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DSM-IV Criteria for Schizophrenia

DSM-IV classifies symptoms into positive & negative symptoms. Two or more of the symptoms, at least one must be positive and at least one must be negative PLUS significant impairment of general functioning.




Symptoms must have all been present during a 1 month period.

DSM-IV Positive Symptoms of Schizophrenia

*Can be visually observed in the patient



  • Delusions
  • Hallucinations
  • Disorganized Speech
  • Grossly Disorganized or Catatonic Behavior
  • Agitation
  • Aggression

DSM-IV Negative Symptoms of Schizophrenia


  • Abulia (absence of willpower/inability to decide)
  • Alogia (absense/poverty of speech)
  • Anhedonia (inability to feel pleasure)
  • Avolition (lack of initiative, motivation to engage in goal-oriented behavior)

Schizophrenia Dysregulation Hypothesis



Psychotic symptoms are due to a lack of control of dopamine, plus other neurotransmitters (GABA, 5-HT, glutamate), with the end result being erratic neurotransmission.




(new theory)





Dopamine Over-Activity Hypothesis

Psychotic symptoms result from hyperactivity of dopamine due to increased dopamine concentrations or increased dopamine receptors.




(old theory)




*Parkinson's Disease drug treatments can cause this exact effect....

Antipsychotics (Neuroleptics) for Schizophrenia

(New) Atypical Antipsychotics: Quetiapine (Seroquel), Olanzapine (Zyprexa), Clozapine (Clozaril)




(Old) Typical Antipsychotics: Chlorpromazine (Thorazine), Haloperidol (Haldol)



Typical Antipsychotics Pharmacology

(Old) Typical Antipsychotics: Blocks various dopamine receptors (DA-1, DA-2, etc.) to varying degrees; strong antagonists



  • Little efficacy for negative symptoms
  • Side effects are many and serious
  • EPS (pseudoparkinsonism, Tardive Dyskinesia, etc.)
  • Neuroleptic Malignant Syndrome (rigidity, high fever, life-threatening)

Atypical Antipsychotics Pharmacology

(New) Atypical Antipsychotics: Selectively blocks DA-1, DA-4, DA-5 in the limbic system, and selectively binds to the 5-HT and alpha-1 adrenergic blockade.


**NO DA-2 blockade = NO EPS effects**



  • Enhanced efficacy, particularly on negative symptoms.
  • Lower potential for Tardive Dyskinesia