schizophrenia.pptx

Bipin Koirala
Masters of Optometry
Himalaya Eye Institute

anup.subedi10@gmail.com
 Emil Kraepelin:
 This illness develops relatively early in life, and its
course is likely deteriorating and chronic
 It was not followed by any organic changes of the brain,
detectable at that time(1887).

 Eugen Bleuler:
 He renamed Kraepelin’s dementia praecox as schizophrenia
(1911);
 He recognized the cognitive impairment in this illness,
which he named as a splitting of mind.

 Kurt Schneider:
 He emphasized the role of psychotic symptoms, as
hallucinations, delusions and gave them the privilege of
the first rank symptoms even in the concept of the
diagnosis of schizophrenia.

 Symptoms usually begin between 15 to 25 yrs age for
male and with females develops later around 30 years
 It is rare for a person to develop schizophrenia before 10
years of age and after 40 yrs of age.
 It occurs in all societies regardless of class, color, religion,
culture etc

 “A group of common major psychoses with a complex
syndromal presentation, affecting young adults (between
ages 16 and 30), showing chronic changes in behavior,
perception, thoughts and emotions, causing a fundamental
disorganization in personality and deterioration from
previous levels of functioning”

 In the worldwide population, approximately 1% of
patients suffer from this severe condition.
 Schizophrenia is still known as among incurable diseases
and its causes remain unknown.

 The pathogenesis of schizophrenia is influenced by many
risk factors, both environmental and genetic.
The environmental factors includes:
1. Birth history
2. Infectious diseases,
3. Complications during pregnancy and delivery,
4. Substance abuse and stress.

 At the present time, in addition to environmental factors,
 Genetic factors are assumed to play a role in the
development of the schizophrenia.
 The heritability of schizophrenia is up to 80%.
 If one parent suffers from the condition, the probability
that it will be passed down to the offspring is 13%.

 If it is present in both parents, the risk is more than 20%.
 The opinions are varied as to the risk factors affecting the
development of schizophrenia.

 It is a universal disease found in all countries and all
times with constant prevalence rates
 Incidence: 15-20/ 100,000/year
Prevalence : 0.5 – 1%
 Age : 15 to 45 years
Sex : Male : Female 1 : 1
Onset is earlier in men
Epidemiology and risk factors of schizophrenia
Neuroendocrinology Letters Volume 37 No. 1 2016 Jana Janoutová, MD., PhD.
Department of Epidemiology and Public Health
Faculty of Medicine, University of Ostrava

 Some communities have high incidence :
1. Northern Sweden,
2. Western Ireland, Catholics in Canada,
3. Tamils of South India and Sri Lanka In Northern Sri
Lanka 34.6 / 100,000 / yr
 Some communities have low incidence like:
1. Hutterites,
2. Anabaptist section of United States

 Both parents 46%
 One parent 15%
 One sibling 10 – 14%
 MZ twin 42%
 DZ twin 10 – 14%
 2nd degree relatives 2 -3 %
 Not related 1%

In patients with the schizophrenia,
Magnetic Resonance Imaging
1. Reduction in volume of some brain structures (amygdala
and/or hippocampus)
2. Enlargement of brain ventricles
3. Loss of white matter (Butterworth 1998).
 Schizophrenia is assumed to be associated with abnormalities
of information processing (White & Siegel 2015).

 Neurotransmitter systems and intracellular signal
transduction are impaired.
 Given the brain’s complexity and function, several
neurotransmitter systems are likely to be affected.
 The most studied neurotransmitter in the relationship with
the schizophrenia is dopamine (Andreou et al. 2014),
with regard to both etiopathogenesis and therapeutic
options.
 Another important neurotransmitter is glutamate
(Nanitsos et al. 2005; Šerý et al. 2015a).

 Variable Phenotypic Expression
 Hereditary
 40% of the Pts have a family history

 Family
 Disorders in relationship and communication
 Emotional family
 Dominant mother
 High Expressed Emotion (EE)

 Viral infection
- In utero influenza like virus
 Birth trauma
- Hypoxia, cerebral injuries
 Endocrine Factors
Postpartum psychosis
Later onset in females
 Stress
Psychological – life events, trauma, migration
Physical – Viral encephalitis, Pyrexia,
anti-malarials, surgery

 Sensory loss / deprivation due to
Head injury
Epilepsy
Drugs – amphetamines, L dopa, cannabis
Multisystem disorders
 Socio – cultural aspects
Low socioeconomic state
Urban (Homeless, Prostitutes, Prisons)
Single, Unemployed

 Dopamine Hypothesis
 Glutamate Hypothesis
 Serotonin Hypothesis

 Over expression of dopamine receptor in brain
 Or Excessive release of dopamine
 Facts to support this hypothesis:
1. Dopamine modulators (Amphetamine, Levodopa,
Apomorphine) produce schizophrenia like symptoms in
normal
2. Dopa antagonist are found to relive such symptoms

 Catatonic
 Disorganized
 Paranoid
 Residual
 Undifferentiated

 Most common type
 Develops later in life
 Hallucinations/ delusions
 Speech and emotions remains unaffected

 Rarest type
 Characterized by unusual sudden movements switching
between being active and still
 Patient doesn’t talk much but might mimic others speech
and movement

