Schizophrenia for undergraduates


Published on

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

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Schizophrenia for undergraduates

  1. 2. <ul><li>A disorder in which patients have psychotic symptoms and social or occupational dysfunction that persists for at least 6 months . </li></ul><ul><li>Psychosis is characterized by impaired reality testing (inability to distinguish reality from fantasy) with specific psychotic symptoms like delusions and hallucinations. </li></ul>
  2. 3. <ul><li>Affects 1 % of the general population. </li></ul><ul><li>8% in sibilings of affected subjects. </li></ul><ul><li>12% in offsprings of one affected parent. </li></ul><ul><li>40% in offsprings of two affected parents. </li></ul><ul><li>47% in subjects of affected monozygotic twins. </li></ul>
  3. 4. <ul><li>Neurotransmitter theory </li></ul><ul><ul><ul><li>Dopamine hypothesis: </li></ul></ul></ul><ul><ul><ul><ul><li>Schizophrenia is due to hyperactivity in brain dopaminergic pathways. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>This theory is consistent with : </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>The efficacy of antipsychotics (dopamine receptor antagonists). </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>The ability of some drugs like amphetamine that stimulate dopaminergic activity to induce psychosis. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Presence of higher levels of dopamine receptors in subcortical nuclei of schizophrenics. </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Serotonin hypothesis: </li></ul></ul></ul><ul><ul><ul><ul><li>Evidenced by the efficacy of serotonin- dopamine antagonists in reducing psychotic symptoms. </li></ul></ul></ul></ul>
  4. 5. <ul><li>Genetic theory </li></ul><ul><ul><li>Defects in long arms of chromosomes 5,11 and 18 and short arms of chromosome 19 and X chromosome. </li></ul></ul><ul><ul><li>Increase the incidence of schizophrenia in subjects related to an affected person. </li></ul></ul><ul><li>Brain structural theory </li></ul><ul><ul><li>Imaging techniques showed decreased size and impaired function in limbic system and frontal lobes. </li></ul></ul><ul><li>Psychosocial theory </li></ul><ul><ul><li>Increased incidence in families with overt criticism, hostility, and overinvolvement (high expressed emotions). </li></ul></ul>
  5. 6. <ul><li>Two or more of the following must be present: </li></ul><ul><li>Hallucinations. </li></ul><ul><li>Delusions. </li></ul><ul><li>Disorganized behavior or catatonic behaviour. </li></ul><ul><li>Disorganized speech. </li></ul><ul><li>Negative symptoms: </li></ul><ul><ul><ul><li>Social withdrawal. </li></ul></ul></ul><ul><ul><ul><li>Affective flattening or blunting. </li></ul></ul></ul><ul><ul><ul><li>Poverty of speech or poverty of speech content. </li></ul></ul></ul><ul><ul><ul><li>Thought blocking. </li></ul></ul></ul><ul><ul><ul><li>Poor grooming. </li></ul></ul></ul><ul><ul><ul><li>Loss of volition. </li></ul></ul></ul><ul><li>The symptoms must last at least for 6 months. </li></ul><ul><li>Presence of significant occupational and /or social dysfunction. </li></ul><ul><li>The condition not substance-induced or due to general medical disease. </li></ul>
  6. 7. <ul><li>Paranoid type: </li></ul><ul><ul><li>paranoid delusions, frequent auditory hallucination. </li></ul></ul><ul><li>Disorganized type: </li></ul><ul><ul><li>disorganized speech, disorganized behaviour. </li></ul></ul><ul><li>Catatonic type: </li></ul><ul><ul><li>motoric immobility or stupor, excessive motor activity, extreme negativism or mutism, pecularities of voluntary movements, echolalia or echopraxia. </li></ul></ul><ul><li>Residual type: </li></ul><ul><ul><li>residual negative symptoms or attenuated positive symptoms. </li></ul></ul><ul><li>Undifferentiated type: </li></ul><ul><ul><li>criteria are not met for paranoid, disorganized, or catatonic subtypes. </li></ul></ul>
