1)Psychosis and Neurosis and differences between them, 2)Schizophrenia (What is Schizophrenia?, Symptoms, Diagnostic Criteria, Subtypes, Aetiology, Epidemiology, Treatment, Prognosis) 3)Delusional Disorder 4)Acute Psychotic Disorder

1. • P S Y C H O S I S & N E U R O S I S ,
• S C H I Z O P H R E N I A ,
• D E L U S I O N A L D I S O R D E R ,
• A C U T E P S Y C H O T I C D I S O R D E R .
T O P I C O F D I S S C U S I O N .
BY
Dr.KARTHEEK VARMA
kartheekminna@gmail.com

3. N E U R O S I S V S P S Y C H O S I S
Neurosis Psychosis
Reality Testing Judgement Present Reality Testing Judgement Absent
Personlaity Not Affected Personality Is Affected
Insight Is Present Insight Is Absent
Delusions Are Absent Delusions Are Present
Hallucinations Are Absent Hallucinations Are Present
No Disorganized Speech Disorganized Speech Present
Disorganized Behaviour Absent Disorganized Behaviour Present

4. F20 SCHIZOPHRENIA
• What is Schizophrenia?
• Symptoms
• Diagnostic Criteria
• Subtypes
• Aetiology
• Epidemiology
• Treatment
• Prognosis

5. WHAT IS SCHIZOPHRENIA?
Schizo means “split”and Phrenia means “Mind”.
*It doesn't refer to split personality but rather refers to describe a
scattered or fragmented pattern of thinking.
It is a Syndrome- lots of symptoms.
Different Patients have different symptoms.

6. • “Eugen Bleuler” coined the term Schizophrenia and given 4 A’s.
1.AUTISM
2.AMBIVALENCE
3.AFFECTIVE BLUNTING
4.ASSOCIATIONAL LOOSENING

7. SYMPTOMS
P O S T I V E S Y M P T O M S
( P S Y C H O T I C S Y M P T O M S )
N E G AT I V E S Y M P T O M S C O G N I T I V E S Y M P T O M S
H A L L U C I N A T I O N S A L O G I A
L A C K O F E X E C U T I V E
M E M O R Y / F U N C T I O N I N G
D E L U S I O N S A S O C I A L I T Y
D I S O R G A N I S E D S P E E C H
A M O T I V A T I O N
( A V O L I A T I O N )
D I S O R G A N I S E D
B E H A V I O U R
A F F E C T I V E B L U N T I N G
C A T A T O N I C B E H A V I O U R

8. *Scheiner”s first rank symptoms of Schizophrenia (SFRS)
1. Made Emotion
2. Made Action
3. Made Impulse
4. Thought insertion
5. Thought withdrawal
6. Thought Broadcasting
7. Thought Echo
8. Running Commentary
9. 3rd Person Auditory Hallucinations
10.Somatic Passivity
11.Delusional Perception

9. PHASES
Prodromal Phase
*Withdrawn
Active Phase
(Severe Symptoms)
Residual Phase
(cognitive symptoms

10. D I A G N O S T I C C R I T E R I A F O R S C H I Z O P H R E N I A
A. Thought echo, thought insertion or withdrawal, and thought
broadcasting;
B. Delusions of control, influence, or passivity, clearly referred to body or
limb movements or specific thoughts, actions, or sensations; delusional
perceptions;
C. Hallucinatory voices giving running commentary or discussing the patient
among themselves
D. Persistent delusions of other kinds that are culturally inappropriate and
completely impossible, such as religious or political identity or
superhuman power eg. being able to control Weather or being in
communication with aliens.

11. E. Persistent hallucinations in any modality, when accompanied either by
fleeting or half formed delusions without clear affective content
F. Breaks or interpolations in the train of thought, resulting in
incoherence or irrelevant speech.
G. Catatonic behaviour such as excitement, posturing or waxy flexibility,
negativism, mutism and stupor
H. “Negative” symptoms such as marked apathy, paucity of speech,and
blunting or incongruity of emotional responses usually resulting in social
withdrawal.
I. A significant and consistent change in overall quality of some aspects
of personal behaviour, manifest as loss of interest, aimlessness.

12. SUBTYPES
F20.0 Paranoid Schizophrenia
• The commonest type.
• Predominantly delusions, perceptual disturbances and hallucinations
(most common auditory)
• Personality is usually stable but often paranoid.
• Late onset schizophrenia.
• Good prognosis.
• Disturbances of affect, volition and speech and catatonic behaviour
not prominent.

13. F20.2 Catatonic Schziophrenia
• Mutism - Absence of Speech
• Negativism
• Stupor
• Echolalia - Echo of Language
• Rigidity
• Echopraxia -Echo of Movement
• Waxy Flexibility
(Catalepsy)
• Best prognosis of Schizophrenia
• Episodes of violent excitement may be a striking feature.
Psychomotor Disturbances

14. F20.1 Hebephrenia
• Silly smiles, giggling , self absorbed smiling.
• Early onset (13-14 year of age).
• Mirror Gazing.
• Worst prognosis schizophrenia.

