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A Brief Lecture on Schizophrenia Spectrum Disorders by DSM-5, NIMH, NIH and SAMHSA


Introduction to Abnormal Psychology and Life

Perspectives on Abnormal Psycholog

Risk and Prevention of Psychological Disorders

Diagnosis and Assessment of Psychological Disorders

Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders

Somatic Symptom and Dissociative Disorders

Depressive and Bipolar Disorders

Eating Disorders

Substance-Related Disorders

Personality Disorders

Sexual Dysfunctions

Schizophrenia and Other Psychotic Disorders

Developmental and Disruptive Behavior Disorders

Information from National Institute of Mental Health
  • Approximately 2.4 million American adults, or about 1.1 percent of the population age 18 and older in a given year, have schizophrenia.
  • Schizophrenia affects men and women with equal frequency.
  • Schizophrenia often first appears in men in their late teens or early twenties. In contrast, women are generally affected in their twenties or early thirties.


Description of Anxiety Disorders

Types of Anxiety Disorders

Causes of Anxiety Disorders

Treatment for Anxiety Disorders

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Description of Obsessive-Compulsive Disorders and Related Disorders

Causes of Obsessive-Compulsive and Related Disorders

Treatments for Obsessive-Compulsive and Related Disorders

US Resources for Obsessive-Compulsive and Related Disorders

Wis Resources for Obsessive-Compulsive and Related Disorders


Description of Trauma and Stress Related Disorders

Causes for Trauma and Stress Related Disorders

Treatments for Trauma and Stress Related Disorders

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Schizophrenia Spectrum Disorders (National Institute of Mental Health)

According to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5, 2013), “Schizophrenia spectrum disorders include schizophrenia, other psychotic disorders, and schizotypal personality disorder.” The symptoms of schizophrenia belong to one or more of the following areas:

  • Delusions – are firmly and constant false beliefs despite disconfirming evidence or logic
  • Hallucinations – are sensory perceptions that are not directly attributable to environmental stimuli
  • Disorganized thinking that results in disorganized speech
  • Abnormal and disorganized motor behavior
  • Negative symptoms, such as lack of emotional expression and lack of motivation

These symptoms (of schizophrenia) fall into three broad categories: positive symptoms, negative symptoms, and cognitive symptoms.

Positive Symptoms

Positive symptoms are psychotic behaviors not seen in healthy people. People with positive symptoms often "lose touch" with reality. These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment. They include the following:

  • Hallucinations, which are things a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. "Voices" are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices. The voices may talk to the person about his or her behavior, order the person to do things, or warn the person of danger. Sometimes the voices talk to each other. People with schizophrenia may hear voices for a long time before family and friends notice the problem. Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects, and feeling things like invisible fingers touching their bodies when no one is near.
  • Delusions, which are false beliefs that are not part of the person's culture and do not change. The person believes delusions even after other people prove that the beliefs are not true or logical. People with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can control their behavior with magnetic waves. They may also believe that people on television are directing special messages to them, or that radio stations are broadcasting their thoughts aloud to others. Sometimes they believe they are someone else, such as a famous historical figure. They may have paranoid delusions and believe that others are trying to harm them, such as by cheating, harassing, poisoning, spying on, or plotting against them or the people they care about. These beliefs are called "delusions of persecution."
  • Thought disorders, which are unusual or dysfunctional ways of thinking. One form of thought disorder is called "disorganized thinking." This is when a person has trouble organizing his or her thoughts or connecting them logically. They may talk in a garbled way that is hard to understand. Another form is called "thought blocking." This is when a person stops speaking abruptly in the middle of a thought. When asked why he or she stopped talking, the person may say that it felt as if the thought had been taken out of his or her head. Finally, a person with a thought disorder might make up meaningless words, or "neologisms."
  • Movement disorders, which may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic. Catatonia is a state in which a person does not move and does not respond to others. Catatonia is rare today, but it was more common when treatment for schizophrenia was not available.

