.