Schizophrenia
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Schizophrenia

Schizophrenia

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  • SchizophreniaSchizophrenia Department of PsychiatryDepartment of Psychiatry 11stst Faculty of MedicineFaculty of Medicine Charles University, PragueCharles University, Prague Head: Prof. MUDr. Jiří Raboch, DrSc.Head: Prof. MUDr. Jiří Raboch, DrSc. Brought to you by
  • DefinitionDefinition  The schizophrenic disorders are characterized inThe schizophrenic disorders are characterized in general by fundamental and characteristicgeneral by fundamental and characteristic distortions ofdistortions of thinking and perception, and affectsthinking and perception, and affects that arethat are inappropriate or blunted. Clear consciousness andinappropriate or blunted. Clear consciousness and intellectual capacity are usually maintained althoughintellectual capacity are usually maintained although certain cognitive deficits may evolve in the course ofcertain cognitive deficits may evolve in the course of time.time.  The most important psychopathological phenomenaThe most important psychopathological phenomena includeinclude • thought echothought echo • thought insertion or withdrawalthought insertion or withdrawal • thought broadcastingthought broadcasting • delusional perception and delusions of controldelusional perception and delusions of control • influence or passivityinfluence or passivity • hallucinatory voices commenting or discussing the patient inhallucinatory voices commenting or discussing the patient in the third personthe third person • thought disorders and negative symptoms.thought disorders and negative symptoms. Brought to you by
  • SchizophreniaSchizophrenia  Schizophrenia occurs with regular frequencySchizophrenia occurs with regular frequency nearly everywhere in the world in 1 % ofnearly everywhere in the world in 1 % of population and begins mainly in young agepopulation and begins mainly in young age (mostly around 16 to 25 years).(mostly around 16 to 25 years).  Schizophrenia is defined bySchizophrenia is defined by • a group of characteristic positive and negativea group of characteristic positive and negative symptomssymptoms • deterioration in social, occupational, or interpersonaldeterioration in social, occupational, or interpersonal relationshipsrelationships • continuous signs of the disturbance for at least 6continuous signs of the disturbance for at least 6 monthsmonths Brought to you by
  • HistoryHistory  Emil KraepelinEmil Kraepelin: This illness develops relatively early in: This illness develops relatively early in life, and its course is likely deteriorating and chronic;life, and its course is likely deteriorating and chronic; deterioration reminded dementiadeterioration reminded dementia („Dementia praecox“(„Dementia praecox“),), but was not followed by any organic changes of thebut was not followed by any organic changes of the brain, detectable at that time.brain, detectable at that time.  Eugen BleulerEugen Bleuler: He renamed Kraepelin’s dementia: He renamed Kraepelin’s dementia praecox aspraecox as schizophreniaschizophrenia (1911); he recognized the(1911); he recognized the cognitive impairment in this illness, which he named ascognitive impairment in this illness, which he named as a „splittinga „splitting““ of mind.of mind.  Kurt SchneiderKurt Schneider: He emphasized the role of psychotic: He emphasized the role of psychotic symptoms, as hallucinations, delusions and gave themsymptoms, as hallucinations, delusions and gave them the privilege ofthe privilege of „the first rank symptoms”„the first rank symptoms” even in theeven in the concept of the diagnosis of schizophrenia.concept of the diagnosis of schizophrenia. Brought to you by
  • 4 A (Bleuler)4 A (Bleuler)  Bleuler maintained, that for the diagnosis ofBleuler maintained, that for the diagnosis of schizophrenia are most important the following fourschizophrenia are most important the following four fundamental symptoms:fundamental symptoms: • affective bluntingaffective blunting • disturbance of associationdisturbance of association (fragmented thinking)(fragmented thinking) • autismautism • ambivalenceambivalence (fragmented emotional response)(fragmented emotional response)  These groups of symptoms, are called „four A’ s” andThese groups of symptoms, are called „four A’ s” and Bleuler thought, that they are „primary” for thisBleuler thought, that they are „primary” for this diagnosis.diagnosis.  The other known symptoms, hallucinations, delusions,The other known symptoms, hallucinations, delusions, which are appearing in schizophrenia very often also,which are appearing in schizophrenia very often also, he used to call as a “secondary symptoms”, becausehe used to call as a “secondary symptoms”, because they could be seen in any other psychotic disease,they could be seen in any other psychotic disease, which are caused by quite different factors — fromwhich are caused by quite different factors — from intoxication to infection or other disease entities.intoxication to infection or other disease entities. Brought to you by
