INTRODUCTIONA Greek word splited as: SKCHIZO-To Divide PHREN-MindTermed by kraplein in 1896 as ‘DemensiaPrecox’In 1908 Eugene bleuler coined it asSchizophrenia
It is a psychotic condition characterized bya disturbance in thinking, emotions,volitions and faculties in the presence ofclear consciousness, which usually leadsto social withdrawalIt is a type of functional psychosischaracterized mainly by disturbance inthinking and associated disturbances inpsychomotor activity, affect, perceptionand behavior.
ETIOLOGY1) IDOPATHIC2) HEREDITARY:- -Incidence high in univolvar twins -Transmission through one or more autosomal recessive genes3) PERSONALITY-SCHIZOID4) CHILD DEVELOPMENT AND PARENT CHILD RELATIONSHIP5) AGE-Peak in between 15-30 and also some after30 yrs
6) SEX-Equal in both sexes7) SOCIAL ISOLATION-Predisposed unstable personal relationship8) INTELLIGENCE9) OVERCROWDING SLUMS10) PRECIPITATION-Stress, regarding ineffective disease, pregnancy, family problem, etc.11) ENDOCRINE-Excess of dopamine dependent neuronal activity in brain12) ASSOCIATED WITH OTHER DISEASES- More common in temporal lobe epilepsy
a) Autistic thinking-important featureb) Considers two things identicalc) Disturbed thinking, emotions and behavior.d) Patient appears absurd and bizarree) Social withdrawal from religion, philosophy, science, sex, and power
g) Absence of links between ideas, crowding and poverty of ideas, flight of ideash) Word are linked without meaning(word salad)a. Emotional blunting or shallowness of affectb. Inappropriate affect-patient laughs when he is expected to cry and cries when he is expected to laughsc. Hypersentiveness or insensitiveness of feelingsd. Ambivalence-experience of 2 opposite of feelings
a) Irrelevant and inappropriate behaviorb) Awkward actionsc) Rowdy, violent, assaultive(a person has a physical or verbal violence), agitationd) Suicidal and homicidal tendenciese) Criminal and sexual over activity, pervasivea) Reduction of drive and desire to carry out routine workb) Avoiding mixing in family and friends(aloof)c) Reduced efficiency and activityd) Feeling of passivity(mind and thoughts controlled by outside force
a) Hallucination –auditory and visual are common, others are very rare.b) Hallucinations are either structured(human or animal voice) or unstructured(vague voices)a) In catatonic, increased psychomotor activity, stupor, negativism, stereotype, mutism, verbegeration(repeating the same words)b) Waxy flexibility
a) Excessive day dreaming and fantasyb) Mutteringc) Spells of laughter and crying without reasond) Childish behaviore) Patient passes urine and stool in his clothes and plays with has own excretaf) Absent mindednessg) Makes lot of mistakes in work
THE ILLNESS OF AS A PHENOMENON OF REGRESSION E.G- Reversal to infantile and childhood patterns of psychological living a state of organization where reality does not exist. Thus the patient attempt to resolve his psychological conflicts by denying the harsh and painful reality world and living in a fantasy would full of pleasures
A. PARANOID SCHIZOPHRENIA:- Early onset ‘Paranoia’ means ‘delusional’ It occurs between 25-30 yrs Seen more in males than females Delusion of suspiciousness, persecution and grandeur Disorganization of speech and thought Hallucinatory voices of threatening or commanding, also voices of whistling and laughs
Affect is usually of hostility, anger or suspiciousness Negative symptoms like flat affect, poverty of speech and poor activity Prognosis is good
