Schizophrenia
CTEVT PSC curriculum295.90 · F20.9CTEVT PSC curriculum: on the official Psychosocial Counselor syllabus, can appear in the exam. Beyond curriculum: added for completeness, not examinable. A chip like 296.2x · F32 is the diagnosis code: the DSM-5's older ICD-9-CM number, then the ICD-10 "F-code" used in hospital records. Non-students can ignore all of these.
Positive symptoms: added to experience
- Delusions: fixed false beliefs (persecution, reference, grandeur, control)
- Hallucinations: perceptions without stimulus; hearing voices is the classic
- Disorganised speech: derailment, incoherence, "word salad"
- Grossly disorganised or catatonic behaviour
Negative symptoms: subtracted from experience
- Diminished emotional expression: flat affect, monotone
- Avolition: loss of motivated, purposeful activity
- Alogia (poverty of speech) · anhedonia · asociality
- Negative symptoms predict long-term disability more than positive ones
- 2 or more of 5, each present a significant portion of one month (less if treated), and at least one must be (1), (2), or (3): delusions · hallucinations · disorganised speech · grossly disorganised/catatonic behaviour · negative symptoms.
- Functioning (work, relationships, self-care) markedly below the level before onset.
- Continuous signs for at least 6 months, including ≥1 month of active symptoms (may include prodromal/residual periods).
- Schizoaffective disorder and mood disorder with psychotic features ruled out.
- Not attributable to a substance or medical condition.
- If autism or a childhood communication disorder is present, prominent delusions or hallucinations ≥1 month are also required.
Cousins on the spectrum: Brief psychotic disorder (298.8/F23): ≥1 day, <1 month, full return, often after acute stress (including postpartum). Schizophreniform: schizophrenia picture, 1–6 months. Delusional disorder (297.1/F22): delusions ≥1 month with otherwise preserved functioning. Schizoaffective: schizophrenia criteria plus major mood episodes, with ≥2 weeks of psychosis without mood symptoms.
Lifetime prevalence ~0.3–0.7% in every population studied; onset typically late teens to early 30s, earlier in men. A famous WHO cross-national finding: outcomes were often better in lower-income countries; family involvement and social reintegration appear protective (later re-analyses have contested how general this finding is).
Stigma is the central fact: "paagal" labels, hidden family members, and in the worst cases chaining; plus years of dhami-jhankri treatment before any clinical contact. The National Mental Health Survey 2020 found schizophrenia-spectrum disorders in 0.1% of adults currently (0.2% lifetime). See Nepal in numbers.
Hearing culturally sanctioned voices (a deceased relative during mourning, deity communication in trance for a jhankri) is not psychosis; the flags are decline in functioning, disorganisation, and distress.
First contact is often the counselor's: your jobs are early detection, urgent psychiatric referral, family psychoeducation, and protecting the client's dignity and safety.