15. F20.3 Undifferentiated Schizophrenia
It meets the criteria of schizophrenia but doesn’t fall under any subtypes.
Or shows symptoms of both subtypes but no specific predominance.
Propf Schizophrenia : Mental Retardation earlier + now schizophrenia.
Van-Gogh Schizophrenia : Schizophrenia + Self mutilation behaviour.
Nuclear Schizophrenia : Catatonia + Hebephrenia.

16. F20.4 Post-Schizophrenic Depression
1) the patient has had a schizophrenic illness within past 12 months.
2) Some schizophrenic symptoms are still present.
3) The depressive symptoms are prominent and distressing: fulfilling the
criteria for depressive episode(F32.-) and has been present for at least
2 weeks.
F20.5 Residual Schizophrenia
1)Prominent Negative Symptoms-psychomotor slowing, under activity, blunting of
affect etc.
2) Evidence in the past of at least one clear cut psychotic episode meeting the
criteria of schizophrenia.
3)A period of at least 1 year during which the intensity and frequency of
hallucinations or delusions are minimal or substantially reduced.
4)Absence of dementia or other organic brain diseaseand chronic depression.

17. AETIOLOGY
• Genetic Hypothesis-Twin studies.
• Biochemical Factor : Dopamine Hypothesis: Dopaminergic system
hyperactivity
• Environmental Factors
• Autoimmune Disease

18. >
Epidemiology
• Third most disabling after quadriplegia and dementia.
• Prevalence 0.3 - 0.7% around the world.
• No racial differences.
Early 20’s Late 20’s
• 85% unemployed; with 3/4th ongoing disability with relapses.

19. MANAGEMENT
Medical Management
Typical Antipsychotics - Side Effects:- Extrapyramidal Symptoms; dystonia,
akathisia, parkinsonism, rigidity, bradykinesia, etc.
Atypical Antipsychotics - Amisulpride,olanzapine,Risperidone, Clozapine;
side effect- Weight Gain.
Clozapine- effective for those who doesnt respond to other drugs.
Family therapy,Assertive Community Treatment,Supported
Employment.

20. F22 Persistent Delusional Disorder
Clinical features: Well systematised delusions of Non bizarre type and
functioning of the patient in other areas eg. self care, occupation etc are usually
intact or. normal.
TYPES:
• Erotomaniac type (de Clerambault’s Syndrome): Delusions that another
person usually of higher states is in love with them.
• Jealous type : Delusion that their spouse or sexual partner is unfaithful
to them.
• Persecutory type: Being malevolently treated in some way.
• Somatic type : Person has some physical defect or general medical
condition.

21. • Capgras Syndrome : Familiar person appears as Stranger posing as
familiar . eg. The patient’s doctor is not the real one but somebody
else is posing as his doctor.
• Fregoli Syndrome: person holds a delusional belief that different
people are in fact a single person who changes appearance or is in
disguise.
• Cotard Syndrome : Nihilistic delusions that person has lost everything.
Usally associated with depression.
• Lycanthropy : Delusion of going ware wolf.
Shared Psychosis:or Induced Delusional Disorder
1) Folie a deux
2) Folie a trios

22. F23 Acute And Transient Psychotic Disorder (ATPD)
A. An acute onset (within 2 weeks) as the defining feature.
B. The presence of typical symptoms-the rapidly changing and variable
type-polymorphic.
C. The presence of acute stress.
F23.0 Acute polymorphic psychotic disorder without symptoms of
schizophrenia:
1) onset must be acute(within 2 weeks).
2) Several types of hallucinations or delusions changing in both type and intensity.
3) There should be a similarly varying emotional state.
4) Inspite of variety of symptoms none should be present with sufficient consistency to
fulfil the criteria of schizophrenia or maniac or depressive episode.

23. F23.2 Acute polymorphic psychotic disorder with symptoms of
schizophrenia:
(A),(B) & (C) must be present.
Symptoms that fulfil the criteria for Schizophrenia (F20.-) must have been present
For the majority of time.
F23.3 Acute Schizophrenia like psychotic disorder:
1) the onset of psychotic symptoms must be acute (less than 2 weeks).
2) Symptoms that fulfil the criteria for schizophrenia.
3) The criteria for acute polymorphic psychotic disorder are not fulfilled.
F23.3 Other acute predominantly delusional psychotic disorders:
1) acute onset (less than 2 weeks)
2) Delusions or hallucinations must be present for majority of the time.
3) Criteria for neither schizophrenia nor acute polymorphic psychotic disorder
fulfilled.

24. THANK YOU