Schizophrenia is a severe mental disorder characterized by difficulties distinguishing between reality and non-reality. It causes disorganized thinking, delusions, and hallucinations. Schizophrenia has several subtypes and is caused by genetic and environmental factors. Symptoms include positive symptoms like hallucinations and delusions as well as negative symptoms like lack of emotion. Treatment involves antipsychotic medication as well as psychosocial therapies like CBT to manage symptoms.

1. SCHIZOPHRENIA

3.  Schizophrenia is a psychological disorder – common longterm
mental disorder
Schizophrenia is characterized by the inability to separate
reality from and a non-reality
It is a serious medical condition which affects the individual’s
normality how he/she thinks, speak, feels and act.
 The individual who encounters schizophrenia finds difficulty in
correlating the imaginary and the reality.
 Schizophrenia patients often experience non-existent stimuli
that create perceptions of things that do not exist, such as voices,
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. It represents disorganized thoughts, delusions, hallucinations,
inappropriate affect, and impaired psychosocial functioning.
ABNORMALITIES OF SCHIZOPHRENIA:
Cognitive symptoms- attention, planning, organization
Negative symptoms- loss of enjoymental activities
Positive symptoms- hallucinations, delusions

5. Epidemiology
It is a universal disease found in all countries and all
times with constant prevalence rates
 Incidence – 15-20/ 100,000/year
 Prevalence – 0.5 – 1%

6. Epidemiology ctd..
 Age – 15 -45 years
 Sex – Male : Female 1 : 1
 Onset is earlier in men

7. Aetiology- Multifactorial
 Hereditary- 40% of the Pts have a family history
 Viral infection- In utero influenza like virus
 Birth trauma- hypoxia, cerebral injuries
 Endocrine Factors
 Postpartum psychosis

8.  Stress
 Psychological – life events, trauma, Viral encephalitis, Pyrexia,
anti- malarials, surgery
 Sensory loss / deprivation
 Head injury
 Epilepsy
 Drugs – amphetamines, L- dopa, cannabis
 low socioeconomic state, urban (homeless, prostitutes, prisons)
single, unemployed

9. TYPES OF SCHIZOPHRENIA
There are five types of schizophrenia:
– Catatonic – little to no movement, possibly a vegetative state.
– Disorganized – common type of schizophrenia; disorganized
thinking, flat effect, inappropriate emotions or behavior.
– Paranoid – common type of schizophrenia; delusions,
hallucinations, false beliefs.
– Residual – long-term schizophrenia where most symptoms have
disappeared, negative symptoms (detractions from normal
behavior) often remain such as flat effect ( declined express of
emotions) or a refusal to talk
– Undifferentiated – does not fit in one of the above categories
because the patient suffers from symptoms of multiple types

10. Schizophrenic Delusions
• A delusion is a false belief
• Not explained by patient
• Some common schizophrenic delusions include:
– Being cheated
– Being harassed
– Being poisoned
– Being spied upon
– Being plotted against

11. Schizophrenic Hallucinations
• A hallucination is a nonexistent sensory perception without actual stimuli
like hearing, seeing things.
• schizophrenic hallucination is hearing voices, however the patient may also
have visual hallucinations where they see a person or object that does not
exist
• Hallucinated voices often interact with the patient:
– By commenting on their behavior
– By ordering them to do things
– By warning of impending dangers
– By talking to other voices about the patient

15. Phases
Prodromal – withdrawn symptoms, spending time
alone
Active- delusion, hallucination, disorganized speech,
disorganized behaviour
Residual phase- inability to concentrate, withdrawn
symptoms

16. Symptoms of Schizophrnia
Positive Symptoms
 Hallucinations
 Delusions
Negative symptoms
 Apathy ( lack of interest)
 Amotivation / Avolition
 Anhedonia ( no longer enjoy the things that they once loved.)
 Blunted effect- inability to express emotions
 Asocialization
 Alogia- decreased speech
Disorganization
 Thoughts
 Emotions
 Disorganised speech and conveying ideas

