2. Key points – a brief history
• Schizophrenia was first clearly identified in the
1890s.
• Its characteristic features were an early onset
and a chronic course.
• Kraepelin described two characteristic
psychopathological processes.
• Bleuler introduced the concept of primary and
secondary symptoms.
.
3. Schneider’s first-rank symptoms of
schizophrenia
• Thought insertion, withdrawal or broadcasting : The experience of
one’s thoughts being put into or taken out of one’s head, or
broadcast to others. Collectively known as ‘thought interference’
• Passivity experiences :Experience that one’s thoughts or actions are
physically being controlled by an external force: ‘made actions’
• Delusional perception :A normal perception followed suddenly by a
seemingly unrelated, fully formed delusion
• Echo de la pensée: Hallucination of a voice repeating one’s own
thoughts Rare
• Running commentary Hallucination describing one’s current actions
• Third-person auditory hallucinations Voices describing patient as
‘he’ or ‘she’
4. Well-established predictors of
Good outcome Poor outcome
outcome
Demographic Female • Married • Male • Single •
Genetic Family history of mood Family history of schizophrenia
disorder Symptoms
Onset: Acute onset , Life event at Slow onset • Long duration of
onset untreated psychosis • Onset
under 17 years old
Psychosocial • Good response to treatment High expressed emotion •
• Substance misuse • Poor
Prompt treatment adherence to treatment
symptoms Good Schizoid traits • Negative
• premorbid adjustment symptoms • Obsessions •
5. Key points – genetics
Having a close relative with schizophrenia increases one’s own risk 15-fold.
Identical twins show a 45% concordance rate.
Individual vulnerability genes exist. Genes are each of small effect and act additively.
So far, 4– 6 susceptibility genes have been identified, some of which also predispose
to bipolar disorder. There are likely to be 15– 20 genes in all.
6. Key points – developmental theories and
environmental factors
• Early neurodevelopmental, non-genetic risk
factors exist for schizophrenia.
• Birth complications increase the child’s risk of
schizophrenia in later life fourfold.
• Psychosocial risk factors are being re-established
as important risk factors.
• Cannabis use appears to increase the risk of
schizophrenia as well as relapse.
• Evidence for specific gene– environment
interactions is beginning to emerge.
7. Key points – neurochemistry
• The dopamine hypothesis remains the major neurochemical
hypothesis of schizophrenia.
• Positive symptoms are hypothesized to be due to increased activity
of the mesolimbic dopamine pathway.
• Negative symptoms are hypothesized to be due to decreased
activity of the mesocortical dopamine pathway.
• Altered glutamate activity may be involved in the pathophysiology
of negative and positive symptoms and cognitive impairments.
• Disturbances in the cholinergic and GABAergic systems have been
hypothesized to underlie cognitive impairments in schizophrenia.
• .
8. Key points – pharmacological
treatment
• The depot forms of conventional and second-generation antipsychotics
are useful for patients who are non-adherent to their medications.
• Clozapine is the only second-generation antipsychotic that is effective for
positive symptoms resistant to conventional antipsychotics.
• Second-generation antipsychotics other than clozapine have become the
first-line treatments for acute psychotic episodes and maintenance
therapy.
• Conventional and second-generation antipsychotics are relatively
effective for treating secondary, but not primary, negative symptoms.
• Conventional antipsychotics have limited effects on the cognitive
impairments of schizophrenia.
• Second-generation antipsychotics may have modest benefits for multiple
cognitive processes.
9. Key points – psychosocial interventions
and non-drug treatments
• Family interventions are known to be effective in
reducing relapse.
• Cognitive-behavioral therapy (CBT) in addition to
drug treatment reduces persistent positive
symptoms. CBT can also abort relapses if targeted
at early signs.
• Motivational intervention techniques can reduce
street drug use and enhance treatment
compliance.
• Cognitive remediation reduces some cognitive
deficits in chronic schizophrenia.
10. Key points – early intervention
Duration of untreated psychosis is usually 3– 6
months.
The longer the delay in treatment the worse the
clinical outcome.
Early detection has been shown to be possible.
Second-generation drugs are preferred.
Treatment of prodromal cases with cognitive-
behavioral or drug therapy may prevent or
delay schizophrenia.
