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SCHIZOPHRENIA
HISTORY <ul><li>Emil Kraepelin :  Manic Depressive Psychosis  Vs. Dementia Praecox. </li></ul><ul><li>Eugen Bleuler :  Sch...
HISTORY ( cont’d ) <ul><li>Thomas Szasz :  Anti-Psychiatry.   “Schizophrenia is myth enabling the society to handle devian...
EPIDEMIOLGY <ul><li>Affects approximately 0.85 % of world’s population. </li></ul><ul><li>Incidence : 15-20 per one lack p...
<ul><li>Increased incidence in- </li></ul><ul><li>- Lower socioeconomic class. </li></ul><ul><li>  - In patients with H/O ...
AETIOLOGY <ul><li>Genetic Theories </li></ul><ul><li>Biochemical Theories. </li></ul><ul><li>Family Theories. </li></ul><u...
GENETIC THEORIES <ul><li>Clustering seen in Families : </li></ul><ul><li>Relationship with Pt. : </li></ul><ul><li>Parents...
GENETIC STUDIES <ul><li>Twin studies -  MZ : DZ  Ratio 42% : 9%  </li></ul><ul><li>Adoption studies also prove the genetic...
BIOCHEMICAL STUDIES <ul><li>Dopamine over activity seen in  Mesolimbic pathway. </li></ul><ul><li>Serotonin hyperactivity ...
FAMILY THEORIES <ul><li>Double – bind  theory (Bateson et al.) – </li></ul><ul><li>Parents convey two or more conflicting ...
<ul><li>Life events and Expressed emotions (Vaughn and Leff ) –  </li></ul><ul><li>Hostility </li></ul><ul><li>Over involv...
PSYCHOLOGICAL THEORIES <ul><li>Over-inclusive thought process (Cameron )- Normal boundaries of concepts cannot be maintain...
<ul><li>Cognitive and linguistic deficits – Information processing in controlled, conscious tasks is impaired. </li></ul>P...
NEUROLOGICAL STRUCTURAL ABNORMALITIES <ul><li>Increased ventricular size. </li></ul><ul><li>Increased periventricular fibr...
NEUROLOGICAL STRUCTURAL ABNORMALITIES ( cont’d ) <ul><li>Abnormal smooth eye pursuit tracking patterns. </li></ul><ul><li>...
DIAGNOSIS (ICD-10)   <ul><li>A. Thought alienation phenomenon. </li></ul><ul><li>B. Delusion of control, passivity, delusi...
<ul><li>E. Hallucinations in other modalities. </li></ul><ul><li>F. Thought block. </li></ul><ul><li>G. Catatonic symptoms...
TYPES OF SCHIZOPHRENIA <ul><li>Paranoid Schizophrenia  </li></ul><ul><li>Hebephrenic Schizophrenia </li></ul><ul><li>Catat...
HALLUCINATION <ul><li>Definition :  </li></ul><ul><li>Hallucination is a false perception in absence of adequate stimulati...
DELUSION <ul><li>Definition :  </li></ul><ul><li>False belief based on incorrect inferences of external reality that is fi...
FORMAL THOUGHT DISORDERS <ul><li>Derailment </li></ul><ul><li>Tangentiality </li></ul><ul><li>Incoherence </li></ul><ul><l...
<ul><li>Circumstantiality </li></ul><ul><li>Persevaration </li></ul><ul><li>Thought block </li></ul>FORMAL THOUGHT DISORDE...
MANAGEMENT <ul><li>Somatic treatment methods :  </li></ul><ul><li>- Pharmacological methods. </li></ul><ul><li>- MECT </li...
PHARMACOLOGICAL TREATMENT <ul><li>Antipsychotics </li></ul><ul><li>Classification : </li></ul><ul><li>Phenothiazines –  </...
<ul><li>Dibenzoxapine -  eg. Loxapine </li></ul><ul><li>Dihydroindole -  eg. Molindone </li></ul><ul><li>Butrophenones – e...
