What is Schizophrenia
• Schizophrenia is a chronic and disabling brain
disorder that has been recognized throughout
• Symptoms usually emerge for men in late teens to
early 20’s. In females mid 20’s to early 30’s.
• Many people with this disorder have difficulty
holding a job or caring for themselves. This creates a
great burden for their families and for society.
• Those with the disorder may hear voices that
others don’t hear. They may believe that
others are reading their minds, controlling
their thoughts, or plotting to harm them.
• They may not make sense when they talk or
they may seem perfectly fine until they start
talking about what they are really thinking.
What are the symptoms?
• The symptoms of schizophrenia fall into three
• Positive Symptoms are unusual thoughts or
perceptions, including hallucinations,
delusions, thought disorder and disorder of
movement. Auditory hallucinations are the
• Negative Symptoms refers to reductions in normal
emotional and behavioral states such as:
• Flat affect with immobile facial expression,
• Lack of pleasure in everyday life.
• Diminished ability to initiate and sustain planned
• Speaking infrequently even when forced to interact
• People with the disorder often neglect basic hygiene
and need help with ADL.
• Cognitive Symptoms are subtle and often detected
only when neuropsychological test are performed.
• Poor executive functioning. (the ability to absorb and
interpret information and make decisions based on
• Inability to sustain attention.
• Problems with working memory (the ability to keep
recently learned information in mind and use it right
Etiology of Schizophrenia
• The etiology and pathogenesis of
schizophrenia is not known
• It is accepted, that schizophrenia is „the group
of schizophrenias“ which origin is
– internal factors – genetic, inborn, biochemical
– external factors – trauma, infection of CNS, stress
• The disorder is believed to result from a
combination of environmental and genetic
• It is well known that the disease runs in
families, and is seen in 10% of people with a
first degree relative.
• Identical twins have 40 to 60% chance of
developing the disorder.
• Although there is a genetic risk for schizophrenia, it is
not likely that genes alone are sufficient to cause the
• Interactions between genes and the environment are
thought to be necessary for the disorder to develop.
• Many risk factors have been identified such as
exposure to viruses or malnutrition in the womb,
problems during birth, and psychosocial factors such
as stressful environmental conditions.
• Scientist feel it is likely that an imbalance in
the complex, interrelated chemical reactions
of the brain involving the neurotransmitters
dopamine and glutamate plays a role in
• Neurotransmitters allow the brain cells to
communicate with one another.
The Criteria of Diagnosis
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
for one month or more:
a) the hearing of own thoughts, the feelings of thought withdrawal, thought
insertion, or thought broadcasting
b) 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
c) 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
d) permanent delusions of different kind, which are inappropriate and
unacceptable in given culture
The Criteria of Diagnosis
e) the lasting hallucination of every form
f) blocks or intrusion of thoughts into the flow of thinking and resulting
incoherence and irrelevance of speach, or neologisms
g) catatonic behavior
h) „the negative symptoms”, for instance the expressed apathy, poor speech,
blunting and inappropriatness of emotional reactions
i) expressed and conspicuous qualitative changes in patient’s behavior, the
loss of interests, hobbies, aimlesness, inactivity, the loss of relations to
others and social withdrawal
Diagnosis of acute schizophorm disorder (F23.2) – if the conditions for
diagnosis of schizophrenia are fulfilled, but lasting less than one month
Diagnosis of schizoaffective disorder (F25) - if the schizophrenic and
affective symptoms are developing together at the same time
Genetics of Schizophrenia
• Many psychiatric disorders are multifactorial (caused
by the interaction of external and genetic factors)
and from the genetic point of view very often
• Relative risk for schizophrenia is around:
1% for normal population
5.6% for parents
10.1% for siblings
12.8% for children
• In the 1990’s, new drugs, called atypical
antipychotics, were developed.
• These medications appear to be equally effective for
helping reduce the positive symptoms like
hallucinations and delusions - but may be better than
the older medications at relieving the negative
symptoms of the illness, such as withdrawal, thinking
problems, and lack of energy.
• The atypical antipsychotics include aripiprazole
(Abilify), risperidone (Risperdal), clozapine (Clozaril),
olanzapine (Zyprexa), quetiapine (Seroquel), and
• Current treatment guidelines recommend using one
of the atypical antipsychotics other than clozapine as
a first line treatment option for newly diagnosed
Suicide in Schizophrenia
• People with schizophrenia attempt suicide
much more often than people in the general
population. About 10% (especially young adult
males) succeed. It is hard to predict which
patients with the disorder are prone to
suicide. Listen when they talk about harming
• On monthly visits monitor for things such as over
eating, weight gain, polyuria (increase urination),
polydipsia (increased thirst).
• When each of you see your clients, if they have
recently been put on an antipsychotic, discuss the
above symptoms with them.
• Have them notify the practitioner if they are having
problems with any of these symptoms.
Treatment of Schizophrenia
The acute psychotic schizophrenic patients will respond usually
to antipsychotic medication.
According to current consensus we use in the first line therapy
the newer atypical antipsychotics, because their use is not
complicated by appearance of extrapyramidal side-effects, or
these are much lower than with classical antipsychotics.
chlorpromazine, chlorprotixene, clopenthixole,
levopromazine, periciazine, thioridazine
droperidole, flupentixol, fluphenazine,
fluspirilene, haloperidol, melperone,
oxyprothepine, penfluridol, perphenazine,
pimozide, prochlorperazine, trifluoperazine
amisulpiride, clozapine, olanzapine,
quetiapine, risperidone, sertindole, sulpiride
• Relapses occur most often when people with
schizophrenia stop taking their antipsychotic
• They may feel better, or their side effects or so bad
they stop the medication.
• At times they don’t feel taking their medication
regularly is important.
• It is our responsibility to education our patient to be
compliant and monitor them to keep them healthy.
• Department of Psychiatry, 1st Faculty of
Medicine, Charles University, Prague, Head:
Prof. MUDr. Jiří Raboch, DrSc.
• Andreasen N.C., Roy M.-A., Flaum M.: Positive
and negative symptoms. In: Schizophrenia,
Hirsch S.R. and Weinberger D.R., eds.,
Blackwell Science, pp. 28-45, 1995