content deals with schizophrenia

1. INTRODUCTION
Eugen Bleuler in 1911 renamed
dementia as schizophrenia. He
recognized that schizophrenia
consist of a group of disorder. He
described the 4 primary symptom
Autism
Ambivalence
Affect disturbance
Association disturbance

2. Schizophrenia
 Schizophrenia is a major mental illness. In this all
the components of the mind of the individual is
affected, destroying his entire personality and
sometimes making him unfit for life. Not only that
but in schizophrenia there may be a disconnection
between what the person is thinking and what he is
feeling. For e.g. when we describe a sad event in
our life such as the death of a close relative, our
feeling becomes sad which is shown in our face
and by the tone of our voice. But a patient with
schizophrenia may laugh while describing sad
events. This is called as incongruous affect. The
patient also has strange beliefs and unusual
perceptions.

3. Epidemiology
 Around 1% of the world population is
affected with schizophrenia. The incidence
of schizophrenia is about 1/1000. The
onset of schizophrenia occurs usually later
in females and often runs a more benign
course, as compared to males. The male
to female incidence is approximately equal.

4. Incidence:
 It is most common of all psychiatric disorders.
 Equally prevalent in men & women
 23rd of cases are in age group 15-30 yrs

5. Epidemiology
 Monozygotic twins - 47%
 Dizygotic twins - 12%
 Siblings/ parents - 12%
 Child of one schizophrenic parent - 12%
 Child of both schizophrenic parents - 40%

6. Definition
 Schizophrenia is a psychotic condition
characterized by a disturbance in the
emotions ,violitions& faculties in the
presence of clear consciousness which
usually lead to social withdrawal
-Sreevani

7. Etiology
Genetic factors – DiGeorge syndrome
(22q11.2 deletion syndrome )others
Biochemical factors-dopamine pathways
Psychological factors-trauma,metabolic
disorder
Social factors-lower social economic

12. ICD AND DSM
 6A20-ICD-11 CODE FOR
SCHIZOPHRENIA
 295.90- DSM 5 CODE FOR
SCHIZOPHRENIA

13. DIAGNOSIS
 BRIEF PSYCHATRIC RATING SCALE
 COGNITIVE DEFICITS IN
SCHIZOPHRENIA-STROOP TEST
- TRAIL MAKING TEST
 PERSONALITY RELATED PROBLEMS-
RORSCHACH INKBLOT TEST
 CT SCAN –VENTRICULAR
ENLARGEMENT
 PET SCAN – INCEREASED D2
RECPETOR

19. A/C TO ICD 11
 THINKING
 PEREPTION SELF EXPERINCE
 COGNITION
 AFFECT
 BEHAVIOUR

21. Pathophysiology
 Neuroanatomy:
prefrontal cortex enlarged lat. ventricle
ed metabolism
ed volume
hippocampus ed volume

22. Pathophysiology
 Neurochemistry:
Dopamine: dopamine excess
hippocampus
positive symptoms
dopamine deficiency
prefrontal lobe
negative symptoms

23. Pathophysiology
 Neurochemistry:
Glutamate
Acetyl choline
Serotonin

26. CLASSIFICATIONS
1.PARANOID SCHIZOPHRENIA
 Delusion of persecution
 Delusion of jealousy
 Delusion of grandiosity
 Hallucinatory voice
 Auditory hallucination

27. 2.DISORGANISED SCHIZOPHRENIA
 MARKED THOUGHT DISODER
 EMOTIONAL DISTURBANCE
 EXTREME SOCIAL WITHDRAWAL

28. 3.CATATONIC
SCHIZOPHRENIA
 Excited catatonia
 Stuporous catatonia
 Catatonia altering between excitement &
stupor

29. 4.Residual & latent schizophrenia
 Emotional blunting
 Eccentric behavior
 illogical thinking
 social withdrawal
 Loosening of association

30. 5.Undifferentiated schizophrenia
 Diagnosed when no subtype are present or
features of more than one subtype are
present

31. 6.Simple schizophrenia
 Negative symptoms of residual
schizophrenia

32. 7. Post
schizophrenic
depression
 Develop within 12
months of acute
episode of
schizophrenia
 Increased risk of
suicide

