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Schizophrenia 123


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psychiatry schizophrenia

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Schizophrenia 123

  1. 1. Benjamin Aubrey Myers
  2. 2. • SCHIZOPHRENIA - derived from the Greekword “Skhizein” meaning “tosplit”,and “phren” meaning “mind” • common, chronic and frequently devastating neuropsychiatric disorder, affecting about 1% of the world’s general population. • among the ten leading causes of disability worldwide.
  3. 3. 1. Major depression 2. Alcohol use 3. Road traffic accidents 4. Schizophrenia 5. Self inflicted injuries 6. Bipolar disorder 7. Drug use
  4. 4. Karl Friedrich Canstatt neurosis
  5. 5. • • • • • • •
  6. 6. GENETICPREDISPOSITION • Concept of genetic pruning • Increased rate among the biological relatives • One parent - 46% • Both parents - 52% • Monozygotictwins–Concordancerateof50%
  7. 7. BIOCHEMICALFACTORS DOPAMINE HYPOTHESIS: Excessive dopamine release in patients with schizophrenia has been linked tothe severity of positive psychotic symptoms NOREPHINEPHRINE HYPOTHESIS: Anhedonia –the impaired capacity for emotional gratification and the decreased ability to experience pleasure –has long been noted to be a prominent feature of schizophrenia.
  8. 8. BRAINMETABOLISM: Studies using resonance spectroscopy, found that patients with schizophrenia had lower levels of phosphomonoester and inorganic phosphate and higher levels of phosphodiester than a control group.
  9. 9. • Hippocampus, amygdala, parahippocamp. –Smaller in affected twin (statictrait) –Disordered hippocampal pyramidal cells –Also in entorhinal, cingulate, parahippocampal cortex
  10. 10. • Shrinkage of cerebellar vermis • Thicker corpus callosum • Frontal lobes –Abnormal neuronal migration in one study –Dendrites have fewer spines –But no major structural abnormalities –Measures of frontal function impaired
  11. 11. FEATURES OF PSYCHOSIS: 1. Delusion 2. Hallucination 3. Disorganised Speech 4. Disorganised behavior 5. Catatonic state
  12. 12. 1.Positive (things that start to happen) 2.Negative (things that stop happening) 3.Cognitive (related to processing information) Mainly classified into three broad categories:
  13. 13. 1. Hallucinations : • Sensations that appear real but are created by mind • Could affect all the senses • These might tell them what to do, warn them of danger. • The voices might talk to each other. 2. Delusions : • An idiosyncratic belief or impression maintained despite being contradicted by reality or rational argument • It is a distortion of reality. • These are beliefs that seem strange and are easy to prove wrong. • Can be of various types 3. Disorganizedspeech : • Have a hard time organizing their thoughts. • They might not be able to follow along when you talk to them. • Words come out all jumbled and not make sense. • Can also have trouble concentrating 4. Disorganized behaviour 5. Catatonic state • Abnormality of movement and behaviour arising from a disturbed mental state
  14. 14. TYPESOFHALLUCINATIONS • AUDITORY : Hearing voices : • VISUAL: Seeing things : • OLFACTORY: Smell things that aren't there : • GUSTATORY: False sense of taste : • TACTILE: Feel things that don't exist :
  15. 15. TYPESOF DELUSIONS • Delusion of Persecution • Delusions of Reference• • Delusions of Grandeur • Delusions of Erotomania • Delusion of Somatomania • Delusion of Infidelity
  16. 16. DISORGANIZEDSPEECH: • Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next. • Neologisms – Made-up words or phrases that only have meaning to the patient. • Perseveration – Repetition of words and statements; saying the same thing over and over. • Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").
  17. 17. DISORGANIZEDBEHAVIOUR: 1. Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. 2. Disorganized behavior appears as: 1. Adecline in overall daily functioning 2. Unpredictable or inappropriate emotional responses 3. Behaviors that appear bizarre and have no purpose 4. Lack of inhibition and impulse control
