Practical issues in schizophrenia


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Practical issues in schizophrenia

  1. 1. In the name of Allah the most merciful most beneficial
  2. 2. Practical Issues in Schizophrenia Dr. Ahsan-ul-Haq Chishti Senior Consultant Psychiatrist Fountain House Lahore
  3. 3. The shortest way to do many things is to do one thing at a time.
  4. 4. Definition <ul><li>Schizophrenia is a psychiatric diagnosis that describes a mental disorder characterized by impairments in the perception or expression of reality and by significant social or occupational dysfunction. A person experiencing untreated schizophrenia is typically characterized as demonstrating disorganized thinking , and as experiencing delusions or hallucinations . </li></ul>
  5. 5. Types <ul><li>Schizophrenia is often described in terms of &quot;positive&quot; and &quot;negative&quot; symptoms. Positive symptoms include delusions , auditory hallucinations and thought disorder and are typically regarded as manifestations of psychosis . Negative symptoms are so named because they are considered to be the loss or absence of normal traits or abilities, and include features such as flat, blunted or constricted affect and emotion , poverty of speech and lack of motivation . </li></ul><ul><li>Acute Schizophrenia </li></ul><ul><li>Chronic Schizophrenia </li></ul>
  6. 6. It is not aptitude, but your attitude, that determines your altitude.
  7. 7. Aetiology <ul><li>Brain Vulenrability (inherited or accquired) </li></ul><ul><li>Genetic factors </li></ul><ul><li>Environmental factors </li></ul><ul><li>Neurological damage around birth </li></ul><ul><li>Interpersonal & social influences </li></ul><ul><li>Perpetuating factors </li></ul><ul><ul><li>Social & family influence </li></ul></ul><ul><li>Stress-vulnerability model </li></ul>
  8. 8. Onset <ul><li>Onset of schizophrenia typically occurs in late adolescence or early adulthood, with males tending to show symptoms earlier than females. </li></ul>
  9. 9. Frequent Signs & Symptoms <ul><li>Self laugh </li></ul><ul><li>Self talk </li></ul><ul><li>Social withdrawal </li></ul><ul><li>Self neglect </li></ul><ul><li>Odd behaviours </li></ul><ul><li>Pressure or Poverty of thoughts </li></ul><ul><li>Loosening of association (word salad) </li></ul><ul><li>Hallucinations (visual, auditory, tactile, olfactory, gastatory) </li></ul><ul><li>Delusions (persecutory, reference, thought withdrawal, thought insertion, thought broadcast) </li></ul><ul><li>Depressive or Aggressive Mood </li></ul><ul><li>Lack of insight </li></ul><ul><li>Neuro Cognitive deficits </li></ul>
  10. 10. It is no sin to attempt and fail. The only sin is not to make the attempt.
  11. 11. Depressive Symptoms in Schizophrenia <ul><li>Depression may be a side effect of antipsychotic medication </li></ul><ul><li>Depressive symptoms may be a response to recovery of insight </li></ul><ul><li>Depression may be integral part of schizophrenia </li></ul>
  12. 12. Substance Abuse in Schizophrenia <ul><li>The rate of substance use is known to be particularly high in this group. In a recent study, 60% of people with schizophrenia were found to use substances and 37% would be diagnosable with a substance use disorder.[69] </li></ul><ul><li>There is strong evidence that using certain drugs can trigger either the onset or relapse of schizophrenia in some people. It may also be the case, however, that people with schizophrenia use drugs to overcome negative feelings associated with both the commonly prescribed antipsychotic medication and the condition itself, where negative emotion, paranoia and anhedonia are all considered to be core features. </li></ul>
  13. 13. It is not so much how busy you are, but why you are busy. The bee is praised; the mosquito is swatted.
