SCHIZOPHRENIA
BY
EMMANUEL GODWIN
5th year Medical Student
College of Medicine
University of Nigeria , Enugu
Campus
OUTLINE
 DEFINITION
 TYPES
 CLINICAL FEATURES
 DIAGNOSTIC CRITERIA(ICD-10 AND
DSM –IV)
 EINDICES OF PROGNOSIS
 TREAT...
DEFINITION
 Schizophrenia is a mental disorder
characterized by a breakdown of thought
process and by deficit of typical ...
History of schizophrenia
 The term schizophrenia was coined by a
swiss psychiatrist EUGEN BLEUER
 He maintained that the...
Four A’s
 Disturbances of association(loosening of
association)
 Changes in emotional reactivity( flattening
of affect)
...
TYPES
 Paranoid-types schizophrenia
 Disorganized-type schizophrenia
 Catatonia-type schizophrenia
 Undifferentiated-t...
Paranoid-type schizophrenia
This is the most common form of
schizophrenia where the individual has
delusions that a person...
Disorganized-type schizophrenia
 In this type of schizophrenia behaviour is
disturbed/abnormal and has no purpose,
there ...
Disorganized-type
schizophrenia
contd
 Common symptoms include Active
behavior but in an aimless manner
,inappropriate em...
Catatonia-type schizophrenia
 This is a form of schizophrenia where a
person loses touch with reality,it is a state
of ne...
Catatonia-type schizophrenia
contd.
 Common symptoms include paucity of
movement or hyperactivity,stereotyped or
repetiti...
Undifferentiated-type
schizophrenia
 This is a form of schizophrenia that is a
jack of all forms but master of none.
 Th...
Residual-type schizophrenia
 This is specifically used for patients that have
had one or more episodes of schizophrenia b...
Simple-type schizophrenia
 It usually begins in childhood
 It usually consists of symptoms like
absence of will
 Reduce...
 Diagnosis of schizophrenia are usually made
clinically based on the patient's behaviours and
patients narrative experien...
CLINICAL FEATURES OF
SCHIZOPHRENIA CONTD
 The symptoms are classified into
 The Schnederian Classification
 The Positiv...
The Schnederian Classification
 The german psychiatrist in the 20th century Kurt Schneider listed the
following symptoms ...
The Positive, Negative and
Cognitive Classification
 Positive symptoms refers to an excess or
distortion of normal functi...
The Positive, Negative and
Cognitive Classification
 Negative symptoms refers to a reduced or
absent characteristic norma...
 LOSS OF INTEREST IN EVERYDAY ACTIVITY
 LACK OF EMOTION
 REDUCED ABILITY TO CARRY OUT
ACTIVITIES
 NEGLECT OF PERSONAL ...
The Positive, Negative and
Cognitive Classification
 Cognitive symptoms involve problems with
thought processes, they car...
DIAGNOSIS
 The diagnosis of schizophrenia is made on
clinical grounds with investigations done
principally to rule out or...
ICD10 CRITERIA
 This system uses the self-reported experiences of the
person and reported abnormalities in behavior,
foll...
DSM iv TR CRITERIA

 According to the DSM iv TR, to be diagnosed with schizophrenia, three
of the following criteria mus...
 Alogia (lack or decline in speech)
 Avolition (lack or decline in motivation)
 Social or occupational dysfunction:- Fo...
EPIDEMIOLOGY
 The prevalence of schizophrenia is similar
world wide at about 1% of the population and the
disorder is mor...
INDICES OF PROGNOSIS
 About ¼ of those with acute schizophrenic
episode have a good outcome, 1/3 develop chronic
schizoph...
TREATMENT
Pharmacotherapy
Psychotherapy
Psychosocial
PHARMACOTHERAPY
 Anti psychotic medications are a must use to help
control both positive and negative symptoms
 Older or...
PHARMACOTHERAPY
contd.
 The newer Anti psychotics are however
better preferred as a result of their ability to
both reduc...
Phases of Treatment in
Schizophrenia
 Treatment of Acute Psychosis:
 In acute psychosis ,patient presents with most seve...
Treatment of Acute Psychosis
contd.
 Clinicians have a number of options for managing agitation that
results from psychos...
Phases of Treatment in
Schizophrenia contd.
 Treatment During Stabilization and Maintenance Phase :
 In the stable or ma...
Other Biological Therapies
 ECT has been studied in both acute and chronic
schizophrenia. Studies in recent-onset patient...
Psychotherapy
 Studies on the effects of individual psychotherapy in
the treatment of schizophrenia have provided data
th...
Psychosocial Therapies
 Psychosocial therapies include a variety of
methods to increase social abilities, self-
sufficien...
Social Skills Training
 Social skills training is sometimes referred to as
behavioral skills therapy . Along with
pharmac...
Thank You
Upcoming SlideShare
Loading in …5
×

