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  2. 2. HISTORY OF SCHIZOPHRENIA <ul><ul><li>Emil Kraepelin – uses the term demence precox to emphasized the distinct pattern of dementia in early onset. </li></ul></ul><ul><ul><li>Eugen Bleuler – coined the term schizophrenia. He chose the term schisms between thought, emotion, and behavior in patients with this disorder </li></ul></ul>
  3. 3. Eugen Bleuler 4 A’s of schizophrenia <ul><li>Associational disturbances </li></ul><ul><li>Affect </li></ul><ul><li>Autism </li></ul><ul><li>Ambivalence </li></ul>
  4. 4. EPIDEMIOLOGY <ul><li>Lifetime prevalence rate is 1% </li></ul><ul><li>Equally prevalent in men and women </li></ul><ul><li>Onset is earlier in men than in women </li></ul><ul><li>The peak age of onset is 10 to 25 for men and 25 to 35 years for women </li></ul><ul><li>About 3 – 10% of women present this illness after age 40. </li></ul><ul><li>90% of schizophrenia in treatment is between 15 to 55 years old. </li></ul><ul><li>Onset of schizophrenia before age 10 or after age 60 is extremely rare </li></ul>
  5. 5. EPIDEMIOLOGY <ul><li>In the northern hemisphere, including the US, persons with schizophrenia are more often born in the months of January to April. In southern hemisphere, it is between July to September </li></ul><ul><li>Ireland have an unusual high prevalence of schizophrenia. </li></ul><ul><li>First degree biological relatives have a 10x greater risk for developing the disease. </li></ul>
  6. 6. EPIDEMIOLOGY <ul><li>Persons with schizophrenia have a higher mortality rates from accidents and natural causes than the general population. </li></ul><ul><li>Suicide is the leading cause of mortality. </li></ul><ul><li>Persons who have realistic awareness of the deteriorative effects of the illness, hopelessness, excessive dependence on treatment or loss of faith in treatment increases the risk of suicide. </li></ul>
  7. 7. EPIDEMIOLOGY <ul><li>Schizophrenic patients are in the low socioeconomic status of life. </li></ul><ul><ul><li>Downward drift hypothesis – that affected persons move into, or failed to rise out of, low socioeconomic status of life </li></ul></ul><ul><ul><li>Social causation hypothesis – proposes that stresses experienced by low socioeconomic groups contribute to the development of schizophrenia </li></ul></ul>
  8. 8. ETIOLOGY <ul><li>Stress Diathesis Model </li></ul><ul><li>Neurobiology </li></ul><ul><ul><li>Dopamine hyperactivity </li></ul></ul><ul><ul><li>Serotonin </li></ul></ul><ul><ul><li>Neuropeptides - cholecystokinin and neurotensin </li></ul></ul><ul><li>Genetic factors </li></ul><ul><li>Psychosocial Factors </li></ul>
  9. 16. Subtypes of schizophrenia <ul><li>Paranoid type </li></ul><ul><li>Disorganized type </li></ul><ul><li>Catatonic type </li></ul><ul><li>Undifferentiated type </li></ul><ul><li>Residual type </li></ul>
  10. 17. Auditory hallucinations, such as hearing voices Delusions, such as believing a co-worker wants to poison you Anxiety Anger Aloofness Violence Verbal confrontations Patronizing manner Suicidal thoughts and behavior SIGNS AND SYMPTOMS OF PARANOID SCHIZOPHRENIA
  11. 18. Paranoid type <ul><li>In paranoid schizophrenia, delusions are often focused on the perception that you're being singled out for harm. Your brain misinterprets experiences and you hold on to these false beliefs despite evidence to the contrary </li></ul>
  12. 19. Paranoid type <ul><li>you may believe that the government is monitoring every move you make or that a co-worker is poisoning your lunch. You may also have delusions of grandeur — the belief that you can fly, that you're famous or that you have a relationship with a famous person </li></ul>
  13. 20. Paranoid type <ul><li>Delusions can result in aggression or violence if you believe you must act in self-defense against those who want to harm you. </li></ul><ul><li>These voices may talk either to you or to each other. The voices are usually unpleasant. They may give a running critique of what you're thinking or doing, or they may harass you about real or imagined faults. Voices may also command you to do things that can be harmful to yourself or to others. When you have paranoid schizophrenia, these voices seem real. You may talk to or shout at the voices. </li></ul>
  14. 21. Disorganized Type <ul><li>Disorganized schizophrenia is characterized by illogical and incoherent thoughts and behaviors. </li></ul><ul><li>Disorganized schizophrenia is considered a more severe type of schizophrenia because you may be unable to carry out routine daily activities, such as bathing and meal preparation. With disorganized schizophrenia, others may not be able to understand what you're saying. Also, frustration and agitation may cause you to lash out. Disorganized schizophrenia is sometimes known as hebephrenic schizophrenia. </li></ul>
  15. 22. Disorganized type symptoms <ul><li>Disorganized thinking. With disorganized thinking, you can't form logical or coherent thoughts. This disorganization is also noticeable in your speech patterns. You may not be able to stay on track in a conversation, instead jumping from one unrelated idea to another. Your disorganized speaking is so severe that it may appear garbled and unintelligible to others, and you may make up words. These same disorganized patterns are evident in your written communication </li></ul>
