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  2. 2. HISTORY OF SCHIZOPHRENIA <ul><li>The word &quot;schizophrenia&quot; is less than 100 years old. However the disease was first identified as a discrete mental illness by Dr. Emile Kraepelin in the 1887 and the illness itself is generally believed to have accompanied mankind through its history. </li></ul>
  3. 3. HISTORY OF SCHIZOPHRENIA <ul><li>Written documents that identify Schizophrenia can be traced to the old Pharaonic Egypt, as far back as the second millennium before Christ. Depression, dementia, as well as thought disturbances that are typical in schizophrenia are described in detail in the Book of Hearts. The Heart and the mind seem to have been synonymous in ancient Egypt. The physical illnesses were regarded as symptoms of the heart and the uterus and originating from the blood vessels or from purulence, fecal matter, a poison or demons. </li></ul>
  4. 4. HISTORY OF SCHIZOPHRENIA <ul><li>At one point, all people who were considered &quot;abnormal,&quot; whether due to mental illness, mental retardation, or physical deformities, were largely treated the same. Early theories supposed that mental disorders were caused by evil possession of the body, and the appropriate treatment was then exorcising these demons, through various means, ranging from innocuous treatments, such as exposing the patient to certain types of music, to dangerous and sometimes deadly means, such as releasing the evil spirits by drilling holes in the patient's skull. </li></ul>
  5. 5. HISTORY OF SCHIZOPHRENIA <ul><li>One of the first to classify the mental disorders into different categories was the German physician, Emile Kraepelin . Dr. Kraepelin used the term &quot;dementia praecox&quot; for individuals who had symptoms that we now associate with schizophrenia. </li></ul>
  6. 6. HISTORY OF SCHIZOPHRENIA <ul><li>The Swiss psychiatrist, Eugen Bleuler, coined the term, &quot;schizophrenia&quot; in 1911. He was also the first to describe the symptoms as &quot;positive&quot; or &quot;negative.&quot; Bleuler changed the name to schizophrenia as it was obvious that Krapelin's name was misleading as the illness was not a dementia (it did not always lead to mental deterioration) and could sometimes occur late as well as early in life. </li></ul>
  7. 7. HISTORY OF SCHZOPHRENIA <ul><li>The word &quot;schizophrenia&quot; comes from the Greek roots schizo (split) and phrene (mind) to describe the fragmented thinking of people with the disorder. His term was not meant to convey the idea of split or multiple personality. </li></ul>
  8. 8. HISTORY OF SCHIZOPHRENIA <ul><li>Henri laborit used chlorpromazine as anesthetic in his surgical cases. </li></ul><ul><li>Laborit goaded his brother-in-law, Pierre Deniker, a psychiatrist who used it in his patients. </li></ul><ul><li>Chlorpromazine was the first antipsychotic approved by the USFDA in 1954 for mental illness </li></ul>
  9. 12. FACTS ABOUT SCHIZOPHRENIA <ul><li>About 150 of every 100,000 persons will develop schizophrenia. </li></ul><ul><li>Schizophrenia affects men and women equally </li></ul><ul><li>About 1% of the population suffers from schizophrenia. </li></ul><ul><li>About 75% of patients developed schizophrenia between the ages of 15-25. </li></ul>
  10. 13. SYMPTOMS <ul><li>Changes in work performance </li></ul><ul><li>Disordered thinking </li></ul><ul><li>Talking in nonsense </li></ul><ul><li>Hallucinations and delusions </li></ul><ul><li>Unusual perceptions </li></ul><ul><li>Changes in social relationships </li></ul>
  11. 14. PSYCHOSOCIAL FACTORS <ul><li>Life/Health Changes: Environmental effects, such as viral infections that changed the body’s chemistry or a highly stressful situation, may trigger susceptibility to the illness. </li></ul><ul><li>Family History: There is an 8-18% chance of children, with one parent who is schizophrenic, to develop the illness. In children with two parents who are schizophrenic, there is a 15-50% risk. </li></ul><ul><li>Genetics: Genetic combinations could result in a person not having certain enzymes or fully developed nerves; both of which could lead to the illness. </li></ul><ul><li>Developmental Problems: In some schizophrenic patients, the prefrontal cortex in the brain may have developed abnormally, thus leading to the disturbances in thought patterns. </li></ul><ul><li>Illness: Autoimmune illness and viral infections may combine with genetics to cause schizophrenia. </li></ul><ul><li>Medication: Use of medication may interfere with the brain’s production of dopamine. Schizophrenia sufferers may be extra sensitive to dopamine, or may produce too much of it. </li></ul>