Schizophrenia by emmanuel godwin

790 views

Published on

Schizophrenia is a severe, chronic and disabling mental disorder with a varying course. It is characterised by a breakdown of thought processes and by a deficit of typical emotional responses. It is a clinical syndrome

Published in: Health & Medicine
  • Be the first to comment

Schizophrenia by emmanuel godwin

  1. 1. SCHIZOPHRENIA BY EMMANUEL GODWIN 5th year Medical Student College of Medicine University of Nigeria , Enugu Campus
  2. 2. OUTLINE  DEFINITION  TYPES  CLINICAL FEATURES  DIAGNOSTIC CRITERIA(ICD-10 AND DSM –IV)  EINDICES OF PROGNOSIS  TREATMENTS  PIDEMIOLOGY
  3. 3. DEFINITION  Schizophrenia is a mental disorder characterized by a breakdown of thought process and by deficit of typical emotional responses.  It originates from the greek word skhzein(to split) and phrein(mind)  It doesn’t simply imply split personality as seen in dissociative identity disorder, but it implies splitting of mental functions.
  4. 4. History of schizophrenia  The term schizophrenia was coined by a swiss psychiatrist EUGEN BLEUER  He maintained that the 4 A’s lie at the core of the disorder and are the fundamental aspects of the disorders  Bleuer maintained that the 4A’s are the main core of the disorder while manifest first rank symptoms of schizophrenia are peripheral and not important
  5. 5. Four A’s  Disturbances of association(loosening of association)  Changes in emotional reactivity( flattening of affect)  Withdrawal from reality into the internal world of fantasy(Autism)  Fluctuation between two opposing ideas(ambivalence)
  6. 6. TYPES  Paranoid-types schizophrenia  Disorganized-type schizophrenia  Catatonia-type schizophrenia  Undifferentiated-type schizophrenia  Residual-type schizophrenia  Simple-type schizophrenia
  7. 7. Paranoid-type schizophrenia This is the most common form of schizophrenia where the individual has delusions that a person or group of persons are plotting against them. Major symptons include Persecutory Delusion,Auditory hallucination,delusions of false grandeur,Anxietyand Anger
  8. 8. Disorganized-type schizophrenia  In this type of schizophrenia behaviour is disturbed/abnormal and has no purpose, there is formal thought disorder which precipitates as disorganized behaviour and speech.  It is also called hebephrenia with respect to the greek goddess of youth HEBE due to its onset at puberty  UNLIKE paraniod schizophrenia delusions and hallucinations are not prominent
  9. 9. Disorganized-type schizophrenia contd  Common symptoms include Active behavior but in an aimless manner ,inappropriate emotional response, inappropriate facial responses, inappropriate laughter , anhedonia and avolition are also present ,they may also have delusions and
  10. 10. Catatonia-type schizophrenia  This is a form of schizophrenia where a person loses touch with reality,it is a state of neurogenic motor immobility and behavourial disorder manifested by stupor. In this type, behaviours at extreme opposites are manifested.For example, the person might be in a coma-like state unable to speak or move or the person might talk or move in a hyperactive way  It is a chronic disorder
  11. 11. Catatonia-type schizophrenia contd.  Common symptoms include paucity of movement or hyperactivity,stereotyped or repetitive movement and waxy flexibility
  12. 12. Undifferentiated-type schizophrenia  This is a form of schizophrenia that is a jack of all forms but master of none.  The person has symptoms as seen in the above forms but not enough to pinpoint it as one of them  Example, the person has a bit of psychomotor(catatonia) and a bit of delusion and hallucinations(paranoid)
  13. 13. Residual-type schizophrenia  This is specifically used for patients that have had one or more episodes of schizophrenia but do not presently have strong positive symptoms like hallucination or delusions. They may have negative symptoms like withdrawal or mild positive symptoms which indicate that the disorder is not yet resolved  It’s usually found in the transition between an acute episode and resolution of the disease
  14. 14. Simple-type schizophrenia  It usually begins in childhood  It usually consists of symptoms like absence of will  Reduced thinking and flattening of affect  There is a gradual deterioration of functioning and reduced socialization  It is rarely diagnosed and it’s a schizophrenia without psychosis
  15. 15.  Diagnosis of schizophrenia are usually made clinically based on the patient's behaviours and patients narrative experiences  General Symptoms include  Hallucinations  Delusions  Impairment in social cognition  Psychomotor disorders
  16. 16. CLINICAL FEATURES OF SCHIZOPHRENIA CONTD  The symptoms are classified into  The Schnederian Classification  The Positive, Negative and Cognitive Classification