Negative Symptoms

Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder to recognize as part of the disorder and can be mistaken for depression or other conditions. These symptoms include the following:

  • "Flat affect" (a person's face does not move or he or she talks in a dull or monotonous voice)
  • Lack of pleasure in everyday life
  • Lack of ability to begin and sustain planned activities
  • Speaking little, even when forced to interact

People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are symptoms caused by the schizophrenia.

Cognitive Symptoms

Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be difficult to recognize as part of the disorder. Often, they are detected only when other tests are performed. Cognitive symptoms include the following:

  • Poor "executive functioning" (the ability to understand information and use it to make decisions)
  • Trouble focusing or paying attention
  • Problems with "working memory" (the ability to use information immediately after learning it)

Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional distress.


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For more information from NIMH, click on the following picture.

Delusional Disorder

Social, marital, or work problems can result from the delusional beliefs of delusional disorder. Individuals with delusional disorder may be able to factually describe that others view their beliefs as irrational but are unable to accept this themselves (i.e., there may be "factual insight" but no true insight) (DSM-5, 2013). According to DSM-5 (2013), the diagnostic criteria for delusional disorder are:

A. The presence of one (or more) delusions with a duration of 1 month or longer.

B. Criterion A for schizophrenia has never been met.

Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation).

C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.

D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.


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Brief Psychotic Disorder

Individuals with brief psychotic disorder typically experience emotional turmoil or overwhelming confusion. They may have rapid shifts from one intense affect to another. Although the disturbance is brief, the level of impairment may be severe, and supervision may be required to ensure that nutritional and hygienic needs are met and that the individual is protected from the consequences of poor judgment, cognitive impairment, or acting on the basis of delusions (DSM-5, 2013). According to DSM-5 (2013), the diagnostic criteria for brief psychotic disorder are:

A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3):

  • Delusions.
  • Hallucinations.
  • Disorganized speech (e.g., frequent derailment or incoherence).
  • Grossly disorganized or catatonic behavior.

B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.

C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

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Schizophreniform Disorder

The characteristic symptoms of schizophreniform disorder are identical to those of schizophrenia Schizophreniform disorder is distinguished by its difference in duration: the total duration of the illness, including prodromal, active, and residual phases, is at least 1 month but less than 6 months (DSM-5, 2013). According to DSM-5 (2013), the diagnostic criteria for schizophreniform disorder are:

A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

  • Delusions.
  • Hallucinations.
  • Disorganized speech (e.g., frequent derailment or incoherence).
  • Grossly disorganized or catatonic behavior.
  • Negative symptoms (i.e., diminished emotional expression or avolition).

B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”

C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.


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The characteristic symptoms of schizophrenia involve a range of cognitive, behavioral, and emotional dysfunctions, but no single symptom is a specific determination of the disorder. The diagnosis involves the recognition of a constellation of signs and symptoms associated with impaired occupational or social functioning (DSM-5, 2013). According to DSM-5 (2013), the diagnostic criteria for schizophrenia are:

A. Two (or more) of the following, each present for a significant portion of time during a 1 -month period (or less if successfully treated). At least one of these must be (1 ), (2), or (3):

  • Delusions.
  • Hallucinations.
  • Disorganized speech (e.g., frequent derailment or incoherence).
  • Grossly disorganized or catatonic behavior.
  • Negative symptoms (i.e., diminished emotional expression or avolition).

B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).

C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).

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Schizoaffective Disorder

Occupational functioning is frequently impaired, but this is not a defining criterion (in contrast to schizophrenia). Restricted social contact and difficulties with self-care are associated with schizoaffective disorder, but negative symptoms may be less severe and less persistent than those seen in schizophrenia. Anosognosia (i.e., poor insight) is also common in schizoaffective disorder, but the deficits in insight may be less severe and pervasive than those in schizophrenia (DSM-5, 2013). According to DSM-5 (2013), the diagnostic criteria for schizoaffective disorder are:

A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia.

