Schizophrenia

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Schizophrenia

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USMLE® Step 1 style questions USMLE

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A 23-year-old man is brought to the physician by his parent due to concerns of abnormal behavior. The patient’s parent tells the physician that the patient has been acting in a strange manner lately. Eight months ago, he spontaneously left his job, which he previously enjoyed, without reason. The parent adds that he no longer spends time with his friends and has become increasingly withdrawn from his family. Last month, he started acting as if he was responding to a voice no one else could hear, and he has been heard talking to himself in his room. The patient tells the physician that someone is talking to him and telling him about plans related to people trying to harm him. The patient recreationally uses alcohol and cocaine. He has also smoked one pack of cigarettes per day for the last five years. He was diagnosed with migraines three years ago but has not experienced any headaches recently. According to the patient’s parent, there is no known history of mental health disorders in the family. The physician strongly suspects a diagnosis of schizophrenia. Which of the following is considered a risk factor for this patient’s condition?  

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Content Reviewers

Schizo means split, and phrenia, in this case refers to the mind.

Even though schizophrenia can be interpreted to mean “splitting of the mind”, it does not refer to a split personality, like some media sources might portray, but rather schizophrenia describes a scattered or fragmented pattern of thinking.

Schizophrenia’s actually a syndrome, meaning there’re all sorts of symptoms that might be associated with it and different patients might experience different symptoms, although the symptoms can be broadly categorized into three major areas: positive symptoms, negative symptoms, and cognitive symptoms.

Alright taking a step back, most human symptoms from any illness are extreme versions of a normal physiologic process (for example everyone has a heartbeat and tachycardia is a fast heartbeat, everyone has a normal body temperature, but during a fever that temperature is higher).

In schizophrenia, patients have positive symptoms which aren’t positive in the sense that they’re helpful, but positive in the sense that they’re some new feature that doesn’t have some “normal” or physiologic counterpart.

These are the psychotic symptoms, so delusions, hallucinations, disorganized speech, and disorganized or catatonic behavior; none of which occur physiologically.

Delusions are false beliefs that the patient might feel very strongly about, so much so that they won’t change their mind, even if you give them evidence against it.

There are all sorts of different delusions, like, for example, a delusion of control, where somebody thinks that some outside force or person or thing is controlling their actions.

They could also be delusions of reference, where someone might think that insignificant remarks are directed at them, like a newscaster is speaking directly to them through the TV.

Hallucinations are a second type of positive symptom, and can be any kind of sensation that’s not actually there, including visual but also including auditory sensations, like hearing voices or commands.

Summary

Schizophrenia is a mental illness characterized by a disconnection from reality and abnormal behaviors. Symptoms are broadly classified as positive symptoms, negative symptoms, or cognitive symptoms. Positive symptoms include delusions, hallucinations, disordered thinking and speech, and unusual behavior; whereas negative symptoms include affective flattening, alogia, apathy, and anhedonia. Cognitive symptoms include things like not being able to remember things, learn new things, or understand others easily. Treatment involves antipsychotic medications and psychotherapy.

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