  17. 17. The Schnederian Classification  The german psychiatrist in the 20th century Kurt Schneider listed the following symptoms known as the FIRST RANK SYMPTOMS and they include  Hearing thoughts spoken aloud  Third person auditory hallucination  Hallucination in the form of commentary  Somatic hallucination  Thought withdrawal or insertion  Thought broadcasting  Delusional perception  Feelings or actions experienced as made or influenced by external agent of force
  18. 18. The Positive, Negative and Cognitive Classification  Positive symptoms refers to an excess or distortion of normal functions and refer to symptoms that are not found in an otherwise normal person. These symptoms respond well to medications and they include  DELUSIONS  HALLUCINATIONS  THOUGHT AND SPEECH DISORDER  DISORGANIZED BEHAVIOUR
  19. 19. The Positive, Negative and Cognitive Classification  Negative symptoms refers to a reduced or absent characteristic normal function  They often appear several years before first acute episode  They often lead to relationship problems with family and friends  They generally respond less to medication and they include
  20. 20.  LOSS OF INTEREST IN EVERYDAY ACTIVITY  LACK OF EMOTION  REDUCED ABILITY TO CARRY OUT ACTIVITIES  NEGLECT OF PERSONAL HYGIENE  SOCIAL WITHDRAWAL  LOSS OF MOTIVATION
  21. 21. The Positive, Negative and Cognitive Classification  Cognitive symptoms involve problems with thought processes, they carry the most disability as the patient has reduced ability to perform daily routine task and they include  Memory problems  Difficulty in paying attention  Problems with interpreting information
  22. 22. DIAGNOSIS  The diagnosis of schizophrenia is made on clinical grounds with investigations done principally to rule out organic brain disease. However, a reasonable diagnosis must be in line with either or the two criteria below.  ICD10 criteria  DSM iv TR criteria.   NB: in practice, agreement between the two systems is high.
  23. 23. ICD10 CRITERIA  This system uses the self-reported experiences of the person and reported abnormalities in behavior, followed by clinical assessment by a mental health professional. The ICD-10 put more emphasis on schneiderian first rank symptoms of acute schizophrenia which include.  Auditory hallucinations-second/third person type, thought echoes  Broadcasting, insertion/withdrawal of thoughts  Controlled feeling, impulses or acts (passivity phenomenon)  Delusional perception
  24. 24. DSM iv TR CRITERIA   According to the DSM iv TR, to be diagnosed with schizophrenia, three of the following criteria must be met.  characteristic symptoms:- two or more of the following, each present for most of the time during one month period (or loss, if symptoms remitted with treatment).  Delusions  Hallucinations  Disorganized speech which is a manifestation of formal thought disorder.  Grossly disorganized behaviors  Negative symptoms  Blunted affect
  25. 25.  Alogia (lack or decline in speech)  Avolition (lack or decline in motivation)  Social or occupational dysfunction:- For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self care, are markedly below the level achieved prior to onset.  Significant duration:- continuous signs of the disturbance persist at least six months. This six months period must include at least one month of symptoms (unless, if symptoms remitted with treatment) if signs of disturbance are present for more than a month but less than six months, the diagnosis of schizophreniforn disorder is
  26. 26. EPIDEMIOLOGY  The prevalence of schizophrenia is similar world wide at about 1% of the population and the disorder is more common in men. The children of one affected parent have approximately a 10% risk of developing the illness, but this rise to about 50% in identical twins. The usual age of onset is the mid-twenties.
  27. 27. INDICES OF PROGNOSIS  About ¼ of those with acute schizophrenic episode have a good outcome, 1/3 develop chronic schizophrenia and remainder recover after each episode but suffer relapses , most will not work or live independently. Prophylactic treatment with antipsychotic drugs reduces the rate of relapse in the first 2 years after episode of schizophrenia from 70% to 40%. Schizophrenia is associated with suicide, 1 in 10 patients take their own lives.
  28. 28. TREATMENT Pharmacotherapy Psychotherapy Psychosocial
  29. 29. PHARMACOTHERAPY  Anti psychotic medications are a must use to help control both positive and negative symptoms  Older or newer anti psychotics may suffice in this case, as they all share (as a mechanism of action) the capacity to antagonize postsynaptic dopamine receptors in the brain.  Antipsychotics can be categorized into two main groups:  the older conventional antipsychotics, which have also been called first-generation antipsychotics or dopamine receptor antagonists e.g Clorpromazine, piperazine  the newer drugs, which have been called second-generation antipsychotics or serotonin dopamine antagonists (SDAs) e.g Clozapine