  • Course of IllnessCourse of Illness  Course of schizophrenia:Course of schizophrenia: • continuous without temporary improvementcontinuous without temporary improvement • episodic with progressive or stable deficitepisodic with progressive or stable deficit • episodic with complete or incomplete remissionepisodic with complete or incomplete remission  Typical stages of schizophrenia:Typical stages of schizophrenia: • prodromal phaseprodromal phase • active phaseactive phase • residual phaseresidual phase Brought to you by
  • Clinical PictureClinical Picture  Diagnostic manuals:Diagnostic manuals: • lCD-10lCD-10 („International Classification of Disease“, WHO)(„International Classification of Disease“, WHO) • DSM-IVDSM-IV („Diagnostic and Statistical Manual“, APA)(„Diagnostic and Statistical Manual“, APA)  Clinical picture of schizophrenia is according to lCD-10,Clinical picture of schizophrenia is according to lCD-10, defined from the point of view of the presence anddefined from the point of view of the presence and expression of primary and/or secondary symptoms (atexpression of primary and/or secondary symptoms (at present covered by the terms negative and positivepresent covered by the terms negative and positive symptoms)symptoms):: • tthehe negative symptomsnegative symptoms are represented by cognitive disorders,are represented by cognitive disorders, having its origin probably in the disorders of associations ofhaving its origin probably in the disorders of associations of thoughts, combined with emotional blunting and small orthoughts, combined with emotional blunting and small or missing production of hallucinations and delusionsmissing production of hallucinations and delusions • tthehe positivepositive symptomsymptom are characterized by the presence ofare characterized by the presence of hallucinations and delusionshallucinations and delusions • tthe division is not quite strict and lesser or greater mixture ofhe division is not quite strict and lesser or greater mixture of symptoms from these two groups are possiblesymptoms from these two groups are possible Brought to you by
  • Positive and Negative SymptomsPositive and Negative Symptoms NegativeNegative PositivePositive AlogiaAlogia HallucinationsHallucinations Affective flatteningAffective flattening DelusionsDelusions Avolition-apathyAvolition-apathy Bizarre behaviourBizarre behaviour Anhedonia-asocialityAnhedonia-asociality Positive formal thoughtPositive formal thought disorderdisorder Attentional impairmentAttentional impairment Andreasen N.C., Roy M.-A., Flaum M.: Positive and negative symptoms. In: Schizophrenia, Hirsch S.R. and Weinberger D.R., eds., Blackwell Science, pp. 28-45, 1995 Brought to you by
  • The Criteria of DiagnosisThe Criteria of Diagnosis For theFor the diagnosis of schizophreniadiagnosis of schizophrenia is necessaryis necessary  presence of one very clear symptompresence of one very clear symptom -- from point a) to d)from point a) to d)  or the presence of the symptoms from at least two groupsor the presence of the symptoms from at least two groups -- fromfrom point e) to h)point e) to h) for one month or more:for one month or more: a)a) the hearing of own thoughts, the feelings of thought withdrawal,the hearing of own thoughts, the feelings of thought withdrawal, thought insertion, or thought broadcastingthought insertion, or thought broadcasting b)b) the delusions of control, outside manipulation and influence, or thethe delusions of control, outside manipulation and influence, or the feelings of passivity, which are connected with the movements offeelings of passivity, which are connected with the movements of the body or extremities, specific thoughts, acting or feelings,the body or extremities, specific thoughts, acting or feelings, delusional perceptiondelusional perception c)c) hallucinated voices, which are commenting permanently thehallucinated voices, which are commenting permanently the behavior of the patient or they talk about him betweenbehavior of the patient or they talk about him between themselves, or the other types of hallucinatory voices, comingthemselves, or the other types of hallucinatory voices, coming from different parts of bodyfrom different parts of body d)d) permanent delusions of different kind, which are inappropriate andpermanent delusions of different kind, which are inappropriate and unacceptable in given cultureunacceptable in given culture Brought to you by
