1. SCHIZOPHRENIA
• Schizophrenia is a serious mental illness
that affects how a person thinks, feels, and
behaves
• People with schizophrenia may seem like
they have lost touch with reality, which
causes significant distress for the individual,
their family members, and friends
2. Schizophrenia is considered the most common
and disabling of the psychotic disorders
Although it is a psychiatric disorder, it stems
from a physiologic malfunctioning of the brain
This disorder affects all races, and is more
prevalent in men than in women
No cultural group is immune and persons with
intelligence quotients of the genius level are
not spared
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Introduction
4. DEFINITION
Schizophrenia is a disorder characterized by
disturbances, for at least 6 months, in the thought
content and form, perception, affect, sense of
self, volition, interpersonal relationships, and
psychomotor behaviour.
Schizophrenia is a mental disorder characterized by
abnormalities in the perception or expression of
reality. It most commonly manifests as auditory
hallucinations, paranoid or bizarre delusions, or
disorganized speech and thinking with significant
social or occupational dysfunction 9
5. INCIDENCE 5
Onset of symptoms typically occurs in late
adolescence or young adulthood
Schizophrenia typically appears earlier in men—the
peak ages of onset are 20–28 years for males and 26–
32 years for females
Around 1% of the population is affected
Diagnosis is based on the patient's self-reported
experiences and observed behavior
No specific laboratory test for schizophrenia
currently exists
6. AETIOLOGY
Biological factors
Biochemical (neurochemical) changes: Increased dopamine
activity in the mesolimbic pathway of the brain is consistently
found in schizophrenic individuals.
The dopamine hypothesis posits that an excessive amount of
the neurotramsmitter dopamine allows nerve impulses to
bombard the mesolimbic pathway, the part of the brain
normally involved in arousal and motivation. Normal cell
communication is disrupted, resulting in the development of
hallucinations and delusions.
Norepinephrine and serotonin systems have also been
implicated in the causation of schizophrenia
.
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7. Endocrine factors:
Changes in prolactin, melatonin, and thyroid function
have been found in schizophrenia.
Brain structural changes:
CT, MRI, and postmortem studies have shown decreased
volume and density in limbic and frontal areas in schizophrenic
patients. Other research has focused on mistiming of neural
responses to stimuli in the brain.
Prenatal:
Causal factors are thought to initially come together in early
neurodevelopment to increase the risk of later developing
schizophrenia. One curious finding is that people diagnosed with
schizophrenia are more likely to have been born in winter or
spring, (at least in the northern hemisphere).
8. .
• There is now evidence that prenatal exposure to
infections (i.e., prenatal exposure to influenza during
the second trimester) increases the risk for
developing schizophrenia later in life
• Other gestational and birth complications, such as Rh
factor incompatibility, as well as prenatal nutritional
deficiencies, have been associated with schizophrenia.
• The vitamin deficiency theory suggests that persons,
who are deficient in vitamin B, namely B1, B6, and
B12, as well as in vitamin C, may lead to
schizophrenia
• Genetics: It has been noted that the closer the
biological relationship between an individual and a
person considered to be schizophrenic, the greater is
the risk. This is based on data from family studies.
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9. Psychological Factors
Personality traits: Personality characteristics of an individual, such as
withdrawn, extreme quietness and shyness, highly dependent and
obedient, having temper tantrums
Environmental/Social Factors
Recreational drug use: Although about half of all patients with
schizophrenia use drugs or alcohol, a clear causal connection
between drug use and schizophrenia has been difficult to prove. The
two most often used explanations for this are “substance use causes
schizophrenia” and “substance use is a consequence of
schizophrenia”, and they both may be correct
10. Childhood experiences of abuse or trauma have also been
implicated as risk factors for a diagnosis of schizophrenia later in
life.
Other social factors could be:
Stress
Immigration
Developmental factors – complication of the foetus during pregnancy
may result in the condition, e.g., malnutrition, maternal drug
use/alcoholism, asphyxia, infections, forceps delivery.