  18. 18. Negative Symptoms represent the absence or diminution of normal intellectual function • AFFECT Schizophrenics have flat(lack of expression), blunt(severe reduction in intensity) or inappropriate (incongruent with situation) affect • ALOGIA It is characterised by poverty of speech,a reduction in the amount of speech, speech content,blocking or late replies.
  19. 19. • AVOLITION It is the loss of motivation • ASOCIALITY It is the diminished interest in, motivation for, and appreciation of social interactions with others, like family and friends • APHEDONIA It is the inability to feel pleasure in normally pleasurable activities
  20. 20. 1. Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed 2. They include the following: • Poor “executive functioning” • Trouble focusing or paying attention • Problems with “working memory”
  21. 21. • Social withdrawal • Hostility or suspiciousness • Deterioration of personal hygiene • Flat, expressionless gaze • Inability to cry or expressjoy • Inappropriate laughter or crying • Depression • Oversleeping or insomnia • Odd or irrational statements • Forgetful; unable to concentrate • Extreme reaction to criticism • Strange use of words or way of speaking
  22. 22. • There are five types ofschizophrenia: 1. Catatonic – little to no movement, possibly a vegetative state 2. Disorganized – disorganized thinking, flat effect, inappropriate emotions or behavior 3. Paranoid –delusions, hallucinations, false beliefs of grandeur 4. Residual –negative symptoms often remain such as flat effect or a refusal to talk 5. Undifferentiated – does not fit in one of the above categories
  23. 23. Schizophrenia F20 Paranoid Schizophrenia F20.0 Hebephrenicor Disorganised schizophrenia F20.1 Catatonic Schizophrenia F20.2 Undifferentiated schizophrenia F20.3 Post Schizophrenic depression F20.4 Residual Schizophrenia F20.5 Simple Schizophrenia F20.6 Other Schizophrenia F20.8 INCLUDES: 1. CENESTHOPATHIC Schizophrenia 2. SCHIZOPHRENIFORM DISORDERNOS Schizophrenia, Unspecified F20.9 *according to ICD10 classificatorysystem.
  24. 24. E) Change in personal behaviors
  25. 25. P S Y C H O S I S Mood disorders Schizophrenia “spectrum” disorders “organic”mental disorders Substance induced Delirium Dementia Amnestic d/o “Functional” disorders
  26. 26. ASSESSMENT How to diagnose?
  27. 27. Domains* Symptoms Severity Environmental influences Functional Impairments including cognitive deficits. Socio- occupational Impairment Roleperformance Subjective experiences like the “Quality of Life” Treatment related influences *adapted from New oxford textbook of psychiatry, pg596
  28. 28. A tool for all psychiatric examinations
  29. 29.  PHENOTHIAZINES •Chlorpromazine  BUTYROPHENONES •Haloperidol  THIOXANTHENES •Flupenthixol
  30. 30. EFFECTIVENESS OF TYPICALS/First Generation (FGAs)  Effective in acute phase and as maintenance therapy  80% Respond  Positive symptoms (hallucinations, delusions, thought disorder)  No effect on negative symptoms  20 % treatment-resistant  50%-80% non-compliance
  31. 31. 1. Dopamine blockade –EPS (TD), raised prolactin levels (sexual side effects, menstural problems, galactorrhoea) 2. Anticholinergic – dry mouth, urinary etc 3. Postural hypotension 4. Sedation 5. Weight gain
  32. 32. 1. Clozapine 2. Remoxipride 3. Risperidone 4. Sertindole 5. Olanzapine 6. Quetiapine 7. Amisulpiride 8. Zotepine 9. Ziprasidone 10.Aripiprazole An antipsychotic that does not cause EPS at therapeutic doses
  33. 33.  Evidence of association between metabolic disturbances and the use of atypical antipsychoitics  The ‘metabolic syndrome’ include: Obesity Diabetes Dyslipidemia
  34. 34. •ECTisnot the primary treatment of choiceforschizophrenia •The indications of ECT include:- •1.Catatonic Stupor 2.Uncontrolled Catatonic Excitement 3.Acute exacerbation not controlled with drugs 2.Severe side-effects with drugs in the presence ofschizophrenia Usually 8-12 ECT’Sare needed administered 2-3 times aweek.
  38. 38.  Schizophrenia - Spectrum of Dysfunctions Affecting cognitive, emotional, and behavioral domains Positive, negative, and disorganized symptom clusters Several Bio-Psycho-Social Variables are Involved Diagnosed according to the ICD 10 criteria Management includes antipsychotics, along with psychosocial interventions Successful Treatment Rarely Includes Complete Recovery Genetic therapy is the way ahead