  • The Criteria of DiagnosisThe Criteria of Diagnosis e)e) the lasting hallucination of every formthe lasting hallucination of every form f)f) blocks or intrusion of thoughts into the flow of thinking andblocks or intrusion of thoughts into the flow of thinking and resulting incoherence and irrelevance of speach, or neologismsresulting incoherence and irrelevance of speach, or neologisms g)g) catatonic behaviorcatatonic behavior h)h) „„the negative symptoms”, for instance the expressed apathy,the negative symptoms”, for instance the expressed apathy, poor speech, blunting and inappropriatness of emotional reactionspoor speech, blunting and inappropriatness of emotional reactions i)i) expressed and conspicuous qualitative changes in patient’sexpressed and conspicuous qualitative changes in patient’s behavior, the loss of interests, hobbies, aimlesness, inactivity, thebehavior, the loss of interests, hobbies, aimlesness, inactivity, the loss of relations to others and social withdrawalloss of relations to others and social withdrawal  Diagnosis ofDiagnosis of acute schizophorm disorderacute schizophorm disorder (F23.2) – if the(F23.2) – if the conditions for diagnosis of schizophrenia are fulfilled, but lastingconditions for diagnosis of schizophrenia are fulfilled, but lasting less than one monthless than one month  Diagnosis ofDiagnosis of schizoaffective disorderschizoaffective disorder (F25) - if the schizophrenic(F25) - if the schizophrenic and affective symptoms are developing together at the same timeand affective symptoms are developing together at the same time Brought to you by
  • F20-F29F20-F29 Schizophrenia, SchizotypalSchizophrenia, Schizotypal and Delusional Disordersand Delusional Disorders F20F20 SchizophreniaSchizophrenia F20.0F20.0 Paranoid schizophreniaParanoid schizophrenia F20.1 Hebephrenic schizophreniaF20.1 Hebephrenic schizophrenia F20.2 Catatonic schizophreniaF20.2 Catatonic schizophrenia F20.3 Undifferentiated schizophreniaF20.3 Undifferentiated schizophrenia F20.4 Post-schizophrenic depressionF20.4 Post-schizophrenic depression F20.5 Residual schizophreniaF20.5 Residual schizophrenia F20.6 Simple schizophreniaF20.6 Simple schizophrenia F20.8 Other schizophreniaF20.8 Other schizophrenia F20.9 Schizophrenia, unspecifiedF20.9 Schizophrenia, unspecified Brought to you by
  • F20-F29F20-F29 Schizophrenia, SchizotypalSchizophrenia, Schizotypal and Delusional Disordersand Delusional Disorders F21F21 Schizotypal disorderSchizotypal disorder F22F22 Persistent delusional disordersPersistent delusional disorders F22.0F22.0 Delusional disorderDelusional disorder F22.8F22.8 Other persistent delusional disordersOther persistent delusional disorders F22.9F22.9 Persistent delusional disorder, unspecifiedPersistent delusional disorder, unspecified F23F23 Acute and transient psychotic disordersAcute and transient psychotic disorders F23.1F23.1 Acute polymorphic psychotic disorder withAcute polymorphic psychotic disorder with symptoms of schizophreniasymptoms of schizophrenia F23.2F23.2 Acute schizophrenia-like psychotic disorderAcute schizophrenia-like psychotic disorder F23.3F23.3 Other acute predominantly delusional psychoticOther acute predominantly delusional psychotic disordersdisorders F23.8F23.8 Other acute and transient psychotic disordersOther acute and transient psychotic disorders F23.9F23.9 Acute and transient psychotic disorder, unspecifiedAcute and transient psychotic disorder, unspecified Brought to you by
  • F20-F29F20-F29 Schizophrenia, SchizotypalSchizophrenia, Schizotypal and Delusional Disordersand Delusional Disorders F24F24 Induced delusional disorderInduced delusional disorder F25F25 Schizoaffective disordersSchizoaffective disorders F25.0F25.0 Schizoaffective disorder, manic typeSchizoaffective disorder, manic type F25.1F25.1 Schizoaffective disorder, depressive typeSchizoaffective disorder, depressive type F25.2F25.2 Schizoaffective disorder, mixed typeSchizoaffective disorder, mixed type F25.8F25.8 Other schizoaffective disordersOther schizoaffective disorders F25.9F25.9 Schizoaffective disorder, unspecifiedSchizoaffective disorder, unspecified F28F28 Other nonorganic psychotic disordersOther nonorganic psychotic disorders F29F29 Unspecified nonorganic psychosisUnspecified nonorganic psychosis Brought to you by