P.S. Double bind theory – Schizophrenia is a consequence of
abnormal patterns in family communication or a person is given
mutually contradictory signals by another person.
11. CLINICAL FEATURES
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Positive Symptoms
• DELUSION: False beliefs that are not based in reality
• HALLUCINATION: Involving seeing or hearing things that don't exist
• DISORGANIZED SPEECH & THINKING: Effective communication can be
impaired and answers to questions may be partially or completely unrelated
• CATATONIA: Purposeless abnormal motor activity or aggressive behavior
Cognitive Symptoms
• POOR EXECUTIVE FUNCTIONING: Unable to understand information to
make decisions
• POOR WORKING MEMORY: Unable to use information immediately after
learning
12. Negative Symptoms
• FLAT EFFECT : Reduced expression of emotions via facial
expression or
voice tone
• ALOGIA : Reduced speech
• AVOLITION : Inability to begin & sustain activities
• ANHEDONIA : Inability to experience pleasure
• ASOCIALITY : Withdrawal from social contacts
• Reluctance to perform everyday tasks
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13. Alogia = poverty of speech
poverty of speech, or a reduction in the amount of speech
Alogia Normal speech
Do you have a job?-Yes
Where do you work? “white Hen ’
What do you do there?
I'm a cashier
How long have you worked there?-
-Six years
Do you have a job?
Yes, I've worked as
a cashier at “White
Hen” for six years.
14. Types
• Paranoid schizophrenia
Common form of schizophrenia
Prominent hallucinations and/or delusions
May develop at a later age than other types of schizophrenia
Speech and emotions may be unaffected
At risk for suicidal or violent behavior under influence of
delusions
• Hebephrenic / Disorganized schizophrenia
Behaviour is disorganised and without purpose
Thoughts are disorganised, difficult to understand by others
Pranks, giggling, health complaints, grimacing and
mannerisms are common
Delusions and hallucinations are fleeting
Usually develops between 15-25
15. Types
• Catatonic schizophrenia - Characterised by unusual,
limited and sudden movements. You may often
switch between being very active or very still. You
may not talk much, and you may mimic other’s
speech and movement
• Undifferentiated schizophrenia - Diagnosis may have
some signs of paranoid, hebephrenic or catatonic
schizophrenia, but it doesn’t obviously fit into one of
these types alone
16. Types
• Residual schizophrenia – Patients diagnosed with residual schizophrenia if you
have a history of psychosis, but only experience the negative symptoms (such as
slow movement, poor memory, lack of concentration and poor hygiene)
• Simple schizophrenia - Negative symptoms (such as slow movement, poor
memory, lack of concentration and poor hygiene) are most prominent early and
worsen, while positive symptoms (such as hallucinations, delusions,
disorganised thinking) are rarely experienced
• Unspecified schizophrenia - Symptoms meet the general conditions for a
diagnosis but do not fit into any of the above categories
17. OTHER FORMS OF PSYCHOTIC
DISORDERS
Brief Psychotic Disorder
People with this illness have sudden, short periods of
psychotic behavior, often in response to a very stressful
event, such as a death in the family. Recovery is often
quick - usually less than a month.
Schizophreniform Disorder
People with this illness have symptoms of schizophrenia,
but the symptoms last more than one month but less than
six months.
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18. OTHER FORMS OF PSYCHOTIC
DISORDERS
Delusional Disorder
People with this illness have delusions involving real-
life situations that could be true, such as being
followed, being conspired against, or having a disease.
These delusions persist for at least one month.
Shared Psychotic Disorder (Folie à deux)
This illness occurs when a person develops delusions in
the context of a relationship with another person who
already has his or her own delusion(s).
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19. OTHER FORMS OF PSYCHOTIC
DISORDERS
Psychotic Disorder due to a General
Medical Condition
Hallucinations, delusions, or other symptoms may be
the result of another illness that affects brain function,
such as a head injury or brain tumor.