<ul><li>Thienobenzodiazepine -  eg. Olanzapine </li></ul><ul><li>Benzisothiazolyl Piperazine -  eg.  </li></ul><ul><li>Zip...
MODIFIED ELECTROCONVULSIVE THERAPY <ul><li>MECT </li></ul><ul><li>‘Modified’ means given under general anesthesia </li></u...
NON-PHARMACOLOGICAL TREATMENTS <ul><li>Psychological treatments </li></ul><ul><li>Social treatments </li></ul>
PSYCHOLOGICAL TREATMENT <ul><li>Social Skills Training </li></ul><ul><li>Supportive therapy </li></ul><ul><li>Counseling <...
PROGNOSIS <ul><li>5 years prognosis ( with treatment ) </li></ul><ul><li>55 % -  Chronic course </li></ul><ul><li>45 % -  ...
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Schizophrenia

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Transcript of "Schizophrenia"

  1. 1. SCHIZOPHRENIA
  2. 2. HISTORY <ul><li>Emil Kraepelin : Manic Depressive Psychosis Vs. Dementia Praecox. </li></ul><ul><li>Eugen Bleuler : Schizophrenia (1911) </li></ul><ul><li>(Splitting of mind). </li></ul><ul><li>4 ‘As’- Abnormal Association. </li></ul><ul><li>Autism </li></ul><ul><li>Abnormal Affect </li></ul><ul><li>Ambivalence </li></ul>
  3. 3. HISTORY ( cont’d ) <ul><li>Thomas Szasz : Anti-Psychiatry. “Schizophrenia is myth enabling the society to handle deviant behaviors”. </li></ul><ul><li>Non-disease Models : The societal reaction theory “ A sane reaction to insane world” </li></ul><ul><li>Kurt Schneider (1959) : First rank symptoms. </li></ul>
  4. 4. EPIDEMIOLGY <ul><li>Affects approximately 0.85 % of world’s population. </li></ul><ul><li>Incidence : 15-20 per one lack population </li></ul><ul><li>Prevalence : 0.5-1.0 % </li></ul><ul><li>Lifetime risk : 0.9 % </li></ul><ul><li>Median age of onset : Males –28 years. </li></ul><ul><li>Females – 32 years. </li></ul>
  5. 5. <ul><li>Increased incidence in- </li></ul><ul><li>- Lower socioeconomic class. </li></ul><ul><li> - In patients with H/O perinatal </li></ul><ul><li>injuries. </li></ul><ul><li>- Left handed individuals. </li></ul><ul><li> - In individuals with winter </li></ul><ul><li>births </li></ul>EPIDEMIOLGY ( cont’d )
  6. 6. AETIOLOGY <ul><li>Genetic Theories </li></ul><ul><li>Biochemical Theories. </li></ul><ul><li>Family Theories. </li></ul><ul><li>Social Theories. </li></ul><ul><li>Psychological Theories. </li></ul><ul><li>Neurological Structural abnormalities. </li></ul>
  7. 7. GENETIC THEORIES <ul><li>Clustering seen in Families : </li></ul><ul><li>Relationship with Pt. : </li></ul><ul><li>Parents </li></ul><ul><li>Siblings </li></ul><ul><li>Child of schizophrenic </li></ul><ul><li>Child of two schizophrenics </li></ul><ul><li>Prevalence </li></ul><ul><li>5 % </li></ul><ul><li>10 % </li></ul><ul><li>14 % </li></ul><ul><li>46 % </li></ul>
  8. 8. GENETIC STUDIES <ul><li>Twin studies - MZ : DZ Ratio 42% : 9% </li></ul><ul><li>Adoption studies also prove the genetic basis of the illness. </li></ul>
  9. 9. BIOCHEMICAL STUDIES <ul><li>Dopamine over activity seen in Mesolimbic pathway. </li></ul><ul><li>Serotonin hyperactivity and hypo-activity , both have been discussed. </li></ul><ul><li>Lack of evidence to support involvement of other neurotransmitter systems. </li></ul>