  • F20.0 Paranoid SchizophreniaF20.0 Paranoid Schizophrenia  Paranoid schizophreniaParanoid schizophrenia is characterized mainlyis characterized mainly by delusions of persecution, feelings of passiveby delusions of persecution, feelings of passive or active control, feelings of intrusion, andor active control, feelings of intrusion, and often by megalomanic tendencies also. Theoften by megalomanic tendencies also. The delusions are not usually systemized too much,delusions are not usually systemized too much, without tight logical connections and are oftenwithout tight logical connections and are often combined with hallucinations of differentcombined with hallucinations of different senses, mostly with hearing voices.senses, mostly with hearing voices.  Disturbances of affect, volition and speech, andDisturbances of affect, volition and speech, and catatonic symptoms, are either absent orcatatonic symptoms, are either absent or relatively inconspicuous.relatively inconspicuous. Brought to you by
  • F20.1 Hebephrenic SchizophreniaF20.1 Hebephrenic Schizophrenia  Hebephrenic schizophreniaHebephrenic schizophrenia is characterized by disorganizedis characterized by disorganized thinking with blunted and inappropriate emotions. It beginsthinking with blunted and inappropriate emotions. It begins mostly in adolescent age, the behavior is often bizarre.mostly in adolescent age, the behavior is often bizarre. There could appear mannerisms, grimacing, inappropriateThere could appear mannerisms, grimacing, inappropriate laugh and joking, pseudophilosophical brooding and suddenlaugh and joking, pseudophilosophical brooding and sudden impulsive reactions without external stimulation. There is aimpulsive reactions without external stimulation. There is a tendency to social isolation.tendency to social isolation.  Usually the prognosis is poor because of the rapidUsually the prognosis is poor because of the rapid development of "negative" symptoms, particularly flatteningdevelopment of "negative" symptoms, particularly flattening of affect and loss of volition. Hebephrenia should normallyof affect and loss of volition. Hebephrenia should normally be diagnosed only in adolescents or young adultsbe diagnosed only in adolescents or young adults..  Denoted also asDenoted also as disorganized schizophreniadisorganized schizophrenia Brought to you by
  • F20.2 Catatonic SchizophreniaF20.2 Catatonic Schizophrenia  Catatonic schizophreniaCatatonic schizophrenia is characterized mainlyis characterized mainly by motoric activity, which might be stronglyby motoric activity, which might be strongly increased (hypekinesis) or decreased (stupor),increased (hypekinesis) or decreased (stupor), or automatic obedience and negativism.or automatic obedience and negativism.  We recognize two forms:We recognize two forms: • productive formproductive form — which shows catatonic— which shows catatonic excitement, extreme and often aggressive activity.excitement, extreme and often aggressive activity. TreatmentTreatment by neuroleptics or by electroconvulsiveby neuroleptics or by electroconvulsive therapy.therapy. • stuporose formstuporose form — characterized by general inhibition— characterized by general inhibition of patient’s behavior or at least by retardation andof patient’s behavior or at least by retardation and slowness, followed often by mutism, negativism,slowness, followed often by mutism, negativism, fexibilitas cerea or by stupor. The consciousness isfexibilitas cerea or by stupor. The consciousness is not absent.not absent. Brought to you by
  • F20.3 UndifferentiatedF20.3 Undifferentiated SchizophreniaSchizophrenia  Psychotic conditions meeting the generalPsychotic conditions meeting the general diagnostic criteria for schizophrenia butdiagnostic criteria for schizophrenia but not conforming to any of the subtypes innot conforming to any of the subtypes in F20.0-F20.2, or exhibiting the features ofF20.0-F20.2, or exhibiting the features of more than one of them without a clearmore than one of them without a clear predominance of a particular set ofpredominance of a particular set of diagnostic characteristics.diagnostic characteristics.  This subgroup represents also the formerThis subgroup represents also the former diagnosis ofdiagnosis of atypical schizophreniaatypical schizophrenia.. Brought to you by
