2. It is a chronic heterogeneous syndrome of disorganized
and bizarre thoughts, delusions, hallucinations,
inappropriate affect, cognitive deficits, and impaired
psychosocial functioning.
It is the most severe and debilitating mental illness in
psychiatry.
Typically begins in adolescence or early adulthood.
Schizophrenia occurs with regular frequency nearly
everywhere in the world in 1 % of population.
3. •
The “cancer of mental illness”.
• Even with treatment prognosis is poor.
• Prevalence same for men and women; onset age 16-25.In men begins earlier
and may be more severe; women more favorable outcomes.
6.
Paranoid schizophrenia is the most common type of
schizophrenia
Paranoid schizophrenia is a subtype of schizophrenia in
which the patient has delusions (false beliefs) and
auditory hallucination that a person or some individuals
are plotting against them or members of their family
7. › lCD-10 (International Classification of Disease, WHO)
› DSM-IV (Diagnostic and Statistical Manual, APA)
8. For the diagnosis of schizophrenia is necessary
presence of one very clear symptom - from point a) to d)
or the presence of the symptoms from at least two groups - from point e) to h)
for one month or more:
a)
b)
c)
hearing of own thoughts, the feelings of thought withdrawal, thought insertion, or thought
broadcasting.
the delusions of control, outside manipulation and influence, or the feelings of passivity, which
are connected with the movements of the body or extremities, specific thoughts, acting or
feelings, delusional perception.
hallucinated voices, which are commenting permanently the behavior of the patient or they talk
about him between themselves, or the other types of hallucinatory voices, coming from different
parts of body
9. d) permanent delusions of different kind, which are inappropriate and unacceptable in given culture
e) blocks or intrusion of thoughts into the flow of thinking and resulting incoherence and irrelevance of
speach, or neologisms
f) catatonic behavior
g) the negative symptoms, for instance the expressed apathy, poor speech, blunting and inappropriateness
of emotional reactions
h) expressed and conspicuous qualitative changes in patient’s behavior, the loss of interests, hobbies,
aimlessness, inactivity, the loss of relations to others and social withdrawal
10. A. Characteristic symptoms: Two or more of the following, each persisting for a significant
portion of at least a 1-month period:
(1) Delusions
(2) Hallucinations
(3) Disorganized speech
(4) Grossly disorganized or catatonic behavior
(5) Negative symptoms
Note: Only one criterion A symptom is required if delusions are bizarre or if hallucinations
consist of a voice keeping a running commentary on the person’s behavior or two or more
voices conversing with each other.
11. B. Social/occupational dysfunction: For a significant portion of the time since onset of the disorder, one
or more major areas of functioning such as work,interpersonal relations, or self-care are
significantly below the level prior to onset.
C. Duration: Continuous signs of the disorder for at least 6 months. This must include at least 1 month
of symptoms fulfilling criterion A (unless successfully treated). This 6 months may include
prodromal or residual symptoms.
D. Schizoaffective or mood disorder has been excluded.
E. Disorder is not due to a medical disorder or substance use.
F. If a history of a pervasive developmental disorder is present, there must be symptoms of
hallucinations or delusions present for at least 1 month.
12. Age : 22 years
Sex
: Female
Wt. : 44kg
Unit : Psychiatry
13. Reason for admission:
Excessive talking and praying since 2 months
Decreased sleep and aggressive behaviour since 3 days
Increased suspiciousness over family members
14. A 22 year old female patient was stable, while on
regular medication until 2 months back, and was on
T.Risperidone 2mg and Quetiapine 100mg.
One day she was watching some TV serial in which
there was a demon. After which, the patient started
saying that she could feel the demon doing some thing
to her in her stomach, a vague uncomfortable
sensation and that the demon was trying to harm them.
15. Patient condition has aggravated since past 1 year and she
used to tell scary story but her family never knew about
these. She thinks that there are evil spirits in the daily things
that she uses like spoons, towels etc., she forbids the entire
family from using this things or even touching them , she
never responded to the question that were asked but she
still believes in evil spirit and thinks that they will kill her
family.
The patient was reported to have a history of praying and
chanting loudly since 1 month. She would have vivid
dreams in the night and as soon as she wakes up, she
would insist the family to go to temple.
16.
The patient was also reported to have a history of hitting her
father under the false assumption that he is a evil spirit and she
also says that some one has replaced her father. Upon
examination the patient revealed that she is scared of her father
and because of which she ran away as soon as she saw him.
Due to this condition she never allows visitors inside the house
and the family members to leave the house. She often has
hallucinations that the evil spirit is growing like a baby inside her.
Also she often tore her clothes and pulled her hair in frustration
and this episode is for 1-2 hrs on most of the days.
No history of low mood/ smiling to herself/ fever/ head injury/
repeated words.
17.
Since past 2 years patient is ill. The symptoms started 2 years
back, the first incident was when she used have thoughts that
people are spying on her while she’s bathing and she often
thought that people could see her naked body through her
clothes while she’s outside.
Patient also had suicidal thoughts and frequent crying spells
which were immediately followed by laughter without any
reason.
She has a history of talking to herself and she used to think that
people are trying to harm her by taking photographs. After
these episodes, she was treated at Spanadana in Banglore and
diagnosed as Schizophrenia with Depressive symptoms .
18.
She was treated accordingly for 4-5 months after
which she was normal.