Note: The major depressive episode must include Criterion A1: Depressed mood.

B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.

C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.

D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

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Substance/Medication-Induced Psychotic Disorder

The essential features of substance/medication-induced psychotic disorder are prominent delusions and/or hallucinations that are judged to be due to the physiological effects of a substance/medication (i.e., a drug of abuse, a medication, or a toxin exposure) (DSM, 2013). According to DSM-5 (2013) the diagnostic criteria for substance/medication-induced psychotic disorder are:

A. Presence of one or both of the following symptoms:

  • Delusions.
  • Hallucinations.

B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

  • The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
  • The involved substance/medication is capable of producing the symptoms in Criterion A.

C. The disturbance is not better explained by a psychotic disorder that is not substance/medication-induced. Such evidence of an independent psychotic disorder could include the following: The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication: or there is other evidence of an independent non-substance/medication-induced psychotic disorder (e.g., a history of recurrent non-substance/medication-related episodes).

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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Explanations for the Causes of Schizophrenia Spectrum Disorders


Mental health professionals believe that mental illnesses are complex and probably result from a combination of genetic, environmental, psychological, and developmental factors.

Biological Explanations

Biochemical Factors

Biochemical factors involve neurotransmitters and hormones. Neurotransmitters are chemicals in the nervous system that process and transmit information. Hormones are messengers produced by glands in the endocrine system. One of the biochemical theories is the dopamine hypothesis, which views the neurotransmitter dopamine as the culprit. That is, neurons that use dopamine send too many messages with high frequency causing the symptoms of schizophrenia (DSM-5, 2013; Sue, et. al., 2013; Comer, 2014). Glutamate, and possibly other neurotransmitters, may also play a role in schizophrenia (National Institute of Mental Health, 2014).

Genetic Factors

According to the National Institute of Mental Health (2014), schizophrenia "occurs in one percent of the general population, but it occurs in ten percent of people who have a first-degree relative with this disorder, such as a parent, brother, or sister." Also, those who have a second-degree relative, such as an aunt, uncle, cousin, or grandparent, will have a greater likelihood of developing schizophrenia than the general population (NIMH, 2014). Research has shown that in monozygotic twins (identical twins), if one is diagnosed with schizophrenia, the other twin will have a 48 percent chance to develop the disorder, compared to dizygotic twins (Fraternal twins) who have a 17 percent chance of developing the disorder (Sue, et. al., 2013; Comer, 2014).

Scientists also believe that several genes are associated with schizophrenia, but there is no specific gene that causes the disease itself. Recent research has led to the finding that those with schizophrenia tend to have higher rates of genetic mutations, which involve hundreds of different genes that may lead to brain development being disrupted; though, "genome scans" are unlikely to be the deciding factor in whether or not someone is likely to develop a mental disorder such as schizophrenia (NIMH, 2014).

Brain Structure and Functions

Brain imagining techniques have supported a link between the diagnosis of schizophrenia and irregularity in brain structures and their activities. Particularly, CAT scan and MRI studies reveal enlarged ventricles in individuals diagnosed with schizophrenia compared to those without schizophrenia. The enlarged ventricles suggest a deterioration or atrophy of brain tissues responsible for cognitive functions (such as perception, memory and learning, thinking, logic, and reasoning), communication, and social behavior. These brain abnormalities are often associated with birth complications, viral infection, toxins, and malnutrition (Sue, et. al., 2013; Comer, 2014). The National Institute of Mental Health (2014) also states that "the brains of people with the illness also tend to have less gray matter, and some areas of the brain may have less or more activity."

Although research of the genetic basis of schizophrenia reveals an increased risk for the relatives of the individual, the concordance rate for monozygotic (identical) twins did not reach 50 percent, indicating the role of environmental factors (Sue, et. al., 2013; Comer, 2014).

