Pathophysiology of Schizophrenia

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Pathophysiology of Schizophrenia

  1. 1. Psychoses/ Schizophrenia By: Dr Urmila M. Aswar
  2. 2.  Psychoses- Severe psychiatric illness with serious distortion of thought, behaviour, capacity to recognize reality and perception.  Schizophrenia- Schizophrenia is a particular type of psychosis that is, a mental disorder caused by some inherent dysfunction of the brain. 2 Fig. 1 Schizophrenia
  3. 3. Prevalence  Schizophrenia occurs with regular frequency nearly everywhere in the world in 1 % of the population and begins mainly in young age (mostly around 16 to 25 years).  Schizophrenia leads to  A group of characteristic positive and negative symptoms  Deterioration in social, occupational, or interpersonal relationships  Continuous signs of the disturbance for at least 6 months
  4. 4. The Primary symptom of schizophrenia : Mania –Hyperactivity, uncontrollable thought and speech, may be associated with violent behaviour Depression – Sadness, guilt, physical and mental slowing, self destructive ideation. Bipolar - (manic-depressive) Unipolar- (mania or depression) Fig. 2 symptom 4
  5. 5. Positive Symptoms Hallucinations Delusions Disorganized thought Perception disturbances Inappropriate emotions Cognition New Learning Memory Negative Symptoms Blunted emotions Anhedonia Lack of feeling Mood Symptoms Loss of motivation Social withdrawal Insight Demoralization 5 Suicide
  6. 6. POSITIVE SYMPTOMS: Hallucinations  Hallucinations are things a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel.  "Voices" are the most common type of hallucination in schizophrenia. The voices may talk to the person about his or her behavior, order the person to do things, or warn the person of danger. Sometimes the voices talk to each other.  Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects, and feeling things like invisible fingers touching their bodies when no one is near.
  7. 7. POSITIVE SYMPTOMS : Delusions  Delusions are false beliefs. The person believes delusions even after other people prove that the beliefs are not true or logical. People with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can control their behavior with magnetic waves.  They may also believe that people on television are directing special messages to them.  Sometimes they believe they are someone else, such as a famous historical figure.  They may have paranoid delusions and believe that others are trying to harm them, such as by cheating, harassing, poisoning, spying on, or plotting against them or the people they care about. These beliefs are called "delusions of persecution."
  8. 8. Negative symptoms  Negative symptoms are associated with disruptions to normal emotions and behaviors.  These symptoms include the following:  "Flat affect" (a person's face does not move or he or she talks in a dull or monotonous voice)  Lack of pleasure in everyday life-Anhedonia  Lack of ability to begin and sustain planned activities  Speaking little, even when forced to interact.
  9. 9. Movement disorders  Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic.
  10. 10. Cognitive symptoms  Like negative symptoms, cognitive symptoms may be      difficult to recognize as part of the disorder. They are detected when other tests are performed. The ability to understand information and use it to make decisions. Trouble in paying attention Problems with "working memory" (the ability to use information immediately after learning it). Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional distress.
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  13. 13. Carlsson and Lindqvist (1963) Repeated administration of stimulants like amphetamines and cocaine, which enhance central dopaminergic neurotransmission, can cause a psychosis that resembles the positive symptoms of schizophrenia. Stress, a major schizophrenia. predisposing factor in 13
  14. 14.  This disorder is far more complex than originally supposed, but it involves a combination of genetics and abnormalities in amine neurotransmitter function (especially that of dopamine)
  15. 15.  Main categories are: A) Typical antipsychotics Phenothiazines (chlorpromazine, fluphenazine, thioridazine) Thioxanthenes (flupenthixol, clopenthixol) Butyrophenones (haloperidol, droperidol) B) Atypical antipsychotics (e.g. clozapine, risperidone, sulpiride, olanzapine) 15
  16. 16. The difference between ‘typical’ and ‘atypical’ antipsychotic is based on the Incidence of extrapyramidal side-effects (less in ‘atypical’ group) Efficacy in treatment-resistant group of patients Efficacy against negative symptoms. 16

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