Schizophrenia is a severe mental disorder characterized by positive symptoms like delusions and hallucinations, negative symptoms like apathy and anhedonia, as well as cognitive and affective symptoms. It has a prevalence of around 1% globally and typically onset is in young adulthood. Treatment involves pharmacological interventions like antipsychotic medications and biological therapies combined with psychological interventions like cognitive behavioral therapy and social skills training. Prognosis depends on factors like comorbidities, with about a third of people experiencing a good response to treatment.

1. SCHIZOPHRENIA
D R . S . K . K A R
A S S O C I AT E P R O F E S S O R O F P S Y C H I AT R Y
K G M U , L U C K N O W, U . P

2. • Schizo: Split
• Phrenia: Mind

3. SCHIZOPHRENIA
• A severe mental disorder
• A psychotic disorder

4. HISTORY
• The term “Schizophrenia” is coined by Eugene Bleuler
• Earlier to it, it was known as “Dementia Precox” & “Demence Precoce”
• Hecker coined the term “Hebephrenia”
• Kahlbaum coined the term “Catatonia”

5. EPIDEMIOLOGY
• Prevalence
– Current 0.6% (India)
– Life-time ~1% (India)
– Effects all age groups, genders, races
– Common age of onset: 2nd to 3rd decade of life
– Onset can be : Early onset / Late onset
– Follows waxing and waning course

6. SYMPTOMS
• Bleuler’s 4A
– Autism
– Ambivalence
– Association disturbances
– Affective disturbances

7. SYMPTOMS
• 1st rank symptoms (described by Kunt Sneider)
• 2nd rank symptoms

8. SYMPTOMS
Positive
symptoms
Negative
symptoms
Affective
symptoms
Cognitive
symptoms
Aggressive
symptoms

9. SYMPTOMS
Positive
symptoms
Delusions
Hallucinations
Negative
symptoms
Affective
symptoms
Cognitive
symptoms
Aggressive
symptoms

10. SYMPTOMS
Positive
symptoms
Negative
symptoms
Avolition
Abulia
Apathy
Anhedonia
Affective
symptoms
Cognitive
symptoms
Aggressive
symptoms

11. SYMPTOMS
Positive
symptoms
Negative
symptoms
Affective
symptoms
Inappropriate
affect
Incongruent
affect
Constricted
affect
Blunted/Flat
affect
Cognitive
symptoms
Aggressive
symptoms

12. SYMPTOMS
Positive
symptoms
Negative
symptoms
Affective
symptoms
Cognitive
symptoms
Impairment of
attention &
concentration
Impairment of
executive function
Impairment of
working memory
Impairment of
verbal fluency
Reduced
processing speed
Aggressive
symptoms

13. SYMPTOMS
Positive
symptoms
Negative
symptoms
Affective
symptoms
Cognitive
symptoms
Aggressive
symptoms
Hostility
Suicidal / homicidal
behaviour

14. CLINICAL SUB-TYPES
Paranoid type
Hebephrenic type
Catatonic type
Simple type
Disorganized (undifferentiated) type

15. ETIOLOGY
BIOLOGICAL
• Genetic
• Inflammation
• Infective
• Neurodevelopmental
• Degenerative??
• Substance use
PSYCHOLOGICAL
• Early life adversities
• Personality (Cluster A)
SOCIAL
• Parenting
• Stress
• Neglect - Abuse

16. OUTCOME
1/3rd : Poor
responders
1/3rd :
Partial
responders
1/3rd :Good
responders

17. PROGNOSTIC FACTORS
Co-
morbidity

18. TREATMENT
Pharmacological
Biological
Psychological

19. TREATMENT
• Antipsychotic medications
• Typical: Haloperidol, Chlorpromazine, Trifluperazine, Zuclopenthixol, Fluphenazine
• Atypical: Risperidone, Olanzapine, Quetiapine, Clozapine, Aripiprazole, Amisulpride
Pharmacological
Biological
Psychological
Important
points to
remember
• Side effects
• Duration of treatment
• Depot preparations
• Relevance of anti-depressants/
Mood stabilizers/
Benzodiazepines
• Investigations (Clozapine)

20. TREATMENT
Pharmacological
• Electroconvulsive therapy (ECT)
• Transcranial Magnetic Stimulation (TMS)
• Transcranial direct current stimulation (tDCS)
Biological
Psychological

21. TREATMENT
Pharmacological
Biological
• Cognitive behaviour therapy
• Family therapy
• Behavioural interventions (Token economy)
• Art therapy
• Social skill training
• Cognitive remediation
Psychological

22. SUMMARY

23. QUERIES