Understanding Schizophrenia Spectrum Disorders

Schizophrenia spectrum and other psychotic disorders is the category of mental health conditions in which psychosis is the primary symptom. Psychosis involves hallucinations (sensory experiences that are not real) and/or delusions (persistent false beliefs that are not based in reality). While all people who have schizophrenia spectrum disorder experience psychosis, psychosis is a symptom of other conditions as well.

In the previous edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-IV), there were distinct subtypes of schizophrenia, a central condition in this category. In the current edition (DSM-5), these different types of schizophrenia were removed in favor of a broader definition of schizophrenia.

This article goes over the conditions that fall under the schizophrenia spectrum and their symptoms. It also discusses the diagnosis and management of these conditions.

What Is Schizophrenia? 

Schizophrenia is a complex and long-term mental illness that affects a person's ability to think clearly, determine reality, manage emotions, relate with others, and function well cognitively.

The symptoms of schizophrenia fall into three main categories.

Positive Symptoms (Psychotic Symptoms)

Positive symptoms reflect things that are present that should not be, namely:

• Hallucinations: Seeing, hearing, smelling, tasting, or feeling (through touch) things that are not there
• Delusions: False beliefs that don't change even when the person is presented with evidence that they are false; these can present as extreme paranoia or irrational fears
• Thought disorder: Unusual thinking or disorganized speech

Negative Symptoms

Negative symptoms, on the other hand, are characteristics that should be present but are not. These might include:

• Loss of motivation
• Disinterest or lack of enjoyment in daily life
• Social withdrawal and reduced speaking
• Difficulty showing emotions
• Difficulty planning, beginning, and sustaining activities
• Displaying a “flat affect" (difficulty expressing emotions using facial expression or voice tone)

Cognitive Symptoms

These include problems with attention, concentration, and memory, such as:

• Problems with processing information to make decisions
• Difficulty using information immediately after learning it
• Difficulty focusing or paying attention

A healthcare provider or mental health expert will evaluate these symptoms to help inform a diagnosis of schizophrenia or another psychotic disorder.

Spectrum of Schizophrenia Disorders

Schizophrenia is just one of several conditions that fall under the spectrum of psychotic disorders. These conditions share similar symptoms but are classified differently based on certain factors, such as the length of the psychotic symptoms and the presence of mood disorder characteristics.

Other examples of psychotic disorders include:

Schizophreniform Disorder

In schizophreniform disorder, a person exhibits the defining symptoms of schizophrenia, but the condition lasts less than six months. Schizophreniform disorder can develop into schizophrenia if the symptoms reach the six-month mark.

Schizoaffective Disorder

Schizoaffective disorder has features of schizophrenia and features of a mood disorder (either major depressive disorder or bipolar disorder), including psychosis, depression, and mania. The person must experience psychosis for at least two weeks when they are not having a depressive or manic episode. Depressive or manic episode symptoms are present over half of the duration of the condition.

Delusional Disorder

The person has experienced at least one delusion for at least one month but has never met the criteria for schizophrenia. Functional impairment is due to the delusion only and not experienced outside of it.

Brief Psychotic Disorder

An episode of psychotic behavior with a sudden onset lasting less than a month, followed by complete remission. Another psychotic episode in the future is possible.

Schizotypal Personality Disorder

A person with schizotypal personality disorder has irrational, obsessive thought patterns and fears that interfere with their ability to form and maintain relationships. They are not disconnected from reality like someone with schizophrenia, but they can develop significant social problems and are often perceived as behaving oddly or inappropriately.

Other Schizophrenia Spectrum Disorders

Other schizophrenia spectrum disorders are disorders that are considered similar to schizophrenia but don't meet the criteria for a diagnosis of schizophrenia. This category exists so healthcare providers can diagnose variations of the condition that wouldn't otherwise qualify as schizophrenia.

Associated Conditions

Schizophrenia is just one of several conditions that fall under the spectrum of psychotic disorders. Some of these conditions commonly occur alongside schizophrenia and/or share symptoms that can make diagnosis more difficult.

These can include:

• Major depressive disorder
• Bipolar disorder with psychotic or catatonic features
• Post-traumatic stress disorder
• Obsessive-compulsive disorder
• Autism spectrum disorder
• Substance use disorder
• Brain tumors
• Cushing's syndrome
• Delirium
• Dementia
• Porphyria
• Lupus
• Thyroid disorder
• Temporal lobe epilepsy
• Vitamin B12 deficiency
• Wilson’s disease

Some studies have demonstrated that individuals with schizophrenia spectrum disorders have higher autistic characteristics than those without schizophrenia spectrum disorders, but lower autistic characteristics than individuals with autism.

Diagnosis

The DSM-5 is a reference book published by the American Psychiatric Association. It is considered the standard in the diagnosis of mental health conditions, outlining criteria that must be met for a diagnosis of a specific condition.

A diagnosis of schizophrenia is typically made after the first episode of psychosis. Under the criteria found in the DSM-5, a person must persistently have two or more of the following symptoms (at least one being in the top three) to receive a diagnosis:

• Delusions
• Hallucinations
• Disorganized speech
• Disorganized or catatonic behavior
• Negative symptoms

Decreased levels of functioning in the areas of work, interpersonal relationships, or self-care must also be present.

While there is one set of criteria for the diagnosis of schizophrenia, the severity of symptoms can vary both by individual and over time in the same individual. Sometimes symptoms can be mild.

Someone who has some symptoms of schizophrenia but doesn't meet the criteria for a diagnosis may be experiencing a different psychotic disorder that is similar to schizophrenia.

It is common for people with one mental illness to have other mental illnesses at the same time. This is also true of schizophrenia. A person with schizophrenia may also have a depressive disorder such as major depression, an anxiety disorder, PTSD, or other comorbid (coexisting) conditions.

Managing Schizophrenia Spectrum Disorders

Schizophrenia is typically treated as a team effort among the individual, their friends and family, medical professionals, mental health experts, and community supporters.

In addition to formal treatment involving medication and therapies, there are ways to make living with schizophrenia more manageable.

Lifestyle practices a person with schizophrenia can adopt include:

• Eating a healthy, balanced diet
• Getting regular exercise
• Getting plenty of sleep, with a healthy sleep routine
• Stopping or quitting smoking, drinking alcohol, and other substance use
• Spending time with family and friends
• Doing mindfulness and relaxation exercises and techniques
• Engaging in healthy activities they enjoy that help reduce daily stress

Friends and family can help a loved one with schizophrenia by:

• Helping them to find and start treatment
• Encouraging them to stay in treatment
• Being respectful, supportive, and kind while setting and enforcing boundaries, including not tolerating dangerous or inappropriate behavior
• Looking for local or online support groups that can be helpful for the individual and their loved ones

Summary

Schizophrenia spectrum disorders are a category of mental health conditions where individuals experience psychosis as a primary symptom. 

Besides schizophrenia, disorders that fall into this cateogry include schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, schizotypal personality disorder, and other disorders that are similar to schizophrenia but don't meet the diagnostic criteria.

Schizophrenia spectrum disorders can be managed with medication, therapy, lifestyle changes, and a strong support system.