  14. 14. Management <ul><li>Pharmacological Therapy </li></ul><ul><ul><li>Typical Antipsychotics (Haloperidol, Chlorpramazine, Fluphenizine) </li></ul></ul><ul><ul><li>A Typical Antipsychotics ( clozapine, risperidone, olanzapine, quetiapine, ziprasidone) </li></ul></ul><ul><li>Electroconvulsive Therapy (also known as ECT or 'electroshock therapy’) </li></ul><ul><li>Psycho Therapy </li></ul><ul><ul><li>Patient & Family Counseling Therapy </li></ul></ul><ul><ul><li>CBT </li></ul></ul><ul><ul><li>Behavior Therapy </li></ul></ul><ul><ul><li>Group & Individual therapy </li></ul></ul><ul><li>Occupational Therapy </li></ul><ul><ul><li>Art Therapy </li></ul></ul><ul><ul><li>Psycho Stage Drama Therapy </li></ul></ul><ul><ul><li>Music Therapy </li></ul></ul>
  15. 15. Prognostic Features <ul><li>Good Poor </li></ul><ul><li>A. History </li></ul><ul><li>1. Prior Psychiatric History No Present </li></ul><ul><li>2. Family History Negative Positive </li></ul><ul><li>3. Family History positive of Mood disorders Schizophrenia </li></ul><ul><li>4. Premorbid adjustment Good Poor </li></ul><ul><li>5. Work history Steady Unsteady or unemployed </li></ul><ul><li>6. Marital status Married Unmarried </li></ul><ul><li>7. Social Support Good Poor </li></ul><ul><li>8. Precipitating factors Obvious; transient Unknown or chronic </li></ul><ul><li>B. Clinical Presentation </li></ul><ul><li>1. Onset Acute Insidious </li></ul><ul><li>2. Age of onset Late Early </li></ul><ul><li>3. Duration of symptoms Short Long </li></ul><ul><li>4. Symptoms Positive Negative </li></ul><ul><li>C. Mental State </li></ul><ul><li>1. General Appearance Confusion Assaultive </li></ul><ul><li>2. Affect Depressed Blunted or flat </li></ul><ul><li>3. Thinking Paranoid or catatonic Obsessive compulsive or </li></ul><ul><li> features disorganized </li></ul><ul><li>D. Tests </li></ul><ul><li>1. Functioning neurologic Normal Impaired </li></ul><ul><li>2. CT Scan Normal Structural brain abnormalities </li></ul><ul><li>E. Course </li></ul><ul><li>1. Type Undulating (remission common) Chronic (no remission in 3 years and numerous relapses). </li></ul>
  16. 16. A helping hand, a smile, or a kind word will brighten anyone’s day, even your own.
  17. 17. History of the I llness <ul><li>Biodata </li></ul><ul><li>Presenting complaints </li></ul><ul><li>History of present illness </li></ul><ul><li>History of past psychiatric illness </li></ul><ul><li>History of physical illness </li></ul><ul><li>Past drug history </li></ul><ul><li>Family history of physical illness </li></ul><ul><li>Family history of psychiatric illness </li></ul><ul><li>Family dynamics, home atmosphere, interpersonal relationships </li></ul><ul><li>Personal history </li></ul><ul><li>Menstrual history </li></ul><ul><li>Sexual history </li></ul><ul><li>Marital history </li></ul><ul><li>Forensic history </li></ul><ul><li>Pre-morbid personality </li></ul>
  18. 18. Mental Status Examination <ul><li>Appearance </li></ul><ul><li>Behaviour </li></ul><ul><li>Speech </li></ul><ul><ul><li>Form </li></ul></ul><ul><ul><li>Content </li></ul></ul><ul><li>Mood and Affect </li></ul><ul><ul><li>Subjective </li></ul></ul><ul><ul><li>Objective </li></ul></ul><ul><li>Thoughts </li></ul><ul><ul><li>Form </li></ul></ul><ul><ul><li>Content </li></ul></ul><ul><li>Disorder of perception </li></ul><ul><ul><li>Hallucinations </li></ul></ul><ul><ul><li>I llusions </li></ul></ul><ul><li>Cognition </li></ul><ul><li>Orientation </li></ul><ul><li>Memory </li></ul><ul><ul><li>Short term </li></ul></ul><ul><ul><li>Long term </li></ul></ul><ul><li>Insight </li></ul>
  19. 19. A candle loses nothing by lighting another candle. Thank you