  10. 10. FAMILY THEORIES <ul><li>Double – bind theory (Bateson et al.) – </li></ul><ul><li>Parents convey two or more conflicting </li></ul><ul><li>messages. </li></ul><ul><li>Marital skew and schism (Lidz et al.) – </li></ul><ul><li>Skew - Overprotective, intrusive parents. </li></ul><ul><li>Schism – Hostility between parents. </li></ul>
  11. 11. <ul><li>Life events and Expressed emotions (Vaughn and Leff ) – </li></ul><ul><li>Hostility </li></ul><ul><li>Over involvement </li></ul><ul><li>Critical comments </li></ul><ul><li>Excessive warmth in emotions. </li></ul><ul><li>Spending > 35 hours in high EE environment </li></ul>FAMILY THEORIES ( cont’d )
  12. 12. PSYCHOLOGICAL THEORIES <ul><li>Over-inclusive thought process (Cameron )- Normal boundaries of concepts cannot be maintained. </li></ul><ul><li>Concrete thinking (Goldstein) – Inability to think in abstract terms. </li></ul><ul><li>Defective filter (Broadbent) – Inability to filter out unnecessary sensory input. </li></ul>
  13. 13. <ul><li>Cognitive and linguistic deficits – Information processing in controlled, conscious tasks is impaired. </li></ul>PSYCHOLOGICAL THEORIES (cont’d)
  14. 14. NEUROLOGICAL STRUCTURAL ABNORMALITIES <ul><li>Increased ventricular size. </li></ul><ul><li>Increased periventricular fibrillary gliosis (on postmortem). </li></ul><ul><li>Associated various ‘soft’ signs ie. Dysgraphaesthesia, gait abnormalities, clumsiness etc. ) </li></ul><ul><li>Impaired dominant lobe functions. </li></ul>
  15. 15. NEUROLOGICAL STRUCTURAL ABNORMALITIES ( cont’d ) <ul><li>Abnormal smooth eye pursuit tracking patterns. </li></ul><ul><li>Non-specific abnormalities on EEG and evoked potentials. </li></ul><ul><li>Non-specific biochemical changes in CSF suggestive of viral infection and immunological abnormalities. </li></ul>
  16. 16. DIAGNOSIS (ICD-10) <ul><li>A. Thought alienation phenomenon. </li></ul><ul><li>B. Delusion of control, passivity, delusional </li></ul><ul><li>perception. </li></ul><ul><li>C. First and third person auditory </li></ul><ul><li>hallucinations. </li></ul><ul><li>D. Bizarre delusions. </li></ul>
  17. 17. <ul><li>E. Hallucinations in other modalities. </li></ul><ul><li>F. Thought block. </li></ul><ul><li>G. Catatonic symptoms. </li></ul><ul><li>H. Negative symptoms – apathy,paucity of </li></ul><ul><li>speech, blunting of affect, incongruity of </li></ul><ul><li>emotional response, social withdrawal </li></ul><ul><li>etc. </li></ul><ul><li>I. Personality deterioration. </li></ul>DIAGNOSIS (ICD-10) – (cont’d )
  18. 18. TYPES OF SCHIZOPHRENIA <ul><li>Paranoid Schizophrenia </li></ul><ul><li>Hebephrenic Schizophrenia </li></ul><ul><li>Catatonic Schizophrenia </li></ul><ul><li>Undifferentiated Schizophrenia </li></ul><ul><li>Residual Schizophrenia </li></ul><ul><li>Simple Schizophrenia </li></ul>
  19. 19. HALLUCINATION <ul><li>Definition : </li></ul><ul><li>Hallucination is a false perception in absence of adequate stimulation ,which is not a sensory distortion or misinterpretation but which occurs at the same time like as a real perception. </li></ul><ul><li>It should be substantial,occurring in objective space, clearly delineated, constant and independent of will. </li></ul>
