Schizophrenia is a mental disorder characterized by splitting of psychic functions and disturbed harmony between thought, emotions, and behavior. It has a prevalence of 0.5% and typically onset is in late adolescence or early adulthood. Etiology involves genetic, biological, and environmental factors. Symptoms include positive symptoms like delusions and hallucinations, negative symptoms such as social withdrawal, and cognitive impairment. Diagnosis involves meeting criteria for symptoms lasting at least 6 months from scales like PANSS. Treatment involves atypical antipsychotic medication which can have side effects as well as psychosocial therapies and hospitalization if risks are present.

1. SCHIZOPHRENIA
-By Dr TANUJA TATRARI

2. Introduction
Epidemiology
Etiology
Pathophysiology
Classification
Signs & symptoms
Complications
Diagnosis
Prognosis
Management

3. Introduction
Schizophrenia(Greek): Schizo= split + Phrene= mind
Term coined by: EUGEN BLEULER
There is splitting of psychic function(s) or disturbed harmony
between thought, emotions and behaviour.
Fundamental symptoms of Schizophrenia: (4As)
1) Ambivalence
2) Affective flattening
3) Association loss
4) Autism

4. Epidemiology
Prevalence: 0.5%
Lifetime morbid risk: 0.72%
Age of onset
- late adolescence
- early adulthood
- Peak:
~1st: 20years
~2nd: 33years
Male:Female = 1.4:1

5. Etiology
Biological factors
- Genetic predisposition
- Structural brain abnormalities
- Dysregulation of neurotransmitters(Dopamine, GABA,
Glutamate)
Psychological factors
- Diathesis-stress model
Social factors
- Role of family

6. Pathophysiology
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7. Classification of Schizophrenia
1. Paranoid
2. Hebephrenic
3. Catatonic
4. Simple
5. Residual
6. Undifferentiated

8. Signs and Symptoms
First rank symptoms:
- 3 Auditory phenomenon:
1) 1st person auditory hallucination
2) 2nd person auditory hallucination
3) 3rd person auditory hallucination
- 3 Made phenomenon:
1) Made impulse
2) Made volition or acts
3) Made Affect

9. - 3 Thought phenomenon:
1) Thought insertion
2) Thought broadcast
3) Thought withdrawal
- 2 Additional symptoms:
1) Somatic passivity
2) Delusional perception

10. Positive symptoms:
- Delusion
- Hallucination
- Disorganised thoughts
Negative symptoms:
- Alogia
- Affective flattening
- Avolition
- Anhedonia
- Social withdrawal
Cognitive symptoms (memory, attention)
Emotional symptoms

11. Complications
Depression
Anxiety
Suicide:
- Co-morbid depressive symptoms
- Hallucinations
- Impulsive behaviour
Substance abuse
Violence
Self-injury

12. Diagnosis
Diagnostic criteria for Schizophrenia
As per ICD-10: F20
a) Thought echo, thought insertion or withdrawal and thought
broadcasting
b) Delusions of control, influence, or passivity
c) 1st, 2nd or 3rd person hallucination
d) Persistent delusions
e) Persistent hallucinations
f) Breaks or interpolations in the train of thought, resulting in
incoherence or irrelevant speech, or neologisms
g) Catatonic behaviour
h) Negative symptoms
i) A significant & consistent change in the overall quality of some aspects of
personal behaviour, manifested as loss of interest, aimlessness & social
withdrawal.

13. Medical history
Investigations:
- All routine investigations
- Thyroid function test
- CT/MRI
- EEG
- Psychometry:
~ PANSS (Positive & negative symptoms scale for Schizophrenia)
~ BPRS (Brief psychiatric rating scale)

14. Prognosis & prognostic factors
- Late onset
- Acute onset
- Positive symptoms
- Affective symptoms — Better prognosis
- Good family support
- Compliant with treatment
- Females
- Family history of Schizophrenia
- Substance use (alcohol, cannabis) —- Poor prognosis
- Premorbid personality
- Males

15. Treatment
1. Pharmacological:
Anti-psychotics:
a) Typical Anti-psychotics (1st generation)
- Haloperidol
- Chlorpromazine
b) Atypical Anti-psychotics (2nd generation)
- Risperidone
- Olanzepine
- Clozapine
- Quetiapine
c) 3rd generation
- Aripiprazole

16. Adverse effects
1. Sedation
2. Autonomic side effects
3. Extrapyramidal side effects
a) Akathisia (motor restlessness)
b) Dystonia (sudden muscle spasm)
c) Pseudoparkinsonism (tremors, rigidity, hypokinesia, mask-like
facies)
d) Tardive dyskinesia (abnormal involuntary movements)
4. Neuroleptic Malignant Syndrome (NMS)
5. Hormonal effects & sexual dysfunction
4. Miscellaneous
- Weight gain
- Jaundice

17. 2. E.C.T. (Electro-convulsive Therapy)
- In adult patients, not responding to drug therapy.
- Indications:
~ Acute exacerbation, not controlled with drugs
~ Risk of suicide, homicide
~ Catatonic stupor
3. C.B.T. (Cognitive Behavioural Therapy)
4. Non-pharmacological:
- Psycho-education (individual therapy)
- Family therapy
- Social skills training
- Rehabilitation and supported employment

18. 5. Need for Hospitalisation:
- Neglect of food & water intake
- Significant neglect of self-care
- Danger to self or others
- Poor treatment adherence
- Lack of social support with evidence of above mentioned risks.

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20. THANKYOU