schizophrenia - symptoms, causes treatments and outcomes

1. Schizophrenia and
other
psychotic disorders

2. What is schizophrenia?
Schizophrenia is a chronic and severe
mental disorder that affects how a person
thinks, feels, and behaves.
People with schizophrenia may seem
like they have lost touch with reality.
 Although schizophrenia is not as
common as other mental disorders, the
symptoms can be very disabling.

3. The German psychiatrist Emil Kraepelin (1856–
1926)who is best known for his careful description of what
we now regard as schizophrenia.
Kraepelin used the Latin version of
Morel’s term (dementia praecox) to refer to a group of
conditions that all seemed to feature mental deterioration
beginning early in life.
It was a Swiss psychiatrist named Eugen Bleuler (1857-
1939) who gave us the diagnostic term we still use today.
 In 1911, Bleuler used schizophrenia (from the Greek roots
of sxizo,pronounced “schizo” and meaning “to split or
crack,” and phren, meaning “mind”)
 because he believed the condition was characterized
primarily by disorganization of thought processes, a lack of
coherence between thought and emotion, and an inward
orientation away (split off) from reality.

4. CLINICAL PICTURES OF SCHIZOPHRENIA

5. Disorganized Speech and
Behavior
Delusions reflect a disorder of thought
content.
 Disorganized speech, on the other hand, is
the external manifestation of a disorder in
thought form.
 catatonia is even more striking behavioral
disturbance.
 A patient with catatonia shows virtual
absence of all movements and speech.
 Or sometimes patient may show unusual
posture for a extended period of time without
any seeming discomfort.

6. What is positive and negative symptoms?
 positive symptoms are those which reflect an
excess or distortion in a normal repertoire of behavior
and experiences, such as delusions and
hallucinations.
 Negative symptoms reflects an absence or deficit
of the behaviors that are normally present.
 It includes flat affect, blunted emotional
expressiveness, alogia and avolition.

7. Subtypes of schizophrenia
Paranoid schizophrenia
Disorganized schizophrenia
Catatonic schizophrenia
Undifferentiated schizophrenia
Residual schizophrenia

9. Paranoid schizophrenia
Paranoia means “Madness”
• It is characterized by delusions and auditory
hallucinations
but relatively normal intellectual functioning and
expression of affect.
• The delusion can often been persecuted unfairly or
being some other person who is famous
• These kind of people shows anger, aloofness, anxiety
and argumentative

10. Disorganized schizophrenia
 Other name hebephrenia
 Characterized by disorganized speech , disorganized behavior,
and flat or inappropriate affect
Catatonic schizophrenia
 It involves disturbances in persons movement
 Affected people may exhibit a dramatic reduction in activity
 They shows stupor ( a state of close to unconsciousness)
 Catalepsy ( trance seizure with rigid body)
 Waxy flexibility ( limbs stay in position another
person put them in)
 Mutism ( lack of verbal response)
 Negativism (lack of response stimuli or instruction)

11. Undifferentiated schizophrenia
 Person exhibits behaviors which fit into two or more
of the other types of schizophrenia,
 It includes delusions, hallucinations, disorganized
speech behavior, catatonic behavior
Residual schizophrenia
 Person has a past history of atleast one episode of
schizophrenia
 But currently has no symptoms
 If the active phase is left untreated, symptoms can
last for weeks, even months.
 Relapses may occur more prevalent

12. Other psychotic disorders
•Schizoaffective
•Schizophreniform
•Delusional disorder
•Shared psychotic disorder
•Brief psychotic disorder

13. SCHIZOAFFECTIVE
An uninterrupted period of illness during which , at sometimes
major depressive episodes , a manic episode or mixed episodes.
Delusions or hallucination for atleast 2 or more weeks in the
absence of major mood episodes.
It is characterized by abnormal thought process.
SCHIZOPHRENIFORM
 It is type of psychotic illness with symptoms similar to those of
schizophrenia , but lasting for less than 6 months.
Psychosis
Perceptual dysregulation
Unusual beliefs or experiences
Disorganized speech or behavior
Lack of insight
Detachment
Social withdrawal
Intimacy avoidance
Restricted emotions
Loss of interest

14. DELUSIONAL DISORDERS
•Persistent false belief of persecution
•Delusions often about finances or marital
fidelity
•Types of delusional disorder -
•Erotomanic – having belief that someone is in love
with him or her
•Grandeous – over – inflated sense of worth , power,
knowledge or identity
•Jealous- having belief that his or her spouse is
unfaithful
•Persecutory - having belief that they are mistreated, or
someone spying on them.
•Somatic – believes that he or she may have any kind of
health issues.
•Mixed – 2 or more kind of symptoms listed above

15. SHARED PSYCHOTIC DISORDER
• It is delusion that is develops in an individual who is
involved in the close relationship with another person who
already have a psychotic disorder.
• The term folio a deux means “shared madness” or “
madness for two” in French
BRIEF PSYCHOTIC DISORDER
• It is characterized by sudden temporary periods of
psychotic behavior, such as delusions, hallucinations,
confusion.
• The disturbance is not better explained by major depressive
or bipolar disorders or other psychotic disorders.