Environmental Explanations

Though studies have shown a great relation between genetics and the development of schizophrenia, scientists also believe that an interaction between genes and the environment are necessary for schizophrenia to develop. Some environmental factors include, but are not limited to, "exposure to viruses or malnutrition before birth, problems during birth, and other not yet known psychosocial factors" (NIMH, 2014).

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Treatment for Schizophrenia Spectrum Disorders


Treatment often includes antipsychotic, cognitive-behavioral techniques, and supportive therapy with an emphasis on social-skills training and changing communication patterns among patients and their families (Sue, et. al., 2013; Comer, 2014).

Medications (Information from National Institute of Mental Health)

What medications are used to treat schizophrenia? Antipsychotic medications are used to treat schizophrenia and schizophrenia-related disorders. Some of these medications have been available since the mid-1950's. They are also called conventional, or "typical", antipsychotics. Some of the more commonly used medications include:

  • Chlorpromazine (Thorazine)
  • Haloperidol (Haldol)
  • Perphenazine (generic only)
  • Fluphenazine (generic only).

In the 1990's, new antipsychotic medications were developed. These new medications are called second generation, or "atypical", antipsychotics.

One of these medications was clozapine (Clozaril). It is a very effective medication that treats psychotic symptoms, hallucinations, and breaks with reality, such as when a person believes he or she is the president. But, clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. Therefore, people who take clozapine must get their white blood cell count checked every week or two. This problem and the cost of blood tests make treatment with clozapine difficult for many people. Still, clozapine is potentially helpful for people who do not respond to other antipsychotic medications.

Other atypical antipsychotics were also developed. All of them are effective and none of them cause agranulocytosis. These include:

  • Risperidone (Risperdal)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)
  • Aripiprazole (Abilify)
  • Paliperidone (Invega).

Note: The FDA issued a Public Health Advisory for atypical antipsychotic medications. The FDA determined that death rates are higher for elderly people with dementia when taking this medication. A review of data has found a risk with conventional antipsychotics, as well. Antipsychotic medications are not FDA-approved for the treatment of behavioral disorders in patients with dementia.
What are the side effects? Some people have side effects when they start taking these medications. Most side effects go away after a few days and can often be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

  • Drowsiness
  • Dizziness when changing positions
  • Blurred vision
  • Rapid heartbeat
  • Sensitivity to the sun
  • Skin rashes
  • Menstrual problems for women

Atypical antipsychotic medications can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol. A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication.
Typical antipsychotic medications can cause side effects related to physical movement, such as:

  • Rigidity
  • Persistent muscle spasms
  • Tremors
  • Restlessness

Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes uncontrollable muscle movements. These movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication.

Every year, an estimated five percent of people taking typical antipsychotics get TD. This condition happens to fewer people who take the new, atypical antipsychotics, but some people may still get TD. People who think that they might have TD should check with their doctor before stopping their medication.

How are antipsychotics taken and how do people respond to them? Antipsychotics are usually pills that people swallow or liquid they can drink. Some antipsychotics are shots that are given once or twice a month.

Symptoms of schizophrenia, such as feeling agitated and having hallucinations, usually go away within days. Symptoms like delusions usually go away within a few weeks. After about six weeks, many people will see a lot of improvement.

However, people respond in different ways to antipsychotic medications and no one can tell beforehand how a person will respond. Sometimes a person needs to try several medications before finding the right one. Doctors and patients can work together to find the best medication, or medication combination and dosage.

Some people may have a relapse where their symptoms come back or get worse. Usually, relapses happen when people stop taking their medication, or when they only take it sometimes. Some people stop taking the medication because they feel better or they may feel they don't need it anymore. But, no one should stop taking an antipsychotic medication without talking to his or her doctor. When a doctor says it is okay to stop taking a medication, it should be gradually tapered off, never stopped suddenly.

How do antipsychotics interact with other medications?