  • F20.4 PostschizophrenicF20.4 Postschizophrenic DepressionDepression  A depressive episode, which may beA depressive episode, which may be prolonged, arising in the aftermath of aprolonged, arising in the aftermath of a schizophrenic illness. Some schizophrenicschizophrenic illness. Some schizophrenic symptoms, eithersymptoms, either „„positivepositive““ oror „„negativenegative““,, must still be present but they no longermust still be present but they no longer dominate the clinical picture.dominate the clinical picture.  These depressive states are associatedThese depressive states are associated with an increased risk of suicide.with an increased risk of suicide. Brought to you by
  • F20.5 Residual SchizophreniaF20.5 Residual Schizophrenia  AA chronic stage in the development ofchronic stage in the development of schizophrenia with clear succession fromschizophrenia with clear succession from the initial stage with one or more episodesthe initial stage with one or more episodes characterized by general criteria ofcharacterized by general criteria of schizophrenia to the late stage with long-schizophrenia to the late stage with long- lasting negative symptoms andlasting negative symptoms and deterioration (not necessarily irreversible).deterioration (not necessarily irreversible). Brought to you by
  • F20.6 Simple SchizophreniaF20.6 Simple Schizophrenia  Simple schizophrenia is characterized bySimple schizophrenia is characterized by early and slowly developing initial stageearly and slowly developing initial stage with growing social isolation, withdrawal,with growing social isolation, withdrawal, small activity, passivity, avolition andsmall activity, passivity, avolition and dependence on the others.dependence on the others.  The patients are indifferent, without anyThe patients are indifferent, without any initiative and volition. There is notinitiative and volition. There is not expressed the presence of hallucinationsexpressed the presence of hallucinations and delusions.and delusions. Brought to you by
  • F21F21 Schizotypal disorderSchizotypal disorder  According to lCD-10 this disorder isAccording to lCD-10 this disorder is characterized by eccentric behavior and bycharacterized by eccentric behavior and by deviations of thinking and affectivity,deviations of thinking and affectivity, which are similar to that occurring inwhich are similar to that occurring in schizophrenia, but without psychoticschizophrenia, but without psychotic features and expressed symptoms offeatures and expressed symptoms of schizophrenia of any type.schizophrenia of any type. Brought to you by
  • F22 Persistent DelusionalF22 Persistent Delusional DisordersDisorders  Includes a variety of disorders in whichIncludes a variety of disorders in which long-standing delusions constitute thelong-standing delusions constitute the only, or the most conspicuous, clinicalonly, or the most conspicuous, clinical characteristic and which cannot becharacteristic and which cannot be classified as organic, schizophrenic orclassified as organic, schizophrenic or affective.affective.  Their origin is probably heterogeneous,Their origin is probably heterogeneous, but it seems, that there is some relation tobut it seems, that there is some relation to schizophrenia.schizophrenia. Brought to you by
  • F22.0F22.0 Delusional DisorderDelusional Disorder  A disorder characterized by theA disorder characterized by the development of one delusion or of thedevelopment of one delusion or of the group of similar related delusions, whichgroup of similar related delusions, which are persisting unusually long, very oftenare persisting unusually long, very often for the whole life.for the whole life.  Other psychopathological symptoms —Other psychopathological symptoms — hallucinations, intrusion of thoughts etc.hallucinations, intrusion of thoughts etc. are not present and are excluding thisare not present and are excluding this diagnosis.diagnosis.  It begins usually in the middle age.It begins usually in the middle age. Brought to you by
  • F23F23 Acute and TransientAcute and Transient Psychotic DisordersPsychotic Disorders  The criteria should be the following features:The criteria should be the following features: • acute beginning (to two weeks)acute beginning (to two weeks) • presence of typical symptoms (quickly changingpresence of typical symptoms (quickly changing “polymorphic symptoms”)“polymorphic symptoms”) • presence of typical schizophrenic symptoms.presence of typical schizophrenic symptoms.  Complete recovery usually occurs within a fewComplete recovery usually occurs within a few months, often within a few weeks or even days.months, often within a few weeks or even days.  The disorder may or may not be associatedThe disorder may or may not be associated with acute stress, defined as usually stressfulwith acute stress, defined as usually stressful events preceding the onset by one to twoevents preceding the onset by one to two weeks.weeks. Brought to you by