  16. 23. Disorganized type symptoms <ul><li>Grossly disorganized behavior. The disorganized behavior of this type of schizophrenia is severe and causes significant impairment in your ability to function in regular daily activities. You may not be able to bathe, dress appropriately or prepare meals, for instance. You may have unprovoked agitation or confrontations, wear many layers of clothes on a warm day, appear disheveled or engage in sexual behavior in public </li></ul>
  17. 24. Disorganized symptoms <ul><li>Absent or inappropriate emotional expression. </li></ul><ul><li>When you lack emotional expression (flat affect), your face appears blank. You don't make eye contact or display common body language. Although you may occasionally show some emotion, your range of expression is usually very limited. Sometimes you may have emotions that are inappropriate to the situation, such as acting silly or laughing loudly during a serious event. </li></ul>
  18. 25. Other symptoms of disorganized type <ul><li>Having beliefs not based on reality (delusions) </li></ul><ul><li>Seeing or hearing things that don't exist (hallucinations), especially voices </li></ul><ul><li>Grimacing </li></ul><ul><li>Odd postures </li></ul><ul><li>Trouble functioning at school or work </li></ul><ul><li>Social isolation </li></ul><ul><li>Clumsy, uncoordinated movements </li></ul>
  19. 26. Risk factors <ul><li>Having a family history of schizophrenia </li></ul><ul><li>Exposure to viruses while in the womb </li></ul><ul><li>Malnutrition while in the womb </li></ul><ul><li>Stressful life circumstances </li></ul><ul><li>Trauma or abuse during childhood </li></ul><ul><li>Older paternal age </li></ul><ul><li>Taking psychoactive drugs during adolescence </li></ul>
  20. 27. Catatonic type <ul><li>a chronic mental illness in which reality is interpreted abnormally (psychosis). Catatonic schizophrenia includes extremes of behavior. At one extreme of catatonic schizophrenia, you're unable to speak, move or respond. At the other, you have overexcited or hyperactive motion </li></ul>
  21. 28. Catatonic type symtoms <ul><li>Physical immobility </li></ul><ul><li>Excessive mobility </li></ul><ul><li>Extreme resistance </li></ul><ul><li>Peculiar movements </li></ul><ul><li>Mimicking speech or movement </li></ul>
  22. 29. Undifferentiated type <ul><li>A form of schizophrenia that is characterized by a number of schizophrenic symptoms such as delusion(s), disorganized behavior, disorganized speech, flat affect, or hallucinations but does not meet the criteria for any other type of schizophrenia. </li></ul>
  23. 30. Residual Type <ul><li>A form of schizophrenia that is characterized by a previous diagnoses of schizophrenia, but no longer having any of the prominent psychotic symptoms. There are some remaining symptoms of the disorder however, such as eccentric behavior, emotional blunting, illogical thinking, or social withdrawal. </li></ul>
  24. 31. Positive symptoms of schizophrenia <ul><li>Hallucinations </li></ul><ul><li>Delusions </li></ul><ul><li>Bizaare behavior </li></ul><ul><li>Positive formal thought disorder </li></ul><ul><ul><li>Derailment </li></ul></ul><ul><ul><li>Tangentiality </li></ul></ul><ul><ul><li>Incoherence </li></ul></ul><ul><ul><li>Illogicality </li></ul></ul><ul><ul><li>Circumstatiality </li></ul></ul><ul><ul><li>Pressure of speech </li></ul></ul><ul><ul><li>Distractible speech </li></ul></ul><ul><ul><li>clanging </li></ul></ul>
  25. 32. Negative symptoms of schizophrenia <ul><li>Affective flattening </li></ul><ul><li>Alogia </li></ul><ul><li>Avolition-Apathy </li></ul><ul><li>Anhedonia-asociality </li></ul><ul><li>Attention </li></ul>
  26. 33. Good prognostic feature of schizophrenia <ul><li>Late onset </li></ul><ul><li>Obvious precipitating stressors </li></ul><ul><li>Acute onset </li></ul><ul><li>Mood disorder symptoms </li></ul><ul><li>Married </li></ul><ul><li>Family history of mood disorder </li></ul><ul><li>Good support system </li></ul><ul><li>Positive symptoms </li></ul>
  27. 34. Poor prognostic feature of Schizophrenia <ul><li>Young onset </li></ul><ul><li>No precipitating stressor </li></ul><ul><li>Insidious onset </li></ul><ul><li>Withdrawn, autistic behavior </li></ul><ul><li>Single, divorced or widowed </li></ul><ul><li>Family history of schizophrenia </li></ul><ul><li>Neurological signs and symptoms </li></ul><ul><li>History of perinatal trauma </li></ul><ul><li>No remissions in three years </li></ul><ul><li>Many relapses </li></ul><ul><li>History of assaultiveness </li></ul>
  28. 35. TREATMENT <ul><li>Hospitalization </li></ul><ul><ul><li>For diagnostic purposes </li></ul></ul><ul><ul><li>For stabilization of medications </li></ul></ul><ul><ul><li>For patient’s safety because of suicidal or or homicidal ideation </li></ul></ul><ul><ul><li>For grossly disorganized or inappropriate behavior </li></ul></ul><ul><ul><li>Establishing an effective association between patients and community support system </li></ul></ul>
  29. 36. TREATMENT <ul><li>Biological therapies </li></ul><ul><li>Psychosocial therapies </li></ul><ul><li>Vocational therapy </li></ul>
  30. 37. THE END
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