  20. 20. DELUSION <ul><li>Definition : </li></ul><ul><li>False belief based on incorrect inferences of external reality that is firmly held despite objective and obvious contradictory evidence or proof and despite the fact that other members of community do not share the belief. </li></ul>
  21. 21. FORMAL THOUGHT DISORDERS <ul><li>Derailment </li></ul><ul><li>Tangentiality </li></ul><ul><li>Incoherence </li></ul><ul><li>Loss of goal </li></ul><ul><li>Metonyms </li></ul><ul><li>Neologisms </li></ul><ul><li>Flight of ideas </li></ul>
  22. 22. <ul><li>Circumstantiality </li></ul><ul><li>Persevaration </li></ul><ul><li>Thought block </li></ul>FORMAL THOUGHT DISORDERS (cont’d )
  23. 23. MANAGEMENT <ul><li>Somatic treatment methods : </li></ul><ul><li>- Pharmacological methods. </li></ul><ul><li>- MECT </li></ul><ul><li>Non-pharmacological treatment methods. </li></ul>
  24. 24. PHARMACOLOGICAL TREATMENT <ul><li>Antipsychotics </li></ul><ul><li>Classification : </li></ul><ul><li>Phenothiazines – </li></ul><ul><li>Aliphatic side chain – eg. Chlorpromazine </li></ul><ul><li>Piperazines – eg. Trifluoperazine </li></ul><ul><li>Piperadines – eg. Thioridazine </li></ul><ul><li>Thioxanthenes - eg.Thiothixene </li></ul>
  25. 25. <ul><li>Dibenzoxapine - eg. Loxapine </li></ul><ul><li>Dihydroindole - eg. Molindone </li></ul><ul><li>Butrophenones – eg. Haloperidol </li></ul><ul><li>Diphenylbutylpiperadine - eg. Pimozide </li></ul><ul><li>Dibenzodiazepine - eg. Clozapine </li></ul><ul><li>Dibenzothiazapine - eg. Quetiapine </li></ul><ul><li>Benzisoxazole - eg. Risperidone </li></ul>PHARMACOLOGICAL TREATMENT (cont’d )
  26. 26. <ul><li>Thienobenzodiazepine - eg. Olanzapine </li></ul><ul><li>Benzisothiazolyl Piperazine - eg. </li></ul><ul><li>Ziprasidone </li></ul><ul><li>Benzamides - eg. Sulpiride </li></ul><ul><li>Others – eg. Clopenthixole, </li></ul><ul><li>Sertindole </li></ul><ul><li>Zotepine </li></ul><ul><li>DSS - eg. Aripierazole </li></ul>PHARMACOLOGICAL TREATMENT (cont’d )
  27. 27. MODIFIED ELECTROCONVULSIVE THERAPY <ul><li>MECT </li></ul><ul><li>‘Modified’ means given under general anesthesia </li></ul><ul><li>Used in schizophrenia for acute agitation, catatonic symptoms, presence of some associated affective symptoms. </li></ul><ul><li>Not important on management of chronic cases. </li></ul>
  28. 28. NON-PHARMACOLOGICAL TREATMENTS <ul><li>Psychological treatments </li></ul><ul><li>Social treatments </li></ul>
  29. 29. PSYCHOLOGICAL TREATMENT <ul><li>Social Skills Training </li></ul><ul><li>Supportive therapy </li></ul><ul><li>Counseling </li></ul><ul><li>Token economy </li></ul><ul><li>Cognitive – Behavioural Therapy </li></ul>
  30. 30. PROGNOSIS <ul><li>5 years prognosis ( with treatment ) </li></ul><ul><li>55 % - Chronic course </li></ul><ul><li>45 % - Acute, improving course </li></ul><ul><li>49 % - Self- supporting </li></ul><ul><li>11 % - Chronically hospitalized </li></ul>
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