  • F24 Induced Delusional DisorderF24 Induced Delusional Disorder  A delusional disorder shared by two or more peopleA delusional disorder shared by two or more people with close emotional links. Only one of the peoplewith close emotional links. Only one of the people suffers from a genuine psychotic disorder; thesuffers from a genuine psychotic disorder; the delusions are induced in the other(s) and usuallydelusions are induced in the other(s) and usually disappear when the people are separated.disappear when the people are separated.  The psychotic disorder of the dominant member ofThe psychotic disorder of the dominant member of this dyad is mainly, but not necessarily, ofthis dyad is mainly, but not necessarily, of schizophrenic type. The original delusions ofschizophrenic type. The original delusions of dominant member and his partner are usuallydominant member and his partner are usually chronic, either persecutory or megalomanic.chronic, either persecutory or megalomanic. Brought to you by
  • F25 Schizoaffective DisordersF25 Schizoaffective Disorders  Episodic disorders in which both affective andEpisodic disorders in which both affective and schizophrenic symptoms are prominentschizophrenic symptoms are prominent ((during theduring the same episode of the illness or at least during few dayssame episode of the illness or at least during few days)) but which do not justify a diagnosis of eitherbut which do not justify a diagnosis of either schizophrenia or depressive or manic episodes.schizophrenia or depressive or manic episodes.  Patients suffering from periodic schizoaffectivePatients suffering from periodic schizoaffective disorders, especially with manic symptoms, havedisorders, especially with manic symptoms, have usually good prognosis with full remissions without anyusually good prognosis with full remissions without any remaining defects.remaining defects.  They are divided in different subgroups:They are divided in different subgroups: • F25.0 Schizoaffective disorder, manic typeF25.0 Schizoaffective disorder, manic type • F25.1 Schizoaffective disorder, depressive typeF25.1 Schizoaffective disorder, depressive type • F25.2 Schizoaffective disorder, mixed typeF25.2 Schizoaffective disorder, mixed type • F25.8 Other schizoaffective disordersF25.8 Other schizoaffective disorders • F25.9 Schizoaffective disorder, unspecifiedF25.9 Schizoaffective disorder, unspecified Brought to you by
  • Genetics of SchizophreniaGenetics of Schizophrenia  Many psychiatric disorders areMany psychiatric disorders are multifactorial (caused by the interaction ofmultifactorial (caused by the interaction of external and genetic factors) and from theexternal and genetic factors) and from the genetic point of view very oftengenetic point of view very often polygenically determined.polygenically determined.  Relative risk for schizophrenia is around:Relative risk for schizophrenia is around: • 1% for normal population1% for normal population • 5.6% for parents5.6% for parents • 10.1% for siblings10.1% for siblings • 12.8% for children12.8% for children Brought to you by
  • Etiology of SchizophreniaEtiology of Schizophrenia  The etiology and pathogenesis ofThe etiology and pathogenesis of schizophrenia is not knownschizophrenia is not known  It is accepted, that schizophrenia is „theIt is accepted, that schizophrenia is „the group of schizophrenias“ which origin isgroup of schizophrenias“ which origin is multifactorial:multifactorial: • internal factors – genetic, inborn, biochemicalinternal factors – genetic, inborn, biochemical • external factors – trauma, infection of CNS,external factors – trauma, infection of CNS, stressstress Brought to you by
  • Etiology of Schizophrenia -Etiology of Schizophrenia - Dopamine HypothesisDopamine Hypothesis  The most influential and plausible are the hypotheses, based on theThe most influential and plausible are the hypotheses, based on the supposed disorder of neurotransmission in the brain, derived mainly fromsupposed disorder of neurotransmission in the brain, derived mainly from 1.1. the effects of antipsychotic drugs that have in common the ability tothe effects of antipsychotic drugs that have in common the ability to inhibit the dopaminergic system by blocking action of dopamine in theinhibit the dopaminergic system by blocking action of dopamine in the brainbrain 2.2. dopamine-releasing drugs (amphetamine, mescaline, diethyl amide ofdopamine-releasing drugs (amphetamine, mescaline, diethyl