Talk given to physician in a general hospital

1. Losing touch with reaLity
Dr Biju Sunny T.
MD (nimhans)
Senior Consultant Psychiatrist
MIMS Calicut

2. Psychiatric disorders
• Neurosis: adjustment disorders, anxiety
minor depression
• Psychosis: Schizophrenia, other types of
psychosis, Delusional disorder

3. Psychosis
• Delusions: BELIEF
• Hallucination: SENSATIONS
• Impaired reality testing
• Loss of insight

4. “Split-Personality”…NO!
• Bleuler - “schizophrenia” April 24th
1908
• Chronic, deteriorating, usually continuous
illness…..( hence earlier considered to be a
form of dementia)
• Like the Syphilis “the great imitator”
• Schizo-affective is separate but related
illness

5. So what is schizophrenia ?
• A special type of psychosis
• Special characteristic features :
1st
& 3rd
person auditory hallucination
Experience of being controlled (E,I,A)
Thoughts inserted, withdrawn, broadcast
Negative symptoms
Disorganized behaviour
Bizarre delusions
Thought disorder

6. • Parallel Universes
by Dan Hoeweler (psychosis patient)
• The universe I live in
Is different than yours
I will show you some day
And you will believe
In places
Where death stalks all
Where trickery takes place
Where deception is king
Where demons rule
Where everything is cruel
• I came here one day
Through a black hole
Called Knowledge
And viewed the world
In a different light

7. • When traveling through
I saw the demons
That rule everything
Everywhere
All the time
• I see them here
In this parallel universe
That you cannot see
That you cannot hear
• They can see
Those that are not blind
They track everyone
Who can see the light

8. • They control me
They hear me
They see all
• I want to be ignorant again
Just like you
But poisoning my mind
With strange pills
Which brainwash me
Will not let me be free
• I wish I was blind
And could not see
This world is a curse
To everything
That I breathe

9. • One day you may discover
This parallel world
And find yourself in
A lot of trouble
With demons
That see and hear
Everything that you do
With voices
That will torment you
• Stay away from the voices
Stay away from the light
Don’t listen to them
Don’t think they exist
They will lead you here
Where I am now
With voices
And demons that I fear

10. Are there many types of schizophrenia
• Paranoid schizophrenia
• Hebephrenic schizophrenia
• Catatonic schizophrenia
• Undifferentiated schizophrenia
• Simple schizophrenia

11. Features of schizophrenia
• 1% in community ( East vs West outcome)
• Increased risk with ganja or cannabis use
• Neuro developmental disorder
higher anomalies, soft neurological signs
Synaptic Pruning >> signal : noise ratio
Dopamine pathways (nigro striatal pathway)

12. Risk of developing schizophrenia
• Relatives with schizophrenia
Chance of developing schizophrenia
• None 1 in 100
• 1 parent 1 in 10
• 1 identical twin 1 in 2
• 1 non-identical twin 1 in 8

13. Management
• Antipsychotics keep sx in check…duration
based treatment.
• Managing adverse effects, affects
compliance
• Teaching relapse prevention
• Education regarding Life Events &
improving coping strategies

14. Management
• Typical antipsychotics vs Atypicals
• Metabolic syndrome, QT prolongation
• Comorbidity with medical problems
• Family care is preferred over institutionalizing

15. • Medicalising schizophrenia is essential
• Analogy of Error Message, false signals
due to chemicals
• Doubts about addiction, “too much
dependence on medications” need
discssn
• Collaboration of a health care
system+Family

16. Thank you for your Attention