Schizophrenia is a severe psychiatric illness characterized by distortions in thought, behavior, and perception. It occurs in about 1% of the population worldwide and typically emerges between ages 16-25. Symptoms include positive symptoms like hallucinations and delusions, negative symptoms such as blunted emotions and anhedonia, and cognitive symptoms involving problems with attention, memory, and decision-making. While the exact causes are unknown, genetics and abnormalities in neurotransmitter function, especially dopamine, are thought to play a role. Treatment involves antipsychotic medications, which are categorized as typical or atypical depending on their side effect profiles and efficacy against various symptom domains.

1. Psychoses/ Schizophrenia
By: Dr Urmila M. Aswar

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.
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Fig. 1 Schizophrenia

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. 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
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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. 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. 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. 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. 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. 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. 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
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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.  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)
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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.
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