Schizophrenia Spectrum and Other Psychotic Disorders

Concept-First Opening

Schizophrenia is not a single disorder but a spectrum of psychotic conditions. The core problem is a break with reality — the person loses touch with what is real and what is not. This is why it is called a psychotic disorder. The word 'schizophrenia' literally means 'split mind', but this refers to a split between thought and emotion, not a split personality (which is a different, rare condition). The disorder devastates every area of life: personal relationships, work, and basic daily functioning. The cost is enormous — not just for the patient, but for families and society as a whole.

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Symptoms of Schizophrenia

The symptoms fall into three clear categories. Think of them as too much (positive), too little (negative), and odd movement (psychomotor).

Positive Symptoms (Pathological Excesses)

These are additions to normal behaviour — things that should not be there.

Delusions — False beliefs held with complete conviction despite clear evidence against them. They are not corrected by logic or argument. The main types are:

• Delusions of persecution — The most common. The person believes others are plotting against them, spying on them, slandering them, or trying to harm them.
• Delusions of reference — The person attaches special, personal meaning to random events or others' actions. A stranger's cough, a newspaper headline, or a passing comment is interpreted as being about them.
• Delusions of grandeur — The person believes they are a specially empowered person, such as a famous leader, a prophet, or even God.
• Delusions of control — The person believes their feelings, thoughts, and actions are being controlled by an outside force — aliens, satellites, the government, or some machine.

Disorganised Thinking and Speech (Formal Thought Disorders) — The person cannot think logically, and their speech reflects this. Communication becomes extremely difficult. Key features include:

• Loosening of associations (derailment) — The person jumps from one topic to another with no logical connection. Sentences become muddled and illogical.
• Neologisms — Inventing new words or phrases that have no meaning to anyone else.
• Perseveration — Persistent and inappropriate repetition of the same thought or word.

Hallucinations — Perceptions that occur without any external stimulus. The person sees, hears, feels, tastes, or smells something that is not there. The most common type is:

• Auditory hallucinations — Hearing voices. These may speak directly to the patient (second-person) or talk about the patient to each other (third-person).
• Tactile hallucinations — Tingling, burning, or crawling sensations on the skin.
• Somatic hallucinations — Sensations inside the body, such as a snake crawling in the stomach.
• Visual hallucinations — Seeing vague colours or distinct people/objects that are not present.
• Gustatory hallucinations — Food or drink tastes strange or different.
• Olfactory hallucinations — Smelling things like poison or smoke when nothing is there.

Inappropriate Affect — Emotions that do not match the situation. For example, laughing at a funeral or showing anger at a happy event.

Negative Symptoms (Pathological Deficits)

These are deficits — things that are missing from normal behaviour.

• Alogia (poverty of speech) — A marked reduction in the amount or content of speech. The person says very little, and what they say is empty.
• Blunted affect — The person shows much less emotion than normal — less anger, sadness, joy, or any feeling.
• Flat affect — An extreme form where the person shows no emotion at all. Their face is blank, their voice is monotone.
• Avolition (apathy) — An inability to start or complete any goal-directed activity. The person may sit for hours doing nothing, unable to initiate even simple tasks.
• Social withdrawal — The person pulls away from others and becomes completely absorbed in their own thoughts and fantasies.

Psychomotor Symptoms

These involve abnormal movements or postures.

• The person moves less spontaneously or makes odd grimaces and gestures.
• Catatonia — An extreme form of psychomotor disturbance. It includes:
  • Catatonic stupor — The person remains motionless and silent for long periods.
  • Catatonic rigidity — Maintaining a rigid, upright posture for hours, resisting any attempt to be moved. …