  7. 8. <ul><li>Brief psychotic disorder: </li></ul><ul><ul><li>One or more of delusions, hallucinations, disorganized or catatonic behaviour, disorganized speech must be present for a duration ranges from one day to one month . </li></ul></ul><ul><li>Schizophrenifiorm disorder: </li></ul><ul><ul><li>The same clinical manifestations as schizophrenia except the duration of schizophreniform disorder ranges from one month to 6 months . </li></ul></ul><ul><li>Delusional disorder: </li></ul><ul><ul><li>Nonbizarre (systematized) delusions of at least one month’s duration, in the absence of other psychotic features. </li></ul></ul><ul><li>Secondary psychotic disorders: </li></ul><ul><ul><li>Psychotic disorder due to general medical conditions and substance-induced psychotic disorder. </li></ul></ul>
  8. 9. <ul><li>Hospitalization : for </li></ul><ul><ul><li>Diagnostic purposes. </li></ul></ul><ul><ul><li>Stabilization of medication. </li></ul></ul><ul><ul><li>Patients with suicidal or homicidal ideation. </li></ul></ul><ul><li>Pharmacotherapy: </li></ul><ul><ul><li>New (atypical) antipsychotics “serotonin and dopamine antagonists” (SDA): </li></ul></ul><ul><ul><ul><li>Mechanism of action : through blocking of serotnin receptors and dopamine receptors. </li></ul></ul></ul><ul><ul><ul><li>Efficacy : effective in both positive and negative psychotic symptoms. </li></ul></ul></ul><ul><ul><ul><li>Examples : risperidone, olanzapine, clozapine, and quitiapine. </li></ul></ul></ul><ul><ul><ul><li>Side effects : less than old antipsychotics. </li></ul></ul></ul>
  9. 10. <ul><ul><li>Old (typical) antipsychotics “dopamine receptor antagonist” (DA): </li></ul></ul><ul><ul><ul><li>Mechanism of action : through blocking of dopamine receptors in mesolimbic-mesocortical pathway. </li></ul></ul></ul><ul><ul><ul><li>Efficacy : effective in positive than negative psychotic symptoms. </li></ul></ul></ul><ul><ul><ul><li>Examples ; trifluperazine, haloperidol, chlorpromazine and thioridazine. </li></ul></ul></ul><ul><ul><ul><li>Side effects : </li></ul></ul></ul><ul><ul><ul><ul><li>Acute dystonia : slow sustained contractions of the trunk or limbs. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Neuroleptic malignant syndrome ; rigidity, hyperpyrexia, disturbed conscious level, elevated CPK, and leucocytosis. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Parkinsonism. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hyperprolactinaemia. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Orthosatic hypotension. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Dry mouth, constipation. </li></ul></ul></ul></ul>
  10. 11. <ul><li>Psychosocial therapy: </li></ul><ul><ul><ul><ul><li>Behavior therapy ; to reinforce the desired behaviours and minimize the undesired behaviours. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Group therapy ; focusing on supporting and developing social skills. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Family therapy ; to improve family dynamics. </li></ul></ul></ul></ul><ul><li>Elcetro-convulsive therapy (ECT): </li></ul><ul><ul><li>Indications : </li></ul></ul><ul><ul><ul><li>Major depressive disorder. </li></ul></ul></ul><ul><ul><ul><li>Bipolar disorder. </li></ul></ul></ul><ul><ul><ul><li>Schizophrenia: nonchronic, acute, especially paranoid, catatonic, or with prominent affective symptoms. </li></ul></ul></ul><ul><ul><ul><li>Pregnancy: drug of choice in suicidally depressed or psychotic pregnant patients who should not receive psychotropic drugs. </li></ul></ul></ul><ul><ul><li>It is performed under general anaesthesia. </li></ul></ul><ul><ul><li>Acts through remodulation of brain neurotransmitters. </li></ul></ul><ul><ul><li>About 6-12 treatments are done twice or three times weekly according to the disease and its severity. </li></ul></ul>