SCHIZOPHRENIA. AS A MEDICAL STUDENT, IT IS VERY IMPORTANT TO STUDY. THIS PRESENTATION IS EDUCATIVE AND HIGHLY INFORMATIVE.

1. MUSA, SAKINA KAIGAMA

2. Psychotic disorders are a group of serious illnesses that affect
the mind.
They make it hard for someone to think clearly, make good
judgements, respond emotionally, communicate effectively,
understand reality and behave appropriately.
When symptoms are severe, people with psychotic disorders
have trouble staying in touch with reality and often are unable
to handle daily life. But even severe psychotic disorders usually
can be treated.

3. The main ones are hallucinations, delusions and disordered
forms of thinking.
HALLUCINATIONS means seeing, hearing, feeling, tasting or
smelling things that don’t exist. For instance, someone might
see things that aren’t there, hear voices, smell odors, have a
“funny” taste in their mouth or feel sensations on their skin
even though nothing is touching their body.
DELUSIONS are false beliefs that don’t go away even after
they’ve been shown to be false (false, fixed belief). For
example, a person who is certain his or her food is poisoned,
even if someone has shown them that the food is fine, has a
delusion.

4.  Disorganized or incoherent speech.
 Confused thinking.
 Strange, possibly dangerous behavior.
 Slowed or unusual movements.
 Loss of interest in personal hygiene.
 Loss of interest in personal activities.
 Problems at school or work and with relationships.
 Cold, detached manner with the inability to express emotion.
 Mood swings or other mood symptoms, such as depression or mania.
People don’t always have the same symptoms and they can change over
time in the same person.

5.  The term schizophrenia was coined in 1908 by the swiss psychiatrist Eugene
Bleuler.
 The word was derived from the greekword schiz (split) and phren (mind).
 People with this illness have changes in behavior and other symptoms such as
delusions and hallucinations that last longer than 6 months.

6.  The lifetime prevalence of schizophrenia has generally been estimated to be approximately 1%
worldwide
 The onset of schizophrenia usually occurs between the late teens and the mid-30s.For males, the
peak age of onset for the first psychotic episode is in the early to middle 20s; for females, it is in
the late 20s.
 The prevalence of schizophrenia is about the same in men and women. The onset of
schizophrenia is later in women than in men, and the clinical manifestations are less severe. This
may be because of the anti-dopaminergic influence of estrogen.

7.  Genetic inheritance
 If there is no history of schizophrenia in a family, the chances of
developing it are less than 1 percent. However, that risk rises to 10
percent if a parent was diagnosed.
 Chemical imbalance in the brain
 Experts believe that an imbalance of dopamine, a neurotransmitter,
is involved in the onset of schizophrenia. Other neurotransmitters,
such as serotonin, may also be involved.
 Family relationships
 There is no evidence to prove or even indicate that family
relationships might cause schizophrenia, however, some patients
with the illness believe family tension triggers relapses.

8.  Environmental factors
 Although there is no definite proof, many suspect trauma before
birth and viral infections may contribute to the development of the
disease.
 Factors such as oxygen deprivation, infection, prenatal maternal
stress, and malnutrition in the mother during fetal development,
may result in a slight increase in the risk of schizophrenia later in
life.
 Stressful experiences often precede the emergence of schizophrenia.
Before any acute symptoms are apparent, people with schizophrenia
habitually become bad-tempered, anxious, and unfocused. This can
trigger relationship problems, divorce, and unemployment.

19.  Diagnosis of schizophrenia needs a period of six months where symptoms are noted,
however a different diagnosis of schizophreniform disorder can be made before the
six months needed for schizophrenia
 Schizophrenia is diagnosed based on criteria in either the Diagnostic and Statistical
Manual of Mental Disorders (DSM) published by the American Psychiatric Association
or the International Statistical Classification of Diseases and Related Health
Problems (ICD) published by the World Health Organization.
 These criteria use the self-reported experiences of the person(History) and reported
abnormalities in behavior, followed by a psychiatric assessment. The mental status
examination is an important part of the assessment. Symptoms associated with
schizophrenia occur along a continuum in the population and must reach a certain
severity and level of impairment before a diagnosis is made
 Physician could also carry out blood tests, brain MRI to rule out other medical
illnesses.
 CT/MRI: Enlarged lateral and 3rd ventricles, decrease in cortical volume.
 PET Scan: Areas of hypodensities in the frontal lobe.