B. HEBEPHRENIC SCHIZOPHRENIA:- Early and insidious onset Occurs between the age of 20-25 yrs Thinking disturbances Regression Childish behavior Inappropriate affect Somatic delusion Unpredictable, giggling and silliness Irrelevant Poverty of ideas Prognosis is poor
C. SIMPLE SCHIZOPHRENIA:- Insidious and gradual course Occurs between age of 15-20 yrs More incidence in males Disturbances in affect Disturbances in thinking Delusions and hallucinations are rare Wandering aimlessly Prognosis is poor
D. CATATONIC SCHIZOPHRENIA:- Occurs between age of 20-25 yrs Equal in both sexes Disturbances of thinking, affect and behavior Acute or sub-acute onset Autism Purposeless excitement and destructive behavior Delusion and hallucinations are common Prognosis is good but reoccurs are common
E. CATATONIC STUPOR:- Absence of speech Maintenance of rigid posture against efforts to be moved Negativism Bizarre postures for longer period of time Stuporous reaction towards surrounding Ecolalia-mimicking of phrases and words Echopraxia-mimicking of actions observed Waxy flexibility Ambitendency
F. RESIDUAL SCHIZOPHRENIA:- Emotional blunting Eccentric behavior Social withdrawal A type of schizophrenia which has been at least one episode in the past but without prominent psychotic symptoms at presentG. UNDIFFERENTIATED SCHIZOPHRENIA:- Late schizophrenia occurs after 40 yrs of age Schizoaffective psychosis with symptoms of depression and mania and also neurosis Prognosis is poor.
H. CHILDHOOD OR JUVENILE SCHIZOPHRENIA:- Not common but seen between age of 5-10 yrs and 12-14 yrs Onset is acute or gradual Prognosis is poorI. SCHIZOAFFECTIVE PSYCHOSIS:- Symptoms of schizophrenia associated with symptoms of depression and mania
J.PSEUDO-NEUROTIC SCHIZOPHRENIA:- Core of illness is schizophrenia but presenting symptoms are suggestive of neurotic symptoms like anxiety state, phobic reactions, obsessive compulsive neurosis or hysteria Treatment such as psychotherapy, abreactive therapy or drug therapy is not satisfactory Careful psychiatric examination done through repeated interview, reveals the true nature of illness
1) Duration of illness:- Shorter duration carries better prognosis2) Type of schizophrenia:- Catatonic and paranoid type carries good prognosis. simple, hebephrenic, juvenile, pseudo- neurotic types do not carry good prognosis.3) Personality:- Non schizoid and stable personality respond better
4) Precipitating factor:- Presence of precipitating factor carries good prognosis.5) Age:- 20-30 yrs of age carries better prognosis than other ages.6) Type of onset:- Acute onset carries better prognosis than gradual onset.
I. PSYCHIATRIC HISTORYII. A MENTAL STATUS EXAMINATIONIII. CLINICAL OBSERVATIONIV. CT SCANV. MRIVI. OFFICIAL DIAGNOSIS IS BASED ON ICD 10 CRITERIA
TREATMENTA. MODALITIES PHARMACOTHERAPY:- Conventional antipsychotics are now used less frequently, because of their only partial efficacy and adverse effects. The following are the drugs given to non-compliant patients; -Chlorpromazine:50- 100mg/day -Fluphenazine decanoate:20- 25mg IM every 1-3 wks -Haloperidol:5-20mg/day IM -Trifluoperazine:1-5mg/day IM
Commonly used atypical antipsychotics; -Clozapine:25-450mg/day PO -Resperidone:2-10mg/day PO -Olanzapine:10-20mg/day PO -Ziprasidone:20-80mg/day PO Other drugs used in schizophrenia are mood stabilizers, anti depressants, benzodiazepines, etc.
B. ELECTROCONVULSIVE THERAPY(ECT):- Indications are catatonic stupor, catatonic excitement Severe side effects with drugs Usually 8-10 ECT’s are required to be given About 8-10 convulsions spread over a period of 4-6 weeksC. PSYCHOLOGICAL THERAPIES:- Cognitive therapy, group therapy, behavior therapy, family therapyD. PSYCHOSURGERY:- Prefrontal leucotomy