17. Disorganized thoughts

18. A. Characteristic symptoms: Two or more of the following, each
persisting for a
significant portion of at least a 1-month period:
(1) Delusions
(2) Hallucinations
(3) Disorganized speech
(4) Grossly disorganized or catatonic behaviour
(5) Negative symptoms
B. Social/occupational dysfunction: For a significant portion of
the time since onset of the disorder, one or more major areas of
functioning such as work, interpersonal relations, or self-care
are significantly below the level prior to onset.
DSM-IV-TR Diagnostic Criteria for
Schizophrenia

19. C. Duration: Continuous signs of the disorder for at least 6
months. This must include at least 1 month of symptoms fulfilling
criterion A (unless successfully treated).
This 6 months may include prodromal or residual symptoms.
1month of active phase symptoms.
D. Schizoaffective or mood disorder has been excluded.
E. Disorder is not due to a medical disorder or substance use.
F. If a history of a pervasive developmental disorder is present,
there must be symptoms of hallucinations or delusions present for
at least 1 month.

22. PATHOPHYSIOLOGY

23. THEORIES
1. Genetic theory- multiple genes are involved.
2. Neurodevelopmental theory – inutero disturbances
during pregnancy.
3. Neuro-chemical theory
4. Psychosocial theory- stress, poor interpretation
skills, low socioeconomic status.

26. At first time diagnosis-
Reduced intracranial volume compared to healthy subjects
Reduction in white and grey matter
Increased dopamine synthesis
NMDA receptor hypofunction
Low inflammatory processes
Decreased brain size
Increased ventricular volume

27. Neurotransmitters in Schizophrenia
 Dopamine Hypothesis
 Dopamine Hyperactivity in Mesolimbic pathways
Hypofunction in Mesocortical pathways
 Glutamate Hypothesis
 NMDA hypofunction
 The role of Serotonin
 Dysfunction in DA release

28. Schizophrenia is a complex disorder involving
dysregulation of multiple pathways in its
pathophysiology.
Dopaminergic, glutamatergic and GABAergic
neurotransmitter systems are affected in schizophrenia
and interactions between these receptors contribute to the
pathophysiology of the disease.

30. Dopamine pathways
Mesolimbic pathway( VTA- straitum) - positive symptoms
Mesocortical pathway ( VTA- frontal/temporal) - negative
symptoms
Nigrostriatal pathway ( s. nigra – dorsal straitum) - Extra
Pyramidal Symptoms
Tuberoinfundibular pathway ( hypothalamus – infundibular
region where pituatary araises) - hyper prolactinemia
VTA- brain stem area where the neurons use dopamine as
NT . Somas of this neurons use dopamine and axons
projected on many areas of brain releazes dopamine.

34. DA Pathways in Schizophrenia

35. The Dopamine Hypothesis
The dopamine system has been shown to play a major role in
cognitive, affective, and motor functions
The dopamine hypothesis of schizophrenia postulates that
hyperactivity of dopamine D2 receptor neurotransmission in
subcortical and limbic brain regions contributes to positive
symptoms of schizophrenia, whereas negative and cognitive
symptoms of the disorder can be attributed to hypofunctionality
of dopamine D1 receptor neurotransmission in the prefrontal
cortex

41. Due to neurodevelopmental abnormalities, in glutamate
synapse., there will be hypofunction of NMDA causing
abnormal dopamine.
Hyperactivation of dopamine in mesolimbic pathway-
positive symptoms
Hypoactivation of dopaminein mesocortical pathway -
negative symptoms

48. Cognitive and social
impairment
Genetic
predisposition
Neurodevelopmental
abnormalities
Biochemical
abnormalities
(DA, 5HT)
Env. factors
-In utero
infection
-Obst. injury
-Social adversity
-Life stress
Neurological soft
signs
SCHIZOPHRENIA

49. Management
1. Pharmacological management
2. Other physical management
3. Psychological management
4. Rehabilitation
5. Family work

50. Management
 Initial tranquilization/ relief of pain
 Control of acute psychotic symptom.
 Long term maintenance treatment- depot
injection. A depot injection is a slow-release,
slow-acting form of your medication.