33. CLINICAL FEATURES
1.Thought & speech disorder
 Autistic thinking
 Loosening of association
 Thought blocking
 Neologism
 Mutism
 Poverty of speech
 Poverty of ideation
 Echolalia
 Delusion

34. 2.Disorder of perception
3 Disorder of affect
4 Disorder of motor behaviour
5.Negative symptoms
6 Miscellaneous

36. Treatment.
 Most of the patients do not require
hospitalisation. The usual indications for
 (a) For diagnostic purposes.
 (b) For stabilization of medication.
 (c) For grossly disorganized and
inappropriate behaviour, including the
inability to take care of basic needs such as
food, clothing and shelter.
 (d) For patients safety because of suicidal or
homicidal ideas.

37. Antipsychotic Medication
 Antipsychotic medications have revolutionized the
treatment of schizophrenia.
 Minimum length of antipsychotic trial is 4-6 weeks
in adequate dosages. If unsuccessful a drug from
a different group should be tried. Patients should
be maintained at the lowest possible effective
dosage for 6 months to 1 year for the first episode,
for 1 to 2 years for the subsequent episodes, and
for indefinite period for repeated episodes or
persistent symptoms.
 Depot preparations with long duration of action are
used in patients who are irregular with their
medication.

38. Electroconvulsive therapy
 Usually 6-8 ECTs are needed, given biweekly.
Indications for ECT include:
(i) Catatonic stupor.
(ii) Uncontrolled catatonic excitement.
(iii) Acute exacerbation not controlled with
drugs.
(iv) Severe side effects with drugs, in
presence of untreated schizophrenia.

39. Psychosocial treatment
(i) Education of the patient and especially the
family regarding the nature of illness, its
course and treatment.
(ii) Group therapy is particularly aimed at
teaching problem solving, and communication
skills. It is usually conducted in a form, which
is known as ‘social skills training package’.
(iii) Family therapy: Apart from education, family
is also given social skills training to enhance
communication and decrease family tensions

40. Psychosocial treatment
(iv) Milieu therapy includes treatment in a living,
learning or working environment ranging from
inpatient psychiatric unit to day-care hospitals
and halfway homes.
(v) Individual psychotherapy is usually of
supportive nature. Cognitive behaviour
therapy is useful.
(vi) Psychosocial rehabilitation is used, usually
along with milieu therapy. This includes activity
therapy, to develop the work habit, training in
a new vocation or retraining in a previous skill,
vocational guidance, job placement, sheltered
employment or self-employment, &
occupational therapy.

41. Prognosis
 The course and prognosis of schizophrenia is
better in the developing countries like India, than
in developed countries. Almost 50% patients show
complete or near complete recovery, and only
18% showed severe disability with only 9%
needing institutionalisation or long term
hospitalisation. We should watch for depression
and suicidal ideation in recovering schizophrenics
to prevent unnecessary loss of life. Depression if it
occurs should be treated aggressively.

42. LETS CHECK YOUR
KNOWLEDGE
QUESTION HOUR

43. Ram Singh a quiet person is behaving strangely for a few days. One
day in public he tore off his clothes and was behaving as if he is not
concerned with any thing. He refuses to do any work and has to be
forcibly taken to hospital.

44. Shyam Singh is known to be a friendly person has been noted to be quiet and
withdrawn for the last few weeks. He has stopped taking care of his personal
hygiene or taking his bath. He does not speak to others even when spoken to
and does not bother about his appearance. He sits in one pose for a long time
without doing anything.

45. KV Oraon believes that his friends are plotting against him. He thinks that
they are trying to kill him and are discussing how to go about it. He
becomes aggressive and attacks his friends. He also complains to the
police that people are trying to harm him. When the police try to counsel
him that no such plot is there he accuses the police of being in league with
his enemies

46. Mrs Kavita a young housewife has suddenly started laughing and crying
without reason. She does not do her house jobs, speaks to herself and says
that a bhoot has taken possession over her body. Her family members take
her to the tantrik in order to cure her.

47. IDENTIFY THE PERSON WITH
PARANOID SHIZOPHRENIA

48. FILM BASED ON
SCHIZOPHRENIA
15 PARK AVENUE

49.  Thank you