Losing touch with reaLityDr Biju Sunny T.MD (nimhans)Senior Consultant PsychiatristMIMS Calicut
Psychiatric disorders• Neurosis: adjustment disorders, anxietyminor depression• Psychosis: Schizophrenia, other types ofps...
Psychosis• Delusions: BELIEF• Hallucination: SENSATIONS• Impaired reality testing• Loss of insight
“Split-Personality”…NO!• Bleuler - “schizophrenia” April 24th1908• Chronic, deteriorating, usually continuousillness…..( h...
So what is schizophrenia ?• A special type of psychosis• Special characteristic features :1st& 3rdperson auditory hallucin...
• Parallel Universesby Dan Hoeweler (psychosis patient)• The universe I live inIs different than yoursI will show you some...
• When traveling throughI saw the demonsThat rule everythingEverywhereAll the time• I see them hereIn this parallel univer...
• They control meThey hear meThey see all• I want to be ignorant againJust like youBut poisoning my mindWith strange pills...
• One day you may discoverThis parallel worldAnd find yourself inA lot of troubleWith demonsThat see and hearEverything th...
Are there many types of schizophrenia• Paranoid schizophrenia• Hebephrenic schizophrenia• Catatonic schizophrenia• Undiffe...
Features of schizophrenia• 1% in community ( East vs West outcome)• Increased risk with ganja or cannabis use• Neuro devel...
Risk of developing schizophrenia• Relatives with schizophreniaChance of developing schizophrenia• None 1 in 100• 1 parent ...
Management• Antipsychotics keep sx in check…durationbased treatment.• Managing adverse effects, affectscompliance• Teachin...
Management• Typical antipsychotics vs Atypicals• Metabolic syndrome, QT prolongation• Comorbidity with medical problems• F...
• Medicalising schizophrenia is essential• Analogy of Error Message, false signalsdue to chemicals• Doubts about addiction...
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Losing touch with reality

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Losing touch with reality

  1. 1. Losing touch with reaLityDr Biju Sunny T.MD (nimhans)Senior Consultant PsychiatristMIMS Calicut
  2. 2. Psychiatric disorders• Neurosis: adjustment disorders, anxietyminor depression• Psychosis: Schizophrenia, other types ofpsychosis, Delusional disorder
  3. 3. Psychosis• Delusions: BELIEF• Hallucination: SENSATIONS• Impaired reality testing• Loss of insight
  4. 4. “Split-Personality”…NO!• Bleuler - “schizophrenia” April 24th1908• Chronic, deteriorating, usually continuousillness…..( hence earlier considered to be aform of dementia)• Like the Syphilis “the great imitator”• Schizo-affective is separate but relatedillness
  5. 5. So what is schizophrenia ?• A special type of psychosis• Special characteristic features :1st& 3rdperson auditory hallucinationExperience of being controlled (E,I,A)Thoughts inserted, withdrawn, broadcastNegative symptomsDisorganized behaviourBizarre delusionsThought disorder
  6. 6. • Parallel Universesby Dan Hoeweler (psychosis patient)• The universe I live inIs different than yoursI will show you some dayAnd you will believeIn placesWhere death stalks allWhere trickery takes placeWhere deception is kingWhere demons ruleWhere everything is cruel• I came here one dayThrough a black holeCalled KnowledgeAnd viewed the worldIn a different light
  7. 7. • When traveling throughI saw the demonsThat rule everythingEverywhereAll the time• I see them hereIn this parallel universeThat you cannot seeThat you cannot hear• They can seeThose that are not blindThey track everyoneWho can see the light
  8. 8. • They control meThey hear meThey see all• I want to be ignorant againJust like youBut poisoning my mindWith strange pillsWhich brainwash meWill not let me be free• I wish I was blindAnd could not seeThis world is a curseTo everythingThat I breathe
  9. 9. • One day you may discoverThis parallel worldAnd find yourself inA lot of troubleWith demonsThat see and hearEverything that you doWith voicesThat will torment you• Stay away from the voicesStay away from the lightDon’t listen to themDon’t think they existThey will lead you hereWhere I am nowWith voicesAnd demons that I fear
  10. 10. Are there many types of schizophrenia• Paranoid schizophrenia• Hebephrenic schizophrenia• Catatonic schizophrenia• Undifferentiated schizophrenia• Simple schizophrenia
  11. 11. Features of schizophrenia• 1% in community ( East vs West outcome)• Increased risk with ganja or cannabis use• Neuro developmental disorderhigher anomalies, soft neurological signsSynaptic Pruning >> signal : noise ratioDopamine pathways (nigro striatal pathway)
  12. 12. Risk of developing schizophrenia• Relatives with schizophreniaChance of developing schizophrenia• None 1 in 100• 1 parent 1 in 10• 1 identical twin 1 in 2• 1 non-identical twin 1 in 8
  13. 13. Management• Antipsychotics keep sx in check…durationbased treatment.• Managing adverse effects, affectscompliance• Teaching relapse prevention• Education regarding Life Events &improving coping strategies
  14. 14. Management• Typical antipsychotics vs Atypicals• Metabolic syndrome, QT prolongation• Comorbidity with medical problems• Family care is preferred over institutionalizing
  15. 15. • Medicalising schizophrenia is essential• Analogy of Error Message, false signalsdue to chemicals• Doubts about addiction, “too muchdependence on medications” needdiscssn• Collaboration of a health caresystem+Family
  16. 16. Thank you for your Attention

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