amide of lysergic acid - LSD) that can induce state closely resembling paranoidlysergic acid - LSD) that can induce state closely resembling paranoid schizophreniaschizophrenia  Classical dopamine hypothesis of schizophreniaClassical dopamine hypothesis of schizophrenia: Psychotic symptoms are: Psychotic symptoms are related to dopaminergic hyperactivity in the brain. Hyperactivity ofrelated to dopaminergic hyperactivity in the brain. Hyperactivity of dopaminergic systems during schizophrenia is result of increaseddopaminergic systems during schizophrenia is result of increased sensitivity and density of dopamine D2 receptors in the different parts ofsensitivity and density of dopamine D2 receptors in the different parts of the brain.the brain. Brought to you by
  • Etiology of Schizophrenia -Etiology of Schizophrenia - Contemporary ModelsContemporary Models  Dopamine hypothesis revisitedDopamine hypothesis revisited: various: various neurotransmitter systems probably takes place in theneurotransmitter systems probably takes place in the etiology of schizophrenia (norepinephric, serotonergic,etiology of schizophrenia (norepinephric, serotonergic, glutamatergic, some peptidergic systems); based onglutamatergic, some peptidergic systems); based on effects of atypical antipsychotics especially.effects of atypical antipsychotics especially.  Contemporary models of schizophreniaContemporary models of schizophrenia conceptualize itconceptualize it as a neurocognitive disorder, with the various signsas a neurocognitive disorder, with the various signs and symptoms reflecting the downstream effects of aand symptoms reflecting the downstream effects of a more fundamental cognitive deficit:more fundamental cognitive deficit: • the symptoms of schizophrenia arise from “cognitivethe symptoms of schizophrenia arise from “cognitive dysmetria” (Nancy C. Andreasen)dysmetria” (Nancy C. Andreasen) • concept of schizophrenia as a neurodevelopmental disorderconcept of schizophrenia as a neurodevelopmental disorder (Daniel R. Weinberger)(Daniel R. Weinberger) Brought to you by
  • Etiology of Schizophrenia -Etiology of Schizophrenia - Neurodevelopmental ModelNeurodevelopmental Model  Neurodevelopmental modelNeurodevelopmental model supposes insupposes in schizophrenia the presence of “silent lesion” in theschizophrenia the presence of “silent lesion” in the brain, mostly in the parts, important for thebrain, mostly in the parts, important for the development of integration (frontal, parietal anddevelopment of integration (frontal, parietal and temporal), which is caused by different factorstemporal), which is caused by different factors (genetic, inborn, infection, trauma...) during very(genetic, inborn, infection, trauma...) during very early development of the brain in prenatal or earlyearly development of the brain in prenatal or early postnatal period of life.postnatal period of life.  It does not interfere too much with the basic brainIt does not interfere too much with the basic brain functioning in early years, but expresses itself infunctioning in early years, but expresses itself in the time, when the subject is stressed bythe time, when the subject is stressed by demands of growing needs for integration, duringdemands of growing needs for integration, during formative years in adolescence and youngformative years in adolescence and young adulthood.adulthood. Brought to you by
  • Treatment of SchizophreniaTreatment of Schizophrenia  The acute psychotic schizophrenic patients willThe acute psychotic schizophrenic patients will respond usually to antipsychotic medication.respond usually to antipsychotic medication.  According to current consensus we use in the firstAccording to current consensus we use in the first line therapy the newer atypical antipsychotics,line therapy the newer atypical antipsychotics, because their use is not complicated by appearancebecause their use is not complicated by appearance of extrapyramidal side-effects, or these are muchof extrapyramidal side-effects, or these are much lower than with classical antipsychotics.lower than with classical antipsychotics. conventional antipsychotics (classical neuroleptics) chlorpromazine, chlorprotixene, clopenthixole, levopromazine, periciazine, thioridazine droperidole, flupentixol, fluphenazine, fluspirilene, haloperidol, melperone, oxyprothepine, penfluridol, perphenazine, pimozide, prochlorperazine, trifluoperazine atypical antipsychotics amisulpiride, clozapine, olanzapine, quetiapine, risperidone, sertindole, sulpiride Brought to you by
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