Antipsychotics can produce unpleasant or dangerous side effects when taken with certain medications. For this reason, all doctors treating a patient need to be aware of all the medications that person is taking. Doctors need to know about prescription and over-the-counter medicine, vitamins, minerals, and herbal supplements. People also need to discuss any alcohol or other drug use with their doctor.

To find out more about how antipsychotics work, the National Institute of Mental Health (NIMH) funded a study called CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness). This study compared the effectiveness and side effects of five antipsychotics used to treat people with schizophrenia. In general, the study found that the older medication perphenazine worked as well as the newer, atypical medications. But, because people respond differently to different medications, it is important that treatments be designed carefully for each person. You can find more information on

Psychosocial Treatments (Information from the National Institute of Mental Health)

Psychosocial treatments can help people with schizophrenia that are already stabilized on antipsychotic medication. Psychosocial treatments help these patients deal with the everyday challenges of the illness, such as difficulty with communication, self-care, work, and forming and keeping relationships. Learning and using coping mechanisms to address these problems allow people with schizophrenia to socialize and attend school and work.

Patients who receive regular psychosocial treatment are more likely to keep taking their medication and less likely to have relapses or be hospitalized. A therapist can help patients better understand and adjust to living with schizophrenia. The therapist can provide education about the disorder, common symptoms or problems patients may experience, and the importance of staying on medications.

Illness Management Skills

People with schizophrenia can take an active role in managing their own illness. Once patients learn basic facts about schizophrenia and its treatment, they can make informed decisions about their care. If they know how to watch for the early warning signs of relapse and make a plan to respond, patients can learn to prevent relapses. Patients can also use coping skills to deal with persistent symptoms.

Integrated Treatment for Co-Occurring Substance Abuse

Substance abuse is the most common co-occurring disorder in people with schizophrenia. But ordinary substance abuse treatment programs usually do not address this population's special needs. When schizophrenia treatment programs and drug treatment programs are used together, patients get better results.


Rehabilitation emphasizes social and vocational training to help people with schizophrenia function better in their communities. Because schizophrenia usually develops in people during the critical career-forming years of life (ages 18 to 35), and because the disease makes normal thinking and functioning difficult, most patients do not receive training in the skills needed for a job.

Rehabilitation programs can include job counseling and training, money management counseling, help in learning to use public transportation, and opportunities to practice communication skills. Rehabilitation programs work well when they include both job training and therapy specifically designed to improve cognitive or thinking skills. Programs like this help patients hold jobs, remember important details, and improve their functioning.

Family Education

People with schizophrenia are often discharged from the hospital into the care of their families. So it is important that family members know as much as possible about the disease. With the help of a therapist, family members can learn coping strategies and problem-solving skills. In this way the family can help make sure their loved one sticks with treatment and stays on his or her medication. Families should learn where to find outpatient and family services.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a type of psychotherapy that focuses on thinking and behavior. CBT helps patients with symptoms that do not go away even when they take medication. The therapist teaches people with schizophrenia how to test the reality of their thoughts and perceptions, how to "not listen" to their voices, and how to manage their symptoms overall. CBT can help reduce the severity of symptoms and reduce the risk of relapse.

Self-Help Groups

Self-help groups for people with schizophrenia and their families are becoming more common. Professional therapists usually are not involved, but group members support and comfort each other. People in self-help groups know that others are facing the same problems, which can help everyone feel less isolated. The networking that takes place in self-help groups can also prompt families to work together to advocate for research and more hospital and community treatment programs. Also, groups may be able to draw public attention to the discrimination many people with mental illness face.

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Behavioral Health Treatment Services Locator

Behavioral Health Treatment Services Locator By entering your zip code at, you can quickly find alcohol and drug abuse treatment or mental health treatment facilities in your area. This service is courtesy of the Substance Abuse and Mental Health Services Administration (SAMHSA) which works to "to improve the quality and availability of substance abuse prevention, alcohol and drug addiction treatment, and mental health services." (SAMHSA)

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