  12. 16. Coronal MR scans from a normal comparison subject (left), and chronic schizophrenic (right). Note increase in CSF in right amygdala-hippocampal complex. (image courtesy of Harvard University Schizophrenia Project
  13. 17. Variability maps are similar in both groups with highest variability in the posterior horns (NC = normal controls, SZ = schizophrenic patients). Increases in LH ventricle length and volume were determined. The color bar encodes the root mean square magnitude of variability in millimeters
  14. 18. Displacement maps show the magnitude of displacement (mm) between schizophrenic patients and normal controls as represented by the color bar for the lateral ventricles and corpus callosum. A significant vertical displacement of the lateral ventricles in schizophrenic patients reflects a bilateral increase in ventricular volume, and corresponds to the displacement of the corpus callosum
  15. 19. Mapping Brain Tissue Loss in Adolescents with Schizophrenia. This map reveals the 3-dimensional profile of gray matter loss in the brains of teenagers with early-onset schizophrenia, with a region of greatest loss in the temporal and frontal brain regions that control memory, hearing, motor functions, and attention. Using novel image analysis algorithms, dramatic reductions in the profiles of gray matter were detected, based on a database of 96 images from schizophrenic patients scanned repeatedly with MRI. The parallel extraction of anatomical models from all patients in the image database required 60 CPU hours, when running in parallel on an SGI RealityMonster with 32 internal CPUs. [Image by Paul Thompson, Christine Vidal, Judy Rapoport, and Arthur Toga].  
  16. 20. Value of Early Diagnosis and Treatment in Schizophrenia <ul><li>Patients with long DUP (delayed untreated psychosis) had a worse outcome regarding the severity level of positive symptoms, of general symptoms and social disability </li></ul><ul><li>Longer DUP results partly from a pattern of symptoms and social functioning which reduces concern by the sufferer and relevant others. DUP's relationship to outcome is strongest in the initial months of psychosis. This has implications for targeting early intervention. </li></ul><ul><li>Earlier diagnosis of schizophrenia improves results of treatment </li></ul><ul><li>The DUP prior to first psychiatric admission adversely affects the long-term outcome in schizophrenia. The findings underline the importance of establishing health service programs for early detection and treatment of schizophrenic patients with the aim to shorten the DUP and to consequently improve the course and outcome of schizophrenic patients. </li></ul>
  18. 22. TYPES OF SCHIZOPHRENIA <ul><li>Paranoid schizophrenia a person feels extremely suspicious, persecuted, grandiose, or experiences a combination of these emotions. </li></ul><ul><li>Disorganized schizophrenia a person is often incoherent but may not have delusions. </li></ul><ul><li>Catatonic schizophrenia a person is withdrawn, mute, negative and often assumes very unusual postures. </li></ul><ul><li>Residual schizophrenia a person is no longer delusion or hallucinating, but has no motivation or interest in life. These symptoms can be most devastating. </li></ul>
  19. 23. POSITIVE vs NEGATIVE SYMPTOMS <ul><li>POSITIVE </li></ul><ul><ul><li>Hallucinations </li></ul></ul><ul><ul><li>Delusions </li></ul></ul><ul><ul><li>Disorganized thinking </li></ul></ul><ul><ul><li>agitation </li></ul></ul><ul><li>NEGATIVE SYMPTOMS </li></ul><ul><ul><li>LACK OF DRIVE </li></ul></ul><ul><ul><li>SOCIAL WITHDRAWAL </li></ul></ul><ul><ul><li>APATHY </li></ul></ul><ul><ul><li>EMOTIONAL UNRESPONSIVENESS </li></ul></ul>