 Typically seen b/w age of 15 to 25 years
 Disorganized thought and behaviors are highly common
 Disorganized speech pattern difficult for other to
understand
 Very little emotions, poor facial expression
 Unusual voice tone and mannerism

 Case of long term schizophrenia where most of the
symptoms have disappeared
 Only negative symptoms remain like:
1. Slow movement
2. Poor memory
3. Lack of hygiene
4. Lack of concentration

 Doesn’t fit in above 4 categories
 Mixed symptoms of above types is seen

 Positive symptoms:
 “Positive” symptoms are psychotic behaviors not
generally seen in healthy people.
 People with positive symptoms may “lose touch” with
some aspects of reality.
 Hallucinations (Auditory,Visual, Olfactory, Tactile)
 Delusions

 Persecutory delusions. The feeling someone is after you
or that you’re being stalked, hunted.
 Referential delusions. When a person believes that
public forms of communication, like song lyrics or a
gesture from a TV host, are a special message just for
them.
 Somatic delusions. These center on the body. The person
thinks they have a terrible illness or bizarre health
problem like worms under the skin or damage from
cosmic rays.

 Erotomanic delusions. A person might be convinced a
celebrity is in love with them or that their partner is
cheating. Or they might think people they’re not attracted
to are pursuing them.
 Religious delusions. Someone might think they have a
special relationship with a deity or that they’re possessed
by a demon.
 Grandiose delusions. They consider themselves a major
figure on the world stage, like an entertainer or a
politician.

 Negative symptoms:
“Negative” symptoms are associated with disruptions to
normal emotions and behaviors.
 Lack of emotions
 Less energy
 Less speaking
 Lack of motivation
 Loss of pleasure
 Poor grooming
 Withdraw from society and normal activities/ role

 Cognitive symptoms:
For some patients, the cognitive symptoms of
schizophrenia are subtle, but for others, they are more
severe and patients may notice changes in their memory
or other aspects of thinking.

 Subjective Sensory Distortions
 Contrast Sensitivity: Decreased
 Tilt After Effects: It is the observation of a temporary
change in the perceived orientation of lines after having
adapted to lines tilted in another direction.
 Color Discrimination: More error than normal.

 Smooth Pursuit Eye Movements error
 Saccadic Movements errors
 Vergence Eye Movements errors

 Diagnosing schizophrenia is not easy. Sometimes using
drugs, such as methamphetamines or LSD, can cause a
person to have schizophrenia-like symptoms.
 The difficulty of diagnosing this illness is compounded by
the fact that many people who are diagnosed do not
believe they have it.

 DSM-IV Diagnostic and Statistical Manual

Schizophrenia is according to lCD-10, defined from the
point of view of the presence and expression of primary
and/or secondary symptoms (at present covered by the
terms negative and positive symptoms)

 Physical and lab examination to rule out psychotic
disorder
 Imaging (CT, MRI ,PET )
 History and symptom analysis

1. Pharmacological management
2. Other physical management
3. Psychological management
4. Rehabilitation
5. Family work

 Antipsychotics
1. Typical antipsychotics
– Chlorpromazine, Trifluoperazine, Haloperidol,
Droperidol, Pimozide,
 2. Atypical antipsychotics
- Olanzapine, Risperidone, Quetieapine,
Amisulpiride, Ziprasidone, Aripiprazole,
Clozapine

 Availability
 Side effect profile
 Symptoms
 Specific contra indications Familiarity
 Cost

 Psychosocial Education
 Supportive psychotherapy
 Cognitive Behavioral Therapy for resistant hallucinations
and delusions
 Social skills training

 Helps to reintegrate
 Training in
 Self care, ADLs
 Attending skills, Communication skills, Ability to
concentrate…

 Vocational training, working in a supportive environment
 Helps in the management of
 Negative symptoms
 Dealing with resistant symptoms
 Dependency / institutionalized syndrome

• Lobotomy
– No longer in widespread use
• New procedures
– Antipsychotic medication delivery system implant

• Nutrition
– Healthy Diet
– Avoid sugar, alcohol,
caffeine and
preservatives
– Add omega3 and
antioxidants
• Exercise
– Including yoga
– Improves physical and
mental health
• Stress Management
– Stress contributes to active
symptoms
– Learn to identify stressors
– Develop relaxation
techniques

 Lack of education
 Lack of access to effective health care
 Lack of funding for Schizophrenia and associated
diseases
 Hopelessness and shame

• We need to actively involve in treatment, and adapt a better
life for yourself.
• The Schizophrenics should be more optimistic and not live
in despair even though life challenges in many way.
•The society should play a vital role in accepting the patients
and give them their deserved chance in this material world.

Epidemiology and risk factors of
schizophrenia Jana Janoutová 1, Petra Janáčková 1,
Omar Šerý 2,3, Tomáš Zeman 2,3, Petr Ambroz 1, Martina Kovalová 1,
Kateřina Vařechová 1, Ladislav Hosák 4,5, Vítězslav Jiřík 1, Vladimír
Janout 1. Jana Janoutová, MD., PhD.
Department of Epidemiology and Public Health Faculty of Medicine, University
of Ostrava Syllabova 19, 703 00 Ostrava 3, Czech Republic. tel: +420 733 784
093; e-mail: jana.janoutova@osu.cz
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schizophrenia.pptx

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