PMHx:
2010: 1st episode : Medications:
Drug
Dose
Freq
Route
T.Risperidone+Trihexphenydyl
3+2mg
1-0-1
PO
T.Alprazolam SR
0.5mg
0-0-1
PO
19. 2011: 2nd episode : Medications:
Drug
Dose
Freq
Route
T.Risperidone +
Trihexphenydyl
3+2 mg
0-0-1
PO
T.Risperidone +
Trihexphenydyl
2+2mg
1-0-0
PO
Liv 52 DS
1 tsp
1-0-1
PO
20. 2012: 3rd episode : Same medications were contd and 1
more drug was added: Clozapine + 50mg PO 0-0-1
On 26/4/12:
T.Risperidone+Trihexphenydyl 3+2mg 1-0-1
Clozapine 50 mg 0-0-1 ,for 1 month
On 28/6/12:
Clozapine 25mg 0-0-1
T.Aripiprazole 15 mg 0-0-1, for 2 months
22. The patient is 2nd child and has an old brother, who has
MD{muscular dystrophy}, mother had committed
suicide 12 years ago with a history of depression, ?
BPAD, when the patient was 10 years old.
Patient was diagnosed as schizophrenic at the age of
10 years and has been on medication and doing well
and has no history of any substance abuse. Patient lives
with her father and brother.
Patient has studied up to SSLC and she had no interest
in studies, and moderately passed.
23. GA&B: ill kempt and not groomed, in touch with surroundings,
alert, not conscious and cooperative, eye contact is not maintain
PMA: decreased
Speech : Occasionally not responding to verbal commands,
Rarely speaks when spoken, volume & output- Decreased
Insight -1
27. BP: 110/90mmHg
Drowsiness was present, father c/o patient hitting him.
Sleep was adequate
Adv :
Start T.Quetiapine 300mg 1-0-2 PO
28. BP: 100/70mmHg
O/e:
Ill kept, not groomed
Conscious, alert.
Mood: Sub: ill ; Obj: irritated
Decreased drowsiness
Adv: CST., ophthalmology opinion
Ophthalmology Report
Impression: normal fundus in both eyes
29. BP: 100/70mmHg
c/o itching on her back.
GA&B: ill kempt and groomed, in touch with surroundings, alert,
conscious and cooperative, eye contact is not maintain
PMA: decreased
Speech : Occasionally not responding to verbal commands, speaks
when spoken, volume & output- normal
Insight -1
Adv: NBM for ECT tomorrow
Stop Inj.Lorazepam 4mg IV
Start T. Lithium Carbonate 450mg 0-0-1
31. 1.
2.
3.
4.
5.
6.
7.
8.
9.
Patient on NBM
Shifted to minor OT
Inj. Atropine 1 amp slow iv given
Mouth gag inserted
ECT given at 31joules for 2 sec
GTCS observed for 25sec
RS/CVS: NAD
Vital stable
Adv . Patient can be given oral feeds after ½ hrs
32. BP:120/80mmHg
GA: normal
Speech: output and volume was normal
Insight:3
Adv: CST. Plan for ECT tommorrow
33. 1.
2.
3.
4.
5.
6.
7.
8.
9.
Patient NBM
Shifted to minor OT
Inj. Atropine 1 amp slow iv given
Mouth gag inserted
ECT given at 28joules for 2 sec
GTCS observed for 25sec
RS/CVS: NAD
Vital stable
Adv . Patient can be given oral feeds after ½ hrs
34. BP:110/70mmHg
GA and PMA was normal
Speech : Volume and Output was normal
Insight :5
Adv: CST. Plan for ECT
35. 1.
2.
3.
4.
5.
6.
7.
8.
9.
Patient NBM
Shifted to minor OT
Inj. Atropine 1 amp slow iv given
Mouth gag inserted
ECT given at 28joules for 2 sec
GTCS observed for 25sec
RS/CVS: NAD
Vital stable
Adv . Patient can be given oral feeds after ½ hrs
36. BP:110/70mmHg
GA: adequetly kempt and groomed in touch with surroundings,
alert, conscious and cooperative, eye contact maintained, patient is
good touch with the surroundings
Patient symptomatically improved by 90%
PMA: decreased
Speech : output and volume normal
Mood: subjectively and objectively good
Insight : 5
39.
Based on the subjective evidence the patient was
diagnosed as Paranoid Schizophrenia.
40. Short term goals
To reduce symptoms and improve the QOL
Maximize adherence with therapy
Long term goals
Ensure remission
Minimizes the ADR
Minimizes the Complications
Prevent relapse
46. About Lifestyle Modifications
Manage stress : Stress can trigger psychosis and make the symptoms of schizophrenia
worse, so keeping it under control is extremely important. Don’t take on more than you
can handle and take time to yourself if you’re feeling overwhelmed.
Try to get plenty of sleep: When you’re on medication, you most likely need even more
sleep than the standard 8 hours. Many people with schizophrenia have trouble with
sleep, but lifestyle changes (such as getting regular exercise and avoiding caffeine) can
help.
Avoid alcohol and drugs : Some evidence indicates a link between drug use and
schizophrenia. And it’s indisputable that substance abuse complicates schizophrenia
treatment and worsens symptoms. If you have a substance abuse problem, seek help.
47.
Get regular exercise: Studies show that regular exercise may help reduce the symptoms of
schizophrenia. That’s on top of all the emotional and physical health benefits! Aim for 30
minutes of activity on most days.
Do things that make you feel good about yourself: If you can’t get a job, find other activities that
give you a sense of purpose and accomplishment. Cultivate a passion or a hobby. Helping others
is particularly fulfilling.
Reduce sugar, carbohydrate and caffeine intake. This will help your blood
sugar stay balanced. Many drugs prescribed to treat schizophrenia can mess
with your blood sugar, so avoiding excess stimulants can help keep it at a
desired level.
Add foods containing essential fatty acids. People with schizophrenia have
reduced amounts of these fatty acids in their brains, so adding foods that
contain them can help treat the illness. Good sources include fish, nuts and
olive oil