17. Causes and risk factors of schizophrenia
 Genetic factors
It includes twin studies and adoption study
Twin study - concordance rate of identical twins are routinely and consistently
found to be significantly higher than those of fraternal twins or ordinary siblings.
Adoption study - in monozygotic twins who are genetically identical , though
they are adopted by different family members they shows same genetic
background.
 Quality of adoptive family
Research shows that dysfunctional family situation shows increase in risk of
schizophrenia.

18. Molecular genetics
•Linkage analysis – inheritance of genetic diseases
•Researchers found that some of the chromosomes such as
1,2,6,8,13 and 22 are responsible for causing schizophrenia.
Why chromosomes are such important?
 It is because host genes are aberrant in schizophrenia and they
are known as candidate genes.
Prenatal exposures
Viral infections
Rhesus incompatibility – damage in mother’s immune system
and blood related diseases
Pregnancy and birth complications
Early nutritional deficiency
Maternal stress

19. Neuro developmental perspectives
Structural and functional brain
abnormalities
Neuro-cognition
Loss of brain volume
Affected brain areas – regions of memory,
language and other sensory inputs
Brain functioning
 low frontal lobe functioning (hypofrontality)
cytoarchitecture
 Disruption of migration of neurons

20. Brain development in adolescence
- problem in brain development
during the period of adolescence.
Synthesis
-Problem in “functional circuits”
Neurochemistry
-Dopamine and glutamite
-Ketamine

21. Psycho social and cultural factors
Destructive parental interactions
Families and relapse
•Higher emotionality leads to relapsed conditions
•Expressed emotions (EE) and family conditions are correlated
•Urban living
•Raised in urban environment seems to be increased risk of
schizophrenia
•Immigration
•First generation immigrants shows 2.7% risk of developing
schizophrenia
• Discrimination among whites and blacks shows risks
Cannabis abuse
Predictor of later schizophrenia
COMT gene
Catechol – o- methyltransferase
An enzyme breaks the normal functions of neurotransmitters

22. Key notes
Environmental stress
 Major unpleasant emotional experiences
 Biochemical or metabolic dysfunctions
 Unsatisfactory and social relationships
 Personal inadequacy, weakness of characters
 Poor parenting, bad upbringing
 Drug or alcohol abuse
 Brain injury
 Hereditary, inherited genetic defects
 Birth complications, prenatal difficulties
 Poor nutrition, vitamin deficiency
 Poor general health, weak
 Structural and functional brain abnormalities
 Neuro-cognition
 Loss of brain volume
 Affected brain areas – regions of memory,
language and other sensory inputs

23. Treatment and
outcomes of
schizophrenia

24. Pharmacological approach
First generation psychotics
• First generation anti- psychotics are medications like
chloropromazine (thorazine) and haloperidol(haldol), which were among
the first to be used to treat psychotic disorders.
• Sometimes it is referred to as neuroleptics – “seizing the neurons”
these medications are introduced in 1950.
• These are called dopamine antagonists.
• Some clinical changes can be seen in 24 hours of treatment
• Common side effects of these medications can include drowsiness,
dry mouth,weight gain.
• Sometimes it shows extrapyramidal side effects.- which resembles
Parkinson diseases.

25. Second generation anti psychotics
It was appeared in 1980s
It includes risperdone, olanzapine, quetiapine,
ziprasidone
It also includes artipiprazole., lurasidone
Psychosocial approach
Cognitive behavioural therapy
Social-skills training
Cognitive remediation training
Individual treatment
Case management
Family therapy – it provides families with
communication skills,
 and other skills of helpful in managing the illness.
It also reduces high levels of expressed
emotions(EE)

26. Reference
Abnormal psychology 16E Butcher et al.,
Abnormal psychology an intregrative approach 6th edition
www.mayoclinic.in
https://www.helpguide.org
www.eurekalert.org
www.verywellmind.com