51. Psychotherapeutic Approaches to the Treatment
of Schizophrenia
Individual -
supportive/counseling , Personal therapy , Social skills
therapies , Vocational sheltered employment
rehabilitation therapies
 Group - Interactive/social
Cognitive Behavioral – CBT, Compliance therapy

52. Pharmacological management
 Antipsychotics (tranquilizers and
neuroleptics )
1. Typical antipsychotics- decrease
overactivity of dopamine
– Chlorpromazine, Trifluoperazine, Haloperidol,
Droperidol, Pimozide,
2. Atypical antipsychotics
 Olanzapine, Risperidone, Quetieapine,
Amisulpiride, Ziprasidone, Aripiprazole,
Clozapine

53. Initial treatment
The goals during the first 7 days of treatment should be
decrease agitation, hostility ( unfriendly) , combativeness
( aggressiveness) , anxiety, tension, and aggression, and
normalization of sleep and eating patterns

54. Antipsychotics
 Second-generation antipsychotics (SGAs) (with the
exception of clozapine) have become first-line agents in the
treatment of schizophrenia.
 Ability of the drug to produce antipsychotic response with
few or no acutely occurring extrapyramidal side effects
(movement problems).
These newer, second-generation medications are
generally preferred because they pose a lower risk of
serious side effects than do first-generation antipsychotics.
 First episode schizophrenia, SGAs are often considered
first-line treatments because of the risk of dyskinesia with
FGAs

62. Name
usual Dosage
Range
(mg/day)
Maximum
Dose (mg/day)
FGA’s (Traditional antipsychotics)
chlorpromazine 100- 800 2000
haloperidol 2- 20 100
loxapine 10- 80 250
trifluoperazine 5-40 80
Atypical antipsychotics (second-generation
antipsychotics
aripiprazole 15-30 30
clozapine suspension 50-500 900
olanzapine 10-20 20
paliperidone 3 -9 12
quetiapine 250-500 800
risperidone 2-8 16

63. Psychosocial management
 PsychoEducation
 Supportive psychotherapy
 CBT for resistant hallucinations and delusions-
Cognitive remediation
 Social skills training

64. Psychotherapy
Cognitive behavioral therapy (CBT)- helps people
identify and change thinking and behavior patterns
that are harmful or ineffective, replacing them with more
accurate thoughts and functional behaviors.
It can help a person focus on current problems and how
to solve them.
CBT can be helpful in treating a variety of disorders,
including depression, anxiety, trauma related disorders,
and eating disorders.

65. Interpersonal therapy (IPT) is a short-term form of
treatment. It helps patients understand underlying
interpersonal issues that are troublesome, like
unresolved grief, changes in social or work roles,
conflicts with significant others, and problems relating
to others. It can help people learn healthy ways to
express emotions and ways to improve communication
and how they relate to others. It is most often used to
treat depression.

66. Rehabilitation
 Training in
 Self care, ADLs
 Attending skills, Communication skills, Ability to
concentrate…
 Vocational training, working in a supportive environment
 Helps in the management of
 Negative symptoms
 Dealing with resistant symptoms
 Dependency / institutionalized syndrome

67. Rehabilitation – ctd
 Day care centers / hospitals
 Half way homes / Supported accommodation
 Occupational Therapy
 Vocational training
 Supportive working environments
 Home environment

68. Electroconvulsive therapy
For adults with schizophrenia who do not
respond to drug therapy, electroconvulsive
therapy (ECT) may be considered. ECT may be
helpful for someone who also has depression.

69. Occupational Therapy- Vocational training
Agrotherapy

70. Early signs of relapse