  30. 30. PHARMACOTHERAPY contd.  The newer Anti psychotics are however better preferred as a result of their ability to both reduce dopamine levels and stabilize serotonin levels (a neurotransmitter pathology seen in schizophrenia). They also have less extra pyramidal effects NB: They are called atypical antipsychotics b/c they share the property of weak D2 receptor antagonism and more potent 5-HT2A receptor
  31. 31. Phases of Treatment in Schizophrenia  Treatment of Acute Psychosis:  In acute psychosis ,patient presents with most severe psychotic symptoms  Acute schizophrenia is typically associated with severe agitation, which can result from such symptoms as frightening delusions, hallucinations, or suspiciousness, or from other causes, including stimulant abuse.  NB: Patients with akathisia can appear agitated when they experience a subjective feeling of motor restlessness, so u have to differentiate the two.  This phase usually lasts from 4 to 8 weeks
  32. 32. Treatment of Acute Psychosis contd.  Clinicians have a number of options for managing agitation that results from psychosis.  Antipsychotics and benzodiazepines can result in relatively rapid calming of patients. With highly agitated patients, intramuscular administration of antipsychotics produces a more rapid effect. An advantage of an antipsychotic is that a single intramuscular injection of haloperidol (Haldol), fluphenazine (Prolixin, Permitil), olanzapine (Zyprexa), or ziprasidone (Geodon) will often result in calming without an excess of sedation  Benzodiazepines are also effective for agitation during acute psychosis. Lorazepam (Ativan) has the advantage of reliable absorption when it is administered either orally or intramuscularly. The use of benzodiazepines may also reduce the amount of antipsychotic that is needed to control psychotic patients.
  33. 33. Phases of Treatment in Schizophrenia contd.  Treatment During Stabilization and Maintenance Phase :  In the stable or maintenance phase, the illness is in a relative stage of remission  The goals during this phase are to prevent psychotic relapse and to assist patients in improving their level of functioning  During this phase, patients are usually in a relative state of remission with only minimal psychotic symptoms.  Stable patients who are maintained on an antipsychotic have a much lower relapse rate than patients who have their medications discontinued.  It is generally recommended that multiepisode patients receive maintenance treatment for at least 5 years, and many experts recommend pharmacotherapy on an indefinite basis.
  34. 34. Other Biological Therapies  ECT has been studied in both acute and chronic schizophrenia. Studies in recent-onset patients indicate that ECT is about as effective as antipsychotic medications and more effective than psychotherapy.
  35. 35. Psychotherapy  Studies on the effects of individual psychotherapy in the treatment of schizophrenia have provided data that the therapy is helpful and that the effects are additive to those of pharmacological treatment  The suggested type is SUPPORTIVE PSYCHOTHERAPY with the primary aim of having the patient understand that the therapist is trustworthy and has understanding of the the patient, no matter how bizarre.  It is nothing more than an “ego builder”  Making the patients feel that he/she can trust you about anything and all you will do is to support them and ensure that they take their medications.
  36. 36. Psychosocial Therapies  Psychosocial therapies include a variety of methods to increase social abilities, self- sufficiency, practical skills, and interpersonal communication in schizophrenia patients. The goal is to enable persons who are severely ill to develop social and vocational skills for independent living. Such treatment is carried out at many sites: hospitals, outpatient clinics, mental health centers, day hospitals, and home or social clubs.
  37. 37. Social Skills Training  Social skills training is sometimes referred to as behavioral skills therapy . Along with pharmacological therapy, therapy can be directly supportive and useful to the patient. In addition to the psychotic symptoms seen in patients with schizophrenia, other noticeable symptoms involve the way the person relates to others, including poor eye contact, unusual delays in response, odd facial expressions, lack of spontaneity in social situations, and inaccurate perception or lack of perception of emotions in other people.
  38. 38. Thank You

×