Substance-Induced Psychotic Disorder
This condition is caused by the use of or withdrawal
from some substances, such as: alcohol, cocaine, LSD and
etc. that may caus58e hallucinations, delusions, or confused
speech.
20. Complications
1. DEPRESSION: Depression afflicts approximately
half of schizophrenic patients. Sadly, it is not always
recognized or treated. It can significantly add to the
suffering of the person. Additionally, comorbid
depression increases the risk of suicide in
schizophrenic.
2. ANXIETY: Many individuals with schizophrenia
also have an anxiety disorder, such as social anxiety
disorder, PTSD, generalized anxiety disorder, OCD
or panic disorder.
21. Complications
3. SUICIDE : Suicide is one of the primary causes of death
for individuals with schizophrenia. There are several
factors which contribute to suicide risk in schizophrenia
which include psychotic symptoms, such as voices telling
the person to kill himself, substance abuse, recent
diagnosis of schizophrenia and comorbid depression
4. SUBSTANCE ABUSE & SMOKING : Substance abuse is
a form of self-medication for many people with
psychiatric disorders. Unfortunately, when patients use
substances such as alcohol or street drugs it can make
their symptoms worse. They are also less likely to
continue taking their medications when they abuse
substances
22. Complications
5. VIOLENCE: While the media often depicts schizophrenic
patients as violent, they are not necessarily more prone
to violence than the general population. That being said,
some factors can increase the risk of violent behavior in
individuals with schizophrenia, such as delusions or
command hallucinations, a history or violent acts or
using alcohol or drugs
6. SELF-INJURY: Self-injury, especially bizarre types of
self-mutilation, is not uncommon with schizophrenia.
Hallucinations and delusions can cause them to harm
themselves in ways which can be very serious, such as
attempting to remove a finger or other body part
23. PROGNOSTIC FACTORS
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Prognosis indicates the likelihood of recovery from a
disease. Factors which are responsible for a good prognostic
outcome of schizophrenia are:
• Age of the patient – The older the patient, the more
favorable the prognosis.
• The duration of illness – The shorter the duration prior to
treatment, the better the outcome.
• The rapidity of development of the symptoms – the more
speedily the symptoms develop, the faster do they respond to
treatment; a very slow, insidious, and gradual onset of illness
suggests a final poor outcome.
24. 24
• A patient who had close friendships and multiple
relationships prior to illness has a brighter chance with few
or no such relationships.
• Life stress prior to onset – An episode brought on by a major
identifiable life stress will respond more quickly than an episode
without any obvious cause.
• Marital history – A patient with a stable and helpful marital
partner has a favorable prognosis as compared to an
unmarried patient.
• Occupational history – A patient with a good stable
occupation or business prior to onset of illness will respond
better than a patient who is jobless and economically
unsound.
• Family’s attitude towards the returning patient – Hostile
behaviour by family members, or vice versa, excessive care and
attention by them can undermine the patient’s sense of
confidence and hamper recovery.
25. Management
HOSPITALIZATION
During crisis periods or times of severe symptoms, hospitalization may be
necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.
PSYCHOSOCIAL INTERVENTIONS
Individual therapy: Psychotherapy may help to normalize thought
patterns. Also, learning to cope with stress and identify early warning signs of
relapse can help people to manage their illness.
Social skills training : This focuses on improving communication, social
interactions and improving the ability to participate in daily activities.
Family therapy: This provides support and education to patient families.
Vocational rehabilitation and supported employment: This focuses on
helping people with schizophrenia prepare for, find and keep jobs.
27. Famous People with
Schizophrenia
John Nash – American Mathmetician
Jack Kerouac – Novelist and Poet
Syd Barrett – Musician and Founder of Pink Floyd
Veronica Lake – Actress
Lionel Aldridge – Football Player
Zelda Fitzgerald – American wife of writer F. Scott
Fitzgerald; writer, dancer and artist
Eduard Einstein – Son of German physicist Albert
Einstein