26.  Delusional disorder: Predominant symptoms are delusions lasting at
least one month. Delusions are non bizarre(real life situation that could
be true but isn’t, such as being followed, being plotted against or
having a disease) thus differentiating this from schizophrenia.
 Patients have no impairment in level of functioning, usually reliable
except in relationship to their delusions.
 Mean age of onset is about 40 years, commonly in women, married
persons.
 Associated with low socioeconomic status.

27.  Delusions can be;
 Persecutory- one is being malevolently treated in some way
 Referential- an individual experiencing innocuous events or mere coincidences and believing
they have strong personal significance.
 Religious- delusional beliefs of a spiritual or religious nature
 Control -thoughts, feelings, or body feel controlled or manipulated
 Unspecified
 Grandiose- inflates sense or worth, power etc.
 Somatic- belief that ones body is defective, has been changed or
is diseased
 Jealous- belief that one’s sexual partner is unfaithful
 Erotomanic- belief that another person is in love with one

28. SUBSTANCE INDUCED
PSYCHOSIS
 alcohol intoxication
 amphetamines (and related substances)
 cannabis (marijuana)
 cocaine,
 hallucinogens,
 inhalants,
 Opioids
 phencyclidine (PCP)
 sedatives, hypnotics, anxiolytics, and other or unknown substances.
 Psychotic symptoms can also result from withdrawal from alcohol,
sedatives, hypnotics, anxiolytics, and other or unknown substances.

29. Causes include:
 brain tumors,
 cerebrovascular disease,
 Huntington's disease
 multiple sclerosis
 epilepsy
 auditory or visual nerve
injury or impairment
 deafness
 migraine
 infections of the central
nervous system
 endocrine disturbances that
affect the thyroid,
parathyroid, or
adrenocortical system
 Autoimmune disorders
(SLE)

30. Antipsychotics are the 1st line treatment for psychotic disorders. Most of
the time, antipsychotics are combined with other medications like
antidepressants, mood stabilizers for effective treatment +
psychotherapy (individual, group, family).
 Supportive/symptomatic therapy.
 The first-generation antipsychotics, now called typical antipsychotics,
only affect dopamine levels. Those brought out later, the second-
generation antipsychotics known as atypical antipsychotics, can also
have effect on another neurotransmitter serotonin.
 Antipsychotics can reduce the symptoms of anxiety within hours of their
use but for other symptoms they may take several days or weeks to
reach their full effect.
 They have little effect on negative and cognitive symptoms, which may
be helped by additional psychotherapies and medications.

31. Older
antipsychotics.
Chlorpromazine
Fluphenazine
Haloperidol
Loxapine
Perphenazine
Thioridazine
Newer
antipsychotics.
Aripiprazole
Clozapine
Olanzapine
Risperidone
Quetiapine
Ziprasidone

32.  Anticholinergic symptoms; dry mouth, poor coordination, decreased mucus
production, cessation of sweating, increased body temperature etc.
 Agranulocytosis, Seizures (clozapine)
 Weight gain.
 Extrapyramidal symptoms (EPS): Anticholinergics (benztropine, diphenhydramine)
 Pseudoparkinsonism (bradykinesia,rigidity,tremor) – Amantadine,
galantamine.
 Acute dystonic reactions (opisthotonos, oculogyric crisis-
continuous spasms).
 Akathisia (motor restlessness) – propranolol, BZD
 Tardive dyskinesia(chronic blockade of dopamine in basal
ganglia); choreoathetosis and involuntary movements
(tetrabenazine-vesicular monoamine transporter 2 inhibitor).

34.  Appearance: disheveled, odd or inappropriate attire.
 Behavior: bizarre mannerisms or stereotyped movements, catatonia with waxy
flexibility or excitement, agitation, eye contact (hypervigilant, staring).
 Speech: Pressured, monotonous, loud or soft, echolalia, poverty in content of
speech.
 affect: constricted or flat, Inappropriate affect (smile or laugh when relating a sad
tale),
 Mood: depressed, indifferent
 Thought process: looseness of associations, tangentiality, circumstantiality, word
salad, clang associations, perseveration

35.  Thought Content: delusions, ideas of reference, Paranoid ideation, somatic
concerns, suicidal ideation, homicidal ideation, Hallucinations (mostly auditory),
less commonly illusions.
 Consciousness and orientation: may be disoriented
 Memory: may not show gross deficits of memory
 Judgement and insight: lack of insight, Poor judgment

36. THANK YOU!!!!